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1.
Laryngoscope ; 2024 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-39276036

RESUMO

The report describes the novel use of an endoscopic CO2 LASER assisted posterior glottic rotation flap in a professional voice user with non-intubation related posterior glottic insufficiency. The 78-year-old patient presented with progressive dysphonia and dyspnea with speaking with stroboscopy findings of posterior glottic insufficiency.After several empiric voice treatments without improvement, the described surgery was performed to correct posterior glottic insufficiency. After surgery, VHI-10 improved from 25 to 9, overall CAPE-V from 69 to 6.5. The patient resumed public speaking and lecturing with maintained improvement in vocal quality and function at last follow-up six months postoperatively. Laryngoscope, 2024.

2.
Ann Otol Rhinol Laryngol ; 133(6): 581-589, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38491861

RESUMO

OBJECTIVE: Compare ventilation pressures of 2 endotracheal tube designs used in laser airway surgery in clinical practice and with a benchtop model to elucidate differences and understand the design elements that impact airflow dynamics. METHODS: Ventilatory and aerodynamic characteristics of the laser resistant stainless-steel endotracheal tube (LRSS-ET) design and the laser resistant aluminum-wrapped silicone endotracheal tube (LRAS-ET) design were compared. Ventilatory parameters were collected for 32 patients undergoing laser-assisted airway surgery through retrospective chart review. An in vitro benchtop simulation measured average resistance and centerline turbulence intensity of both designs at various diameters and physiological frequencies. RESULTS: Baseline patient characteristics did not differ between the 2 groups. Clinically, the median LRAS-ET peak inspiratory pressure (PIP; 21.00 cm H2O) was significantly decreased compared to LRSS-ET PIP (34.67 cm H2O). In benchtop simulation, the average PIP of the LRAS-ET was significantly lower at all sizes and frequencies. The LRSS-ET consistently demonstrated an increased resistance, although no patterns were observed in turbulence intensity data between both designs. CONCLUSION: The benchtop model demonstrated increased resistance in the LRSS-ET compared to the LRAS-ET at all comparable sizes. This finding is supported by retrospective ventilatory pressures during laser airway surgery, which show significantly increased PIPs when comparing identically sized inner diameters. Given the equivocal turbulence intensity data, these differences in resistance and pressures are likely caused by wall roughness and intraluminal presence of tubing, not inlet or outlet geometries. The decreased PIPs of the LRAS-ET should assist in following lung protective ventilator management strategies and reduce risk of pulmonary injury and hemodynamic instability to the patient.


Assuntos
Desenho de Equipamento , Intubação Intratraqueal , Humanos , Intubação Intratraqueal/instrumentação , Feminino , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Terapia a Laser/métodos , Idoso , Adulto , Resistência das Vias Respiratórias/fisiologia , Lasers
3.
Otolaryngol Clin North Am ; 57(2): 319-328, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37867109

RESUMO

Allergic rhinitis (AR) is associated with increased sleep disturbances in adults and children. Pathogenesis is multifactorial, with nasal obstruction playing a large role. Intranasal corticosteroids, antihistamines, leukotriene inhibitors, and allergen immunotherapy have been demonstrated to relieve self-reported symptoms of sleep impairment. Given the high prevalence of sleep impairment in AR, providers should consider evaluating any patient with AR for sleep disturbances and sleep-disordered breathing.


Assuntos
Rinite Alérgica Perene , Rinite Alérgica , Síndromes da Apneia do Sono , Transtornos do Sono-Vigília , Criança , Adulto , Humanos , Rinite Alérgica Perene/complicações , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica/epidemiologia , Rinite Alérgica/terapia , Rinite Alérgica/complicações , Sono , Antagonistas dos Receptores Histamínicos/uso terapêutico , Síndromes da Apneia do Sono/etiologia , Transtornos do Sono-Vigília/complicações
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