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1.
J Voice ; 2018 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-30545492

RESUMO

OBJECTIVES: To evaluate otolaryngology residents' level of confidence and understanding in interpreting laryngeal stroboscopy. METHODS: Otolaryngology residents from three residency programs with fellowship-trained laryngologists on faculty were invited to participate. An assessment consisting of a survey and five stroboscopic exams was administered. Each exam consisted of questions on perceptual voice evaluation, laryngoscopic findings, and stroboscopic findings. Scores were compared to answers provided by three fellowship-trained laryngologists. RESULTS: Thirty-eight of 47 invited residents (80.8%) enrolled in the study. On a five-point likert scale, residents reported low confidence (median = 2, range = 1-4) in interpreting stroboscopy, regardless of training program (P = 0.81). Mean assessment scores were 56.5% ± 11.9, with scores in perceptual voice evaluation = 68.5% ± 10.6; laryngoscopy = 70.2% ± 12.8; and stroboscopy = 45.3% ± 17.8. Residents performed worse on stroboscopy questions compared to laryngoscopy questions (P < 0.0001). There was a significant difference in scores by postgraduate year (P = 0.03), but not by institution (P = 0.34). A moderately positive correlation between reported level of confidence and overall scores (ρ = .47, P = 0.003) was demonstrated. CONCLUSIONS: Despite didactic and clinical exposure, residents report low confidence in interpreting stroboscopy and scored lower on stroboscopy-specific questions compared to other assessment items. Additional resources and learning opportunities are needed to improve resident confidence and comprehension of stroboscopy.

2.
Ann Otol Rhinol Laryngol ; 127(10): 726-730, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29962232

RESUMO

OBJECTIVES: To describe a safe and effective treatment for endobronchial Mycobacterium avium complex. METHODS: Case report and literature review. RESULTS: We present a case of endobronchial M. avium complex in a healthy child treated with serial carbon-dioxide laser excisions and antibiotic triple therapy using azithromycin, rifampin, and ethambutol. No current guideline for the treatment of these lesions in the pediatric population exists. CONCLUSIONS: In patients with airway impingement, serial endoscopic surgical resection combined with antibiotics can provide safe and effective management.


Assuntos
Antituberculosos/uso terapêutico , Bronquite/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Terapia a Laser/métodos , Microcirurgia/métodos , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Bronquite/diagnóstico , Bronquite/terapia , Broncoscopia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/terapia , Tomografia Computadorizada por Raios X
3.
Ann Otol Rhinol Laryngol ; 127(6): 384-389, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29732908

RESUMO

OBJECTIVES: To characterize the frequency of airway anomalies in patients with 22q11.2 deletion syndrome (22q11DS). METHODS: Retrospective review of patients with 22q11DS who had undergone microlaryngoscopy/bronchoscopy (MLB) for aerodigestive symptoms at a tertiary care children's hospital from 2011 to 2016. RESULTS: Thirty patients underwent an MLB due to the following indications: aspiration (11), stridor (10), chronic respiratory failure due to ventilator dependence (8), and difficult intubation (1). Median age at MLB was 6.5 months (range, 0.25-32 months). Forty airway anomalies were identified in 20 (66%) patients. Laryngomalacia (10), tracheomalacia (8), and bronchomalcia (8) were the most common intraoperative findings, followed by laryngeal cleft (5), anterior glottic web (5), subglottic stenosis (3), and subglottic cysts (1). Synchronous airway anomalies were common and identified in 11 (55%) of the patients who had identified anomalies on MLB. Nineteen of the 20 patients required operative intervention due to the anomalies identified. CONCLUSIONS: Structural airway abnormalities are common in children with 22q11DS undergoing MLB, and synchronous anomalies can frequently exist. Providers caring for children with 22q11DS should be vigilant about airway evaluation when aerodigestive symptoms are present.


Assuntos
Síndrome de DiGeorge/complicações , Síndrome de DiGeorge/patologia , Anormalidades do Sistema Respiratório/epidemiologia , Broncoscopia , Pré-Escolar , Síndrome de DiGeorge/cirurgia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Laringoscopia , Masculino , Anormalidades do Sistema Respiratório/patologia , Anormalidades do Sistema Respiratório/cirurgia , Estudos Retrospectivos
4.
Ann Otol Rhinol Laryngol ; 127(7): 445-449, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29807438

RESUMO

OBJECTIVES: To determine the incidence of early postoperative tympanostomy tube insertion otorrhea and obstruction in pediatric patients receiving antibiotic ear drops with or without steroid perioperatively. METHODS: A retrospective chart review was performed on patients who underwent outpatient myringotomy and tube placement. Patients from June 2013 to February 2014 received ciprofloxacin/dexamethasone perioperatively while patients from May 2014 to April 2015 received ofloxacin. Statistical analysis was performed to compare outcomes between the cohorts. RESULTS: One hundred thirty-four patients received topical ciprofloxacin/dexamethasone, and 116 patients received topical ofloxacin. The rate of postoperative otorrhea was 5.2% for the ciprofloxacin/dexamethasone group and 8.2% for the ofloxacin group. Tube obstruction was seen in 6.0% of the ciprofloxacin/dexamethasone group and 5.2% in the ofloxacin group. Neither outcome had a statistically significant difference ( P = .21 and .85, respectively). There was no difference in the rate of effusion at the time of tube placement between the 2 cohorts ( P = .16), and this included subgroup analysis based on effusion type (mucoid, purulent, serous). Patients with a mucoid effusion at the time of surgery were more likely to experience otorrhea/obstruction than patients with dry ears (odds ratio = 2.23, P = .02). CONCLUSION: No significant difference in the incidence of immediate postoperative tympanostomy tube otorrhea or obstruction was seen between the antibiotic-steroid and antibiotic alone cohorts, regardless of effusion type. Overall, patients with mucoid effusions are more likely to develop tube otorrhea or obstruction at follow-up. Cost-effective drops should be used when prescribing topical therapy to prevent complications after ear tubes.


Assuntos
Ciprofloxacino/administração & dosagem , Dexametasona/administração & dosagem , Ventilação da Orelha Média/efeitos adversos , Otite Média/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes/efeitos adversos , Administração Tópica , Antibacterianos/administração & dosagem , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Lactente , Masculino , Estudos Retrospectivos
5.
Otolaryngol Head Neck Surg ; 159(3): 572-575, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29634432

RESUMO

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascularized and locally aggressive tumor that typically presents in adolescent males. The molecular biology of this tumor remains understudied. We sought to identify differentially expressed genes in the JNA transcriptome through messenger RNA sequencing of primary fibroblasts from 2 tumor explants and tonsil tissue from tumor-free subjects. In total, 1088 significant, differentially expressed genes were identified with 749 upregulated and 339 downregulated. Pathway analysis identified a number of activated signaling pathways, most notably, the vascular endothelial growth factor (VEGF) pathway (adjusted overlap P = .03). VEGF-A showed a 4.4-fold upregulation in JNA samples. In addition, the angiogenic receptor, fibroblast growth factor receptor 2 (FGFR2), was not present in tumor-free samples but increased in JNA. We validate these findings with immunohistochemistry, demonstrating upregulation of VEGF and FGFR2 in patient sections. Inhibition of the VEGF or FGFR signaling axes may have therapeutic potential in the treatment of JNA.

6.
BMJ Case Rep ; 20182018 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-29592978

RESUMO

Upper airway stimulation of the tongue using an implantable neurostimulator has recently been approved for select patients with moderate to severe obstructive sleep apnoea (OSA) and intolerance to continuous positive airway pressure therapy. Effective implantation depends on the integrity of the hypoglossal nerve as well as the tongue musculature, notably the genioglossus. Prior trauma to either of these structures may be viewed as a relative contraindication to implantation. We describe a case of successful right hypoglossal nerve implantation in a patient with a history of left cardiac pacemaker placement and severe left penetrating tongue trauma with decreased mobility from contracture and deviation mimicking a hypoglossal nerve palsy. Preoperative and postoperative apnoea-hypopnoea index values were 52/hour and 5/hour, respectively. Prior soft tissue trauma to the tongue may not necessarily preclude surgical candidacy for upper airway stimulation in patients with OSA.


Assuntos
Terapia por Estimulação Elétrica/métodos , Nervo Hipoglosso , Neuroestimuladores Implantáveis , Lacerações/complicações , Apneia Obstrutiva do Sono/terapia , Língua/lesões , Idoso , Humanos , Masculino , Apneia Obstrutiva do Sono/complicações
7.
Ann Otol Rhinol Laryngol ; 127(3): 209-212, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29313370

RESUMO

OBJECTIVES: To describe a unique case of bilateral dehiscence of the malleus and incus heads into the middle fossa making contact with the temporal lobes, along with its clinical implications. METHODS: An analysis of a patient case and review of pertinent literature were performed. RESULTS: A patient with a history of right-sided mastoidectomy for cholesteatoma was evaluated for persistent conductive hearing loss. On computed tomography (CT) and magnetic resonance imaging (MRI), the patient had a complete dehiscence of the tegmen tympani on the right, with ossicular heads being located above the floor of the middle cranial fossa. A similar finding to a milder degree was noted on the left. The patient underwent revision tympanoplasty with mastoidectomy with removal of the incus and ossicular chain reconstruction and middle fossa craniotomy for repair of the right epitympanic dehiscence. CONCLUSIONS: We present some of the unique imaging and operative findings involved in an unusual presentation of encephalocele in which the bilateral malleus and incus heads rise above the level of the middle fossa floor.


Assuntos
Colesteatoma/cirurgia , Fossa Craniana Média , Encefalocele , Perda Auditiva Condutiva , Mastoidectomia/efeitos adversos , Reoperação/métodos , Timpanoplastia/métodos , Adulto , Fossa Craniana Média/diagnóstico por imagem , Fossa Craniana Média/patologia , Encefalocele/diagnóstico , Encefalocele/etiologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Mastoidectomia/métodos , Complicações Pós-Operatórias/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
8.
Int Forum Allergy Rhinol ; 7(10): 973-979, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28707818

RESUMO

BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that presents in adolescent males. Although surgical excision is the mainstay of treatment, recurrences complicate treatment. There is a need to develop less invasive approaches for management. JNA tumors are composed of fibroblasts and vascular endothelial cells. We identified fibroblast growth factor receptor (FGFR) and vascular endothelial growth factor (VEGF) expression in JNA-derived fibroblasts. FGFR influences fibroblast proliferation and VEGF is necessary for angiogenesis. We hypothesized that targeting FGFR would mitigate JNA fibroblast proliferation, invasion, and migration, and that targeting the VEGF receptor would attenuate endothelial tubule formation. METHODS: After informed consent, fibroblasts from JNA explants of 3 patients were isolated. Fibroblasts were treated with FGFR inhibitor AZD4547, 0 to 25 µg/mL for 72 hours and proliferation was quantified using CyQuant assay. Migration and invasion of JNA were assessed using 24-hour transwell assays with subsequent fixation and quantification. Mitigation of FGFR and downstream signaling was evaluated by immunoblotting. Tubule formation was assessed in human umbilical vein endothelial cells (HUVECs) treated with vehicle control (dimethylsulfoxide [DMSO]) or semaxanib (SU5416) as well as in serum-free media (SFM) or JNA conditioned media (CM). Tubule length was compared between treatment groups. RESULTS: Compared to control, AZD4547 inhibited JNA fibroblast proliferation, migration, and invasion through inhibition of FGFR and downstream signaling, specifically phosphorylation of - p44/42 mitogen activated protein kinase (p44/42 MAPK). JNA fibroblast CM significantly increased HUVEC tubule formation (p = 0.0039). CONCLUSION: AZD4547 effectively mitigates FGFR signaling and decreases JNA fibroblast proliferation, migration, and invasion. SU5416 attenuated JNA fibroblast-induced tubule formation. AZD4547 may have therapeutic potential in the treatment of JNA.


Assuntos
Angiofibroma/metabolismo , Antineoplásicos/farmacologia , Benzamidas/farmacologia , Neoplasias Nasofaríngeas/metabolismo , Piperazinas/farmacologia , Pirazóis/farmacologia , Receptores de Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Fibroblastos/fisiologia , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Indóis/farmacologia , Pirróis/farmacologia , Receptores de Fatores de Crescimento de Fibroblastos/genética , Receptores de Fatores de Crescimento de Fibroblastos/metabolismo , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Receptores de Fatores de Crescimento do Endotélio Vascular/genética
9.
Ann Otol Rhinol Laryngol ; 126(4): 274-278, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28056532

RESUMO

OBJECTIVES: To analyze the area under the curve (AUC) from 24-hour pharyngeal pH probes and evaluate this parameter as a predictor of disease severity for laryngopharyngeal reflux. METHODS: Eighty patients met inclusion criteria of a completed 24-hour pharyngeal pH probe and Reflux Symptom Index (RSI) questionnaire. The AUC was calculated below a pH threshold of 5.5 using the trapezoidal rule. The RSI and RYAN scores were correlated with AUC values, and nonparametric tests were used for comparisons. RESULTS: The median AUC value was 18 007 pH-seconds with an interquartile range (IQR) of 63 156, the median RSI score was 21 (IQR = 16), and the median RYAN score was 15.3 (IQR = 78). There was a Spearman's correlation of .36 between the RSI scores and AUC values ( P = .001) and a moderate correlation between AUC values and RYAN scores (0.58, P < .001). An insignificant correlation of .19 between RYAN scores and RSI scores was observed ( P = .09). CONCLUSIONS: The AUC may be a useful objective value in establishing the diagnosis of laryngopharyngeal reflux. Prospective studies with larger patient populations are necessary to validate these findings and determine standardized thresholds for symptomatic patients.


Assuntos
Concentração de Íons de Hidrogênio , Refluxo Laringofaríngeo/diagnóstico , Faringe/química , Adulto , Idoso , Área Sob a Curva , Monitoramento do pH Esofágico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos Prospectivos , Inquéritos e Questionários
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