A cross-sectional comparative study: ChatGPT 3.5 versus diverse levels of medical experts in the diagnosis of ENT diseases.

PURPOSE: With recent advances in artificial intelligence (AI), it has become crucial to thoroughly evaluate its applicability in healthcare. This study aimed to assess the accuracy of ChatGPT in diagnosing ear, nose, and throat (ENT) pathology, and comparing its performance to that of medical experts. METHODS: We conducted a cross-sectional comparative study where 32 ENT cases were presented to ChatGPT 3.5, ENT physicians, ENT residents, family medicine (FM) specialists, second-year medical students (Med2), and third-year medical students (Med3). Each participant provided three differential diagnoses. The study analyzed diagnostic accuracy rates and inter-rater agreement within and between participant groups and ChatGPT. RESULTS: The accuracy rate of ChatGPT was 70.8%, being not significantly different from ENT physicians or ENT residents. However, a significant difference in correctness rate existed between ChatGPT and FM specialists (49.8%, p < 0.001), and between ChatGPT and medical students (Med2 47.5%, p < 0.001; Med3 47%, p < 0.001). Inter-rater agreement for the differential diagnosis between ChatGPT and each participant group was either poor or fair. In 68.75% of cases, ChatGPT failed to mention the most critical diagnosis. CONCLUSIONS: ChatGPT demonstrated accuracy comparable to that of ENT physicians and ENT residents in diagnosing ENT pathology, outperforming FM specialists, Med2 and Med3. However, it showed limitations in identifying the most critical diagnosis.

Smoking cessation intervention for patients with head and neck cancer: A prospective randomized controlled trial.

AIMS: To evaluate the effectiveness of a brief smoking cessation intervention in head and neck cancer patients (HNCP). STUDY DESIGN: A prospective randomized controlled trial that randomly assigns participants in two groups: a usual care group (UCG), and a standardized intervention group (SIG). MATERIAL AND METHODS: Patients with a confirmed diagnosis of head and neck squamous cell carcinoma (HNSCC) and who are active smokers were prospectively approached by one of 4 trained Ear-nose-throat (ENT) residents. Participants were randomized into a UCG, and a SIG consisting of a brief perioperative smoking cessation intervention based on National Institute of Health (NIH) "5A's" model along with an informative motivational document and nicotine patch therapy (NPT) offered for 8 weeks in gradually decreasing doses. OBJECTIVE: The evaluation of abstinence at 3, 6 and 12 months after enrollment. RESULTS: 56 subjects were randomized into the UCG (N = 29, 52%), and the SIG (N = 27, 48%). The overall smoking cessation rates were not statistically different between the two groups; we observed at 3 months cessation rates of 57.1% vs. 57.7% (p = 0.96); at 6 months, 42.9% vs. 24% (p = 0.148); and at 12 months, 33.3% vs. 20.8% (p = 0.318), for the UCG and the SIG respectively. CONCLUSION: This study failed to show the effectiveness of a combined brief smoking cessation approach led by and ENT resident in HNSCC patients. A multifaceted approach addressing different pharmacological treatments, factors contributing to smoking maintenance, mainly alcohol dependence and mood disturbances and dealing with relapse risks through close face-to-face or phone call follow-ups may have better outcomes and should be evaluated in upcoming trials.

Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement.

PURPOSE: To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. METHODS: Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. RESULTS: The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. CONCLUSION: Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.

Correction to: Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society.

The article 'Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society,' written by Marc Remacle, Christoph Arens, Mostafa Badr Eldin, Guillermo Campos, Carlos Chiesa Estomba, Pavel Dulguerov, Ivana Fiz, Anastasios Hantzakos, Jerôme Keghian, Francesco Mora, Nayla Matar, Giorgio Peretti, Cesare Piazza, Gregory N. Postma, Vyas Prasad, Elisabeth Sjogren, Frederik G. Dikkers, was originally published Online First without open access. After publication in volume 274 issue 10, page 3723-3727 the authors decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to

Translation and transcultural adaptation of the VHI-10 questionnaire: the VHI-10lb.

Subjective assessment tools are essential in voice disorders evaluation. The Voice Handicap Index-30 (VHI-30) and the Voice Handicap Index-10 (VHI-10) are the most studied and used questionnaires to assess the severity of the handicap caused by hoarseness on the quality of life of dysphonic patients and, therefore, guiding physician's therapeutic decision making. The aim of our study is to validate a Lebanese version of the VHI-10. The Lebanese Arabic version of the VHI-10 (VHI-10lb) was obtained after a forward translation towards Lebanese Arabic then a back-translation towards English and a pilot study. It was then submitted to 154 participants with clinical dysphonia and 100 healthy subjects. The questionnaire's intrinsic parameters such as the reliability, the reproducibility, the validity, the sensitivity, and the study of the correlation between each item and the total score were measured for the validation of the questionnaire. The results show a high internal consistency of the VHI-10lb (Cronbach's α 0.915) and an intra-class correlation coefficient of 0.963 in the reliability analysis (p < 0.001). The VHI-10lb is also found to be clinically valid (p < 0.001) and sensitive to the improvement of the quality of life after treatment of dysphonic patients (p < 0.001). The Lebanese version of the VHI-10, the VHI-10lb, can be used to self-assess the severity of the impact of dysphonia on the quality of life of the affected patients. This study allows to add the VHI-10lb to the voice evaluation tools adapted to the Lebanese population.

Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society.

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO2 laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes of delivery. Classification and definition of the different types of procedures, performed transorally or transnasally, are proposed by the Working Committee for Nomenclature of the European Laryngological Society, emphasizing the type of laser used and the way this laser is transmitted. What is usually called TLM, would more clearly be defined as CO2 laser transoral microsurgery or CO2 TOLMS or CO2 laser transoral surgery only (with a handpiece) would be defined as CO2 TOLS. KTP transnasal flexible laser surgery would be KTP TNFLS. Transoral use of the flexible CO2 wave-guide with a handpiece would be a CO2 TOFLS. One can argue that these clarifications are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufficient. But this is not the case. Laser surgery, office-based laser surgery and microsurgery are frequently and erroneously interchanged for one another. These classifications allow for a clear understanding of what was performed and what the results meant.

Survival of T4aN0 and T3N+ laryngeal cancer patients: a retrospective institutional study and systematic review.

OBJECTIVE: We aim to assess the correlation of tumor and nodal staging to survival in pT3N+ and T4aN0 laryngeal cancer with subgroup analysis within stage IVa (pT4N0 and pT3N2). STUDY DESIGN: Retrospective cohort study with systematic review of the literature. SETTING: Hotel Dieu de France University Hospital (tertiary referral center). SUBJECTS AND METHODS: Laryngeal cancer patients' registries were reviewed from 1998 to 2012 selecting pT3N+ and pT4aN0 patients treated by primary total layngectomy. Overall survivals were compared using Log rank and Kaplan-Meier analysis. A systematic review was performed by 2 reviewers including all the articles reporting the outcome of these categories of patients. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. RESULTS: Thirteen T3N+ patients and 19 T4aN0 patients treated by primary total laryngectomy were included. Five-year overall survival for T3N+, T3N2 and T4aN0 was respectively 33%, 32.1% and 73.7%. Due to the small sample, the difference was not significant. The systematic review revealed three articles reporting overall survival outcome for the T4N0 group and 6 articles for the T3N+. At 5years, the survival ranged from 62.5% to 73% in T4N0 and from 32.2% to 77% in T3N+. CONCLUSION: In advanced stage laryngeal cancer, T4aN0 tends toward a better survival than T3N+ especially when compared to T3N2 although they are grouped in the same TNM stage IVa.

European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer.

It is accepted that the follow-up of patients who had treatment for laryngeal cancer is a fundamental part of their care. The reasons of post-treatment follow-up include evaluation of treatment response, early identification of recurrence, early detection of new primary tumours, monitoring and management of complications, optimisation of rehabilitation, promotion smoking and excessive alcohol cessation, provision of support to patients and their families, patient counselling and education. Controversies exist in how these aims are achieved. Increasing efforts are being made to rationalise the structure and timing of head and neck cancer follow-up clinics. The aim of this document is to analyse the current evidence for the need to follow up patients who have been treated for LC and provide an up to date, evidence-based statement which is meaningful and applicable to all European Health Care Systems. A working group of the Head and Neck Cancer Committee of the ELS was constituted in 2009. A review of the current published literature on the management and follow-up of laryngeal cancer was undertaken and statements are made based on critical appraisal of the literature and best current evidence. Category recommendations were based on the Oxford Centre for Evidence-Based Medicine. Statements include: length, frequency, setting, type of health professional, clinical assessment, screening investigations, patient's education, second primary tumours, and mode of treatment considerations including radiotherapy, chemo-radiation therapy, transoral surgery and open surgery. It also addresses specific recommendations regarding patients with persistent pain, new imaging techniques, tumour markers and narrow band imaging.

Long-term functional results after endoscopic cricopharyngeal myotomy with CO2 laser: a retrospective study of 32 cases.

Endoscopic cricopharyngeal myotomy (ECPM) with CO(2) laser is indicated in cases with swallowing disorders when a dysfunction of the cricopharyngeal muscle is diagnosed. We present the results of a retrospective study including 32 of the 65 consecutive patients who underwent ECPM in our center between 2002 and 2009. The aim of this study is to evaluate the postoperative complications and complaints, the improvement of swallowing after surgery, the global satisfaction of the surgery and the swallowing improvement according to the deglutition handicap index (DHI). No major postoperative complication was reported. Postoperative pain was present in 46.9 % of the patients and estimated on an analog scale at 4.4/10. For the others, this surgery was painless. Improvement in swallowing liquids was present in 75 % of the patients and 81 % of the patients could swallow solids. The overall patients' satisfaction on a scale of 10 was 7.2; if needed, 83.9 % of the patients would do the surgery again. Concerning the DHI, we report a significant improvement of all items except the last one. ECPM is a safe procedure which provides improvement of symptoms and satisfaction for the majority of patients.

Objective measurement of real time subglottic pressure during medialization thyroplasty: a feasibility study.

It is hypothesized that real time objective measurement of the subglottic pressure could contribute to the choice of the implant's size (IS) in medialization thyroplasty (MT). A prospective study was conducted with patients with glottal insufficiency. Patients had a MT using a Montgomery implant(®) (Boston medical, Boston, USA). Peak direct subglottic pressure (PDSGP) was measured intraoperatively using a catheter inserted in the cricothyroid membrane. The implant's choice was based on the results of PDSGP measured prior and after placement of the implant and was compared to the surgeon's and patient's perception and fiber optic estimation of the glottis aperture. Six patients were included in the first part of the study. The PDSGP could be measured in all the patients without increasing the surgical time or patients' discomfort. The mean PDSGP before and after the placement of the implant was 15.2 (SD = 5) and 10.6 (SD = 4) cmH(2)O, respectively. In the second part of the study, five patients were included. The PDSGP varied with the size of the implant and the implant with the lowest pressure was chosen in 4/5 patients. Peroperative measurement of PDSGP is easy, feasible and might allow a more objective choice of the IS in MT. Level of evidence 2c.

Reliability and efficacy of a new CO2 laser hollow fiber: a prospective study of 39 patients.

We present the first series of patients treated by transoral laser surgery (TLS) using the new AcuPulse 40WG CO(2) laser with the FiberLase flexible waveguide (CO(2) LWG) (Lumenis, Santa Clara, CA) with the objective to test its reliability and efficacy. Patients older than 18 years, with oral, pharyngo-laryngeal or tracheal benign or premalignant lesions were enrolled after signing an informed consent. This prospective study was conducted between October 2010 and May 2011 in two tertiary care university hospitals. Thirty-nine patients were enrolled in the study. The mean age was 47.9 years (range 18-86 years). There were 21 women and 18 men. Thirteen patients had hypertrophy of lymphoid tissue (palatine and or lingual), nine patients had granulomas, four patients had an exudative glottic lesion, three patients had severe dysplasia (glottic and supraglottic), three patients had leukoplakia, two patients had glottal cysts, two patients had laryngeal papilloma, two patients had bilateral paralysis of the vocal folds and one patient suffered from spasmodic dysphonia. Eighty-two percent of the procedures were performed under general anesthesia with laryngo-tracheal intubation. The CO(2) fiber passed through a handpiece was used with a microscope in the majority of the procedures. The laser delivery mode parameter used was: SuperPulse or Continuous Wave. Power levels were 3-15 Watts (W), continuous delivery. Each procedure utilized one CO(2) fiber which performed adequately throughout the procedure. No complications were noted with the use of this technology. A bipolar cautery was needed to control bleeding in eight procedures; all these procedures were tonsillectomies. The CO(2) LWG is a safe and reliable tool for TLS. It is durable enough to last through the entire surgical procedure without the need for replacement. Its use must be tailored depending on the type and location of the lesion, the CO(2) lasers tissue effects as well as the surgeon's experience.

Combining a new CO2 laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors.

We present a series of patients treated by transoral robotic surgery (TORS) using a new CO(2) laser wave guide (CO(2) LWG) (Lumenis, Santa Clara, CA). Patients older than 18 years, with malignant pharyngo-laryngeal tumors were enrolled in this prospective study after signing an informed consent. Four patients were enrolled in the study. The mean age was 56 years. One patient had a T1 base of tongue tumor, two patients had supraglottic tumors (T1, T2), and one had a T1 palatine tonsil tumor. All the procedures could be performed using a Maryland forceps, a 0° endoscope and a CO(2) LWG introduced via the robotic arm introducer. The laser parameters were: superpulse or continuous mode, 7-15 W, continuous delivery. The average set-up time was 30 min. The average surgical time was 94 min. No complications were noted due to the intraoperative use of the robot or the CO(2) LWG. One laser fiber was used for each of the surgeries. The mean coagulation depth was 200 µm (range 100-300). The mean hospital stay was 6 days. The CO(2) LWG is a reliable tool for TORS. It allowed more than 1 h of work without any trouble.

Lipoinjection for Unilateral Vocal Fold Paralysis Treatment: A Systematic Review and Meta-Analysis.

INTRODUCTION: Lipoinjection is one of the available treatments for unilateral vocal fold paralysis. OBJECTIVE: To evaluate lipoinjection predictability, and analyze the differences in safety and efficacy of the different techniques. STUDY DESIGN: Systematic review and meta-analysis. METHODS AND RESULTS: A systematic review on Medline, Cochrane, and Scopus databases included 49 articles analyzing the data of 1,166 patients, concerning technical details and voice parameters changes. Lipoinjection used a mean volume of 1.3 mL, 95% confidence interval (CI) (0.92, 1.69)-average overcorrection of 30%. Meta-analysis of pre- and postoperative voice parameters' means showed a significant improvement at 6 months of mean phonation time (preoperative: 5.12, 95% CI [4.48, 5.76]-6 months: 10.46, 95% CI [9.18, 11.75]), Jitter (preoperative: 2.71, 95% CI [2.08, 3.33])-6 months: 1.37, 95% CI [1.05, 1.70]), Shimmer (preoperative: 4.55, 95% CI [3.04, 6.07]-6 months: 2.57, 95% CI [1.69, 3.45]), grade (preoperative: 2.15, 95% CI [1.73, 2.57]-6 months: 0.12, 95% CI [0.97, 1.43]), breathiness (preoperative: 2.012, 95% CI [1.48, 2.55]-6 months: 0.99, 95% CI [0.58, 1.40]), and asthenia (preoperative: 1.90, 95% CI [1.33, 2.47]-6 months: 0.75, 95% CI [0.17, 1.33]) of GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain), and Voice Handicap Index-30 (preoperative: 72.06, 95% CI [54.35, 89.76]-6 months: 26.24, 95% CI [19.58, 32.90]). Subgroup analysis by harvesting technique concluded in no statistically significant difference between them. Few complications were reported. Reintervention was only required for 86 patients. CONCLUSION: Lipoinjection seems a safe therapeutic option for unilateral vocal fold paralysis, with available data showing an efficacy lasting 6 months to 1 year. Laryngoscope, 132:1630-1640, 2022.

Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study.

Purpose: In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). Methods: We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. Results: Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority. Conclusion: This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.

Pharyngo-laryngeal examination with the narrow band imaging technology: early experience.

The prognosis of cancer patients is highly dependent on the time of diagnosis. Early, stage 1 disease is often curable whereas late stage diseases are usually beyond curable treatments. Therefore, new diagnostic tools for malignancies of the upper aerodigestive tract are developed all the time and narrow band imaging (NBI) is one of these new options for early diagnostics. In this paper, we describe the implementation of NBI technique in our institution. During the first 6 weeks we used NBI to examine 73 patients with different types of pharyngeal or laryngeal problems. Most of the patients (77%) were on follow-up visits after earlier malignant disease. In our series we had 11 NBI-positive patients and the histological diagnosis was carcinoma or dysplasia among 10 of these. Among the NBI negative patients we found four carcinomas. It is notable that NBI affected the decision of a biopsy procedure in three patients, with final diagnosis of dysplasia or carcinoma. In conclusion, we find NBI useful in the diagnostics of malignancies of the upper aerodigestive tract. This is a useful tool in improving the accuracy of the diagnostics. However, it still takes an experienced clinician and a learning curve can be expected.

Transoral robotic surgery for the management of head and neck tumors: learning curve.

Transoral robotic surgery (TORS) is an emerging technique for the treatment of head and neck tumors. The objective of this study is to describe our first steps and present our experience on the technical feasibility, safety, and efficacy of TORS for the treatment of selected malignant lesions. From April 2008 to September 2009, 24 patients were enrolled in this prospective trial. Inclusion criteria were: adults with T1, T2 and selected T3 tumors involving the oral cavity, pharynx, and supraglottic larynx and a signed informed consent was obtained from the patient. Exclusion criteria were: tumors not accessible to TORS after unsuccessful attempts to expose properly the lesion to operate. The ethical committee's approval was obtained to perform this study. Twenty-four patients were included in this study: 10 supraglottic tumors, 10 pharyngeal tumors and 4 oral cavity tumors. Nine patients had T1 tumors, 12 had T2 tumors, and 1 patient had a T3 tumor. In all cases, tumor resection could be performed by robotic surgery exclusively and negative resection margins were achieved with control by frozen section. None of them received intraoperative reconstruction. None of the patients required tracheotomy. There was no intraoperative complication related to the use of the robot. The average setup time was 24 ± 14 min (range 10-60 min). The average surgical time was 67 ± 46 min (range 12-180 min). Surgical and setup time decreased after the first cases. The mean hospital stay was 9 days. Oral feeding was resumed at 3 days. TORS seems to be a safe, feasible, minimally invasive treatment modality for malignant head and neck tumors with a short learning curve for surgeons already experienced in endoscopic surgery.

New trends in the management of head and neck cancers.

Head and neck cancers affect more than half million person a year worldwide. More than 40% have an advanced stage at diagnosis. The incidence in Lebanon according to the statistics of the Ministry of Public Health was 268 new cases in 2007. The tumors and their treatment modalities have an important impact on the quality of life because they influence communication, breathing and4 swallowing. Treatment modalities are evolving to more conservative approaches for better functional results without impeding survival. We present in this review the state of the art of the management of head and neck cancer in 2011 with emphasis on the most recent advances in the assessment, treatment and follow-up.

Profiling of Oropharyngeal Dysphagia in an Acute Care Hospital Setting.

PURPOSE: To identify the main complaints, diagnostic tools, as well as the treatment plan in patients presenting with oropharyngeal dysphagia in the acute care settings. METHODS: The electronic medical chart of 100 consecutive hospitalized patients who presented an oropharyngeal dysphagia were retrospectively reviewed from January 2017 to January 2019. RESULTS: The mean age of patients was 76.03 (standard deviation = 16.06) years old with 71% of patients being males. The most common admission diagnosis was pneumonia (30%), followed by stroke (28%). The swallowing evaluation was performed on the regular floor in 85% of patients and in the intensive care unit in 15% of patients. The main reasons for the swallowing evaluation are suspicion of aspiration by the medical or nursing teams (60%), systematic evaluation (20%), ear, nose and throat (ENT) complaints by the patient (14%), and aspiration pneumonia (6%). Fiberoptic endoscopic evaluation of swallowing with sensitivity testing was the most common diagnostic tool used alone in 88% of patients. Diet and postural modifications were prescribed to 71% and 62% of the patients, respectively. Swallowing exercises were performed in 43% of patients. Overall, otolaryngologist interventions resulted in an increased rate of patients getting oral intake compared to nonoral feeding routes (P = .05). CONCLUSIONS: This study adds knowledge about the causes and characteristics of oropharyngeal dysphagia in an acute tertiary medical setting. It also provides insights regarding the role, and the consequences of a swallowing intervention led by an ENT specialist in collaboration with the members of the health team.

Pediatric laryngeal inflammatory myofibroblastic tumour: Case report and systematic review of the literature.

INTRODUCTION: Inflammatory myofibroblastic tumours (IMT) are rare benign neoplasms in the pediatric population, found most frequently in the lungs with rare reports of laryngeal involvement. The aim of this paper is to present a clinical case of laryngeal IMT followed by a systematic review on pediatric laryngeal IMT. CASE REPORT: We present the case and the management of a 13-year-old boy with a laryngeal IMT MATERIAL AND METHODS: A comprehensive review of literature was conducted in September 2019 using Pubmed and Scopus. Included articles were reviewed for mean age at presentation, gender, main symptoms, treatment modality, histopathological features and follow-up RESULTS: Sixteen cases of pediatric laryngeal IMT were reported in the literature. The mean age of presentation was 7 years; endoscopic surgical resection was used in 87% of procedures, and the mean number of interventions needed to achieve remission was 1.6. CONCLUSIONS: Pediatric laryngeal IMT are rare benign proliferations with only 16 reported case in the medical literature. The diagnosis of this entity remains a challenge and the standard of care is surgery with clear margins.

Management of postintubation tracheal stenosis: appropriate indications make outcome differences.

BACKGROUND: Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses. OBJECTIVE: To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center. METHODS: A retrospective study was conducted on all patients treated for PILTS over a 10-year period. Patients were divided into a surgically and an endoscopically treated group according to predefined criteria. The characteristics of the two groups were analyzed and the outcomes compared. RESULTS: Thirty-three consecutive patients were included in the study: 14 in the surgically treated group and 19 in the endoscopically treated group. Our candidates for airway surgery were healthy patients presenting with complex tracheal stenoses, subglottic involvement or associated tracheomalacia. The endoscopic candidates were chronically ill patients presenting with simple, strictly tracheal stenoses not exceeding 4 cm in length. Stents were placed if the stenosis was associated with tracheomalacia or exceeded 2 cm in total length. In the surgically treated group, 2/14 patients needed more than one procedure versus 8/19 patients in the endoscopically treated group. At the end of the intervention, 50% of the patients were decannulated in the surgically treated group versus 84.2% in the endoscopically treated group (p = 0.03). However, the decannulation rates at 6 months and the symptomatology at rest and on exertion on the last follow-up visit were comparable in the two groups. CONCLUSION: Our experience in the management of PILTS demonstrates that both surgery and endoscopy yield excellent functional outcomes if the treatment strategy is based on clear, predefined objective criteria.