Improvement of the aerobic performance in endurance athletes presenting nasal valve compromise with the application of an internal nasal dilator.

PURPOSE: We investigated the effects of an internal nasal dilator on nasal airflow and cardio-respiratory capacity in adult endurance athletes, while performing controlled exhaustive physical exercise. METHODS: Prospective observational study. Participants were 38 adult endurance athletes, 23 with and 15 without nasal valve compromise. Nasal patency was objectively evaluated with anterior rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow (PNIF). Maximum oxygen uptake (VO2max), maximum pulmonary ventilation, time to exhaustion and total time of nasal respiration were recorded during a submaximal treadmill test. Dyspnea intensity and fatigue perception were evaluated using a labeled visual analog scale. All assessments were performed with and without the application of the internal nasal dilator. RESULTS: All the parameters related to aerobic capacity were significantly reduced in the group of athletes with nasal valve compromise (p. <0.05 for all variables). The internal nasal dilator improved statistically significantly the nasal patency (p. <0.001), VO2max and aerobic performance and self-rating of dyspnea and fatigue (p. <0.05 for all parameters) only in athletes with nasal obstruction. PNIF correlated significantly with VO2max (rho = 0.4, p. <0.05). CONCLUSIONS: Internal nasal dilation improves nasal patency and aerobic performance during submaximal exercise in adult endurance athletes with nasal obstruction symptoms due to nasal valve compromise.

The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial.

PURPOSE: Chronic rhinosinusitis (CRS) is a prevalent chronic disease observed on a global scale. The utilization of endoscopic sinus surgery (ESS) has gained significant recognition as an effective intervention for individuals with CRS and nasal polyps who have not responded to conventional treatments. The need (or not) for revision surgery frequently relies on the promotion of optimal wound healing. The impact of platelet-rich plasma (PRP) on tissue healing has been extensively examined in various surgical fields. METHODS: The present prospective study involved 30 patients suffering with nasal polyposis who underwent endoscopic sinus surgery. 15 patients were assigned to the PRP group, and 15 patients to the control group. The clinical follow-up of the patients took place at specific intervals, at weeks 1, 2, 3, 4, 8, and 12 after the surgical procedure. The evaluator identified the existence of adhesions, crusting, bleeding, granulation and infection using a visual analogue scale score. The patients also completed the SNOT 22 questionnaire prior to surgery and at each postoperative visit. RESULTS: The present study observed a lower incidence of adhesion, infection, hemorrhage and granulation in the PRP group. Furthermore, a statistically significant difference was detected between the groups. CONCLUSION: Based on the findings of the present investigation, it seems that platelet-rich plasma (PRP) is beneficial on wound healing during the early stages following the surgical procedure. The technique is characterized by its limited invasiveness, which contributes to its low risk profile and the achievement of clinically good outcomes.

Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society.

PURPOSE: Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible-even unethical-to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach. METHODS: A review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above. RESULTS: Initial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions. CONCLUSION: Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies.

Prelaminated Nose Reconstruction: Comparison of Forehead and Radial Donor Site and Review of the Literature.

INTRODUCTION: Total nose reconstruction is demanding as it is a 3-dimensional structure that needs lining, support and external coverage. Usually, several stages are needed to achieve a satisfactory result. The authors present 2 cases of prelaminated radial forearm and 2 prelaminated forehead nose reconstructions and compare both methods. According to our review of the literature, this is the first report of prelaminated forehead for total nose reconstruction. MATERIALS AND METHODS: The last 5 years the authors have treated 4 patients with prelaminated flaps for total nose reconstruction. The age ranged from 50 to 75 years. There were 3 male patients and one female. Three patients underwent total nose amputation due to squamous cell carcinoma and one due to melanoma. RESULTS: Two patients were treated with prelaminated radial forearm reconstruction and 2 with prelaminated forehead reconstruction. Both patients that were treated with prelaminated radial forearm reconstruction had the collapse of the nasal pyramid and had salvage procedures with replacement of the cartilaginous framework with iliac bone graft framework. CONCLUSIONS: Prelaminated nose reconstruction with either the radial forearm or forehead flap needs several stages. There is the possibility of infection-collapse of the cartilage framework, therefore, the authors recommend reconstruction of the nasal skeleton with an iliac bone graft. The flaps are stiff and difficult to handle. The authors don't think that prelaminated nose reconstruction with the radial forearm flap has advantage compared with the classic several stages nose reconstruction with radial forearm flap. Possibly, prelaminated forehead reconstruction can be applied for aged patients who cannot undergo microsurgical reconstruction.

Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction.

PURPOSE: The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life. METHODS: Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6 months after septoplasty. RESULTS: Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively). CONCLUSION: Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life.

Swallowing disorders after thyroidectomy: a systematic review and meta-analysis.

PURPOSE: Swallowing disorders following thyroidectomy are common, even after surgery without confirmed complications. The purpose of the current systematic review is to investigate the prevalence of dysphagia at various time points after thyroidectomy, at the whole spectrum of it (total/partial, open/endoscopic, for benign/malignant disease). METHODS: The literature available at PubMed, SciELO and Cochrane Library databases was reviewed, according to PRISMA guidelines, using the terms "dysphagia", "swallowing disorder", "deglutition disorder", "thyroidectomy" and "thyroid surgery" in the appropriate combinations. A quantitative synthesis of the results followed. RESULTS: The systematic review of the literature resulted in 35 articles, which met the inclusion criteria and were analyzed regarding their type, sample, follow-up and results regarding post-thyroidectomy dysphagia in multiple follow-up times. A significant increase of swallowing impairment compared to baseline was recorded shortly after surgery. Dysphagia reverted to pre-operative levels 2-3 months later. Dysphagia continued to be reported in a significantly lower proportion of patients, even 1 year after surgery. No significant difference was noticed between open and endoscopic thyroid surgery at 2-3 months post-surgery. CONCLUSIONS: The swallowing disorders reported after thyroidectomy should be expected, but are not always detectable through objective methods. This should not lead to underestimation of symptoms, since the patients' quality of life is negatively affected by the symptomatology.

Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis.

OBJECTIVES: Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy. METHODS: The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively. RESULTS: Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively). CONCLUSIONS: This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.

Dysphagia Prevalence, Attitudes, and Related Quality of Life in Patients with Multiple Sclerosis.

Dysphagia in patients with multiple sclerosis (MS) is associated with significant morbidity and has profound impact on the quality of life (QoL). This study aimed to analyze the dysphagia prevalence, attitudes, and dysphagia-related QoL in patients with MS, not at relapse. A prospective study of 108 consecutively recruited patients. The patients were asked to report dysphagia and completed a general dysphagia questionnaire (the Eating Assessment Tool-10, EAT-10), a disease-specific dysphagia questionnaire (the Dysphagia in Multiple Sclerosis, DYMUS), and a dysphagia-related QoL questionnaire (the Swallowing-Quality of Life). Twenty-six percent of the patients reported dysphagia. Many more were classified as dysphagic by the questionnaires (34.3% by EAT-10 and 44.4% by DYMUS). Overall, one out of four patients reported difficulties or choking while drinking fluids and eating food, cough related to eating, food sticking in the throat, need for food and drink segmentation, and repetitive swallows. The pleasure of eating was found to be moderately affected. The patients seem to cope well with the psychological and social impact of dysphagia. Serious consideration must be given to patients' perceptions and attitudes towards dysphagia. Our patients reported very little fear associated with their swallowing difficulties and choking. Apparently, they do not perceive the severity of their symptoms as an actual danger, as they have developed coping strategies. Dysphagia is common in MS patients not at relapse, even with mild disease-related impairment. Swallowing should be systematically assessed with validated questionnaires in all patients with MS at the course of the disease.

Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safety.

PURPOSE: Percutaneous endoscopic gastrostomy [PEG] by the pull-technique is easy and safe to perform through the oral cavity. However, the presence of a cervical esophageal fistula, either due to tumor invasion or simply inflammation and tissue necrosis after previous intervention or radiotherapy, in the anterior cervical region is of crucial importance when passing the endoscope and the PEG catheter from the mouth downwards. METHODS: We describe a modification of the standard peroral PEG, which is to insert the endoscope from the cervical esophageal opening instead of the oral cavity, and we support the use of this "stoma" as a way to protect it and avoid possible forceful dilatation/expansion when advancing the endoscope and the gastrostomy catheter through the mouth. RESULTS: The performance of PEG through the cervical esophageal opening was applied in 8 cases of esophageal fistula of different primary etiology but where the oro-pharyngeal passage was easily accessible. The procedure was technically successful in all patients, and no bleeding or tearing of the friable esophageal wall was evident. CONCLUSION: The use of the esophageal fistula at the anterior cervical region as a route for PEG insertion is a safe and practical alternative, highly to be recommended.

Olfaction and quality of life in patients with nasal septal deviation treated with septoplasty.

OBJECTIVE: Patients with septal deviation-induced nasal obstruction may experience olfactory impairment. This study aimed to evaluate septoplasty-related changes in olfactory function and their effect on patients' quality of life (QoL). METHODS: Prospective study of sixty patients with nasal obstruction and septal deviation and 25 healthy controls. Objective measurements were performed for the evaluation of nasal patency and "Sniffin' sticks" tests were used for quantitative assessment of lateralized and bilateral olfactory performance. All participants self-assessed their smell using a visual analog scale and completed validated questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation: NOSE), for nasal symptoms QoL (SinoNasal Outcome Test-22: SNOT-22), for olfaction-associated QoL (Questionnaire of Olfactory Deficits: QOD) preoperatively and six months after septoplasty and reported personal benefit after surgery (Glasgow Benefit Inventory: GBI), six months postoperatively. RESULTS: Smell was significantly compromised due to septal deviation especially in the more obstructed nasal cavity side. Smell improved significantly after septoplasty (subjective report and olfactory measurements), along with increased nasal patency. Increased nasal cavity volume was significantly correlated with olfactory thresholds but not with suprathreshold measurements. Subjective hyposmia and lateralized olfaction were significantly reduced postoperatively. Postoperatively, normosmic patients reported higher personal benefit from surgery than patients with olfactory disorders. The patients' QoL improved significantly, but it remained lower than the controls' group. Olfaction-associated QoL was not significantly different between patients and controls before and after septoplasty. CONCLUSION: Septoplasty leads to improvement in smell perception, and patients with improved smell report greater personal benefit from septoplasty than patients with remaining olfactory deficits.

Predictive factors of patients' general quality of life after nasal septoplasty.

PURPOSE: Although septoplasty is considered to be the definitive treatment of septal deviation and is associated with an increase of nasal patency, patients are not always satisfied with the surgical outcome as assessed by its effect on their general Quality of Life (QOL).The aim of this study was to identify the predictive factors that influence the patients' QOL after surgery. METHODS: 60 patients with nasal obstruction and septal deviation were enrolled in this prospective study, and they all completed the follow-up survey of 6 postoperative months. Symptom severity (Nasal Obstruction Symptom Evaluation-NOSE, Sino nasal outcome test 22-SNOT-22), sleep quality (Epworth Sleepiness Scale-ESS), olfactory function (Threshold Discrimination Identification-TDI score), voice quality (Nasalance score and Voice Handicap Index-VHI), stress (SQ test) and emotional status (Beck Depression Index-BDI) were evaluated as predictive factors of patients' QOL (Glasgow Benefit Inventory-GBI) postoperatively. We also analyzed age, gender, smoking, socioeconomic status, type of septal deviation and changes of nasal patency (with the use of rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow). RESULTS: From all the analyzed parameters, the nasal obstruction symptom severity, the sleep quality, and stress levels were only significantly associated with patients' overall QOL (p < 0.05; univariate analysis). However, on multiple regression, positive changes in NOSE score (OR 15.09, 95% CI 1.47-22.64, p < 0.05) and SQ test (OR 4, 95% CI 1.12-14.3, p < 0.05) were only related with higher likelihood of participants' QOL improvement after surgery. CONCLUSIONS: Thorough preoperative evaluation of the symptom severity and stress levels is critical as these two factors are predictive of patient's satisfaction after septoplasty.

Reliability and validity of the Eating Assessment Tool-10 (Greek adaptation) in neurogenic and head and neck cancer-related oropharyngeal dysphagia.

PURPOSE: Dysphagia is a symptom associated with significant morbidity and mortality, with profound impact on physical ability and quality of life. Many questionnaires have been used to assess patient-reported dysphagia, but issues related to developmental and measurement properties affect their wide applicability. The purpose of this study was to assess the validity and reliability of the Eating Assessment Tool-10 (EAT-10, Greek adaptation) in neurogenic and head and neck cancer-related dysphagia. METHODS: The study consisted of: item generation in the Greek language, internal consistency and reliability analysis, normative data generation, and validity analysis. Data were collected prospectively from 421 participants: 144 asymptomatic subjects, 146 patients with dysphagia, and 131 patients with dysphagia-related diagnoses. Validity was assessed by comparing scores of healthy and dysphagic participants, by comparing pre- and post-treatment scores, and by correlating the Greek-EAT-10 with fibreoptic endoscopic evaluation of swallowing (FEES). RESULTS: The mean participants' age was 52.85 years (ranging from 18 to 85 years). All questionnaires were completed in less than 3 min. The overall internal consistency (assessed with Cronbach's alpha) was 0.963. The test-retest reliability was excellent with Spearman's rho ranging from 0.937 to 1. Dysphagic patients had a significantly higher score compared to healthy participants (p < 0.001). The mean EAT-10 improved significantly after treatment (Wilcoxon signed rank, p < 0.001). The Greek-EAT-10 and FEES scores were significantly correlated (Spearman's rho = 0.69). CONCLUSIONS: The EAT-10 is a valid, reliable, symptom-specific tool for the assessment of dysphagia, easily self-administered, and practical for clinical use.

Neck dissection in relation with disease-free, disease-specific, and overall survival of patients with squamous cell cancer of the oral cavity.

PURPOSE: The aims of this study were to assess the accuracy of the presurgical TNM staging of patients with oral squamous cell carcinoma who underwent neck dissection, to explore the relation between the site of the primary tumor and the histopathologically determined neck metastasis, and to perform survival analysis in relation to the histopathologic neck status. PATIENTS AND METHODS: A retrospective chart review with prospective follow-up of oral squamous cell carcinoma patients who underwent neck dissection was performed. Presurgical clinical neck status (cN) and postsurgical histopathologic neck status (pN) were recorded. Sensitivity, specificity, and likelihood ratios were calculated. Kaplan-Meier survival analysis was performed. RESULTS: The patients clinically staged as cN+ have more than 2-fold odds of having a pN+ neck. Those staged as cN0 have 4 times less odds of a pN+ neck. The mean follow-up was 45.8 months. The median overall survival was 27 months (41 mo in the patients with pN0 and 19.5 mo in the patients with pN+). For the patients with pN0, the 1-year overall survival probability was 95%, falling to 90% at 2 years and 81.8% at 5 years. In the patients with pN+, the 1-year overall survival probability was 72.2%, falling to 44.4% at 2 years and 26.7% at 5 years. Disease-specific and disease-free survival exhibited similar trends. CONCLUSIONS: No means of presurgical assessment either clinical or imaging was sufficiently sensitive and specific enough to predict the metastatic status of the neck. An approximately 50% decrease in the 5-year overall survival rate may be expected when regional metastasis is confirmed.

Eustachian Tube Dysfunction Diagnostic Pathway-What Is the Current State of the Art and How Relevant Is Chronic Nasal Disease?

Background: Eustachian tube dysfunction (ETD) presents a complex diagnostic challenge in otolaryngology, compounded by its multifaceted nature and overlapping symptoms with chronic nasal disease. This article examines the intricacies of ETD diagnosis, emphasising the necessity for a consensus on diagnostic procedures. Methods: A review of the literature was performed through the OVID research tool in the Pubmed/Medline databases to identify relevant articles that discuss eustachian tube dysfunction diagnostics as well as its correlation with chronic nasal disease. Results: The literature review harvested 201 articles, and only 51 of them were included in the full text review. A consensus statement was identified on eustachian tube dysfunction, function and diagnostics. It appears that there is significant variability in the diagnostic tools used to identify eustachian tube dysfunction. The main diagnostic approaches used are tympanometry, tubomanometry and sonotubometry, combined with the Patient-Reported Outcome Measure ETDQ-7 questionnaire to support the diagnosis of the condition. Nasal pathology is mostly absent from the retrieved studies, while ear pathology is more commonly mentioned in the current literature. Conclusions: There is no gold standard diagnostic tool to determine the presence of eustachian tube dysfunction. Further discussion, large multicentre studies and focused research are required to achieve a consensus on a diagnostic approach. The authors suggest a diagnostic pathway that combines subjective and objective diagnostic tools to determine the presence of eustachian tube dysfunction. This pathway is simple and can be used in district ENT departments, highlighting the nasal pathology relevance to ETD.

The Relationship Between the Retromandibular Vein and the Extratemporal Segment of the Facial Nerve: A Prospective Cadaveric Study of 24 Hemifaces.

INTRODUCTION: Anatomical preservation and functional integrity of the facial nerve (FN) are the main concerns of parotid surgery. Even though a variety of anatomical landmarks have been proposed and widely utilized, temporal or permanent postoperative FN palsy is still a significant comorbidity of parotid surgery. Therefore, the literature must fully elucidate the consistency of the anatomical relationship between the FN and the retromandibular vein (RMV). METHODS: We conducted a cadaveric study of 24 hemifaces to map the relationship between the FN and the RMV. Three distinct patterns were identified. Fourteen of the hemifaces were males, and 10 were females. Thirteen cadaveric dissections were performed on the right side and 11 on the left side. RESULTS: Our study found three distinct patterns and proposed a classification system. Type I (66.7%) is when the nerve lies exclusively lateral to the RMV. Type II (29.2%) is when the FN lies superficial to the RMV, but its mandibular branch lies deep to the anterior branch of the RMV, and type III (4.1%) is when the FN lies exclusively medial to the RMV. CONCLUSION: The FN and RMV relationship is not constant, and surgeons should be aware of every anatomical variation. Especially in cases where the FN is estimated to lie more in-depth to the level of the RMV, a retrograde approach may be required to avoid a FN injury.

The Role of Primary Repair of the Recurrent Laryngeal Nerve during Thyroid/Parathyroid Surgery in Vocal Outcomes-A Systematic Review.

Recurrent laryngeal nerve (RLN) injury is a well and long-known complication of thyroid and parathyroid surgery that significantly affects the quality of life of patients. Despite the advances in surgical techniques and technology, it still occurs in clinical practice either as temporary paresis or as permanent paralysis of the corresponding vocal cord. The purpose of the current systematic review is to examine the value of intraoperative repair of the RLN in voice restoration. A systematic review of the existing literature was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar databases according to the PRISMA guidelines. The systematic review resulted in 18 studies, which met the inclusion criteria. An improvement in phonatory function and voice quality was observed in all these studies after immediate RLN reconstruction (not always statistically significant). This improvement appears to be comparable to or even higher than that achieved with other methods of repair, and in some cases, the improvement approaches levels found in normal subjects. Intraoperative RLN reconstruction is not widely used in clinical practice, but the evidence so far makes it a viable and safe alternative to traditional techniques with better long-term results, as it prevents the occurrence of atrophy of the vocal cord and should be considered in the operating room if possible.

Strategies for Inhibition of Biofilm Formation on Silicone Rubber Voice Prostheses: A Systematic Review.

BACKGROUND: Lifetime elongation of the silicone voice rubber prostheses by inhibition of biofilm formation is a primary objective in voice restoration of laryngectomized patients. This systematic review sought to explore the existing strategies in this direction. MATERIALS: We conducted a systematic search of both in vitro and in vivo literature published in PubMed, Scopus, and Cochrane Central Register of Controlled Trials, until December 31, 2022, for published and unpublished trials assessing the strategies for inhibiting biofilm formation on silicone rubber voice prostheses, and appraised quality assessment with the modified Consolidated Standards of Reporting Trials tool. We analyzed the infection prevention capacity of the included antibacterial and antifungal agents. RESULTS: The qualitative synthesis showed that both surface modification methods and prophylactic treatment of silicone rubber voice prostheses present adequate antibiofilm activity. Of note, the majority of the suggested prosthetic surfaces were not chronically exposed to both human fluids and biofilm-forming microorganisms. CONCLUSION: Various experimental methods provide promising antibiofilm activity and, thus, possible lifespan elongation of silicone rubber voice prostheses.

Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy.

Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.