Pediatric Tracheal Lobular Capillary Hemangioma: A Case Report and Review of the Literature

xlomafota13 shared this article with you from Inoreader Pediatric Tracheal Lobular Capillary Hemangioma: A Case Report and Review of the Literature Via The Laryngoscope Chronic cough is a common complaint in the pediatric population and can have many different etiologies. We present a rare case of a tracheal lobular capillary hemangioma (LCH), also known as pyogenic granuloma, causing chronic cough in a child. In this case, the tracheal LCH was managed successfully with laser ablation. A review of the literature reveals only 2 other reported pediatric cases of tracheal LCH. Laryngoscope, 131:1729–1731, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Increased Risk of Nasal Septal Abscess After Septoplasty in Patients with Type 2 Diabetes Mellitus

xlomafota13 shared this article with you from Inoreader Increased Risk of Nasal Septal Abscess After Septoplasty in Patients with Type 2 Diabetes Mellitus Via The Laryngoscope Objective/Hypothesis To investigate the risk of nasal septal abscess (NSA) in patients with type 2 diabetes mellitus (T2DM) after septoplasty. Study Design Retrospective cohort study through Taiwan National Health Insurance database. Methods The Taiwan National Health Insurance Research Database was used to conduct this retrospective cohort study. A total of 382 patients with T2DM (DM group) diagnosed between 2000 and 2010 and 382 matched patients without a DM diagnosis (non-DM group) were enrolled. Patients were followed up until death or December 31, 2013. NSA incidence was the main outcome. Results After septoplasty, the cumulative incidence of NSA in the DM group was significantly higher than that in the non-DM group (P < .001). Cox proportional hazards regression indicated a significant association between T2DM and higher NSA incidence (adjusted hazard ratio, 2.62; 95% CI, 1.44–3.61; P < .001). However, subgroup analysis and sensitivity testing demonstrated that the effect of T2DM on NSA risk was stable. In addition, the subgroup with a Diabetes Complications Severity Index (DCSI) of ≥1 had higher NSA risk than that with DCSI = 0 (adjusted hazard ratio, 3.58; 95% CI, 2.10–6.09; P < .001). The treatment type for NSA did not differ between the groups. Conclusions T2DM is an independent risk factor for NSA in patients undergoing nasal septoplasty, and the NSA risk is greater among patients with high DM severity. Level of Evidence IV Laryngoscope, 131:E2420–E2425, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tertiary Lymphoid Organs: A Primer for Otolaryngologists

xlomafota13 shared this article with you from Inoreader Tertiary Lymphoid Organs: A Primer for Otolaryngologists Via The Laryngoscope Objectives/Hypothesis Lymphoid neogenesis or the development of organised, de novo lymphoid structures has been described increasingly in chronically inflamed tissues. The presence of tertiary lymphoid organs (TLOs) has already been demonstrated to result in significant consequences for disease pathology, severity, prognosis and patient outcomes. Whilst the wider medical community has embraced TLOs as important markers of disease and potential therapeutic targets, the otolaryngology field has only begun turning to these entities in an academic capacity. This review aims to outline the role of tertiary lymphoid organs in disease and summarise key early findings in the ENT field. We also an overview of TLOs, their developmental process and clinicopathological implications. Study design Literature review. Methods A literature search for all relevant peer-reviewed publications pertaining to TLOs and ENT diseases. Search was conducted using PubMed, Embase and CINAHL databases. Results A total of 24 studies were identified relevant to the topic. The majority of TLO research in ENT fell into the areas of oral squamous cell carcinoma (SCC) and chronic rhinosinusitis (CRS). Conclusions Early research into both oral SCC and CRS suggests that TLOs have significant roles within ear, nose and throat (ENT) diseases. At this point in time, however, TLOs remain somewhat a mystery amongst otolaryngologists. As information in this field increases, we may develop a better understanding of how lymphoid neogenesis can influence disease outcomes amongst our patients and, ultimately, how they can be utilised in an immunotherapeutic manner. Laryngoscope, 131:1697–1703, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term Follow‐up After Radiation Therapy for Laryngeal Amyloidosis

xlomafota13 shared this article with you from Inoreader Long‐term Follow‐up After Radiation Therapy for Laryngeal Amyloidosis Via The Laryngoscope Objectives Laryngeal amyloidosis (LA) is a rare disease characterized by extracellular protein deposition within the larynx. Treatment is difficult due to the frequently submucosal and multifocal nature of disease. The mainstay of treatment is surgical resection; however, recurrence rates are high. Recently, use of radiotherapy (RT), either alone or postoperatively, for LA has been adapted from the management of extramedullary plasmacytoma and has been shown to provide local disease control. Here, we describe the experience with adjuvant RT for LA at our center. Study Design Retrospective case series. Methods Retrospective study of patients with amyloidosis of the larynx, with or without other disease sites, seen at a tertiary academic center between 2011 and 2019. Outcomes included disease characteristics, recurrence rates, treatment modalities, and pre- and posttreatment voice handicap index (VHI)-10. Results Ten patients met eligibility criteria. Mean follow-up time for all patients was 62.0 ± 41.0 months; mean follow-up time after last treatment was 51 ± 55 months. All but one patient underwent surgical resection of disease. Seven patients underwent subsequent RT. Of these seven, six underwent RT at our institution; five received a dose of 45 Gray (Gy); and one received a dose of 20 Gy. All seven completed RT without toxicity-related interruption. Patients undergoing RT underwent 2.1 ± 1.3 surgical procedures prior to RT; no patients required surgery after RT. Mean pretreatment VHI-10 was 22.9 ± 8.1; mean posttreatment VHI-10 was 12.9 ± 13.3. Conclusion RT after surgery for LA can provide good local control without unacceptable toxicity and may decrease the need for further surgery. Level of Evidence 4 Laryngoscope, 131:1810–1815, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Yield of Imaging to Evaluate Unilateral Vocal Fold Paralysis of Unknown Etiology

xlomafota13 shared this article with you from Inoreader Yield of Imaging to Evaluate Unilateral Vocal Fold Paralysis of Unknown Etiology Via The Laryngoscope Objectives/Hypothesis To identify the incidence and nature of positive findings on imaging studies ordered for evaluation of unilateral vocal fold paralysis (UVFP) of unknown etiology, to analyze these findings based on laterality, and to examine the use of the expanded-field computed tomography (CT) neck protocol in this evaluation. Study Design Retrospective review. Methods A total of 145 patients from 2000 to 2018 with UVFP of unknown etiology were studied. Data on imaging studies ordered, laterality of paralysis, and significant positive results were studied. An expanded-field CT neck protocol that included the entire course of the vagus and recurrent laryngeal nerves was instituted during the study period. Results A total of 20.7% of patients had an etiology for paralysis identified on imaging. Malignancies comprised the majority of findings overall (19/30), whether in the chest (12/18) or the neck (7/12). Etiology was more often found in the chest for left-sided paralysis (15/21) and in the neck for right-sided paralysis (6/9). In 26 patients who underwent both expanded-field CT neck and CT chest, no findings related to the UVFP were seen on CT chest that were not captured by expanded-field CT neck. Conclusions This is one of the largest retrospective studies examining the incidence of positive findings on imaging studies for evaluation of UVFP of unknown etiology. Imaging in one of five patients with UVFP of unknown etiology will reveal a causative lesion, most often malignant. Left-sided paralysis tends to localize to the chest, and right-sided paralysis to the neck. Expanded-field CT neck may allow practitioners to forego dedicated CT chest in evaluation of UVFP. Level of Evidence 4 Laryngoscope, 131:1840–1844, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transorbital Endoscopic Approach for Repair of Frontal Sinus Cerebrospinal Fluid Leaks: Case‐Series

xlomafota13 shared this article with you from Inoreader Transorbital Endoscopic Approach for Repair of Frontal Sinus Cerebrospinal Fluid Leaks: Case‐Series Via The Laryngoscope Objectives To highlight the feasibility and evaluate the outcomes of the transorbital endoscopic approach (TOEA) in the management of frontal sinus cerebrospinal fluid (CSF) leaks. Study design Retrospective case series. Methods The database of patients with frontal sinus CSF leaks managed with TOEA from January 2017 through December 2019 at our institution was reviewed. Two videos of clinical case examples are presented. Results Sixteen patients (10 males, 6 females, mean age 53; range 21–61 years) underwent TOEA through the superior eyelid corridor for the repair of frontal sinus CSF leak. The most common etiology of the CSF leak was trauma (nine cases; 56.3%), followed by injury from iatrogenic causes in six cases (37.5%), and spontaneous leak in one case (6.2%). Average defect size was 8.8 mm (range 2.0–20.8 mm). Ten patients were revision cases who had undergone prior nontransorbital CSF leak repair at outside institutions. All patients underwent successful repair via TOEA without postoperative complications. Complete resolution was maintained in all cases. Mean follow-up period was 11 months (range 6–22 months). Conclusions TOEA is a safe minimally disruptive alternative for definitive management of frontal sinus CSF leak in well-selected primary or revision cases. Further studies are necessary to define its indications and outcomes. Level of Evidence 4 Laryngoscope, 131:1753–1757, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology

xlomafota13 shared this article with you from Inoreader Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology Via The Laryngoscope Objective/Hypothesis The COVID-19 pandemic has resulted in telehealth becoming commonplace in many health care fields. Telehealth benefits include improving access, decreasing costs, and elevating patient's experience. A review of cost minimization (CM) analyses was performed in order to explore scientific studies associated with integrating tele-otolaryngology in clinical practice. Our primary objective was to evaluate published literature for cost related to the implementation of telemedicine across otolaryngology, and to determine CM when compared to in-person visits. Study Design Systematic Literature Review. Methods We performed a systematic review using PubMed, EMBASE, and Cochrane in May 2020, to identify studies with a cost analysis of tele-otolaryngology care. Inclusion criteria focused on articles citing CM data from telehealth services. Literature quality was assessed using the MINORS scoring system. Results From 380 original articles screened only nine evaluated cost in otolaryngology. CM in the US ranged from $68 to $900 per visit. Cost was evaluated in general otolaryngology, sleep medicine, otology, and head and neck cancer surgery, the latter had the most benefit. The most common types of telehealth visits were routine follow-up and screening. Data were insufficient for meta-analysis. Conclusions Telemedicine has been trialed across various otolaryngology subspecialties; its incorporation is projected to have a meaningful impact on access to specialty care. This research suggests that the delivery of virtual care reduces cost with the potential of increasing net revenue across multiple otolaryngology subspecialties. Further studies are needed to better discern the entirety of cost savings and the best settings for integration. Level of Evidence 3 Laryngoscope, 131:1741–1748, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.