COVID-19 in otolaryngologists: a cross-sectional multicenter study

xlomafota13 shared this article with you from Inoreader COVID-19 in otolaryngologists: a cross-sectional multicenter study Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 19:S1808-8694(21)00130-0. doi: 10.1016/j.bjorl.2021.06.007. Online ahead of print. ABSTRACT INTRODUCTION: The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers. OBJECTIVE: To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period. METHODS: In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied. RESULTS: We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p < 0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p < 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively. CONCLUS ION: Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion. PMID:34364822 | DOI:10.1016/j.bjorl.2021.06.007 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Patient perspectives on surveillance after head and neck cancer treatment: a systematic review

xlomafota13 shared this article with you from Inoreader Patient perspectives on surveillance after head and neck cancer treatment: a systematic review Via Clinical Otolaryngology Abstract Objectives Current guidelines advise post-treatment surveillance of Head and Neck Cancer (HNC) patients should involve scheduled appointments with a variety of practitioners. Increasing numbers of HNC survivors raises the burden to provide efficient and effective care. With resource limitation there is growing importance to identify how surveillance can be justified and optimised for survivors. This systematic review presents current evidence on patient-perspectives of post-treatment HNC surveillance, aiming to inform future work putting patient priorities at the forefront of surveillance planning. Design MEDLINE, Embase, the Cochrane Library, NIHR Dissemination Centre, The Kings Fund Library, Clinical Evidence, NHS Evidence and NICE Clinical Evidence were searched to identify publications regarding patient-perspectives of HNC post-treatment surveillance. Studies not reporting on both surveillance and patient-perspectives were excluded. Results 3558 citations were screened and 49 full-text articles reviewed. 16 studies were included in the final review. 3 authors reviewed all articles prior to final analysis to ensure all met inclusion criteria. Most evidence was low-quality. Study models returned included cross-sectional surveys, structured-interviews and one systematic review. Overall, positive perceptions of HNC surveillance mostly related to increased reassurance. Negative perceptions predominantly focused on anxiety and fear of recurrence, but a lack of psychological support and inadequate access to certain aspects of care were also reported. Conclusions This systematic review demonstrates that patients' perceptions of surveillance after HNC are mostly positive, feeling it provides reassurance. However, several studies report unmet needs, particularly regarding managing anxiety. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Trends in Cancer Treatment for Oral Cavity, Oropharynx, and Larynx in 2016 Versus 2009: SEER Patterns of Care Studies

xlomafota13 shared this article with you from Inoreader Trends in Cancer Treatment for Oral Cavity, Oropharynx, and Larynx in 2016 Versus 2009: SEER Patterns of Care Studies Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Aug 6:34894211037194. doi: 10.1177/00034894211037194. Online ahead of print. ABSTRACT PURPOSE: To determine if there was a higher percentage of patients treated surgically and with advanced radiotherapy in 2016 (N = 897) versus 2009 (N = 1136), the patient and tumor characteristics associated with surgical care and advanced radiotherapy, and if chemotherapy or targeted agent use varied over time for squamous cell carcinoma of the head and neck. METHODS: We utilized Surveillance Epidemiology and End Results Patterns of Care datasets. Rao-Scott Chi-square tests and logistic regressions were applied to determine differences in surgery, advanced radiotherapy (RT), and chemotherapy by year. RESULTS: There was a lower prevalence of surgery only treatment in 2016 versus 2009 with exception of oral cavity stages IVB/IVC and unknown, and larynx stage unknown. Advanced RT was more common in 2016 for patients receiving definitive RT among all sites, excluding stages I/II glottic larynx. Among each site (oral cavity, oropharynx, and larynx) lower stage was associated with increased odds of surgery. Among each site, advanced RT was more common in patients receiving definitive versus postoperative RT. For the larynx site, 2016 versus 2009 was associated with greater odds of advanced RT. Systemic treatment with fluorouracil, taxanes, or cetuximab was less prevalent in 2016. CONCLUSION: In 2016 versus 2009, there was la rgely not a higher percentage of patients treated surgically. There was a higher prevalence of advanced RT for definitive care. Further investigations of these patterns are needed, including trend analysis. PMID:34365844 | DOI:10.1177/00034894211037194 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Consideration for Surgical Management in Select T4b Oral Cavity Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader A Consideration for Surgical Management in Select T4b Oral Cavity Squamous Cell Carcinoma Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Aug 7:34894211038213. doi: 10.1177/00034894211038213. Online ahead of print. ABSTRACT OBJECTIVES: The role of surgery for conventionally "unresectable" (cT4b) oral cavity squamous cell carcinoma is unclear. We analyzed factors associated with overall survival in cT4b relative to cT4a oral cavity squamous cell carcinoma. METHODS: We identified 6830 cT4a and 522 cT4b oral cavity squamous cell carcinoma chemoradiation or surgery + adjuvant t herapy patients in the National Cancer Data Base from 2004 to 2016. The main outcome was overall survival. Statistical analysis was performed using chi-squared tests, univariable and multivariable regression analysis. RESULTS: The cT4b group had a higher rate of positive margins (30.4% vs 21.3%, P = .009) and downstaging (41.2% vs 13.1%; P < .001) compared to cT4a, while only 1.7% were upstaged. cT4b surgery + chemoradiation patients had similar survival to cT4a surgery + radiation (HR 0.93; 95% CI, 0.70-1.25) and cT4a surgery + chemoradiation patients (HR, 0.92; 95% CI, 0.69-1.23), while cT4b surgery + radiation patients had worse OS (HR, 1.55; 95% CI, 1.05-1.47). CONCLUSIONS: Clinical T4b staging is a poor predictor of pathologic staging given a high rate of downstaging on final pathology. Surgical resection with adjuvant chemoradiation is an option in select cT4b oral cavity squamous cell carcinoma patients. PMID:34365858 | DOI:10.1177/00034894211038213 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes after radioiodine ablation in patients with thyroid cancer: Long-term follow-up of a Chinese randomized clinicaltrial

xlomafota13 shared this article with you from Inoreader Outcomes after radioiodine ablation in patients with thyroid cancer: Long-term follow-up of a Chinese randomized clinicaltrial Via radioactive iodine Clin Endocrinol (Oxf). 2021 Aug 8. doi: 10.1111/cen.14563. Online ahead of print. ABSTRACT OBJECTIVE: Two large randomized trials of patients with differentiated thyroid cancer (DTC) reported recently (HiLo and ESTIMABL1) found that the recurrence rate among patients who underwent 1.1 GBq radioactive iodine (RAI) ablation was not higher than that of patients who underwent 3.7 GBq radioactive iodine (RAI) ablation. However, no similar studies have been conducted in China. We aimed t o report clinical outcomes in Chinese patients with low/intermediate risk of recurrence DTC after long-term follow-up, and evaluate the risk factors that influence the presence or absence of incomplete response at the final follow-up. DESIGN: A long-term follow-up of a Chinese randomized clinical trial (October 2014 and February 2021) was conducted. PATIENTS: A total of 506 DTC patients at low/intermediate risk of recurrence who were randomized into two groups to receive 1.1 (n = 251) or 3.7 GBq (n = 255) RAI ablation following thyroid hormone withdrawal were followed on levothyroxine treatment for a median of 4.5 years (range: 1.6-6.3). MEASUREMENTS: Suppressed serum thyroglobulin (Tg) and anti-thyroglobulin antibody (TgAb) levels were determined, and neck ultrasonography was performed. RESULTS: At the final follow-up, 499 (98.6%) patients showed an excellent response. The other seven patients (two patients underwent 1.1 GBq and five patients underwent 3.7 G Bq RAI ablation, respectively) showed either structural incomplete response (lymph node metastasis, n = 1), biochemical incomplete response (increased serum Tg ≥ 1 ng/ml, or increased positive TgAb levels, n = 5), or indeterminate response (stable positive TgAb levels, n = 1). The risk of incomplete response at the final follow-up was significantly increased in patients with stimulated serum Tg ≥ 10 ng/ml at ablation (p = .003) and in patients with unsuccessful ablation (p = .008). CONCLUSION: Our findings indicated that there was no difference in the long-term outcomes with RAI ablation using either 1.1 or 3.7 GBq in patients with low/intermediate risk of recurrence DTC, and 1.1 GBq RAI might be suitable for patients who are recommended for ablation. PMID:34368999 | DOI:10.1111/cen.14563 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quantifying Upper Aerodigestive Sequelae in Esophageal Atresia/Tracheoesophageal Fistula Neonates

xlomafota13 shared this article with you from Inoreader Quantifying Upper Aerodigestive Sequelae in Esophageal Atresia/Tracheoesophageal Fistula Neonates Via The Laryngoscope Objectives We examined rates of upper aerodigestive tract (UADT) procedures in a multi-institutional cohort of neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF) to estimate secondary UADT pathology. Methods A retrospective cohort study was performed using a previously-validated population of patients with EA/TEF within the Pediatric Health Information System (PHIS) between 2007 and 2015. ICD-9/10-CM codes for aerodigestive procedures were examined from 2007 to 2020: 1) diagnostic direct laryngoscopy and/or bronchoscopy (DLB), 2) DLB with intervention, 3) tracheostomy, 4) gastrostomy, 5) fundoplication, 6) aortopexy, 7) laryngotracheoplasty, and 8) esophageal dilation. Associations between procedures and demographics, length of gestation, and weight were estimated using generalized linear mixed models. Results We identified 2,509 patients with EA/TEF from 47 hospitals, 56.7% male and 43.3% female. Median length of stay for the first admission was 24 days (interquartile range: 12–55). Of these patients, 1,943 (77.4%) had at least one aerodigestive procedure within 14 admissions. Specifically, 1,635 (65.2%) underwent diagnostic DLB, 85 (3.4%) DLB with intervention, 167 (6.7%) tracheostomy, 1,043 (41.2%) gastrostomy, 211 (11.0%) fundoplication, 52 (2.1%) aortopexy, 161 (6.4%) laryngotracheoplasty, and 207 (8.3%) esophageal dilation. Preterm gestation increased odds of tracheostomy (adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5–3.7), gastrostomy (OR 2.1, CI 1.7–2.7), fundoplication (OR 1.7, CI 1.1–2.4), aortopexy (OR 5.8, CI 2.1–16.1), and esophageal dilation (OR 2.0, CI 1.4–3.0). Very low birth weight (<1,500 g) increased odds of gastrostomy (OR 2.5, CI 1.6–3.8). Conclusion Patients with EA/TEF frequently have aerodigestive sequelae. This work helps quantify aerodigestive needs in neonates with EA/TEF, suggesting early otolaryngology evaluation in their care. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Delayed Diagnosis of Idiopathic Subglottic Stenosis

xlomafota13 shared this article with you from Inoreader Delayed Diagnosis of Idiopathic Subglottic Stenosis Via The Laryngoscope Objective Idiopathic subglottic stenosis (iSGS) is a rare disease, causing life-threatening dyspnea secondary to scarring. Perhaps because it is rarely encountered, there is often a delay in diagnosing iSGS. The objective of this study is to characterize diagnostic delay of iSGS, factors that prolong delay, and its impact on iSGS patients. Study Design Retrospective chart review. Methods A retrospective chart review of 124 iSGS patients was performed. Times of symptom onset, presentation to otolaryngologist, diagnosis, imaging, pulmonary function testing (PFTs), surgeries, emergency department (ED) visits, and hospitalizations were recorded and univariate analyses were used to identify risk factors for delay. Results The median total time to diagnosis from symptom onset was 24.5 months, with time to first presentation of 6.3 months and healthcare delay of 17.8 months. 54.8% of patients were diagnosed with asthma. Earlier presentation to otolaryngologist was associated with shorter healthcare delay and total time to diagnosis (rho = 0.75, rho = 0.99, P < .0001). Earlier CT imaging was correlated to shorter healthcare delay (rho = 0.84, P < .0001) and total time to diagnosis (rho = 0.74, P < .001), while earlier PFTs were correlated to shorter total time to diagnosis alone (rho = 0.71, P = .01). During evaluation, 10.5% (n = 17/124) of patients had ED visits and 13.7% (n = 13/124) patients were hospitalized. Before diagnosis, 7% (9/124) of patients underwent surgeries (including 3% (n = 4) undergoing tracheostomy) and 8% (n = 10) of patients r equired unplanned urgent endoscopic surgery that may have been avoided with earlier diagnosis. Conclusion iSGS diagnosis is frequently delayed, resulting in additional surgeries (including tracheostomy), ED visits, and hospitalizations. Further, patients' symptoms are commonly attributed to asthma. Earlier otolaryngologist evaluation, PFTs, and CT imaging may expedite iSGS diagnosis. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Incidence of Mucormycosis in a Tertiary Care Hospital During Covid First Wave-A Retrospective Study

xlomafota13 shared this article with you from Inoreader Incidence of Mucormycosis in a Tertiary Care Hospital During Covid First Wave-A Retrospective Study Via Otolaryngology Indian Abstract Rhino orbital cerebral mucormycosis is a medical emergency; though rare it's a life threatening infection in patients. It commonly occurs in immunocompromised patients due to various causes. A retrospective study was conducted in tertiary care centre wherein 30 non-covid, diabetic patients were treated for mucormycosis. All underwent intensive debridement and diabetic management along with antifungal- amphotericin. All the cases improved with aggressive therapy: medical and surgical. Early recognition and treatment is needed to prevent morbidity and mortality. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Study of Surge of Mucormycosis in COVID-19 Pandemic: A Tertiary Care Center Study

xlomafota13 shared this article with you from Inoreader Clinical Study of Surge of Mucormycosis in COVID-19 Pandemic: A Tertiary Care Center Study Via Otolaryngology Indian Abstract The aim of this study is to evaluate the prevalence, pathogenesis and management of mucormycosis in post covid 19 patients in our tertiary care covid dedicated hospital. A prospective cross sectional study was done in 70 patients who were admitted in the covid department of BJ Medical College, Civil hospital Ahmedabad and presented with mucormycosis during admission or after discharge over a period of 10 months from March 2020 to December 2020. Middle aged to elderly population were found to be most commonly affected with mucormycosis. It was found that majority of the affected population was uncontrolled diabeteic and had a delayed presentation to hospital due to ongoing covid pandemic crisis. Covid infection had major effect on the hormonal balance of the body as evident from the uncontrolled blood glucose levels of affected patients. In patients with mucormycosis, early detection, surgical debridement, suitable antifungal therapy, and control of risk fact ors like diabetes mellitus are the main parameters of successful management of this lethal infection. Early diagnosis and treatment of mucormycosis can be life saving as it is a rapidly progressing disease and have been proven fatal. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evolving a Radiological Protocol for Cochlear Duct Length Measurement: Three Audit Cycles

xlomafota13 shared this article with you from Inoreader Evolving a Radiological Protocol for Cochlear Duct Length Measurement: Three Audit Cycles Via Otolaryngology Indian Abstract To develop an accurate protocol for measuring the Cochlear Duct Length (CDL) by using Multi Detector Computerized Tomography (MDCT) imaging of the temporal bones and thereby make the appropriate choice of electrode for cochlear implantation. 79 MED-EL® Cochlear implantees were divided into three cohorts in chronological order of their implantation. CDL was calculated from MDCT images and correlated with the CDL calculated using the existing Jolly's formula. Results of the CDL measured by unfurling the cochlea correlated well with the existing formula. In addition to CDL measurement, measuring diameter of each turn, especially the apical turn, helped in choosing the appropriate electrode for complete cochlear coverage. Having dedicated radiographers and neuro-radiologists can avoid inter-observer variations in CDL measurements. Measuring the CDL and the diameter of each turn helps in choosing an appropriate electrode thus minimizing intra-operative difficulties and achieving complete safe insertion. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficiency–Efficacy Assessment of External Lateral Osteotomy Technique Versus Internal One in the Rhinoplasty

xlomafota13 shared this article with you from Inoreader Efficiency–Efficacy Assessment of External Lateral Osteotomy Technique Versus Internal One in the Rhinoplasty Via Otolaryngology Indian Abstract In this study we aimed to compare external lateral osteotomy technique vs. internal one in the rhinoplasty. In this before-after clinical trial study 30 patients who were candidates for rhinoplasty involved. In each patient, external lateral osteotomy was performed on one side and internal lateral osteotomy was performed on the other side randomly. Information, including patients' age, sex, grade of edema and ecchymosis 1, 3, and 7 days after the surgery, and the type of lateral osteotomy, the amount of step deformity, the need for the specialist intervention, nasal bone mobility, and flail nasal bone was recorded and analyzed. The incidence of edema and ecchymosis on the first and the third day was statistically lower in the external method (P value < 0.001). Although the incidence of edema and ecchymosis on the seventh day was lower in the external method, it was not statistically significant (P value > 0.05). Forty seven perce nt of patients in the internal method and 36% of patients in the external method had step deformity (p value < 0.001). Fifty percent of patients in the internal method and 41% of patients in the external method needed the specialist intervention (p value > 0.05). Seventy four of patients in the internal method and 83% of patients in the external method had nasal bone mobility (p value > 0.05). Out of 30 patients, only one had flail nasal bone. Based on our findings, the external technique is suggested as a more effective and convenient method with less complications for inexperienced surgeons. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.