Impact of the economic crisis and drug shortage on Lebanese cancer patients' care.

BACKGROUND: As a consequence of the economic crisis, the sociopolitical instability and the advent of the coronavirus disease-19 pandemic, nested challenges faced the Lebanese healthcare system. These have resulted in critical shortages of essential resources, including medications vital for oncologic patients. AIM: To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department. METHODS: A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy. The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications. RESULTS: Among 182 interviewed patients, 31.87% experienced treatment interruption mainly due to acute drug shortages. Despite 87.91% of the patients benefiting from third-party coverage, 69.60% had to self-pay for their medications leading to 69.78% of patients perceiving that healthcare was more difficult to access after 2020. Psychologically, one-third of the patients exhibited symptoms of anxiety and/or depression, with 7 patients reporting suicidal ideations. Notably, 37.93% of patients who interrupted cancer treatment reported a history of comorbidities, and 89.66% who altered their treatment cited financial difficulties. CONCLUSION: Lebanese cancer patients face complex challenges spanning economic, healthcare, and psychological realms. Income inequalities exacerbated by the economic crisis hindered healthcare access.

Hairy polyps: A new case presentation and a pathogenetic hypothesis.

Hairy polyps are benign lesions found in the oropharynx or nasopharynx that are thought to be present at birth and can lead to upper airway obstruction in infants. Also known as naso-oropharyngeal choristoma, they are increasingly viewed as aggregates of bigeminal tissue, likely from the first or second branchial arches, found in aberrant locations. They are benign lesions that are usually successfully treated by surgical excision. Here we present a rare case of a hairy polyp originating in the eustachian tube of a 7-week-old male, discuss our management of the patient, and put forth a new hypothesis as to the origin of these lesions. Laryngoscope, 129:2398-2402, 2019.

Trends in Pediatric Otolaryngology Disparities Research.

Objectives To describe trends in disparities research within pediatric otolaryngology as evidenced by major meeting presentations and to compare observed trends with those in the realm of patient safety and quality improvement (PSQI). Study Design Retrospective review of presentations at national otolaryngology meetings. Setting Online review of meeting programs. Subjects and Methods Meeting programs from the American Society of Pediatric Otolaryngology, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery Foundation, and Society for Ear, Nose and Throat Advances in Children from 2003 to 2016 were manually searched for pediatric oral and poster presentations addressing disparities and socioeconomic determinants of health, as well as PSQI. Presentation frequency was compared between categories and within each category over time. Results Of 11,311 total presentations, 3078 were related to the pediatric population, and 1945 (63.2%) of those were oral presentations. Disparities-related presentations increased from 0 in 2003 to 17 in 2016. From 2003 to 2009, 9 of 656 (1.4%) presentations involved disparities, as opposed to 70 of 2422 (2.9%) from 2010 to 2016 ( P = .03). The proportion of presentations regarding PSQI also increased: from 42 of 656 (6.4%) in 2003-2009 to 221 of 2422 (9.1%) in 2010-2016 ( P = .01). PSQI presentations remain more common than disparities presentations (9.1% vs 2.9%, P < .001). Conclusion Health care disparities are increasingly addressed in pediatric otolaryngology meeting presentations. Compared with the well-established realm of PSQI, disparities research remains nascent but is gaining attention. Health care reform and quality improvement efforts should recognize the role of socioeconomic factors and include strategies for addressing disparities.

Resolution of vocal fold immobility in preterm infants.

INTRODUCTION: Vocal fold immobility (VFI) is an important sequela of preterm birth due to patent ductus arteriosus (PDA) ligation and invasive ventilation. A minority of these patients experience VFI resolution. The purpose of this study is to determine factors associated with VFI resolution in preterm infants. METHODS: This is a case control study of preterm (<37 weeks gestation) infants admitted to a metropolitan Level IV neonatal intensive care unit from 2006 to 2012. All patients diagnosed with VFI by flexible nasolaryngoscopy were divided into 2 cohorts: those with and without laryngoscopic resolution of VFI during follow-up. Univariate and multivariate analyses were performed to determine factors associated with VFI resolution. RESULTS: Of 71 patients with VFI and adequate follow-up, 17 (23.9%) experienced resolution. Median (range) follow-up was 25.7 (0.4-91.3) months and time to resolution 4.4 (0.4-38.8) months. Compared to the ongoing-VFI cohort, those who experienced resolution had higher median gestational age (31 vs 25 weeks, p = 0.006) and birth weight (1550 vs 765 g, p = 0.02), and lower likelihood of undergoing PDA ligation (47.1% vs 77.8%, p = 0.02). On multivariate analysis, history of PDA ligation remained independently associated with a lower likelihood of VFI resolution (p = 0.02, OR 0.2, 95% CI 0.1-0.8). Among PDA ligation patients, birth weight >1000 g was more common in the resolution cohort compared to the ongoing-VFI cohort (62.5% vs 24.4%, p = 0.047). CONCLUSION: While lower birth weight and gestational age are known risk factors for VFI following PDA ligation, in this study, these factors were also associated with a decreased likelihood of VFI resolution. Furthermore, PDA ligation appears to be a risk for both the development and persistence of VFI. This evidence should inform prognosis and intervention decisions for preterm infants with VFI.

Vocal Fold Immobility due to Birth Trauma: A Systematic Review and Pooled Analysis.

Objectives To describe the present understanding of birth trauma-related vocal fold immobility and quantitatively compare it with idiopathic congenital vocal fold immobility to explore whether it is a discrete entity. Data Sources PubMed, Ovid, and Cochrane databases. Review Methods English-language, observational, or experimental studies involving infants with idiopathic congenital or birth trauma-related vocal fold immobility were included. Data from these studies were pooled with our institution's vocal fold immobility database, with the resultant idiopathic congenital and birth trauma cohorts compared regarding patterns and outcomes of immobility. Results The search returned 288 articles, with 24 meeting inclusion criteria. Of studies reviewing all-cause immobility, 8 of 9 (88.9%) identified birth trauma as an etiology, although birth trauma definitions and proposed mechanisms of immobility varied. The study subjects, combined with our institution's database, yielded 188 idiopathic congenital and 113 birth trauma cases. Compared with idiopathic congenital cases, birth trauma cases had a higher proportion of unilateral immobility (72 of 113 [63.7%] vs 52 of 188 [27.7%], P < .001) and rate of resolution (41 of 51 [80.4%] vs 91 of 159 [57.2%], P = .003). Resolution occurred in 24 of 26 (91.3%) unilateral and 17 of 25 (68.0%) bilateral birth trauma cases and in 30 of 40 (75.0%) unilateral and 59 of 109 (54.1%) bilateral idiopathic congenital cases ( P = .11 and .20, respectively). Conclusion While the definition and mechanism of birth trauma-related vocal fold immobility warrant further investigation, these findings suggest that it is distinct from idiopathic congenital vocal fold immobility, with a unique presentation and potentially more favorable outcomes. This can inform counseling and management for infants with otherwise unexplained immobility but known birth trauma.

Phonatory symptoms and impact on quality of life in female patients with goiter.

Our objective is to report on the prevalence of phonatory symptoms and impact on quality of life in a group of female patients with goiter who had not been selected for surgery or who had not presented to the emergency room with respiratory distress. A total of 40 patients with goiter and 14 controls were enrolled in this study. Demographic data included age, sex, laryngopharyngeal reflux disease, allergy, smoking, duration of disease, presence or absence of compressive symptoms, presence or absence of thyroid gland nodules, vascular status, presence or absence of calcifications, and thyroid-stimulating hormone levels. Phonatory symptoms included hoarseness, vocal fatigue, vocal straining, lump sensation, and aphonia. The Voice Handicap Index 10 was used to assess the impact of phonatory symptoms on quality of life. The most common phonatory symptom in the patients with goiter was vocal fatigue followed by lump sensation. The only phonatory symptom that was significantly more present in patients with goiter was vocal straining. As for the impact of phonatory symptoms on quality of life, 15.8% of goiter patients had a Voice Handicap Index score >7 compared with 7.7% of controls. Phonatory symptoms are common in patients with goiter, with vocal straining occurring significantly more frequently than in controls. In 1 of 6 patients, the presence of phonatory symptoms had an impact on quality of life.

Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility.

OBJECTIVE: Describe the natural history of all-cause bilateral vocal fold immobility (BVFI) in pediatric patients and analyze factors associated with tracheotomy and subsequent decannulation. METHODS: This is a retrospective review of all patients diagnosed with complete or partial BVFI at a metropolitan private pediatric otolaryngology practice between 2001 and 2012. Records were reviewed for data on demographics, etiologies, vocal fold position, and BVFI resolution. Patients requiring tracheotomy were further investigated for tracheotomy duration and associated complications and procedures. RESULTS: One hundred two patients were included, with a median (range) follow-up of 32.9 (0.3-124.2) months. Of these, 68.6% required tracheotomy. Tracheotomies were more likely in those with concomitant airway disease (p = 0.005) and paramedian vocal fold position compared to lateral position (p = 0.02). Among patients requiring tracheotomy, 64.3% underwent decannulation during follow up. Decannulation was more likely in those who demonstrated VFI resolution (p = 0.002) and those with idiopathic compared to neurogenic etiologies (p = 0.003). Median duration of cannulation was 30.6 (0.5-297.3) months. The most common tracheotomy-related complication requiring medical attention was tracheal and stomal granuloma formation (77.1%), while the most frequent associated procedures included granuloma excision (47.1%) and airway reconstruction (31.4%). Of those who avoided tracheotomy, 40.6% did not demonstrate BVFI resolution during median follow up of 13.4 (0.6-44.4) months. CONCLUSIONS: Most pediatric BVFI patients require tracheotomy, with the majority of those undergoing eventual decannulation. A better understanding of the factors associated with tracheotomy and subsequent decannulation improves the otolaryngologist's ability to counsel parents and caregivers of children with BVFI.

Recovery of vocal fold immobility following isolated patent ductus arteriosus ligation.

OBJECTIVE: Identify laryngoscopic and functional outcomes of infants with vocal fold immobility (VFI) following patent ductus arteriosus (PDA) ligation and identify predictors of recovery. METHODS: Retrospective review of patients with VFI following PDA ligation from 2001 to 2012 at a single institution. Inclusion criteria were: (1) PDA ligation as only cardiac surgical procedure; (2) left VFI documented by laryngoscopy; (3) minimum follow up 120 days, with at least 2 laryngoscopies performed. Resolution of VFI was determined at follow-up laryngoscopy. Univariate logistic regression models were used to identify variables associated with VFI recovery. RESULTS: 66 subjects were included with median follow up of 3.0 (± 2.1) years. The mean gestational age was 24.5 ± 1.4 weeks, mean birth weight 673 ± 167 g, and mean age at procedure was 18.6 ± 14.3 days. Patients presented with respiratory symptoms (39%), dysphonia (78%) and dysphagia (55%). Resolution of VFI was observed in 2/66 (3%) patients. Recovery was documented at 20 days and 11 months respectively. Respiratory symptoms, dysphagia, and dysphonia persisted at last follow up in 11%, 47%, and 20% of patients. CONCLUSIONS: VFI associated with ligation of the ductus arteriosus has a low rate of recovery. Clinical symptoms frequently persist, and as such regular follow-up by otolaryngologists to mitigate morbidity is indicated.

Pediatric vocal fold immobility: natural history and the need for long-term follow-up.

IMPORTANCE The clinical course and outcomes of pediatric vocal fold immobility (VFI) vary widely in the literature, and follow-up in these patients varies accordingly. A better understanding of the natural history of pediatric VFI is crucial to improved management. OBJECTIVE To characterize the natural history of pediatric VFI, including symptoms and rates of resolution and surgical intervention. DESIGN, SETTING, AND PARTICIPANTS Retrospective review at an academically affiliated private pediatric otolaryngology practice in a metropolitan area of all patients seen between July 15, 2001, and September 1, 2012, with a diagnosis of complete or partial VFI. After elimination of 92 incomplete or duplicate files, 404 patient records were reviewed for demographic characteristics, etiologies, symptoms, follow-up, resolution, and interventions. Follow-up records were available for 362 patients (89.6%). MAIN OUTCOMES AND MEASURES Resolution of VFI confirmed by repeated laryngoscopy, length of follow-up, and surgical intervention rates. RESULTS Among the 404 patients, left VFI was present in 66.8%, right VFI in 7.9%, and bilateral VFI in 25.3%. Median (range) age at presentation was 2.9 (0-528.1) months. Major etiological categories included cardiac surgery in 68.8%, idiopathic immobility in 21.0%, and neurologic disease in 7.4%. At presentation, 61.4%experienced dysphonia, 54.0%respiratory symptoms, and 49.5%dysphagia. Tracheotomy was performed in 25.7%and gastrostomy in 40.8%. Median (range) duration of follow-up among the 89.6%of patients with follow-up was 17.2 (0.2-173.5) months. Resolution evidenced by laryngoscopy was found in 28.0%, with a median (range) time to resolution of 4.3 (0.4-38.7) months. In patients without laryngoscopic resolution, median follow-up was 26.0 months, and 28.9% reported symptomatic resolution. CONCLUSIONS AND RELEVANCE The natural history of pediatric VFI involves substantial morbidity, with lasting symptoms and considerable rates of surgical intervention. In this large database, the majority of patients did not experience resolution. This suggests a need for more regimented follow-up in these patients, a recommendation for which is proposed here.

Vocal changes in patients with prostate cancer following androgen ablation.

OBJECTIVE: To compare the prevalence of vocal symptoms and parameters in patients with prostate cancer treated with androgen deprivation therapy (ADT). MATERIALS AND METHODS: Thirty-two male patients aged 60-83 years were recruited for this study. The subjects were divided into two groups: one group consisted of 18 patients with prostate cancer treated with ADT using gonadotropin-releasing hormone agonists and the other group consisted of 14 controls matched according to age. Demographic data included age, history of smoking, reflux, and duration of therapy. The reported phonatory symptoms were hoarseness, inability to project the voice, and vocal fatigue. Patients also underwent acoustic analysis, and the following acoustic variables were measured: fundamental frequency, relative average perturbation, shimmer, noise-to-harmonic ratio, and voice turbulence index. RESULTS: Compared with the control group, there was no statistical difference in any of the phonatory symptoms. The habitual pitch was significantly higher in the prostate cancer group compared with the controls (131.76 vs 114.11 Hz), with a P value of 0.021. There was also a significant increase in all the perturbation parameters, namely, relative average perturbation and shimmer, with a significant difference with respect to the latter (P value=0.014). There was also a significant increase in the noise-to-harmonic ratio (P value=0.014). CONCLUSION: The administration of ADT for patients with prostate cancer can affect the habitual pitch. However, there are no noticeable vocal changes reported by the patients.

Vocal characteristics in patients with type 2 diabetes mellitus.

The objective of this study is to report the vocal characteristics of patients with type 2 diabetes mellitus in relation to disease duration, glycemic control, and neuropathy. This is a prospective study. The setting is institutional setting. A total of 82 patients were recruited for this study, and a healthy control group matched according to age and gender was recruited. Subjects underwent acoustic analysis and perceptual evaluation using the GRABS classification where G stands for grading, R for roughness, A for asthenia, B for breathiness, and S for straining using a scale of 0­3 where o stands for normal and three for severe deviation from normal. There was no significant difference in any of the acoustic variables between diabetic patients and control. There was no significant difference in the mean score of any of the perceptual evaluation parameters between diabetic patients and control, despite the fact that the mean scores were all higher in the diseased group except for roughness. When looking at subgroups, we see that diabetic patients with poor glycemic control and with neuropathy had significantly higher mean score for the G overall grade of the voice compared to controls with P values of 0.005 and 0.009, respectively. What is also worth noting is that diabetic patients with poor glycemic control had more straining compared to controls, P value 0.043. Patients with type 2 diabetes mellitus and poor glycemic control or neuropathy have a significant difference in the grade of their voice compared to controls.