Coverage for Gender‐Affirming Voice Surgery and Therapy for Transgender Individuals

xlomafota13 shared this article with you from Inoreader Coverage for Gender‐Affirming Voice Surgery and Therapy for Transgender Individuals Via The Laryngoscope Objectives/Hypothesis To determine insurance coverage for gender‐affirming surgery and voice therapy for individuals who seek to align their voice with their gender identity, and to analyze differences based on state‐by‐state transgender equality. Study Design Cross‐sectional study. Methods Policies from the top three commercial insurers per state in 2019 were reviewed. Coverage status was determined by web‐based search, telephone interviews, and email inquiries. A state‐by‐state equality score was calculated based on the number of laws and policies relating to the transgender community. Correlation between number of preauthorized procedures and state equality scores was assessed. Results Of the 150 insurance companies reviewed, only four (2.7%) held favorable policies, whereas 113 (75.8%) provided no coverage. Endoscopic surgery, open surgery, individual voice therapy, and group voice therapy interventions were equally excluded (n = 93, 62.4%). Coverage was not correlated with laws driving transgender equality (P = .782). Conclusions Gender‐affirming voice interventions are seldom covered by commercial insurance companies. Despite established medical necessity and years of experience in practice, gender‐affirming interventions for voice have not yet been fully considered by third‐party payors. Further investigation regarding cost‐effectiveness and treatment efficacy is warranted to improve insurance coverage of voice‐related gender‐affirming care. Level of Evidence NA Laryngoscope, 131:E896–E902, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

An Open‐Source Three‐Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training

xlomafota13 shared this article with you from Inoreader An Open‐Source Three‐Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training Via The Laryngoscope Objectives/Hypothesis A limited number of three‐dimensionally (3D)‐printed laryngeal simulators have been described in the literature, only one of which is specifically designed for percutaneous injection laryngoplasty (PIL) training and is currently of limited availability. This study describes the development and evaluation of a high‐fidelity, open‐source, low‐cost 3D‐printed simulator for PIL training, improving on existing models. Study Design Simulator design and survey evaluation. Methods Computed tomography scans of the upper airways were processed with 3D Slicer to generate a computer model of the endolarynx. Blender and Fusion 360 were used to refine the mucosal model and develop casts for silicone injection molding. The casted endolaryngeal structures were inserted into a modified version of a publicly available laryngeal cartilage model. The final models were evaluated by 10 expert laryngologists using a customized version of the Michigan Standard Simulation Experience Scale. Internal consistency and interrater reliability of the survey were evaluated using Cronbach's α and intraclass correlation, respectively. Results Expert laryngologists highly rated the model for measures of fidelity, educational value, and overall quality (mean = 4.8, standard deviation = 0.5; 1 = strongly disagree, 5 = strongly agree). All reviewers rated the model as ready for use as is or with slight modifications. The filament needed for one cartilage model costs $0.96, whereas the silicone needed for one soft‐tissue model costs $1.89. Conclusions Using 3D‐printing technology, we successfully created the first open‐source, low‐cost, and anatomically accurate laryngeal model for injection laryngoplasty training. Our simulator is made freely available for download on Wikifactory with step‐by‐step tutorials for 3D printing, silicone molding, assembly, and use. Level of Evidence NA Laryngoscope, 131:E890–E895, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO‐IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat

xlomafota13 shared this article with you from Inoreader IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO‐IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat Via The Laryngoscope Objectives/Hypothesis Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design DELPHI survey. Methods Twenty‐seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high‐definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ‐specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre‐ and postoperative videos in voice surgery and preoperative drawings and photos o f scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence 5 Laryngoscope, 131:E732–E737, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

xlomafota13 shared this article with you from Inoreader Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach Via The Laryngoscope Objectives/Hypothesis Revision endoscopic dacryocystorhinostomy (END‐DCR) is the preferred approach for failed primary surgeries, yet quality data on long‐term outcomes are lacking. This study aimed to evaluate three aspects of revision END‐DCR: 5‐year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. Methods This retrospective study included all revision END‐DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long‐term follow‐up analysis, two subgroups of first and second revision END‐DCRs with a minimum of documented 5‐year follow‐up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. Results After exclusions, a total of 45 eyes from 38 patients who underwent revision END‐DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5‐year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END‐DCR showed favorable 5‐year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT‐DCR) in both first and second revisions, but this did not reach significance. Conclusions Revision END‐DCR carries an excellent short‐term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow‐up should be maintained within this timeframe. Revision END‐DCR following either primary endoscopic or EXT‐DCR produces comparable surgical outcomes and patient‐reported satisfaction. Level of Evidence 3b Laryngoscope, 131:E682–E688, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Taste Dysfunction in Chronic Rhinosinusitis

xlomafota13 shared this article with you from Inoreader A Systematic Review and Meta‐Analysis of Taste Dysfunction in Chronic Rhinosinusitis Via The Laryngoscope Objectives Patients with chronic rhinosinusitis (CRS) often describe alterations in sense of taste. These complaints have historically been attributed to olfactory dysfunction; however, there is evidence of direct, objective, gustatory disturbances in the setting of CRS that are not thoroughly characterized. This study sought to investigate and summarize gustatory dysfunction experienced by patients with CRS. Methods PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were reviewed following PRISMA guidelines. English language, original studies investigating objective taste in adult patients with CRS were included. A meta‐analysis with inverse variance, random‐effects model was performed. Results Of 2750 studies screened, 11 articles with 471 unique patients were included. Patients with CRS exhibit worse gustatory function compared to healthy controls (standardized mean difference 0.94 [95% CI, 0.44–1.45]). Hypogeusia was identified in 32/95 (33.7%) patients from three studies that used methods with a validated definition of hypogeusia. Older age, male gender, and smoking history were associated with taste dysfunction, while objective gustatory and olfactory dysfunction were not correlated. Subjective taste and quality of life measures were also not associated with objective taste. The impact of sinus surgery on objective taste is unclear. Conclusion Approximately 34% of patients with CRS experience hypogeusia. Neither olfactory function nor subjective taste were associated with objective gustatory function. Given the substantial prevalence of taste dysfunction patients with CRS, there is significant potential for growth in understanding of pathogenesis, impact on quality of life, and potential treatment strategies of taste impairment in the CRS patient population. Level of Evidence 1 Laryngoscope, 131:482–489, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma

xlomafota13 shared this article with you from Inoreader Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma Via The Laryngoscope Objective Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA. Methods This was a single‐center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery. Results Ninety‐two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05). Conclusion In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease. Level of Evidence 4 Laryngoscope, 131:E775–E780, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoperative Fluorescence‐Guided Surgery in Head and Neck Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Intraoperative Fluorescence‐Guided Surgery in Head and Neck Squamous Cell Carcinoma Via The Laryngoscope The rate of positive margins in head and neck cancers has remained stagnant over the past three decades and is consistently associated with poor overall survival. This suggests that significant improvements must be made intraoperatively to ensure negative margins. We discuss the important role of fluorescence imaging to guide surgical oncology in head and neck cancer. This review includes a general overview of the principles of fluorescence, available fluorophores used for fluorescence imaging, and specific clinical applications of fluorescence‐guided surgery, as well as challenges and future directions in head and neck surgical oncology. Laryngoscope, 131:529–534, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.