Strategies for CO2 Laser Use in Laryngeal Microsurgery: A Systematic Review.

OBJECTIVE: We aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety. DATA SOURCES: A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted. REVIEW METHODS: Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software. RESULTS: Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up). CONCLUSION: The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.

A Randomized Controlled Trial on Facial Muscle Therapy in Nasal Obstruction.

Background: Muscular exercises of the lateral nasal wall have been described as a potential treatment of nasal valve obstruction. The objective of this study was to compare whether nasal exercises improve nasal obstruction, using a randomized controlled model. Methods: Participants were randomized into groups performing exercises targeting nasal (group A) or facial (group B) muscles. Nasal obstruction was measured using a validated standardized patient-reported outcome measure (PROM) questionnaire (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]) at enrolment and at the end of the 8 weeks program. Results: Fifty-six patients completed the study. Upon completion of the programs, a three-point SCHNOC-C score improvement (95% [confidence interval, CI] = [-9 to 2]) was seen in Group A, whereas an eight-point score improvement (95% [CI] = [-15 to -0.4]) was observed in Group B. A seven-point SCHNOS-O score difference (95% [CI] = [-13 to -1]) was observed in Group A, whereas a difference of 15 points was seen in Group B (95% [CI] = [-22 to -8]). No significant difference was found between group A and B (p = 0.373 and p = 0.065, respectively). Conclusion: This randomized controlled trial suggested that nasal muscle exercises show no improvement on nasal obstruction.

Chronic suppurative otomastoiditis due to nontuberculous mycobacteria: A case series.

INTRODUCTION: Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center. METHODS: All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec's provincial public health and reference laboratory. RESULTS: All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically. CONCLUSION: Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control.