Strategies for Evaluating Anosmia Therapeutics in the COVID-19 Era

alexandrossfakianakis shared this article with you from Inoreader Strategies for Evaluating Anosmia Therapeutics in the COVID-19 Era via JAMA Otolaryngology–Head & Neck Surgery Online First Two studies in this issue of JAMA Otolaryngology–Head & Neck Surgery evaluate the use of nasal theophylline, a phosphodiesterase inhibitor that may promote neural olfactory signaling and recovery for postviral olfactory dysfunction (OD). The first, a dose-modification Research Letter by Lee et al was conducted in patients with non-COVID-19–related hyposmia or anosmia secondary to viral infection and confirmed by the objective University of Pennsylvania Smell Identification Test. This open-label, dose-escalation trial provides an educational description of how to evaluate the appropriate dose for an emerging pharmacologic intervention. Specifically, the authors identified 400 mg of theophylline twice daily as a tolerated dosage. This was calculated as an equivalent oral dose of 20 mg. A phase 2 pilot study by Gupta et al was desig ned using this valuable information. Patients with suspected COVID-19–related OD completed the University of Pennsylvania Smell Identification Test and were randomized to either theophylline or placebo nasal irrigations for 6 weeks. This study was inconclusive regarding the clinical benefit of theophylline nasal irrigations, although there was suggested improvement by subjective assessments. The authors acknowledge several limitations, including small sample size, the virtual nature of the study design and subsequent inability to conduct endoscopic nasal examinations, lack of information regarding participant COVID-19 vaccination status, lack of polymerase chain reaction–confirmed COVID-19 infection, and short-term participant follow-up. These acknowledgments are justified, and many can be overcome in subsequent studies with adequate funding and time. However, the heterogeneous nature of COVID-19 and associated research make this area of work particularly challenging. Herein, we propose several approaches to improve the rigor of OD research in the COVID-19 era. View on Web

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Efficacy and Safety of Saline Nasal Irrigation Plus Theophylline for COVID-19–Related Olfactory Dysfunction

alexandrossfakianakis shared this article with you from Inoreader Efficacy and Safety of Saline Nasal Irrigation Plus Theophylline for COVID-19–Related Olfactory Dysfunction via JAMA Otolaryngology–Head & Neck Surgery Online First This randomized clinical trial evaluates the efficacy and safety of theophylline added to saline nasal irrigation compared with placebo for COVID-19–related olfactory dysfunction. View on Web

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Safety of High-Dose Nasal Theophylline Irrigation in the Treatment of Postviral Olfactory Dysfunction

alexandrossfakianakis shared this article with you from Inoreader Safety of High-Dose Nasal Theophylline Irrigation in the Treatment of Postviral Olfactory Dysfunction via JAMA Otolaryngology–Head & Neck Surgery Online First This case series aims to determine the maximum tolerable dose of theophylline delivered via high-volume, low-pressure nasal saline irrigation for treatment of postviral olfactory dysfunction. View on Web

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Surgeon Thyroidectomy Case Volume Impacts Disease‐free Survival in the Management of Thyroid Cancer

alexandrossfakianakis shared this article with you from Inoreader Surgeon Thyroidectomy Case Volume Impacts Disease‐free Survival in the Management of Thyroid Cancer via The Laryngoscope In this population-based cohort study involving 37,233 thyroidectomies performed in Ontario, Canada between 1993 and 2017, we found both high-volume surgeons and hospitals to be predictors of better disease-free survival (DFS) in patients with well-differentiated thyroid cancer. DFS is higher among surgeons performing more than 40 thyroidectomies a year. Objectives To assess the association between surgeons thyroidectomy case volume and disease-free survival (DFS) for patients with well-differentiated thyroid cancer (WDTC). A secondary objective was to assess a surgeon volume cutoff to optimize outcomes in those with WDTC. We hypothesized that surgeon volume will be an important predictor of DFS in patients with WDTC after adjusting for hospital volume and sociodemographic and clinical factors. Methods In this retrospective population-based cohort study, we identified WDTC patients in Ontario, Canada, who underwent thyroidectomy confirmed by both hospital-level and surgeon-level administrative data between 1993 and 2017 (N = 37,233). Surgeon and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively and divided into quartiles. A multilevel hierarchical Cox regression model was used to estimate the effect of volume on DFS. Results A crude model without patient or treatment characteristics demonstrated that both higher surgeon volume quartiles (p < 0.001) and higher hospital volume quartiles (p < 0.001) were associated with DFS. After controlling for clustering and patient/treatment covariates and hospital volume, moderately low (18–39/year) and low (0–17/year) volume surgeons (hazard ratios [HR]: 1.23, 95% confidence interval [CI]: 1.09–1.39 and HR: 1.34, 95% CI: 1.17–1.53 respectively) remained an independent statistically significant negative predictor of DFS. Conclusion Both high-volume surgeons and hospitals are predictors of better DFS in patients with WDTC. DFS is higher among surgeons performing more than 40 thyroidectomies a year. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database

alexandrossfakianakis shared this article with you from Inoreader Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database via The Laryngoscope This database study represents the largest cohort analysis to date characterizing bilateral vocal fold dysfunction. The majority of pediatric patients with bilateral vocal fold dysfunction (BVFD) have a complex chronic condition, with respiratory conditions being the most common followed by gastrointestinal conditions. Prognostic indicators of improved hospital survival include gastrointestinal comorbidities and presence of tracheostomy. Objectives The purpose of this study was to characterize pediatric bilateral vocal fold dysfunction and to examine the overall inpatient mortality. Methods Retrospective cohort analysis. Data from the Pediatric Health Information System was gathered for all pediatric patients with a diagnosis of bilateral vocal fold dysfunction between January 2008 and September 2020. Univariate and multivariate analyses were performed using Cox proportional hazard models. Results 2395 patients accounted for 4799 hospitalizations with bilateral vocal fold dysfunction. Inpatient mortality occurred in 2.9% of the study sample. Chiari 2 was found in 2.8% of patients. The most common associated diagnoses were related to comorbid respiratory conditions (61.1%). The median adjusted ratio of cost to charges was $76,569. Aspiration was noted in 28 patients (1.2%). Gastrostomy was performed in 607 patients (25.3%). Tracheostomy was performed in 27% of patients. The overall 90-day readmission rate was 61%. On multivariate analysis, prognostic factors associated with increased hospital survival include gastrointestinal comorbidities (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.18–0.49) and tracheostomy (HR: 0.21; 95% CI: 0.12–0.37). Conclusion This database study represents the largest cohort analysis to date characterizing bilateral vocal fold dysfunction. Favorable prognostic indicators of overall hospital survival include gastrointestinal comorbidities and the presence of tracheostomy. Tracheostomy is associated with an increase in hospital costs, comorbidities, gastrostomy tube placement, and Chiari diagnosis. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Periodontitis Prevalence in ulcerative Colitis & Crohn's disease (PPCC) patients: A case–control study

alexandrossfakianakis shared this article with you from Inoreader Periodontitis Prevalence in ulcerative Colitis & Crohn's disease (PPCC) patients: A case–control study via Journal of Clinical Periodontology Abstract Aim The aim of this questionnaire-based, case–control study was to assess whether self-reported oral health and periodontitis in ulcerative colitis (UC) and Crohn's disease (CD) patients differ from that in matched controls without inflammatory bowel disease (IBD). Methods A survey including questions on general anamnestic information, IBD diagnosis, and oral health was distributed online. Self-perceived overall health of teeth and gums, severe periodontitis, and tooth loss were defined as outcome parameters. Results Analyses were based on answers from 1108 IBD patients and 3429 controls. IBD patients reported significantly worse oral health and more periodontal problems compared to controls. Regression analyses corrected for relevant confounders showed for UC and CD patients significantly increased odds for fair or poor self-perceived overall health of teeth and gums (OR 2.147 and 2.736, respectively) and for severe periodontitis (OR 1.739 and 2.574, respectively) compared to controls; CD patients presented additionally 91% higher odds for having <20 remaining teeth. Conclusions UC and CD patients have significantly increased odds for worse self-perceived oral health and severe periodontitis compared to controls, with CD patients being more severely affected and losing more teeth. It is strongly recommended that IBD patients are kept under close surveillance to prevent periodontitis development and/or mitigate its progression. This article is protected by copyright. All rights reserved. View on Web

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Tooth Preservation vs. Extraction and Implant Placement in Periodontally Compromised Patients: A Systematic Review and Analysis of Studies

alexandrossfakianakis shared this article with you from Inoreader Tooth Preservation vs. Extraction and Implant Placement in Periodontally Compromised Patients: A Systematic Review and Analysis of Studies via Journal of Prosthodontics Abstract Purpose : The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated. Material and methods : A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included. Results : The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained non-surgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a meta-analysis. Conclusion : Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject. This article is protected by copyright. All rights reserved View on Web

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