Clinical predictors of multiple tympanostomy tube placements in Ontario children

Objectives

To characterize risk factors that predict the need for multiple tympanostomy tube (TT) procedures.

Study Design

Retrospective population-based cohort study of children aged 18 years and younger in Ontario, Canada, who underwent at least one TT placement between January 1, 1994, and October 31, 2013.

Methods

The relative risk (RR) of need for multiple TT procedures was determined using log-binomial regression.

Results

There were 193,880 children who underwent TT insertion included in this cohort. Of these, 28.58% underwent at least two separate TT procedures. Over time, the RR of undergoing multiple TT procedures is decreasing for all children. In general, the younger the child was at the first TT procedure, the more likely the child was to undergo multiple TT procedures. Significantly higher RR for multiple TT procedures also was associated with male sex, the second-highest neighborhood income quintile, asthma or reactive airways, gastrointestinal disease, prematurity, or cleft lip and/or palate. Significantly lower RR for multiple TT procedures was associated with adenoidectomy or tonsillectomy (with or without adenoidectomy) at first TT placement or within 3 years prior. Furthermore, the benefit of adjuvant adenoidectomy or tonsillectomy was present for children aged under 4 years, in addition to those aged 4 years and older.

Conclusion

Among Ontario children who have had TT placement, more than one in four will have multiple sets placed. These identified risk factors permit improved preoperative counseling and enable identification of children who need closer follow-up.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2f1znfB

Preliminary results of tissue-engineered injection laryngoplasty material in a rabbit model

Objectives/Hypothesis

Design and test a novel biomaterial for injection laryngoplasty aimed to increase the duration of effectiveness of micronized acellular dermis.

Study Design

Animal model.

Methods

Injection laryngoplasty was performed in three groups (n = 5) of New Zealand White rabbits. Acellular dermis was either used alone as a control (group 1), was combined with undifferentiated stem cells (group 2), or with predifferentiated chondrocytic cells (group 3). Groups 2 and 3 were supplemented with growth factors. Animals were sacrificed 4 and 12 weeks after laryngoplasty and histologic analysis was completed. The major outcome measure was volume of tissue remaining.

Results

After 4 weeks, the mean volume of tissue remaining was 341 ± 89 mm³, 295 ± 102 mm³, and 133 ± 15 mm³, for groups 1 to 3, respectively. At the 12-week time point, volumes were 62 ± 62 mm³, 235 ± 35 mm³, and 107 ± 99 mm³. After 12 weeks, there was a significantly higher volume in group 2 compared to group 1 or 3 (P = .01, P = .04). Volumes between week 4 and week 12 were significantly lower in group 1 (P = .02), but not significantly different for groups 2 and 3 (P = .38, P = .74). Histologic evaluation revealed a robust lymphocytic infiltration in all cases as well as morphologic and immunophenotypic features suggestive of chondrogenic differentiation in a single animal.

Conclusions

Micronized acellular dermis combined with stem cells and growth factors showed significantly less resorption 12 weeks after injection laryngoplasty compared to micronized acellular dermis alone. Groups using novel tissue-engineered biomaterial showed a lower resorption rate over time compared with acellular dermis alone.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2jkPfuZ

Chemosensory function before and after multimodal treatment in chronic rhinosinusitis patients

Objectives/Hypothesis

Olfactory dysfunction is common among the general population, with chronic rhinosinusitis (CRS) as one of the leading causes. Patients affected by CRS often report changes in taste sensations; however, quantitative measurements have not been performed to date. Therefore, the present study aimed to investigate gustatory and olfactory function in CRS patients prior to and after multimodal treatment.

Study Design

Prospective cohort study.

Methods

Twenty-one patients suffering from CRS with nasal polyps (14 male, seven female) with a mean age of 48 ± 15 years were included in the study. Chemosensory function was assessed prior to and approximately 190 days after multimodal treatment, which included endoscopic sinus surgery, oral antibiotics for 5 days, oral steroids for 12 days, and at least 6 weeks of topical nasal steroids. Olfactory function was tested with the Sniffin' Sticks test battery, whereas gustatory function was measured with taste strips. A clinically relevant change in olfactory function was defined as a change of ≥5 points in the threshold, discrimination, and identification scores.

Results

Compared to normative data, patients baseline gustatory and olfactory function was impaired. After multimodal treatment, improvements were seen in olfactory function for eight patients (42%), remained stable in 10 patients (53%), and deteriorated in one patient (5%). Taste function remained unchanged following sinus surgery.

Conclusions

Patients suffering from CRS with polyps exhibit olfactory and taste dysfunctions. Multimodal treatment leads to an improvement in olfactory, but not gustatory functionality.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2f0Ok1K

Effect of aging and direction of impulse in video head impulse test

Objective

The aim of this study was to identify the difference of gain value in the video head impulse test (vHIT) according to the age of the patient and the direction of the impulse.

Method

All participants were subjected to vHIT with horizontal semicircular canal (HSCC). vHIT with vertical canal (posterior and anterior semicircular canal [PSCC and ASCC]) additionally was performed in 434 participants.

Results

The mean vestibulo-ocular reflex (VOR) gain was maintained in patients in the HSCC at below 70 years (1.025 ± 0.08) and in the vertical canal at below 80 years (PSCC: 0.965 ± 0.12, ASCC: 0.975 ± 0.14). However, the decrease of VOR gain was significant in patients over 70 years in the HSCC (0.978 ± 0.35, P < .001) and in patients over 80 years in the vertical canal (PSCC: 0.828 ± 0.16, ASCC: 0.851 ± 0.13, P < .001). In addition, a VOR gain of rightward impulse was higher than the leftward impulse, but there was no difference based on the direction of impulse in the vertical impulse test.

Conclusion

VOR gain declines with increasing age, over 70 years on the horizontal canal, and over 80 years on the vertical canal. Additionally, horizontal VOR gain of rightward impulse was higher than the leftward impulse in right-eye recordings only, but the vertical canal showed no difference of gain according to the direction of impulse.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2jkYOdy

Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis

Objectives

This study aimed to assess the effects of perioperative dexmedetomidine as an adjuvant to tonsillectomy compared with opioid or sham in children.

Data Source

Five databases (PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) were searched from inception of article collections to April 2017.

Review Methods

Prospective, randomized controlled studies that compared outcomes between children who underwent tonsillectomy plus dexmedetomidine administration (intervention) and children who underwent tonsillectomy with placebo or opioid (control) were systemically and independently reviewed by two researchers. The outcomes of interest were emergence agitation, postoperative pain intensity, rescue analgesic consumption, and other morbidities (nausea and vomiting and agitation).

Results

Fifteen studies with n = 1,552 met the inclusion criteria. Postoperative pain scores and the need for analgesics in the postanesthesia care unit (PACU) were significantly decreased in the dexmedetomidine group versus the control group. The incidence and degree of agitation and desaturation incidence in the PACU also were significantly lower in the dexmedetomidine group than in the control group. Additionally, there was no significant difference in the duration of staying PACU between both groups. In subgroup analyses by administration method (bolus injection or continuous injection), dexmedetomidine was shown to be effective at reducing postoperative morbidities regardless of administration method.

Conclusion

Perioperative administration of dexmedetomidine can provide pain and agitation relief without side effects in children undergoing adenotonsillectomy. Considering the high heterogeneity of results within some parameters; however, further clinical trials with robust research methodology should be conducted to confirm the results of this study. Laryngoscope, 2017

http://ift.tt/2f0Ox4K

Oncologic outcomes of KTP laser surgery versus radiation for T1 glottic carcinoma

Objectives/Hypothesis

To characterize outcomes for patients who underwent transoral microsurgery with potassium titanyl phosphate (KTP) laser resection of early glottic cancers and to compare outcomes with patients who received external beam radiation therapy.

Study Design

Retrospective cohort study.

Methods

The history of patients with T1 glottic carcinoma treated with curative primary radiation or transoral KTP laser resection was reviewed. Oncologic outcomes for both radiation and surgery cohorts including disease-free and overall survival were calculated.

Results

Eighty-seven patients met inclusion criteria from 2011 to 2016; 47 patients (54%) received primary KTP laser ablation, and 40 patients (46%) received primary external beam radiotherapy. The average length of follow-up was 924 ± 529 days in the KTP laser group and 994 ± 603 days in the radiation group (P = .26). There were no significant differences between the two treatment groups in terms of medical or demographic variables. There were six recurrences in the KTP laser group (13%), versus six in the radiotherapy group (15%) (P = .77). The laryngeal preservation rate for the cohort of patients who initially received KTP laser treatment was 46 out of 47 patients (98%). Of the cohort that received primary radiation therapy, the laryngeal preservation rate was 36 out of 40 patients (90%, P = .18). Disease-free and overall survival were 88% and 98% in the KTP laser cohort and 85% and 95% in the radiation cohort (P = .78, P = .56), respectively.

Conclusions

KTP laser ablation is a modality equivalent to primary radiation therapy in oncologic outcomes for T1 glottic squamous cell carcinoma.

Level of Evidence

4 Laryngoscope, 2017

http://ift.tt/2jmwBDl

Perceptions of pain of laryngeal electromyography

Objective

To evaluate pain associated with laryngeal electromyography (LEMG).

Study Design

A prospective case series.

Methods

Adult patients scheduled for LEMG in a tertiary care laryngology practice were recruited between July 20, 2016, and March 1, 2017. Demographic and clinical data were extracted from the charts. Study participants reported their anticipated pain level using a visual analog scale (VAS) prior to the procedure. VAS was administered again within 10 minutes after the procedure, along with the validated McGill Pain Questionnaire, to gauge patient's pain perception after undergoing LEMG.

Results

Results were reviewed for 80 patients (mean age 48.2 ± 16.6 years, 37.5% male). Preprocedure VAS pain scores (4.59 ± 2.3 out of 10) were not significantly different than postprocedure VAS pain scores (4.61 ± 2.4) (P = 0.95). The McGill Pain Questionnaire reported a moderate pain level (32.1 ± 12.7 out of 78). Females anticipated a higher preprocedure VAS pain score (5.04 ± 2.3) than males (3.85 ± 2.2) (P = 0.02); however, postprocedure scores were not significantly different between genders. The following factors did not influence the pain scores: age, professional voice use, history of previous EMG, chronic pain diagnosis, psychiatric diagnosis, or current treatment with pain/psychiatric medications. All LEMGs were completed without any complications.

Conclusion

Patients appropriately anticipated their pain levels for the LEMG, which may be attributed to proper patient education and counselling before the procedure. Overall pain levels were mild to moderate, and all LEMGs were completed; thus, LEMG was well tolerated.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2f0Olm2