Microdebrider is less aerosol-generating than CO2 laser and cold instruments in microlaryngoscopy

xlomafota13 shared this article with you from Inoreader Microdebrider is less aerosol-generating than CO<sub>2</sub> laser and cold instruments in microlaryngoscopy Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 8. doi: 10.1007/s00405-021-07105-9. Online ahead of print. ABSTRACT OBJECTIVE: COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. METHODS: We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. RESULTS: Thirteen laryng ological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. CONCLUSIONS: Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff. PMID:34623498 | DOI:10.1007/s00405-021-07105-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy

xlomafota13 shared this article with you from Inoreader Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 8. doi: 10.1007/s00405-021-07111-x. Online ahead of print. ABSTRACT OBJECTIVE: Epistaxis after radiotherapy for nasopharyngeal carcinoma (NPC) is a common clinical critical illness, which often leads to death of patients. This article focuses on the relationship between massive epistaxis and pseudoaneurysm after radiotherapy in patients with NPC and discusses clinically relevant treatment strategies. METHODS: A review was performed in 21 patients with massive epistaxis after radiotherapy for NPC from January 2011 to December 2019, and all of the patients were examined by computed tomography angiography (CTA). We also reviewed the English literature over the past 10 years to analyze the characteristics and related causes of pseudoaneurysms in terms of the clinical stage of NPC, course of radiotherapy, and affected artery. An analysis was performed on the methods of endovascular interventional tr eatment of such pseudoaneurysms. RESULTS: Among the 21 patients, 19 cases had bone destruction of the skull base; 13 cases were also found to have tumor recurrence; 15 cases were in stage III or IV of NPC; pseudoaneurysms were observed in 14 cases, of which nine cases had pseudoaneurysms in the internal carotid artery (ICA), and the rest had pseudoaneurysms in the external carotid artery (ECA). These data were consistent with the results of the literature review. Analysis with imaging revealed that the petrous ICA was the common predilection site. There were 11 out of 14 cases of pseudoaneurysms with sentinel hemorrhage in the initial phase. All 14 pseudoaneurysm patients underwent endovascular interventional therapy, but one died from hemorrhagic shock during the procedure. No rebleeding was observed among the other patients during 72 h after intravascular treatment. Nevertheless, regrettably two patients died on the 10th and 17th days after intervention. CONCLUSION: Ps eudoaneurysm, which was a serious complication after radiotherapy in patients with NPC, could cause massive epistaxis with high mortality. The formation of a pseudoaneurysm was closely associated with a high carcinoma stage, re-radiotherapy, and local bone destruction and infection. Most cases had sentinel epistaxis, which was considered the bleeding characteristic. The imaging material prompted that pseudoaneurysm had a predisposition to the petrous part of the ICA, while the preferred therapy was endovascular embolization treatment. PMID:34623497 | DOI:10.1007/s00405-021-07111-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment

xlomafota13 shared this article with you from Inoreader Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 8. doi: 10.1007/s00405-021-07115-7. Online ahead of print. ABSTRACT PURPOSE: The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS: All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS: Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were id entified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION: S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes. PMID:34623496 | DOI:10.1007/s00405-021-07115-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A New Biomarker on Bone Resorption in Chronic Otitis Media: Osteoprotegerin and NLRP3 Inflammasome Gene Polymorphisms

xlomafota13 shared this article with you from Inoreader A New Biomarker on Bone Resorption in Chronic Otitis Media: Osteoprotegerin and NLRP3 Inflammasome Gene Polymorphisms Via Otolaryngology Indian Abstract Chronic Otitis Media (COM) is a chronic inflammation of the middle ear and mastoid with persistent membrane perforation and hearing loss. Osteoprotegerin (OPG) and NOD like receptor protein 3 (NLRP3) play an important role in bone metabolism. The aim of the study was to investigate the role of OPG and NLRP3 gene polymorphism on ossicular chain resorption in COM. Fourty COM patients and 20 healhty control group were included in the study. While 20 patients underwent ossiculoplasty, 20 patients underwent type 1 tympanoplasty. DNA was isolated from peripheral blood using the DNA kit. OPG gene c.226A > C (p.Thr76Pro) and NLRP3 gene c.592G > A (p. Val198Met) polymorphisms were genotyped using melting curve analysis technique. NLRP3 gene polymorphism were determined in 6 of 20 patients (30%) in ossiculoplasty group, 4 of 20 patients (20%) in type 1 tympanoplasty group and 3 of 20 patients (15%) in control group. OPG gene polymorphism were determined in 5 of 20 patients (25%) in ossiculoplasty group, 3 of 20 patients (15%) in type 1 tympanoplasty group and 1 of 20 patients (5%) in control group, respectively. There was no statistically significant difference between groups regarding to results. Although the difference was not significant NLRP3 and OPG gene polymorphisms were higher in the ossiculoplasty group. Since NLRP3 and OPG gene polymorphisms were determined to be higher numerically in the ossiculoplasty group, OPG and NLRP3 gene regulation system may have an effect on ossicular chain destruction in COM. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Styloid Process; Correlation Between Symptoms, Palpability and Measurements on Three Dimensional Computed Tomography

xlomafota13 shared this article with you from Inoreader Styloid Process; Correlation Between Symptoms, Palpability and Measurements on Three Dimensional Computed Tomography Via Otolaryngology Indian Abstract Styloid process is a long and slender osseous projection protruding downward, forward and slightly medially from the temporal bone and serves as an anchor point for various muscles associated with the tongue and the larynx. The aim of the present study was to record the length and the angle of Styloid process on three dimensional computed tomography in patients with unilateral symptomatic and palpable styloid process and compare the length and the angle of styloid process of symptomatic side to asymptomatic side on three dimensional computed tomography. 3D-CT face reconstruction were perfomed in all 35 patients (17 females, 18 males of age range 25–69 years). The length of the styloid process and its angulation (transverse and sagittal angles) were measured by means of three dimensional and multiplanar reconstruction images. The length of styloid process on symptomatic side had a mean of 33.61 ± 5.08 mm while on asymptomatic side mean was 31 .11 ± 5.02 mm. The mean transverse angle on symptomatic sides had a mean of 72.37° ± 4.48° while on asymptomatic side mean was 74.17° ± 4.48°. The mean sagittal angle seen on symptomatic side was 88.11° ± 5.21° while on asymptomatic side was 87.88° ± 5.03°. Symptomatic side has a longer styloid. Length of the styloid process has a statistical correlation with the symptoms and symptomatic side has a longer styloid. Though there was a difference in transverse and sagittal angulation in symptomatic versus asymptomatic side; but it was not statistically significant. On examination of the opposite asymptomatic side, 5 patients had a palpable styloid process therefore we infer that long styloid process may not always be associated with symptoms. Patients with cervicofacial pain should be evaluated for Eagle syndrome by palpation of styloid process in the tonsillar fossa and further by three dimensional computed tomography (3D-CT). 3D CT is an effectiv e tool in evaluating patients with cervicofacial pain and making a diagnosis of Eagle's syndrome. Therefore, 3D CT should be performed while evaluating patients with these symptoms. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparative Study of Parathyroid Identification Techniques Using Zuckerkandl’s Tubercle Versus Parathyroid Arterial Supply as Intra-Operative Markers

xlomafota13 shared this article with you from Inoreader Comparative Study of Parathyroid Identification Techniques Using Zuckerkandl's Tubercle Versus Parathyroid Arterial Supply as Intra-Operative Markers Via Otolaryngology Indian Abstract Thyroid surgeons should be able to identify factors that prevent parathyroid damage. The aim of the study was (i) to compare the effectiveness of using Zuckerkandl's Tubercle (ZT) versus superior thyroid artery (STA) and inferior parathyroid artery (ITA) as markers for identification of superior and inferior parathyroid glands and (ii) to demonstrate a series of detailed, logical and orderly operative steps to identify ZT during thyroidectomy operation. This 1-year prospective observational study was carried out in the Department of Otolaryngology in a tertiary medical institute. Out of 36 cases of thyroidectomy, parathyroid identification in Group A was based on STA and ITA and in Group B was based on ZT. The surgical steps, parathyroid location, preservation and its anatomical relations were noted. The mean age in Group A and Group B was 38.8 years and 44.9 years respectively with 77.4 and 62.5% SPT identified above the intersection of RLN and ITA respectively. On left side 62.5% SPT were  located at 2 o'clock position and 50% at 10 o'clock location in right side. In Group A, 60.7% of IPT glands were related close to ITA while in Group B it was 44.4%. Group B reported a higher rate of successful identification and preservation (93.75%). ZT greatly improved the reliability for localising and preserving the parathyroid glands during thyroidectomy. SPT is usually found to lie cranial to ZT, above the intersection of RLN & ITA and behind RLN whereas IPT is variable and lies below the intersection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extrapulmonary Tuberculosis: An Otorhinolaryngologist’s Perspective

xlomafota13 shared this article with you from Inoreader Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective Via Otolaryngology Indian Abstract Objective The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Study design Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions. Results The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. Conclusion A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of Effects on Prolonged Usage of Face Mask by ENT Professionals During Covid-19 Pandemic

xlomafota13 shared this article with you from Inoreader Assessment of Effects on Prolonged Usage of Face Mask by ENT Professionals During Covid-19 Pandemic Via Otolaryngology Indian Abstract The protection efficacy of face masks during this covid 19 pandemic has been well documented. The changes in human nasal functions after wearing facemask for prolonged period is not known. The aim of this study is to determine the effects of prolonged usage of facemask by ENT professionals during covid 19 pandemic. It is a cross sectional study conducted in department of ENT in Chettinad Hospital and Research Institute, Kelambakkam. A self-constructed questionnaire containing 21 queries regarding the effects of prolonged use of face mask, after being analysed by the experts of our institution were distributed to 124 ENT professionals all over India. People who are ENT by professionals can participate in this study. Participation is voluntary. Study period was from March 2020 to December 2020. All answered questionnaires were sent for statistical analysis. 63.71% experienced difficulty in breathing while wearing face mask, 37.10% experienced dry nose, 46.77% exper ienced dry mouth. The most common modality of prevention in an OPD setup was face mask with face shield (31.45%). About 80.65% people believed there are side effects due to wearing mask. Since facemasks are essential to protect us from COVID-19, certain strategies can be followed to reduce the discomfort due to its prolonged usage such as encouraging nasal breathing, taking short breaks from wearing mask in a safe environment and to maintain hydration. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Warthin like Variant of Papillary Carcinoma Thyroid with BRAF Mutation

xlomafota13 shared this article with you from Inoreader Warthin like Variant of Papillary Carcinoma Thyroid with BRAF Mutation Via Otolaryngology Indian Abstract Warthin like papillary carcinoma of thyroid (WLPTC) is a distinct entity and rare variant of papillary thyroid carcinoma (PTC). Here we report two cases of WLPTC with clinical, pathological and molecular characteristics. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Experience with Systemic Bevacizumab in Advanced Juvenile Recurrent Respiratory Papillomatosis

xlomafota13 shared this article with you from Inoreader Experience with Systemic Bevacizumab in Advanced Juvenile Recurrent Respiratory Papillomatosis Via Otolaryngology Indian Abstract Vascular Endothelial Growth Factor has been demonstrated in squamous papillomas of Recurrent Respiratory Papillomatosis patients. This case series aimed at studying the feasibility and efficacy of systemic use of VEGF inhibitor Bevacizumab in advanced Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP) patients. Three pediatric patients with advanced RRP were included in this study. A detailed bronchoscopic and radiological follow-up is presented. All patients responded well to the treatment. We conclude that systemic Bevacizumab can be tried as a feasible and rational adjuvant treatment in advanced JORRP patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intratemporal Facial Nerve Anatomy and its Variations in 30 Cases of Cadaveric Temporal Bones

xlomafota13 shared this article with you from Inoreader Intratemporal Facial Nerve Anatomy and its Variations in 30 Cases of Cadaveric Temporal Bones Via Otolaryngology Indian Abstract It is important for the ENT surgeon to be familiar with the anatomy of the facial nerve and to prevent iatrogenic injury to nerve as it shows variations in its intratemporal course. Present study was done to delineate the intratemporal course of facial nerve and observe its variations. Thirty wet cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of Otorhinolaryngology and Head Neck Surgery, Government Medical College, Patiala. The length of intratemporal segments of facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variations in its course were observed. The mean length of labyrinthine, tympanic and mastoid segment was found to be 4.28 ± 0.605 mm, 10.40 ± 1.416 mm and 12.34 ± 0.915 mm respectively in the dissected specimens. The first and second genu angle varied between 50°–90° and 90°–120° respectively. Facial canal dehiscence was present at the level of first genu in 10% of cases and at the level of tympanic segment in 33%. Distance between chorda tympani origin and stylomastoid foramen varied between 4 and 6 mm with mean value of 5.31 ± 0.603 mm. Chorda-facial angle was found to be in the range of 20° to 31° with mean of 25.30° ± 2.90°. The tympanomastoid segment of facial nerve has variations in length and in its relations with various middle ear structures. The facial canal, as it traverses the temporal bone, may display bony dehiscence, variations, and anomalies in its natural course, having its own clinical and surgical significance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.