Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease.

Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.

Bubble-Based Drug Delivery Systems: Next-Generation Diagnosis to Therapy.

Current radiologic and medication administration is systematic and has widespread side effects; however, the administration of microbubbles and nanobubbles (MNBs) has the possibility to provide therapeutic and diagnostic information without the same ramifications. Microbubbles (MBs), for instance, have been used for ultrasound (US) imaging due to their ability to remain in vessels when exposed to ultrasonic waves. On the other hand, nanobubbles (NBs) can be used for further therapeutic benefits, including chronic treatments for osteoporosis and cancer, gene delivery, and treatment for acute conditions, such as brain infections and urinary tract infections (UTIs). Clinical trials are also being conducted for different administrations and utilizations of MNBs. Overall, there are large horizons for the benefits of MNBs in radiology, general medicine, surgery, and many more medical applications. As such, this review aims to evaluate the most recent publications from 2016 to 2022 to report the current uses and innovations for MNBs.

Quality and Readability of Online Patient Education Materials Related to Branchial Cleft Cysts.

Introduction Branchial cleft cysts are the second most common congenital neck mass and can cause significant anxiety for patients and families despite their benign nature. Education through online patient education materials (PEMs) is critical for informing patients and reducing stress. We aimed to determine the content, quality, and readability of online PEMs related to branchial cleft cysts. Methods The search engine Google was used to collect the first 100 website results for the query "branchial cleft cyst." PEMs were included and assessed for content, quality via the DISCERN tool, and readability via Flesch Reading Ease Score (FRES), Flesch-Kincaid Reading Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Results Twenty-six websites containing PEMs related to branchial cleft cysts were assessed. Most websites were from universities or medical centers and did not contain any media. The mean DISCERN score was 49.3 (SD: 11.1, Median: 52.5), the mean FRES score was 51.9 (SD: 12.1, Median: 54.0), the mean FKGL score was 10.35 (SD: 2.52, Median: 9.95), the mean GFOG score was 13.32 (SD: 2.52, Median: 13.00), and the mean SMOG score was 10.25 (SD: 1.83, Median: 9.95). DISCERN was not significantly correlated with FRES, FKGL, GFOG, or SMOG. Conclusion Online PEMs related to branchial cleft cysts are consistently written above the National Institutes of Health (NIH) recommended sixth-grade reading level and are often of unsatisfactory overall quality. Writers of online PEMs for branchial cleft cysts should consider the readability and quality of their materials to improve patient education and reduce anxiety.

Virtual otolaryngology interest group meetings and didactic sessions in the COVID-19 pandemic.

The COVID-19 pandemic has placed tremendous strain on medical education and prevented multiple in-person activities like specialty interest group meetings. Specialty interest groups are important resources for students interested in competitive fields like otolaryngology where they may find mentoring, research opportunities, and teaching sessions. To allow continued meetings despite COVID-19, the Texas Tech University Health Sciences Center otolaryngology interest group transitioned to virtual meetings and added student-led didactic sessions. Most students who participated found the virtual didactic sessions helpful and appreciated the opportunity to practice presenting cases. Students were able to network with residents and faculty members, resulting in 60% of participants finding involvement in research projects. Virtual meetings allowed the participation of students from multiple institutions. Participants agreed that the networking, teaching, and research opportunities presented by the virtual sessions made them better applicants for otolaryngology residency. This study provides a framework for transitioning specialty interest group meetings to a virtual platform while adding student-led didactic sessions.

Extranodal natural killer/T-cell lymphoma nasal type.

Extranodal natural killer/T-cell lymphoma nasal type (ENKL) is a rare neoplasm uncommon in the US. Diagnosis is complicated by low incidence and rapid tissue necrosis preventing timely histologic confirmation. We report the case of a 55-year-old woman with ENKL who faced a challenging diagnostic workup due to widespread nasal tissue necrosis and nonspecific sinus-related complaints. While ENKL is significantly more common in Asia and South America, clinicians worldwide should maintain a high level of suspicion for patients presenting with nonspecific nasopharyngeal complaints who have signs of tissue necrosis. Early recognition and treatment with combined radiotherapy and chemotherapy can improve survival.

A Rare Infratemporal Fossa Abscess of the Lateral Pterygoid.

The infratemporal fossa (ITF) contains many critical neurovascular structures and the muscles of mastication. Infections of the ITF are rare and carry significant pathologic implications due to nearby structures. Abscesses of the ITF often occur due to odontogenic spread and present with trismus and facial pain. We present the case of a 26-year-old male with an uncommon ITF abscess of the lateral pterygoid following maxillary wisdom tooth extraction. The abscess resolved following bedside and operative intraoral drainage in addition to intravenous antibiotic therapy. We highlight the rarity of lateral pterygoid abscesses and the importance of distinguishing ITF abscesses from other similarly presenting conditions such as temporomandibular joint dysfunction.

The Utility of Brain Natriuretic Peptide in Patients Undergoing an Initial Evaluation for Pulmonary Hypertension.

Introduction: Brain natriuretic peptide (BNP) is a polypeptide released from the cardiac ventricles and has been used as a diagnostic marker in cardiovascular diseases. Some patients with pulmonary hypertension have significant increases in BNP levels. This study wanted to determine whether the BNP levels in patients referred for evaluation of possible pulmonary hypertension were associated with a particular functional class or diagnostic group. Methods: Data were collected on patients from the Pulmonary Vascular Disease clinic undergoing right heart catheterization between 1/1/2019 and 5/20/2020. Clinical information, laboratory results including BNP, and hemodynamic parameters were recorded. Results: This study included 117 patients referred for evaluation for PH with measured BNP levels. The mean age was 63; the female to male ratio was 2:1, 25.4% of the patients were Hispanic. The average BNP level for the entire cohort was 4127.1 ± 11761.98 pg/ml. Patients in higher WHO functional classes tended to have higher levels of BNP, but statistical analysis BNP showed no differences between the functional classes. Patients in WHO Group 4 had significantly higher BNP levels than other WHO groups. Hemodynamic group classification demonstrated significant differences in BNP values between the low, intermediate, and high composite score patients. Conclusions: Patients undergoing evaluation for pulmonary hypertension had a wide range of BNP values. Patients with more abnormal composite hemodynamic scores higher BNP levels. Measurement of BNP provides an independent test to help interpret patients' descriptions of their functional limitations and to identify patients with more abnormal hemodynamic parameters.

Seizures Related to Neurocysticercosis and Cocaine Use.

Neurocysticercosis (NCC) is an infection of the central nervous system with Taenia solium cysts that most commonly results in seizures. In stable patients without recent symptoms, these seizures may be provoked by seizure threshold-lowering drugs such as cocaine. This case details a 38-year-old male with a past medical history of epilepsy presenting with seizures due to comorbid NCC and cocaine use. This case was complicated by the lack of available information regarding the patient's past medical history and medication use. We highlight the importance of obtaining a full work-up, including brain imaging, to provide optimal treatment for patients with seizures despite a history of drug use.

Correlation between echocardiographic measurements and right heart hemodynamic parameters in patients undergoing evaluation for pulmonary hypertension.

Echocardiograms provide important information for the evaluation and management of patients with pulmonary hypertension. Right ventricular free wall strain measurements provide additional information about the longitudinal contractile function of the right ventricle. Clinical information, including echocardiographic measurements and right heart hemodynamic parameters, on patients undergoing right heart catheterization for evaluation of possible pulmonary hypertension was collected retrospectively. This study included 60 patients (35 women) with a mean age of 62.6 ± 14.8 years. For World Health Organization categories, 32 patients were in Group 1, 12 in Group 2, 4 in Group 3, 3 in Group 4, and 7 had mixed clinical features of both Group 2 and Group 3. The mean pulmonary artery pressure was 40.6 ± 13.2 mm Hg. The right atrial volume index had significant positive correlations with the brain natriuretic peptide level, right ventricular volume index, left atrial volume index, and right atrial pressure and negative correlations with the cardiac index and mixed venous oxygen saturation. The mean right ventricular free wall strain was -17.85 ± 5.56%; it did not have significant correlations with right heart hemodynamic parameters. Therefore, the right atrial volume index but not the right ventricular strain index provides important objective information for the evaluation of patients with possible pulmonary hypertension.

A Case Report of Olmesartan-Induced Enteropathy.

Chronic olmesartan use can cause a drug-induced enteropathy as a rare side effect leading to diarrhea, significant weight loss, and reduced quality of life. The mechanism of this enteropathy is poorly understood and requires further investigation. We present a case of olmesartan-induced enteropathy resulting in recurrent hospitalizations for intractable diarrhea. Significant enteropathy is more commonly related to infectious or autoimmune causes making the diagnosis of drug-induced enteropathy a challenge. In this case, the lack of significant findings on labs or imaging resulted in a thorough diagnostic work-up revealing olmesartan-induced enteropathy. We present this case to inform providers of the possibility of olmesartan-induced enteropathy and characteristics to identify in other similar cases.

Bicompartmental Bucket Handle Meniscal Tear with Chronic ACL Deficiency Causing a Rare Triple PCL and Triple Cruciate Sign: A Case Report.

CASE: A 16-year-old football player presented with chronic ACL deficiency along with bicompartmental bucket handle meniscal tears. CONCLUSION: We present a "triple cruciate" sign in addition to the triple posterior cruciate ligament (PCL) sign seen on Magnetic Resonance Imaging (MRI) to aid in diagnosing this injury.

The clinical associations with cardiomegaly in patients undergoing evaluation for pulmonary hypertension.

BACKGROUND: Chest radiographs can identify important abnormalities in patients undergoing diagnostic evaluation for cardiovascular diseases. Cardiomegaly often reflects cardiac chamber dilation, or cardiac muscle hypertrophy, or both conditions. The clinical implications of cardiomegaly depend on the underlying clinical disorder. Does cardiomegaly have any clinical, laboratory, echocardiographic, and right heart catheterization associations in patients undergoing evaluation for pulmonary hypertension? METHODS: Patients referred to a pulmonary vascular disease clinic for possible pulmonary hypertension underwent a comprehensive evaluation that included right heart catheterization. These patients also had chest radiographs, laboratory studies, and echocardiograms. The patients were divided into two groups based on the presence or absence of cardiomegaly. RESULTS: This study included 102 patients (63.7% female) with a mean age of 62.3 ± 15.0 years. Patients with cardiomegaly (n = 64) had elevated BNP, BUN, and creatinine levels. They had elevated right atrial pressures, right ventricular pressures, and pulmonary artery pressures and reduced cardiac indices and reduced mixed venous oxygen saturations. There were no differences in echocardiographic parameters between the two groups. CONCLUSIONS: This study demonstrates that the presence of cardiomegaly on chest radiographs has important clinical implications, including increased BNP levels and increased right heart pressures, in patients undergoing evaluation for pulmonary hypertension. Consequently, the presence of cardiomegaly supports the need for additional evaluation, including right heart catheterization, and provides useful information for primary care physicians and specialists.

Sort, Assess, Life-Saving Intervention, Triage With Drone Assistance in Mass Casualty Simulation: Analysis of Educational Efficacy.

Introduction Mass casualty incident (MCI) simulation and triage are educational methods used to provide high fidelity training to first response teams. Simulation and triage need to be as effective as possible to train professionals for true emergencies involving mass casualty. Although MCI simulation and triage have been used in the pre-professional setting (i.e. medical school, nursing school, etc.), more data is required regarding quality improvement of these simulations. This study focuses on quality improvement of MCI simulation and triage in the pre-professional training. In order to evaluate simulation quality to optimize future triage simulations, this study had three specific aims: (1) assess participant accuracy of triage after training in Sort, Assess, Life-Saving Interventions, Triage/Transport (SALT); (2) evaluate the role of stress and confidence in participants of triage simulation; (3) determine trainees' perception of unmanned aerial vehicles (drones) in the setting of mass casualty simulation. Methods A total of 44 attendees of the University of Central Florida (UCF) College of Medicine Global Health Conference participated in this study across three groups. Each group was provided a 15-minute lecture on SALT protocol. After the training, the participants continued to a 30-minute simulation in which they were asked to accurately triage up to 46 patient-actors. Each participants' triage designations were compared to the previously assigned designations of each patient-actor. Pre- and post-simulation surveys were collected and analyzed using Statistical Package for the Social Sciences (SPSS) (IBM Corp., Chicago, IL). All other data were analyzed using descriptive statistics.  Results Qualitative and Likert data for the simulation were collected from 44 participants. Given a total of 1,113 triage scores (average of 25.29 triage designations per person), there was data to support that novice learners in this study tended to under-triage using the SALT protocol after 15-minute SALT training, with an overall accuracy of 52.43%. Survey data showed that confidence in mass casualty triage improved post-simulation, improving from median 3/10 to 5/10. Most participants were unaware of the use of unmanned aerial vehicles in MCI but most had positive opinions of their usefulness in MCI after the simulation, with a median score of 8/10. Conclusions Participant accuracy of triage after undergoing a 15-minute training in SALT triage was 52.43%, with a non-statistically significant tendency to under-triage. This accuracy level is consistent with other studies of SALT triage in MCI, but the tendency to undertriage requires further study for validation. Stress levels during the simulation were significantly elevated, while post-simulation confidence increased significantly from pre-simulation. The perception of drone utility in MCI was favorable among participants in this study, indicating drones may be useful for first response teams in future mass casualty simulations.