Tonsillectomy for Obstructive Sleep‐Disordered Breathing: Should They Stay, or Could They Go?

xlomafota13 shared this article with you from Inoreader Tonsillectomy for Obstructive Sleep‐Disordered Breathing: Should They Stay, or Could They Go? Via The Laryngoscope Objectives/Hypothesis Children who do not require oxygen beyond 3 hours after surgery and pass a sleep room air challenge (SRAC) are safe for discharge regardless of polysomnogram (PSG) results or comorbidities. Study Design Cross-sectional prospective study. Methods All children observed overnight undergoing an adenotonsillectomy for obstructive sleep-disordered breathing were prospectively recruited. Demographic, clinical, and PSG characteristics were stratified by whether the patient had required oxygen beyond 3 hours postoperatively (prolonged oxygen requirement [POR]) and compared using t test, chi-squared test, or Fisher's exact test depending on distribution. Optimal cut points for predicting POR postsurgery were calculated using receiver operating characteristic curves. The primary analysis was performed on the full cohort via logistic regression using POR as the outcome. Significant characteristics were analyzed in a logistic regression model, with significance set at P < .05. Results A total of 484 participants met the inclusion criteria. The mean age was 5.65 (standard deviation = 4.02) years. Overall, 365 (75%) did not have a POR or any other adverse respiratory event. In multivariable logistic regression, risk factors for POR were an asthma diagnosis (P < .001) and an awake SpO2 <96% (P = .005). The probability of a POR for those without asthma and a SpO2 ≥ 96% was 18% (95% confidence interval: 14–22). Age, obesity, and obstructive apnea/hypopnea index were not associated with POR. Conclusions In conclusion, all children in our study who are off oxygen within 3 hours of surgery and passed a SRAC were safe for discharge from a respiratory standpoint regardless of age, obesity status, asthma diagnosis, and obstructive apnea/hypopnea index. Additional investigations are necessary to confirm our findings. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cutibacterium acnes and Staphylococcus epidermidis: the unmissable modulators of skin inflammatory response

xlomafota13 shared this article with you from Inoreader Cutibacterium acnes and Staphylococcus epidermidis: the unmissable modulators of skin inflammatory response Via Experimental Dermatology Abstract Acne is a multifactorial inflammatory dermatose that affects all age categories from teenagers to adults, resulting in important psychological impacts. Multiple hypotheses currently attempt to decrypt the physiopathology of this disease, and four main actors were identified as highly implicated in it: hyperkeratinization of the pilosebaceous follicle, hyperseborrheae, host factors (innate immunity) and skin microbiota. In this letter, we present results illustrating the impact of skin microbiota on inflammatory skin response, and how far the proper balance between each bacterial community, especially C. acnes and S. epidermidis, is crucial to maintain an appropriate inflammatory response on the skin. The data presented in this study demonstrate that within the skin microbiota, an imbalance between Cutibacterium acnes and Staphylococcus epidermidis, is able to induce the activation of inflammation-related markers such as IL-1ra, IL-6, IL-8, G-CSF, and th e molecules C5 / C5a, soluble CD14 MIP-3beta, Serpin E1, VCAM-1 and beta-defensin-2. Moreover, S. epidermidis appears to have a more important role than C. acnes on the induction of inflammation-related markers, particularly on IL-6. This work is the basis of future in vitro studies to further understand acne physiopathology, inspiring the development of future innovative therapies based on skin microbiota modulation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bacterial membrane vesicles shape S. aureus skin colonization and induction of innate immune responses

xlomafota13 shared this article with you from Inoreader Bacterial membrane vesicles shape S. aureus skin colonization and induction of innate immune responses Via Experimental Dermatology Abstract Staphylococcus aureus colonization is abundant on the skin of atopic dermatitis (AD) patients where it contributes to skin inflammation. S. aureus produces virulence factors that distinguish it from commensal skin bacteria such as S. epidermidis and S. lugdunensis. However, it has remained unclear, which of these virulence factors have the strongest impact on AD. Membrane vesicles (MVs) are released by pathogenic bacteria and might play an essential role in the long-distance delivery of bacterial effectors such as virulence factors. We show that MVs are also released by skin commensals in a similar quantity and membrane lipid amount as those from pathogenic S. aureus. Interestingly, MVs from skin commensals can protect against S. aureus skin colonization by conditioning human skin for enhanced defence. In contrast, MVs released by S. aureus are able to induce CXCL8 and TNF-α in primary human keratinocytes, recruit neutrophils and i nduce neutrophil extracellular traps, which enhance S. aureus skin colonization. CXCL8 induction is TLR2- and NFkB-dependent and the induction level correlates with the membrane lipid and protein A content of the MVs. Interestingly, MVs of S. aureus strains from the lesional skin of AD patients show an enhanced membrane lipid and protein A content compared to the strains from the non-lesional sites and have an enhanced proinflammatory potential. Our data underline the complex interplay in host- and bacterial derived factors in S. aureus skin colonization and the important role of bacterial derived MVs and their membrane lipid and protein A content in skin inflammatory disorders. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Access and Polarization Electrode Impedance Changes in Electric-Acoustic Stimulation Cochlear Implant Users with Delayed Loss of Acoustic Hearing

xlomafota13 shared this article with you from Inoreader Access and Polarization Electrode Impedance Changes in Electric-Acoustic Stimulation Cochlear Implant Users with Delayed Loss of Acoustic Hearing Via Journal of the Association for Research in Otolaryngology Abstract Acoustic hearing can be preserved after cochlear implant (CI) surgery, allowing for combined electric-acoustic stimulation (EAS) and superior speech understanding compared to electric-only hearing. Among patients who initially retain useful acoustic hearing, 30–40 % experience a delayed hearing loss that occurs 3 or more months after CI activation. Increases in electrode impedances have been associated with delayed loss of residual acoustic hearing, suggesting a possible role of intracochlear inflammation/fibrosis as reported by Scheperle et al. (Hear Res 350:45–57, 2017) and Shaul et al. (Otol Neurotol 40(5):e518–e526, 2019). These studies measured only total impedance. Total impedance consists of a composite of access resistance, which reflects resistance of the intracochlear environment, and polarization impedance, which reflects resistive and capacitive properties of the electrode–electrolyte interface as described by Dymond (IEEE Trans Biomed Eng 23(4):274–280, 1976) and Tykocinski et al. (Otol Neurotol 26(5):948–956, 2005). To explore the role of access and polarization impedance components in loss of residual acoustic hearing, these measures were collected from Nucleus EAS CI users with stable acoustic hearing and subsequent precipitous loss of hearing. For the hearing loss group, total impedance and access resistance increased over time while polarization impedance remained stable. For the stable hearing group, total impedance and access resistance were stable while polarization impedance declined. Increased access resistance rather than polarization impedance appears to drive the increase in total impedances seen with loss of hearing. Moreover, access resistance has been correlated with intracochlear fibrosis/inflammation in animal studies as observed by Xu et al. (Hear Res 105(1–2):1–29, 1997) and Tykocinski et al. (Hear Res&n bsp;159(1–2):53–68, 2001). These findings thus support intracochlear inflammation as one contributor to loss of acoustic hearing in our EAS CI population. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐Term Outcome of a cohort of 272 patients undergoing sialendoscopy.

xlomafota13 shared this article with you from Inoreader Long‐Term Outcome of a cohort of 272 patients undergoing sialendoscopy. Via Clinical Otolaryngology ABSTRACT Objectives To assess the cohort of patients undergoing sialendoscopic intervention for improvement of symptoms and gland-related quality of life at long-term follow up. Methods This is a retrospective review of medical records with a prospective follow-up by questionnaire. All patients undergoing sialendoscopy between March 2008 and June 2020 were analyzed in detail regarding indications, technical aspects and postoperative course. To maximize follow-up, patients also received a questionnaire by e-mail. Results 272 sialendoscopies were performed in 221 patients. Median follow-up time was 37 months. The sialendoscopies were performed in 130 patients for lithiasis, in 66 for stenosis, in 14 for recurrent parotitis of childhood, in 8 for recurrent sialadenitis of unknown origin and in 3 for radio-iodine induced sialadenitis. Complications occurred in 11 of 272 sialendoscopies (4%). Those were iatrogenic perforations, temporary lingual nerve paresthesia and swelling of the floor of the mouth. 53% of patients returned the questionnaire, for a total of 146 evaluable sialendoscopies. The majority of the responders indicated that sialendoscopy had improved their symptoms (83.6%). Salivary glands could be preserved in 89% of the responder group. The highest percentage of patients reporting residual symptoms was found in the RPC group (81.3%) and the lowest in the lithiasis group (16.2%). Besides age, no statistical differences in demographic and pathological features between the responder and non -responder groups were found, supporting generalization of the responders' results to the entire cohort. Conclusions This study confirms the good long-term outcomes of sialendoscopic interventions in patients with chronic sialadenitis of different etiologies and a high rate of gland preservation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Use of an Autoinflation Device Does Not Lead to a Clinically Meaningful Change in Hearing Thresholds in Children With Otitis Media With Effusion

xlomafota13 shared this article with you from Inoreader Use of an Autoinflation Device Does Not Lead to a Clinically Meaningful Change in Hearing Thresholds in Children With Otitis Media With Effusion Via Clinical Otolaryngology Abstract Objectives The objective of this study was to establish whether autoinflation was an effective intervention in a paediatric audiology service. The aims were to evaluate whether there was improvement in hearing thresholds following introduction of an autoinflation device, and whether there was a reduction in further audiology follow-ups, and in referrals to an ear, nose and throat specialist for consideration of ventilation tube insertion. Design This was a pragmatic retrospective study with historical controls using a paired availability design at a single paediatric audiology service in England. Participants All children seen in the clinic over a two-year period who were aged between 3 and 11 years and who had a type B tympanogram in at least one ear were included. The Otovent autoinflation device was available as a treatment option over the second year (Cohort B) but not the first (Cohort A). There were 976 children included in the study: Cohort A comprised 513 children, Cohort B comprised 463 children. Results There was a statistically significant improvement in hearing thresholds in Cohort B compared to Cohort A, however the improvements were clinically minimal with small effect sizes. There was no significant difference in improvement of tympanometry results between the two cohorts. Significantly more children in Cohort B (autoinflation group) were referred to an ear, nose and throat specialist after their second appointment compared to Cohort A. Conclusions It was feasible to introduce autoinflation into the care pathway, however there was no evidence of clinically meaningful improved outcomes for patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta‐analysis

xlomafota13 shared this article with you from Inoreader Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta‐analysis Via Clinical Otolaryngology ABSTRACT Objectives The present meta-analysis sought to assess further evidence for the efficacy of steroids in vestibular neuritis (VN). Methods The PubMed, EMBASE and Cochrane Library databases were searched through August 30, 2019. The main outcome measure was dizziness handicap inventory (DHI) and secondary outcomes included complete caloric recovery and improvement of canal paresis (CP). The follow-up times were divided into short, mid, and long-term. Results Among 276 records identified, 5 studies (n = 253) were included in the analysis. The therapeutic effect of steroid on VN was confirmed (Hedges' g = 0.172, 95% CI 0.05 to 0.30, p = .006). Although there was no significant difference between steroids and control in the DHI score (Hedges' g = -0.323, 95% CI -0.533 to -0.113, p < 0.01), significant effect was seen on complete caloric recovery and improvement in CP (Hedges' g = 0.364, 95% CI 0.18 to 0.55, p < 0.0001; Hedges' g = 0.592, 95% CI 0.32 to 0.59, p < .0001) Conclusions The results suggest that corticosteroids have an effect on the results of caloric tests for VN recovery, especially in long-term follow-up. However, in the term of dizziness handicap, we did not find any evidence of positive effect of corticosteroid. More data are required before recommendations can be made regarding management in patients on corticosteroids. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.