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1.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 35(4): 351-354;359, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33794636

RESUMO

Objective:To investigate the prevalence and affecting factors of laryngopharyngeal reflux disease(LPRD) in otolaryngology head and neck surgery in Chongqing,and to provide a basis for the clinical diagnosis and therapy of LPRD. Methods:Multi-center cross-sectional survey method and systematic sampling method were used to select patients at fifteen hospitals in Chongqing from August to November in 2019. Then reflux symptom index(RSI) was investigated. At the same time, the information of the relevant dietary habits, including smoking and drinking, spicy diet, high-fat diet, and satiety was collected. Moreover, the factors related to LRPD(gender, age, symptoms, diet and lifestyle) were analyzed. Results:The composition ratio of LPRD was 11.90%(385/3234) in 3234 effective questionnaires and 385 positive ones. The composition ratio was 12.55%(173/1378) in men and 11.42%(212/1856) in women. The difference between the two groups was statistically significant(P<0.05). The difference in composition ratio among different age groups was statistically significant(P<0.05), with the highest composition ratio between 40 and 59 years old(170/1390). Constant throat-clearing(symptom 2) and globus sensation(symptom 8) were most correlated with LPRD. Logistic regression analysis showed that spicy diet, over eating, and smoking were highly related to LPRD. Conclusion:Globus sensation and constant throat-clearing are the most common symptoms in LPRD patients. Spicy diet, over eating, and smoking are risk factors for LPRD.


Assuntos
Refluxo Laringofaríngeo , Otolaringologia , Estudos Transversais , Feminino , Humanos , Hipofaringe , Recém-Nascido , Masculino , Inquéritos e Questionários
5.
J Laryngol Otol ; 135(3): 241-245, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33648611

RESUMO

OBJECTIVE: Utilisation of the Head and Neck Cancer Risk Calculator version 2 has been recommended during the coronavirus disease 2019 pandemic for the assessment of head and neck cancer referrals. As limited data were available, this study was conducted to analyse the use of the Head and Neck Cancer Risk Calculator version 2 in clinical practice. METHOD: Patients undergoing telephone triage in a two-week wait referral clinic were included. Data were collected and analysed using appropriate methods. RESULTS: Sixty-four patients in the study were risk-stratified into low-risk (51.6 per cent, 33 of 64), moderate-risk (14.1 per cent, 9 of 64) and high-risk (34.4 per cent, 22 of 64) groups. Of the patients, 53.1 per cent (34 of 64) avoided an urgent hospital visit, and 96.9 per cent (62 of 64) were cancer free, while 3.1 per cent (2 of 64) were found to have a head and neck malignancy. The sensitivity, specificity, negative predictive value and accuracy were 50.00 per cent, 66.13 per cent, 99.92 per cent and 66.11 per cent, respectively. CONCLUSION: It is reasonable to use the calculator for triaging purposes, but it must always be accompanied by a meticulous clinical thought process.


Assuntos
/epidemiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Otolaringologia/organização & administração , Encaminhamento e Consulta/organização & administração , Consulta Remota/organização & administração , Triagem/organização & administração , /prevenção & controle , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Telefone , Fatores de Tempo , Reino Unido
7.
J Laryngol Otol ; 135(3): 264-268, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632350

RESUMO

OBJECTIVES: This study aimed to report the pre- and post-operative laryngeal endoscopic findings in patients referred by non-otolaryngologists who are undergoing thyroid and/or parathyroid surgery, and to determine the number and nature of referrals before and after the release of the clinical practice guideline for improving voice outcomes after thyroid surgery. METHODS: This retrospective cohort study, conducted at a tertiary care academic hospital, comprised adult patients referred by the endocrine surgery service for laryngoscopy from 2007 to 2018 (n = 166). Data regarding patient demographics, reason for referral and endoscopic findings were recorded. RESULTS: The number of referrals increased significantly after the release of the practice guideline. The most common indication for referral pre- and post-operatively was voice change. The most common finding during laryngoscopy was normal examination findings (pre-operatively) and unilateral vocal fold immobility (post-operatively). CONCLUSION: Peri-operative thyroid and/or parathyroid patients have laryngoscopic findings other than vocal fold immobility. Laryngoscopy to detect structural and functional pathology is warranted.


Assuntos
Laringoscopia/estatística & dados numéricos , Otolaringologia/estatística & dados numéricos , Glândulas Paratireoides/cirurgia , Encaminhamento e Consulta/estatística & dados numéricos , Glândula Tireoide/cirurgia , Adulto , Feminino , Humanos , Laringoscopia/normas , Laringe/patologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Otolaringologia/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Encaminhamento e Consulta/normas , Estudos Retrospectivos , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Prega Vocal/patologia , Prega Vocal/cirurgia , Voz , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia
9.
Medwave ; 21(1): e8098, 2021 Jan 08.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-33617520

RESUMO

Introduction: Coronavirus disease 2019, or COVID-19, has become a global pandemic. Given that the highest viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in the airway, otolaryngologists are at high risk of infection. As a result, multiple recommendations have emerged regarding protective measures for surgical teams, including suspending non-urgent procedures and surgeries. Objectives: To evaluate the impact of the COVID-19 pandemic on otolaryngology residency training programs nationwide. Methods: A cross-sectional survey-based study was completed in April 2020. The participants were recruited through an online survey, sent by email to all Chilean otolaryngology residents. Demographics, clinical activities, on-call shifts, COVID-19 infection status, exposure to COVID-19 patients, deployment to other specialties, diagnostic/therapeutic procedures, and surgeries performed were analyzed. Self-reported surgical data logs from previous years were used to compare results. Results: Forty-seven residents completed the survey (84% response rate); 64% of residents refer seeing patients ten days or less during April 2020. Commonly performed procedures such as flexible nasolaryngoscopy, rigid nasal endoscopy, and peritonsillar abscess drainage were not performed by over 40% of the residents in that month. Only 38% participated in surgeries, with an average of 0.6 surgeries as a first surgeon, a dramatic decrease in surgical exposure when comparing the data logs from previous years. Most residents refer the following measures taken by their residency program to improve residency training: bibliographic videoconferences (87%), online clinical case seminars (60%), weekly journal clubs (38%), among others. Conclusions: Clinical and surgical opportunities decreased dramatically during April 2020. Adjustments to the regular academic curricula should be considered to decrease the negative impact of this pandemic on residency training.


Assuntos
Internato e Residência , Otolaringologia/educação , Adulto , Chile , Estudos Transversais , Feminino , Humanos , Masculino
10.
J Laryngol Otol ; 135(3): 191-195, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593465

RESUMO

OBJECTIVES: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.


Assuntos
Assistência Ambulatorial/organização & administração , Epistaxe/terapia , Otolaringologia/organização & administração , Abscesso Peritonsilar/terapia , Tonsilite/terapia , /prevenção & controle , Emergências , Serviço Hospitalar de Emergência/organização & administração , Humanos , Encaminhamento e Consulta/organização & administração
14.
J Laryngol Otol ; 135(1): 83-85, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33413719

RESUMO

OBJECTIVE: Microlaryngoscopy is an aerosol-generating procedure. This paper presents a novel approach for better protecting staff during microlaryngoscopy. METHODS: A clear plastic microscope drape is attached to the objective lens. Instead of using the drape to cover the microscope, it is pulled down to cover the patient's head and torso. The holes designated for the binoculars of the microscope are used for the surgeon hands, forming protective clear plastic sleeves. CONCLUSION: The proposed technique, which is simple, relatively inexpensive and technically feasible for any hospital to perform during microlaryngoscopy procedures, can increase safety and minimise droplet and aerosol exposure in the operating theatre.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laringoscopia/métodos , Doenças Profissionais/microbiologia , Doenças Profissionais/prevenção & controle , Otolaringologia , Humanos , Microscopia
15.
J Laryngol Otol ; 135(1): 74-79, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33478609

RESUMO

OBJECTIVE: The ENT run through pilot was introduced in 2018 to improve early recruitment to the specialty. This study aimed to understand what makes a successful interview applicant and the experience of the run through trainees during the specialty trainee one and specialty trainee two years. METHOD: A questionnaire survey was sent to all ENT run through trainees. RESULTS: Twenty-three trainees responded. Of the successful candidates, 74 per cent held additional degrees prior to application. The median core surgical interview rank was 27 (range: 3-174). Trainees felt that being on the run through pilot had increased ENT trainer engagement. CONCLUSION: The ENT run through posts are highly competitive, and holding an additional degree may improve applicant success. The pilot programme has been successful by increasing trainer engagement at this critical stage of training. These results will enable development of the pilot programme and provide valuable information for those applying to an ENT run through post.


Assuntos
Otolaringologia/educação , Escolha da Profissão , Inglaterra , Entrevistas como Assunto , Projetos Piloto , Inquéritos e Questionários
16.
Clin Otolaryngol ; 46(2): 295-296, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33484619

RESUMO

During the COVID-19 pandemic, the ENT community has demonstrated strong clinical leadership, adaptability to rapid change, enhanced clinical pathways and local networks, widespread use of digital technology for consultation and teaching and redirection of research programmes. These have permanently changed the way we work and, when the current global pandemic improves as COVID-19 infections drop and vaccination programmes are rolled out, we should ensure that the positive changes that have been made are embedded in clinical practice to improve patient care.


Assuntos
/epidemiologia , Otolaringologia/normas , Melhoria de Qualidade , Humanos , Liderança , Pandemias
18.
Am J Otolaryngol ; 42(2): 102873, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33431196

RESUMO

BACKGROUND: The Covid-19 pandemic has had a profound impact on the Otolaryngology outpatient clinical practice, which is at high risk of respiratory viral transmission due to the close contact between the examiner and the patient's airway secretions [1]. Moreover, most otolaryngological procedures, including oropharyngoscopy, generate droplets or aerosols from high viral shedding areas [1]. Thus, only non-deferrable consultations were performed in the outbreak's acute phase. Along with the re-opening of elective clinical services and the impending second wave of the outbreak, a reorganization is necessary to minimize the risk of nosocomial transmission [1]. METHODS: This video (Video 1) shows how to safely conduct an outpatient Otorhinolaryngological consultation, focusing on complete ear, nose and throat examination, according to evidences from the published literature and Otolaryngological societies guidelines [2,3]. RESULTS: After telephonic screening, patients reporting Covid-19 symptoms or closecontact with a Covid-19 case within the last 14 days are referred to telehealth services [1-3]. To avoid crowding, the patient is admitted alone, after body temperature control, except for underage or disabled people [1]. The waiting room assessment must guarantee a social distance of 6 ft [1-3]. The consultation room is reorganized into two separate areas (Fig. 1): 1) a clean desk area, where an assistant wearing a surgical mask and gloves, handles the patient's documentation and writes the medical report, keeping proper distance from the patient, and 2) a separate consultation area, where the examiner, equipped with proper personal protective equipment (Fig. 2) [3,4], carries out the medical interview and physical examination. Endoscopic-assisted ear, nose and throat inspection using a dedicated monitor allows the examiner to maintain an adequate distance from the patient throughout the procedure while providing an optimal view (Figs. 3-6) [3]. Recent evidence shows that nasal endoscopy does not increase droplet production compared to traditional otolaryngological examination [5]. When necessary, nasal topic decongestion and anesthesia must be performed using cottonoids rather than sprays [3]. The patient keeps the nose and mouth covered throughout the consultation, lowering the surgical mask on the mouth for nasal endoscopy and removing it only for oropharyngoscopy. After the consultation, the doffing procedure must be carried out carefully to avoid contamination [4]. All the equipment and surfaces must undergo high-level disinfection with 70% alcohol or 0.1% bleach solutions [3]. Proper room ventilation must precede the next consultation [3]. CONCLUSIONS: The hints provided in this video are useful to ensure both patient and examiner safety during Otolaryngological outpatient consultations and to reduce SARS-CoV-2 transmission.


Assuntos
/prevenção & controle , Controle de Infecções/métodos , Otolaringologia/métodos , Encaminhamento e Consulta , Assistência Ambulatorial , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Equipamento de Proteção Individual
19.
JAMA Otolaryngol Head Neck Surg ; 147(3): 287-295, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443539

RESUMO

Importance: The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders. Objective: To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic. Design, Setting, and Participants: This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows. Main Outcomes and Measures: Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons. Results: Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit. Conclusions and Relevance: These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.


Assuntos
/epidemiologia , Disparidades em Assistência à Saúde , Otolaringologia , Participação do Paciente/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Demografia , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Fatores Socioeconômicos , Estados Unidos
20.
Curr Opin Allergy Clin Immunol ; 21(1): 38-45, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369568

RESUMO

PURPOSE OF REVIEW: The WHO announced the coronavirus disease 2019 (COVID-19) outbreak as a pandemic in February 2020 with over 15 million confirmed cases of COVID-19 globally to date. Otolaryngologists are at a high risk of contracting COVID-19 during this pandemic if there is inadequate and improper personal protective equipment provision, as we are dealing with diseases of the upper-aerodigestive tract and routinely engaged in aerosol-generating procedures. RECENT FINDINGS: This article discusses the background and transmission route for severe acute respiratory syndrome coronavirus 2, its viral load and temporal profile as well as precaution guidelines in outpatient and operative setting in otorhinolaryngology. SUMMARY: As it is evident that COVID-19 can be transmitted at presymptomatic or asymptomatic period of infections, it is essential to practice ear, nose, and throat surgery with high vigilance in a safe and up-to-standard protection level during the pandemic. This article provides a summary for guidelines and recommendations in otorhinolaryngology.


Assuntos
/prevenção & controle , Otolaringologia/métodos , Pandemias , Aerossóis , Instituições de Assistência Ambulatorial , Infecções Assintomáticas , /transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Nasofaringe/virologia , Orofaringe/virologia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Equipamento de Proteção Individual , Exame Físico , Carga Viral
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