Impact of Fiberoptic Endoscopic Evaluation of Swallowing Outcomes and Dysphagia Management in Neurodegenerative Diseases

xlomafota13 shared this article with you from Inoreader Impact of Fiberoptic Endoscopic Evaluation of Swallowing Outcomes and Dysphagia Management in Neurodegenerative Diseases Via The Laryngoscope Objectives/Hypothesis To determine the incidence of abnormal fiberoptic endoscopic evaluation of swallowing (FEES) findings in patients with progressive neurologic disorders and identify the most commonly implemented dysphagia management strategies. Study Design Retrospective Review. Methods A retrospective review was performed of patients with neurodegenerative disease who underwent FEES at a tertiary‐care center between 2008 and 2019. Patient demographics, diagnosis, and Eating Assessment Tool‐10 (EAT‐10) scores were recorded. Rates of penetration, aspiration, and functional change in management (FCIM) to include dietary modifications, home exercises, swallow therapy, surgical intervention (injection augmentation or esophageal dilation), or alternative means of nutrition (i.e., percutaneous enteral gastrostomy [PEG] tube) were calculated. Results Two hundred nine FEES assessments were performed in 178 patients with a mean age of 64.8 years (standard deviation = ±14). The most common diagnoses were amyotrophic lateral sclerosis (32%) followed by Parkinson's disease or Parkinsonism (26%). FEES demonstrated penetration in 72.5% of patients and aspiration in 14.6%. Mean EAT‐10 scores differed between patients with aspiration versus penetration versus normal FEES (24.7 vs. 14.9 vs. 13.9, respectively, P < .001). An FCIM was recommended in 88% of patients and most commonly included self‐directed modifications (43%). Overall, 4.5% of patients underwent surgical intervention. A PEG tube was recommended for either supplemental or sole form of nutrition in 19% of the entire cohort. Conclusions Most patients with neurodegenerative diseases presenting with dysphagia demonstrated abnormal FEES findings necessitating an FCIM, suggesting early dysphagia evaluation may be warranted in this cohort. These findings correlate with worsened EAT‐10 scores in patients with aspiration or penetration on FEES. Level of Evidence 4 Laryngoscope, 131:726–730, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

xlomafota13 shared this article with you from Inoreader Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members Via The Laryngoscope Objectives/Hypothesis To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management. Study Design Cross‐sectional survey. Methods We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link. Results A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty‐five percent prefer a specimen‐based approach. The majority of respondents believe FS is efficacious in guiding re‐resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin. Conclusions To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen‐based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination. Level of Evidence 4 Laryngoscope, 131:782–787, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Emotional and Personality Traits are Determinants of Activity Avoidance in Chronic Rhinosinusitis Patients

xlomafota13 shared this article with you from Inoreader Emotional and Personality Traits are Determinants of Activity Avoidance in Chronic Rhinosinusitis Patients Via The Laryngoscope Objectives Chronic rhinosinusitis (CRS), like other sinonasal diseases, may be associated with avoidance of daily activities. Our goal was to identify characteristics associated with avoidance of activities due to CRS. Materials and Methods A total of 194 CRS patients were recruited. CRS symptom burden was assessed with the 22‐item Sinonasal Outcome Test (SNOT‐22). SNOT‐22 nasal, sleep, ear/facial discomfort and emotional/psychological subdomain scores were calculated. Depressed mood was assessed using the two‐item Patient Health Questionnaire (PHQ‐2). Personality traits including conscientiousness, neuroticism, agreeableness, openness, and extraversion were assessed using the Big Five Inventory‐10 (BFI‐10) questionnaire. As the primary outcome, participants rated how often in the prior week that they had avoided any activities in day‐to‐day life due to their nasal or sinus symptoms on a scale of "never," "rarely," "sometimes," "often," or "extremely often." Ordinal regression models, with bootstrap validation, were used to identify associations between activity avoidance and participants' characteristics. Results On multivariable analysis, SNOT‐22 score (odds ratio [OR] = 1.03, 95% CI, 1.01–1.04, P = .026), and conscientiousness personality trait (OR = 1.38, 95% CI, 1.05–1.81, P = .019) were positively associated with activity avoidance while age (OR = 0.98, 95% CI, 0.96–0.99, P = .049) was negatively associated with activity avoidance. Of CRS symptom burden/SNOT‐22 subdomains, only the emotional/psychological subdomain score (OR = 1.28, 95% CI, 1.12–1.46, P < .001) was associated with activity avoidance. Conclusion Younger age and the conscientiousness personality trait were associated with activity avoidance in CRS patients. Of CRS‐associated symptomatology, sadness and embarrassment were associated with activity avoidance. Emotional traits and personality most strongly predict avoidance of activities in CRS patients. Level of Evidence 2c. Laryngoscope, 131:707–712, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Disruption of Sinonasal Epithelial Nrf2 Enhances Susceptibility to Rhinosinusitis in a Mouse Model

xlomafota13 shared this article with you from Inoreader Disruption of Sinonasal Epithelial Nrf2 Enhances Susceptibility to Rhinosinusitis in a Mouse Model Via The Laryngoscope Objectives/Hypothesis Oxidative stress has been postulated to play an important role in chronic rhinosinusitis. Nrf2 is a transcription factor that is involved in the regulation of multiple antioxidant genes, and its function has been previously shown to be important in sinonasal inflammation. Although the sinonasal implications of whole body Nrf2 −/− has been reported, the function of sinonasal epithelial expression of Nrf2 has not been studied. The primary aim of this study was to generate a mouse model that is genetically deficient in epithelial‐specific Nrf2 and to understand its role in regulating sinonasal inflammation. Study Design Basic science. Methods An epithelial‐specific Nrf2 knockout mouse was generated by crossing Krt5‐cre(K5) with Nrf2flox/flox . A papain‐induced model of rhinosinusitis was performed in the resulting K5 Nrf2−/− mouse. Immunohistochemistry was performed to quantify goblet cell hyperplasia. Mucosal cellular infiltrates were quantified using flow cytometry, and tissue cytokines were measured using an enzyme‐linked immunosorbent assay. Lastly, the cellular source of type 2 cytokines was determined using intracellular cytokine staining. Results Papain‐sensitized mice lacking epithelial‐specific Nrf2 demonstrate increased goblet cell hyperplasia, significant tissue eosinophilia, and statistically significant increase in mucosal IL‐13 when compared to Nrf2 wild‐type mice. Lastly, mucosal T cells were identified as the cellular source of IL‐13. Conclusions We demonstrate enhanced severity of eosinophilic sinonasal inflammation from disruption of the epithelial‐specific Nrf2 pathway. The responsiveness of Nrf2‐directed antioxidant pathways may act as a major determinant of susceptibility to eosinophilic inflammation and may have potential as a therapeutic target for chronic rhinosinusitis. Level of Evidence NA Laryngoscope, 131:713–719, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Recumbent Position Affects Nasal Resistance: A Systematic Review and Meta‐Analysis

xlomafota13 shared this article with you from Inoreader The Recumbent Position Affects Nasal Resistance: A Systematic Review and Meta‐Analysis Via The Laryngoscope Objective Nasal diseases are among the main motives for the early discontinuation of continuous positive airway pressure therapy and for long‐term therapeutic compliance with mandibular advancement device. Although our clinical experience leads us to the belief that recumbency impacts nasal airflow in some patient populations, there is no consensus regarding the magnitude of this effect and the specific group of patients who are the most affected by this condition. In this study, we conducted a meta‐analysis to assess the effect of the recumbent position on nasal resistance and nasal airflow. Review Methods PubMed (Medline), Cochrane Library, EMBASE, Scopus, and SciELO databases were checked for relevant studies by two members of the YO‐IFOS study group. The two authors extracted the data. The main outcome was expressed as the difference between nasal resistance and nasal airflow before and after recumbency. Results Nine studies with a total population of 291 individuals were included in the meta‐analysis for nasal resistance after recumbency. We found a statistically significant difference in nasal airway resistance of −0.18 Pa sec/cm3 as compared to before and after recumbency through rhinomanometry (RMM) analysis. A subgroup analysis revealed a variation of −0.20 Pa sec/cm3 for patients with snoring or sleep apnea and − 0.10 Pa sec/cm3 for healthy individuals. Regarding nasal airflow measured with RMM, three studies (n = 32) in asymptomatic controls revealed a statistically significant difference of 47.33 ml/sec. Conclusions Recumbency increases nasal resistance and diminishes nasal airflow. This finding is of utmost importance in snorers and sleep apnea patients. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

How Enhancing Immunity to Low‐Risk HPV Could Cure Recurrent Respiratory Papillomatosis

xlomafota13 shared this article with you from Inoreader How Enhancing Immunity to Low‐Risk HPV Could Cure Recurrent Respiratory Papillomatosis Via The Laryngoscope Recurrent respiratory papillomatosis (RRP) is currently treated with repeat surgical resection of papillomatous disease that does not address the fundamental underlying issue of chronic infection with low‐risk human papillomavirus. Here, we review the biology and immunology of low‐risk human papillomavirus (HPV) infections. Antiviral or antiangiogenic adjuvant treatments similarly address the papillomatous disease itself but do not activate HPV immunity. It is likely that only through immune‐mediated clearance of low‐risk HPV infection can patients with RRP be cured. In some patients, this occurs spontaneously. In others with more aggressive disease, adjuvant immunotherapy to activate immunity may be needed. Based on current understanding of antiviral immune responses, the only rational strategy to clear HPV‐infected epithelial cells is through activation of the T‐lymphocyte arm of the adaptive immune response. Translation of immunotherapies that are Food and Drug Administration‐approved or under clinical study for cancer, such as immune checkpoint blockade or engineered therapeutic vaccines, may provide a path toward tolerable and efficacious adjuvant immunotherapy for RRP. Level of Evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of Sugammadex Dose for Intraoperative Neuromonitoring in Thyroid Surgery: A Randomized Controlled Trial

xlomafota13 shared this article with you from Inoreader Comparison of Sugammadex Dose for Intraoperative Neuromonitoring in Thyroid Surgery: A Randomized Controlled Trial Via The Laryngoscope Objectives/Hypothesis To compare effect of 1 and 2 mg/kg of sugammadex on the incidence of intraoperative bucking and intraoperative neuromonitoring (IONM) quality in thyroid surgery. Study Design Randomized controlled trial. Methods Patients qualified for thyroid surgery with IONM were eligible for this double‐blind, randomized, controlled trial. After tracheal intubation with 0.6 mg/kg rocuronium, 1 or 2 mg/kg of sugammadex was administered to patients in group I or II, respectively. The quality of the IONM for the external branch of the superior laryngeal nerve (EBSLN) was evaluated (strong/intermediate/weak). The initial amplitude of electromyography for the vagus nerve (V1) and the recurrent laryngeal nerve (R1) were recorded. Intraoperative bucking movements was recorded. Results A total of 102 patients (51 in each group) completed the study. Time from sugammadex administration to initial checking for the EBSLN was not different between group I and II (25.0 ± 7.9 vs. 25.5 ± 9.0 minutes, P = .788). There was no difference in the neuromonitoring quality for the EBSLN between group I and II (strong/intermediate/weak: 46/5/0 vs. 50/1/0, P = .205). The amplitudes of V1 (1,086.3 ± 673.3 μV vs. 1,161.8 ± 727.5 μV, P = .588) and R1 (1,328.2 ± 934.1 μV vs. 1,410.5 ± 919.6 μV, P = .655) were comparable between the groups. Patients who experienced bucking were significantly fewer in the group I than the group II (13.7% vs. 35.3%, P = .020). Conclusion A dose of 1 mg/kg sugammadex induced less bucking than 2 m/kg while providing comparable IONM quality during thyroid surgery. Level of Evidence 2. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.