Surgical management of iSGS in pregnant patients: Survey among North American expertise centers.

OBJECTIVE: To identify, group and document the surgical management of idiopathic subglottic stenosis (iSGS) in pregnant women among North American centers with expertise in the treatment of airway stenosis. BACKGROUND: Idiopathic subglottic stenosis is a rare airway disease that primarily affects women in their third to fifth decade of life. Symptoms of iSGS often worsen during pregnancy and can present as a threat to optimal maternal and fetal health; however there is a lack of evidence addressing the management of iSGS in pregnancy. STUDY DESIGN: Cross-Sectional Survey Study. METHODS: A twenty-four question survey was designed to query the surgical management, ventilation, and perioperative considerations for pregnant patients with iSGS. Twenty-nine North American academic tertiary care centers with airway surgery expertise were identified. A designated surrogate for each center was contacted by email to distribute and obtain results of the survey. RESULTS: 17 centers responded. Most centers include differences in perioperative assessment such as frequency of consultation with a maternal/fetal medicine specialist. There is occasional use of a tocometer and rarely a non-stress test. Ventilation with intermittent jet ventilation or high-flow nasal cannula is favored. The surgical protocols include positional modifications, with pregnant patients in the left lateral decubitus position. The preferred timing for intervention is in the second or third trimester. CONCLUSION: This is the first national survey describing surgical and perioperative considerations for the pregnant patient with iSGS among centers with airway expertise in the United States and Canada.

Systematic review of international guidelines for head and neck oncology management in COVID-19 patients.

PURPOSE: The coronavirus pandemic has redefined the practice of head and neck surgeons in the management of oncology patients. Several countries have issued practice recommendations in that context. This review is a collaboration of the YO-IFOS (Young Otolaryngologists of the International Federation of Otolaryngological Societies) group in order to summarize, in a systematic way, all available guidelines and provide clear guidelines for the management of head and neck cancer patients in the COVID-19 pandemic. METHODS: This systematic review was performed according to the PRISMA statements. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to assess quality of all practice guidelines included in this review. RESULTS: Recommendations include adjustments regarding new patients' referral such as performing a pre-appointment triage and working in telemedicine when possible. Surgical prioritization must be adjusted in order to respect pandemic requirements. High-grade malignancies should, howeve,r not be delayed, due to potential serious consequences. Many head and neck interventions being aerosol-generating procedures, COVID-19 testing prior to a surgery and adequate PPE precautions are essential in operating rooms. CONCLUSION: These recommendations for head and neck oncology patients serve as a guide for physicians in the pandemic. Adjustments and updates are necessary as the pandemic evolves.

French Translation and Validation of the Synkinesis Assessment Questionnaire.

Synkinesis is a distressing sequela of peripheral facial palsy (PFP). This study aimed to translate and validate the Synkinesis Assessment Questionnaire (SAQ), a reliable patient-reported outcome evaluation tool for synkinesis, in French. The SAQ was translated following a standard forward-backward translation procedure. After a cognitive debriefing with 10 PFP patients, the SAQ-F was assessed amongst 50 patients for internal consistency, known-group validity, construct validity, criterion validity, and test-retest reliability. Results demonstrated that the SAQ-F was valid, reliable, and had a unidimensional structure. The SAQ-F should be accompanied by clinician-based scales, to provide valuable additional information on the severity of synkinesis.

Immune Checkpoint Inhibitor Induced Supraglottitis: A Case Series.

OBJECTIVE: To report a series of two cases of unusual airway complications with immunotherapy. METHOD: Case series and review of literature. RESULTS: We report two cases of significant supraglottitis in patients treated with immunotherapy. The first patient is a 62-year-old male receiving treatment for a stage 4 melanoma with Nivolumab and Relatlimab. He presented in Otolaryngology clinic for subacute dysphonia and dysphagia. Flexible laryngoscopy showed significant airway edema, mucopurulent secretions, and inflammation. He was admitted inpatient and treated with high dose systemic steroids and intravenous antibiotics. Daily airway examination with flexible laryngoscopy showed improvement with this medical management. The patient was discharged with antibiotics and a steroid taper. Treatment with immunotherapy was held due to this severe and potentially life-threatening complication. The second patient is a 76-year-old male with bladder cancer treated with Pembrolizumab. Four months after beginning treatment, he experienced hoarseness and throat discomfort. His laryngoscopic examination showed diffuse supraglottic swelling. He was treated inpatient with high dose systemic steroids, intravenous antibiotics, and antifungals, which resulted in improvement of supraglottic swelling. He remained on his immunotherapy treatment. Repeat examination demonstrated persistent supraglottic swelling without airway obstruction. Regarding airway-related complications with immunotherapy, the literature reports three other cases of tracheitis related to immune checkpoint inhibitors. CONCLUSION: This is the first case series of supraglottitis in patients treated with immune checkpoint inhibitors. This adds to the emerging literature of the potential respiratory implications of these medications. Laryngoscope, 2024.

Assessing Dysphagia in the Adult.

This article explores the landscape of dysphagia assessment in adults. Dysphagia, a complex condition affecting the lifespan and many health conditions, significantly compromises individuals' quality of life. Dysphagia is often underdiagnosed, emphasizing the need for comprehensive assessment methods to ensure timely and accurate intervention. It encompasses clinical history, physical examination, clinical and instrumental swallow evaluations. Procedures within each of these modalities are reviewed, highlighting strengths, limitations, and contribution toward a complete understanding of dysphagia, ultimately guiding effective intervention strategies for improved patient outcomes.

Prevalence of self-reported voice and swallowing complaints in an outpatient geriatric population.

Background: Older adults suffer from increased rates of dysphagia and dysphonia, both of which have a profound effect on quality of life and are often underdiagnosed. We sought to better understand the prevalence of these complaints and the potential utility of a patient-reported screening program in a geriatrics clinic. Methods: Using an IRB-approved cross-sectional survey and retrospective cohort design, we recruited participants from a population of new patients seeking care at an academic geriatrics clinic. We used three validated questionnaires to assess self-reported dysphagia, dysphonia, and pill dysphagia: the Eating-Assessment Tool-10 (EAT-10), the Voice Handicap Index-10 (VHI-10), and the PILL-5. Patients who screened positive on any questionnaire were offered referral to a laryngologist for additional evaluation. Patients who screened positive on the PILL-5 were also offered referral to our geriatric pharmacist. Results: Among our 300 patients surveyed, the mean age was 76 (SD 8.46). A total of 82 (27.3%) patients screened positive (73 on EAT-10, 10 on PILL-5, 13 on VHI-10) and were offered referral, of which 36 accepted. These positive screening patients took more prescription medications (p = .024) and had a higher GDS score (p < .001) when compared to the patients who screened negative. Conclusions: Many new patients seeking generalized care at our center screened positively for dysphagia and/or dysphonia on validated questionnaires. Geriatric patients may benefit from integrating screening for these disorders to identify the need of further evaluation. It is unknown if these survey tools are appropriate in a non-otolaryngology clinic. Level of evidence: III.

Modification of Distal Tibiofibular Relationship After a Mild Syndesmotic Injury.

BACKGROUND: The hypothesis of this study is that a sprain or tear of 1 or more of the 3 syndesmotic ligaments will result in a significant change in the osseous anatomy relationship when comparing injured to uninjured syndesmosis. Our secondary objective was to determine whether injuries to the syndesmosis as diagnosed on magnetic resonance imaging (MRI) could be found using static imaging. METHODS: This is a descriptive radiological study of ankle MRI reports over a 12-year period, from 2 different institutions, and divided in two groups: normal and injured syndesmotic ligaments. A series of 6 lengths and 2 angles were measured on MRI axial views that describe the rotation, lateral, and anteroposterior translational relation between the distal tibia and fibula. Parameters from injured and uninjured ankles were compared using Student's t-test. RESULTS: Fifty uninjured syndesmosis were compared to 64 injured syndesmoses. The majority of syndesmosis injuries concerned either an anterior inferior tibiofibular ligament sprain or tear. There was a significant difference in the anatomic position of the tibia and the fibula between injured and uninjured syndesmosis. CONCLUSIONS: The anterior inferior tibiofibular ligament is the most commonly injured ligament in the syndesmosis in sports injury and results in subtle variations in the syndesmotic anatomy, which plain radiographs cannot assess. Because of the previously validated computed tomography scan measurement, this study demonstrates a potential to identify syndesmotic injury on other more accessible imaging modalities, such as computed tomography scan, by using a well-defined measurement system. LEVELS OF EVIDENCE: Diagnostic, Level III : Retrospective, Radiologic Study.