Congenital Nasal Pyriform Aperture Stenosis.

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal stridor and airway obstruction. In this case report we present management of congenital CNPAS in an eight day old female child. Inability to pass nasogastric tube (of size 5Fr) raised suspicion of choanal atresia or pyriform aperture (PA) stenosis (PAS). Computed tomography scan of the paranasal sinuses is the investigation of choice. Transnasal endoscopic dilatation and stenting with ngt of 8Fr under general anaesthesia was done. In this case report we discuss the aetiology, presenting symptoms, diagnostic methods and treatment modalities for CNPAS.

Vocal Cord Melanosis: To Worry or Not to Worry?

Laryngeal Melanosis is a rare entity with unclear significance: whether it is a premalignant lesion for squamous cell carcinoma of the larynx or a sign of mucosal melanoma. In the few reported cases in the literature, it is descried as localised/diffused brownish discoloration of the mucosal surface of the involved subsite of the larynx. We hereby report a raised localised laryngeal melanosis of the vocal cord with an initial histopathology report of dysplasia.

Nasopharyngeal Lymphoma: Rare Case Report.

A case of Nasopharyngeal Non Hogkins lypmhomas, diagnosed on Histopathology (HPE) and immunohistochemistry. In this case report we present the clinical presentation, diagnosis and treatment protocol of nasopharyngeal NHL.

Lidocaine Induced Laryngeal Angioedema in Sweet Syndrome: Is it incidental or anticipated?

Sweet's Syndrome is a rare inflammatory disease in which there is neutrophilic infiltration of the cutaneous tissue with or without vasculitis. Rarely, the extra-cutaneous tissue is affected. In the ENT Clinic, Sweet Syndrome can have variable manifestations due to the possible co-existing vasculitis and autoimmune diseases. We hereby report a middle-aged male patient with active Sweet's Syndrome and developed laryngeal angioedema after receiving laryngeal wash with lidocaine for a routine video laryngoscopy. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03396-4.

A Prospective Observational Study to Determine the Added Clinical Value of Videokymography to Videostroboscopy in Patients with Change in Voice.

Videolaryngostroboscopy (VLS) is considered gold standard method for assessing voice disorders. But patients with irregular waveform of vocal folds cannot benefit from the VLS. Videokymography [VKG] is a single line real time, high speed imaging technique. It detects voice disorders based on vocal fold vibration characteristics whether the vibrations are regular or irregular. There is no standard clinical protocol or evidence on the clinical relevance of VKG for functional assessment of voice disorders. Since mechanism of voice production depends on vibration characteristics, VKG imaging leads to new possibilities for diagnosis, objective documentation and monitoring of vocal fold behavior in clinical practice in case of voice disorders. This study aims to evaluate clinical value of VKG in addition to VLS as a complementary tool for the assessment of voice disorder.

Pre- and Postoperative High-Speed Videolaryngoscopy Findings in Adductor Spasmodic Dysphonia Following Transoral CO2 LASER-Guided Thyroarytenoid Myoneurectomy.

INTRODUCTION: Vocal cord vibration after transoral CO2 LASER-guided thyroarytenoid (TA) myoneurectomy in adductor spasmodic dysphonia (AdSD) patients is unclear to date. The precise vibratory patterns in AdSD patients are difficult to evaluate with routine videolaryngostroboscopy. High-speed videolaryngoscopy (HSV) is an ideal choice to evaluate such patients. This study was performed to compare pre- and postoperative, after 6 months, vocal fold vibratory onset delay (VFVOD) and closed phase glottal cycle (CPGC) in AdSD patients following transoral CO2 LASER-guided TA myoneurectomy using the HSV. MATERIALS AND METHODS: Retrospective study, conducted from January, 2016 to January, 2019, of the AdSD patients who underwent transoral CO2 LASER-guided TA myoneurectomy using the HSV. Patient data were acquired from the hospital database to evaluate VFVOD and CPGC from HSV recordings of the patients. VFVOD was calculated as sum of prephonatory delay (PPD) and steady-state delay (SSD). The PPD and SSD were evaluated and compared separately for each patient. The MedCal Version 19.2.6 was used for data analysis. Paired sample t test was performed to compute the significance of the difference between the mean of the dataset. A P value less than 0.05 was considered significant. RESULTS: A total of nine patients were included in the study, out of which three were females and six were males. The average age was 45.5 ± 6.9 years. The mean of postoperative PPD (166.8 ± 22.1), SSD (76.5 ± 8.6), and CPGC (62.6 ± 4.8) were significantly less than mean of preoperative PPD (222.6 ± 22.1), SSD (97.7 ± 9.5), and CPGC (71.6 ± 5 %), with P values of 0.0007, 0.0001, and 0.0001, respectively. CONCLUSIONS: There was a significant decrease in VFVOD and CPGC posttransoral CO2 LASER-guided TA myoneurectomy in AdSD patients after 6 months follow-up. This study also establishes efficiency of the HSV to measure the vocal cord vibration in the patients with AdSD. The primary limitations of the study were the small sample size and its retrospective nature. Future prospective studies with increased sample size can further substantiate the findings of the work performed here.

Demography and Pattern of Tobacco Usage in Carcinoma of Upper Aerodigestive Tract.

Upper aerodigestive tract (UADT) malignancies account for significant proportion of all malignancies. The aim of the study is to know the demography and patterns of tobacco consumption and the proportion of non-tobacco consumers in patients with UADT carcinoma. Patient diagnosed with primary UADT carcinoma visiting outpatient department in a tertiary centre from February 2009 to May 2011 were included in the study. 150 patients were documented with UADT carcinoma and analysed. Among these 133 were males and 17 were female. 40% of them had smoking, 25% had smokeless tobacco, 13% had both smoking and smokeless tobacco and 22% hadn't had any form of tobacco. Carcinoma larynx is the most common site and glottis is the commonest subsite. Most individuals who developed UADT carcinoma have used tobacco in some form. The high proportion of UADT carcinoma in non-tobacco consumer is alarming.

Low Grade Laryngeal Chondrosarcoma: Clinical Presentation, Management and Short Term Outcome.

Low grade laryngeal chondrosarcomas are rare, slow growing tumors. Surgical removal of the tumor along with preservation of laryngeal function is the preferred modality of treatment. We report a case of a large low grade chondrosarcoma removed by transoral CO2 LASER surgery which had avoided an open surgery.

Long term Follow Up of Severe Laryngomalacia Patients Following CO2 LASER Supraglottoplasty.

Laryngomalacia is the most common cause of stridor. It is believed to be due to delayed development of the supraglottic structures. On the basis of presentation, it has been divided into 3 grades. Management is dependent upon the grades: Mild and moderate laryngomalacia are managed conservatively, while CO2 LASER supraglottoplasty is the surgical management of choice for severe disease. In this study we evaluated the outcomes of supraglottopasty in long term follow up. It was a retrospective study which included patients with severe laryngomalacia who have undergone supraglottoplasty for the dates from July 2013 to July 2018. Weight and height of the patients were taken during the follow up visit after one year and have been compared with that of the normal children of comparable age using the pediatrics growth charts. Follow up was done by telephonic conversation to evaluate the status of other symptoms associated with laryngomalacia. Total of 44 patients were included in the study, 47.7% and 52.3% females and males respectively. Weight for age, weight for height and height for age were normal in 80.9%, 80.9% and 76.1% of patients respectively after supraglottoplasty. Of the patients studied, stridor was resolved in 80.9%, early tiredness during play was resolved in 43.2%, swallowing was normal in 85.7% and there was no aspiration in 90.5%. It can be concluded that patients with severe laryngomalacia improved with respect to airway symptoms, as well as, weight and height on long term follow up after CO2 LASER supraglottoplasty. It is important to evaluate the general status of the patients as a whole to truly assess the success of the surgery in addition to the airway symptoms.

Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases.

To prepare safety protocols for performing videolaryngoscopy (VLS) during COVID-19 pandemic, that would be feasible for patients, hospital and the health care providers. This was a prospective study performed from March 01, 2020 to June 30, 2020. It analyzed the precautions adapted for VLS initially and subsequently describes modifications with the time. The safety protocols are developed considering the safety aspect, the feasibility aspect (due to increase in number of the VLS), and the financial aspect. The VLS was performed with the personal protective equipment (PPE), including the face shield mask and head cover. The PPE was re-used after sterilization with ethylene oxide. For local anesthesia, the oropharynx was sprayed with 15% xylocaine and nose packed with 4% xylocaine soaked pledget. Following the VLS, the scope was wiped three times with 80% alcohol and then immersed in 5.25% sodium hypochlorite and 0.55% ortho-phthalaldehyde for 10 min each. Each VLS was spaced by at least 15 min gap. The endoscopy suite maintained with laminar air flow. It can be concluded that during the COVID-19 pandemic, the VLS must be performed using PPE with proper sterilization of the scope and the endoscopy suite after the procedure. The use of face shield mask and 15% xylocaine spray into the oropharynx were also highlighted. The financial burden should be minimized by reusing the materials whenever possible.

The Rocks Valley: Tracheopathia Osteochondroplastica: A Case Report.

Tracheopathia Osteochondroplastica is a rare benign tracheobronchial condition. Its unspecific symptoms and high clinical threshold for diagnosis make the condition an incidental diagnosis. We report an incidental tracheopathia osteochondplastica in 66 years old male patient with suspected thyroid malignancy.

Pre- and post-operative high-speed videolaryngoscopy in unilateral vocal cord paralysis following autologous fat augmentation.

PURPOSE: To compare high-speed videolaryngoscopy (HSV) parameters such as open quotient (OQ), amplitude symmetry index (ASI), phase symmetry index (PSI), and frequency symmetry index (FSI), of the unilateral vocal cord paralysis (UVCP) patients pre and post (after 6 months) autologous fat augmentation. MATERIALS AND METHODS: This retrospective study evaluated all age and gender patients with UVCP that underwent autologous fat augmentation from July 2016 to July 2019. The OQ, ASI, PSI, and FSI were calculated from the HSV recordings by using the montage and fast Fourier transform point analysis. The pre-and post-operative means were compared using a paired student t-test, with a p-value less than 0.05 considered significant. RESULT: A total of 37 patients, age 41.2 ± 11.3 years (21 to 67 years), 59.4% females and 40.6% males, were included in the study. The average duration of symptom onset was 2.3 ± 0.87 months. The post-operative mean values of OQ, ASI, PSI, and FSI following the fat augmentation were significantly improved compared to the pre-operative mean values with p-values <0.0001, 0.0018, 0.0011, and 0.0006, respectively. CONCLUSION: There was a significant improvement in the OQ, ASI, PSI, and FSI in UVCP patients after 6 months of autologous fat augmentation, signifying an enhanced vibratory function. The ability of HSV to measure the minute details of vocal cord vibration by providing quantitative measurements has also been highlighted. The need for future prospective research with an increased sample size and longer duration of follow up is recommended.

High-speed videolaryngoscopy in early glottic carcinoma patients following transoral CO2 LASER cordectomy.

PURPOSE: To compare high-speed videolaryngoscopy (HSV) findings, like open quotient (OQ), vocal fold vibratory onset delay (VFVOD), amplitude symmetry index (ASI) and phase symmetry index (PSI), after 6 months of cordectomy with that after 1 year, and to compare later with the control group. METHODS: Retrospective analysis of HSV recordings of 33 patients of early glottic carcinoma after cordectomy was performed after 6 months and 1 year of cordectomy with the help of videokymogram and digital kymogram. The control group of ten individuals was selected from patients who came to hospital with complaints other than larynx. The comparison was done for different types of cordectomy separately. RESULTS: The mean of OQ, VFVOD, ASI and PSI was found to be significantly higher after 6-month follow-up than after 1-year follow-up, the later was in turn found to be significantly higher than that of the control group, for type II and III cordectomy. The mean of OQ, VFVOD, ASI and PSI for other types of cordectomy also showed similar results, but the significance was not calculated due to less sample size. CONCLUSION: There was significant improvement in OQ, VFVOD, PSI and ASI following CO2 LASER cordectomy after 1 year of follow-up, making it a good management option for early glottic carcinoma. The ability of the HSV to measure variations in the vocal cord vibration, following cordectomy, was well established by this study.

Patient Radiation Exposure Associated With the Use of Computer Navigation During Spinal Fusion.

BACKGROUND: Calibration of computer navigation for spinal fusion is most commonly conducted using either a preoperative computed tomography (CT) scan or intraoperative O-arm scanning. This study aimed to directly compare patient radiation exposure from intraoperative O-arm use for pedicle screw placement versus typical diagnostic lumbar spine CT studies. METHODS: A retrospective review of patients undergoing O-arm navigated lumbar spine fusion procedures was performed to record radiation exposure as the primary outcome, as well as surgical and demographic details. The same was done for a control group of patients undergoing lumbar spine CT scans. RESULTS: A total of 83 patients undergoing lumbar spine fusion with O-arm navigation were included, as well as 105 unique patients who underwent a lumbar spine CT. The 2 groups were similar in terms of average age (60.2 versus 60.5, P = .90), average height (170 cm versus 169 cm, P = .50), and average weight (92.6 kg versus 90.9 kg, P = .62). Dose-length product for O-arm navigated procedures was 798.3 mGy-cm and 924.2 mGy-cm for CT scans (P = .064). Subgroup analysis revealed 18 patients who had both an O-arm navigated surgery and a lumbar spine CT. In this group the average dose-length product for O-arm surgeries was 806.2 mGy-cm and 822.1 mGy-cm for CT scans (P = .92) CONCLUSION: This study revealed no statistically or clinically significant differences between patient radiation exposure for O-arm operative navigation compared to lumbar spine CT. CLINICAL RELEVANCE: Given the similarity in radiation exposure, surgeons should rely on other factors to guide decision making in regard to mode of imaging for navigation. Knowledge of this comparison and total radiation exposure will also be useful for patient education and shared decision making in regard to navigated procedures.

INDUCIBLE TRANSIENT CENTRAL RETINAL ARTERY VASOSPASM: A CASE REPORT.

PURPOSE: To report a case of inducible transient central retinal artery vasospasm with associated imaging. METHODS: Observational case report. RESULTS: A 51-year-old man presented for outpatient follow-up for recurrent inducible transient vision loss in his right eye. He experienced an episode during examination and was found to have central retinal artery vasospasm. Fundus photography and fluorescein angiography obtained during his vasospastic attack confirmed retinal arterial vasospasm. Treatment with a calcium-channel blocker (nifedipine) has been effective in preventing recurrent attacks. CONCLUSION: Idiopathic primary vasospasm is a rare cause of transient vision loss that is difficult to confirm because of the transient nature. We obtained imaging showing the initiation and resolution of the vasospastic event. The patient was then successfully treated with a calcium-channel blocker.

Autologous Fat Augmentation in Post Type III Cordectomy Patients.

Neocord formation after Type III cordectomy is insufficient for complete glottic closure due to scarring and soft tissue deficit. This study evaluates the role of autologous fat injection (AFI) in phonosurgical management of patients who have previously undergone Type III cordectomy for early glottic cancer. Data was collected from hospital records of patients who underwent AFI after previously undergoing Type III cordectomy. A minimum duration of 6 months post-cordectomy was maintained before fat injection. Trans-oral injection was performed at a single site. Pre-operative voice evaluation was done using VHI, GRBAS scale and MDVP software. Post-operative evaluation was done at 6 weeks. 21 out of 62 post-Type III cordectomy patients chose to undergo fat augmentation and were included in the study. A comparison of pre-operative and 6 months post-operative AFI voice analysis showed a significant improvement in VHI, all parameters of GRBAS scale, and improvement in Jitter, Shimmer, SPI and NHR. There was a decrease in fundamental frequency but this was not statistically significant. AFI is an effective procedure for surgical voice rehabilitation of patients who have undergone Type III cordectomy for early laryngeal cancer.

A comparison of phonatory outcome between trans-oral CO2 Laser cordectomy and radiotherapy in T1 glottic cancer.

PURPOSE: This study aimed at comparing phonatory outcomes between Trans-oral Laser Surgery and Radiotherapy in T1 glottic cancer. INTRODUCTION: Early glottic carcinoma, i.e. T1 stage, can be treated using trans-oral surgery, radiotherapy, or partial open surgery. Trans-oral laser (TOL) surgical techniques and Radiotherapy (RT) have undergone significant advancement in the past few years leading to a decrease in open procedures. Various studies have been published comparing voice quality after TOL surgery and RT. There are few works which consider patients' opinions, i.e. subjective parameters regarding functional voice quality post treatment. This study uses both subjective and objective parameters to evaluate phonatory outcome of both treatment options. METHODS: Phonatory outcomes were measured in patients who underwent RT and CO2 Laser excision for early laryngeal cancer. VHI, GRBAS and MDVP were used to measure the vocal outcome of treatment modality after 1 year of cancer-free survival. A comparison was then made between the outcomes in the two groups. RESULTS: Superior vocal outcomes in G, R and S criteria of the GRBAS scale, a better VHI index, and better jitter, shimmer and NHR were found in patients who underwent CO2 laser excision as compared to patients who underwent RT. Other parameters were comparable between the two groups. CONCLUSIONS: TOL surgery provides excellent vocal outcome as compared to RT in management of early glottic cancer and should be considered as the first line of management for the same.

Enhanced biocompatibility of neural probes by integrating microstructures and delivering anti-inflammatory agents via microfluidic channels.

OBJECTIVE: Biocompatibility is a major issue for chronic neural implants, involving inflammatory and wound healing responses of neurons and glial cells. To enhance biocompatibility, we developed silicon-parylene hybrid neural probes with open architecture electrodes, microfluidic channels and a reservoir for drug delivery to suppress tissue responses. APPROACH: We chronically implanted our neural probes in the rat auditory cortex and investigated (1) whether open architecture electrode reduces inflammatory reaction by measuring glial responses; and (2) whether delivery of antibiotic minocycline reduces inflammatory and tissue reaction. Four weeks after implantation, immunostaining for glial fibrillary acid protein (astrocyte marker) and ionizing calcium-binding adaptor molecule 1 (macrophages/microglia cell marker) were conducted to identify immunoreactive astrocyte and microglial cells, and to determine the extent of astrocytes and microglial cell reaction/activation. A comparison was made between using traditional solid-surface electrodes and newly-designed electrodes with open architecture, as well as between deliveries of minocycline and artificial cerebral-spinal fluid diffused through microfluidic channels. MAIN RESULTS: The new probes with integrated micro-structures induced minimal tissue reaction compared to traditional electrodes at 4 weeks after implantation. Microcycline delivered through integrated microfluidic channels reduced tissue response as indicated by decreased microglial reaction around the neural probes implanted. SIGNIFICANCE: The new design will help enhance the long-term stability of the implantable devices.

Steroid exposure, acute coronary syndrome, and inflammatory bowel disease: insights into the inflammatory milieu.

BACKGROUND: Steroids are anti-inflammatory agents commonly used to treat inflammatory bowel disease. Inflammation plays a critical role in the pathophysiology of both inflammatory bowel disease and acute coronary syndrome. We examined the relationship between steroid use in patients with inflammatory bowel disease and acute coronary syndrome. METHODS: In 177 patients with inflammatory bowel disease (mean age 67 years, 75% male, 44% Crohn's disease, 56% ulcerative colitis), we performed a 1:2 case-control study matched for age, sex, and inflammatory bowel disease type, and compared 59 patients with inflammatory bowel disease with acute coronary syndrome to 118 patients with inflammatory bowel disease without acute coronary syndrome. Steroid use was defined as current or prior exposure. Acute coronary syndrome was defined as myocardial infarction or unstable angina, confirmed by cardiac biomarkers and coronary angiography. RESULTS: In patients with inflammatory bowel disease, 34% with acute coronary syndrome had exposure to steroids, vs 58% without acute coronary syndrome (P < .01). Steroid exposure reduced the adjusted odds of acute coronary syndrome by 82% (odds ratio [OR] 0.39; 95% confidence interval [CI], 0.20-0.74; adjusted OR 0.18; 95% CI, 0.06-0.51) in patients with inflammatory bowel disease, 77% in Crohn's disease (OR 0.36; 95% CI, 0.14-0.92; adjusted OR 0.23; 95% CI, 0.06-0.98), and 78% in ulcerative colitis (OR 0.41; 95% CI, 0.16-1.04; adjusted OR 0.22; 95% CI, 0.06-0.90). There was no association between other inflammatory bowel disease medications and acute coronary syndrome. CONCLUSIONS: In patients with inflammatory bowel disease, steroid use significantly reduces the odds of acute coronary syndrome. These findings provide further mechanistic insight into the inflammatory processes involved in inflammatory bowel disease and acute coronary syndrome.