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2.
Orbit ; 39(4): 305-310, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32419568

RESUMO

We review two cases of adolescents with orbital cellulitis, sinusitis and SARS- CoV-2 infection presenting to emergency departments within a 24 hour period. SARS-CoV-2 samples obtained within 24 hours were positive, supporting prior infection despite relatively limited early symptoms of COVID-19. Unusual clinical and radiographic characteristics included hemorrhagic abscess with blood of varying age in the first, intracranial epidural abscess in the second, radiographic signal consistent with hemorrhagic or thrombotic phenomena, retro-maxillary antral fat changes, and meningeal enhancement or extension in both cases. Radiographic findings thereby mimic fungal infection, although final cultures and ancillary investigation for allergic and invasive fungal disease have remained negative. These cases highlight two unusual orbital presentations of cellulitis occurring in the context of SARS-CoV-2 co-infection.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Desbridamento/métodos , Sinusite Frontal/terapia , Celulite Orbitária/terapia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Betacoronavirus , Criança , Técnicas de Laboratório Clínico/métodos , Terapia Combinada/métodos , Serviço Hospitalar de Emergência , Seguimentos , Sinusite Frontal/diagnóstico por imagem , Sinusite Frontal/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Celulite Orbitária/diagnóstico por imagem , Celulite Orbitária/etiologia , Pandemias , Medição de Risco , Amostragem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Am J Otolaryngol ; 41(3): 102484, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32359869

RESUMO

IMPORTANCE: Anatomically, viral density is greater in the nasal cavity and the nasopharynx. It is to be expected that instrumentation in or through those areas will entail a higher risk of transmission. That's why head and neck and otolaryngologist surgeons are among the most vulnerable health professionals. OBSERVATIONS: Surgeons should essentially perform procedures they require. Surgeries should be performed with personal protective equipment suitable for the high risk of aerosolization: goggles, N95 face mask, facial mask, blood-repelling gown and gloves. It is advisable to have the cooperative COVID-19 test in all patients. Telemedicine is a useful resource if resources allow it. CONCLUSIONS AND RELEVANCE: Otolaryngologists and related specialists are among the groups at higher risk when performing surgeries and upper airway examinations. There are no emergencies in a pandemic. The care of health professionals is crucial to combating this health situation.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Saúde do Trabalhador , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Otorrinolaringologistas/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Medição de Risco , Cirurgiões/estatística & dados numéricos
4.
J Otolaryngol Head Neck Surg ; 49(1): 29, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393346

RESUMO

BACKGROUND: Adequate personal protective equipment is needed to reduce the rate of transmission of COVID-19 to health care workers. Otolaryngology groups are recommending a higher level of personal protective equipment for aerosol-generating procedures than public health agencies. The objective of the review was to provide evidence that a.) demonstrates which otolaryngology procedures are aerosol-generating, and that b.) clarifies whether the higher level of PPE advocated by otolaryngology groups is justified. MAIN BODY: Health care workers in China who performed tracheotomy during the SARS-CoV-1 epidemic had 4.15 times greater odds of contracting the virus than controls who did not perform tracheotomy (95% CI 2.75-7.54). No other studies provide direct epidemiological evidence of increased aerosolized transmission of viruses during otolaryngology procedures. Experimental evidence has shown that electrocautery, advanced energy devices, open suctioning, and drilling can create aerosolized biological particles. The viral load of COVID-19 is highest in the upper aerodigestive tract, increasing the likelihood that aerosols generated during procedures of the upper aerodigestive tract of infected patients would carry viral material. Cough and normal breathing create aerosols which may increase the risk of transmission during outpatient procedures. A significant proportion of individuals infected with COVID-19 may not have symptoms, raising the likelihood of transmission of the disease to inadequately protected health care workers from patients who do not have probable or confirmed infection. Powered air purifying respirators, if used properly, provide a greater level of filtration than N95 masks and thus may reduce the risk of transmission. CONCLUSION: Direct and indirect evidence suggests that a large number of otolaryngology-head and neck surgery procedures are aerosol generating. Otolaryngologists are likely at high risk of contracting COVID-19 during aerosol generating procedures because they are likely exposed to high viral loads in patients infected with the virus. Based on the precautionary principle, even though the evidence is not definitive, adopting enhanced personal protective equipment protocols is reasonable based on the evidence. Further research is needed to clarify the risk associated with performing various procedures during the COVID-19 pandemic, and the degree to which various personal protective equipment reduces the risk.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Equipamento de Proteção Individual/normas , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Sistema Respiratório/virologia , Carga Viral
5.
J Otolaryngol Head Neck Surg ; 49(1): 28, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375884

RESUMO

BACKGROUND: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Humanos , Otorrinolaringopatias/complicações , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/virologia , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pandemias , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto
6.
Otolaryngol Head Neck Surg ; 163(1): 83-85, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32366158

RESUMO

Currently, there is a lack of reliable patient-centric educational videos in otolaryngology. In light of COVID-19, otolaryngologists have had to see patients through virtual visits and have been encouraged to send patients home after nonelective surgery. Additionally, most hospitals are not permitting patients' family members and caretakers to enter patient rooms, thus often preventing them from receiving adequate education on postoperative care. Embracing educational videos as a valuable tool will improve communication with patients, especially during the times of COVID-19 and beyond. The goal of this commentary is to describe our early lessons learned in developing educational videos in a streamlined, efficient, and accessible format that can be shared among all members of the multidisciplinary and design production team. Background on the use of multimedia to reduce patient anxiety and frustration with surgical interventions is provided.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pandemias , Educação de Pacientes como Assunto/métodos , Pneumonia Viral/complicações , Gravação em Vídeo/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
7.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(3): 161-166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32362564

RESUMO

In Otorhinolaryngology - Head and Neck Surgery, clinical examination and invasive procedures on the respiratory tract and on airway-connected cavities, such as paranasal sinuses and the middle ear, expose people to direct transmission of SARS-CoV-2 by inhalation or ocular projection of contaminated droplets, and to indirect transmission by contact with contaminated hands, objects or surfaces. Estimating an R0 of COVID-19 at around 3 justified postponing non-urgent face-to-face consultations and expanding the use of teleconsultation in order to limit the risks of SARS-CoV-2 infection of patients or health workers and comply with the lockdown. The health authority recommends cancellation of all medical or surgical activities, which are not urgent as long as this does not involve a loss of chance for the patient. The purpose of this cancellation is to significantly increase critical care capacity, prioritise the reception of patients with COVID-19, prioritise the allocation of staff and provision of the equipment necessary for their medical or surgical management, and contribute to the smooth running of downstream critical care within their establishment. Another goal is to reduce the risks of patient contamination within healthcare facilities. This document provides guidance on how to proceed with and adapt ENT surgery in the current pandemic context, as well as on the management of postponed operations. This best practice advice must of course be adapted in each region according to the development of the epidemic and pre-existing arrangements. Their local application can only be decided within the framework of collaboration between the ENT teams, the operational hygiene units and all the other specialties concerned.


Assuntos
Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , França/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Otolaringologia/métodos , Otolaringologia/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
9.
Head Neck ; 42(6): 1159-1167, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298036

RESUMO

The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgent-consider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Agendamento de Consultas , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Prioridades em Saúde , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Oncologia Cirúrgica/organização & administração , Estados Unidos
10.
Otolaryngol Head Neck Surg ; 162(6): 783-794, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32340588

RESUMO

OBJECTIVE: To review the impact of coronavirus disease 2019 (COVID-19) on pediatric otolaryngology and provide recommendations for the management of children during the COVID-19 pandemic. DATA SOURCES: Clinical data were derived from peer-reviewed primary literature and published guidelines from national or international medical organizations. Preprint manuscripts and popular media articles provided background information and illustrative examples. METHODS: Included manuscripts were identified via searches using PubMed, MEDLINE, and Google Scholar, while organizational guidelines and popular media articles were identified using Google search queries. Practice guidelines were developed via consensus among all authors based on peer-reviewed manuscripts and national or international health care association guidelines. Strict objective criteria for inclusion were not used due to the rapidly changing environment surrounding the COVID-19 pandemic and a paucity of rigorous empirical evidence. CONCLUSIONS: In the face of the COVID-19 pandemic, medical care must be judiciously allocated to treat the most severe conditions while minimizing the risk of long-term sequelae and ensuring patient, physician, and health care worker safety. IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic will have a profound short- and long-term impact on health care worldwide. Although the full repercussions of this disease have yet to be realized, the outlined recommendations will guide otolaryngologists in the treatment of pediatric patients in the face of an unprecedented global health crisis.


Assuntos
Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto/normas , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/normas , Saúde Global , Humanos , Masculino , Otolaringologia/métodos , Otolaringologia/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Segurança do Paciente , Seleção de Pacientes , Pediatria/normas , Pneumonia Viral/diagnóstico , Medição de Risco , Estados Unidos
11.
Otolaryngol Head Neck Surg ; 162(6): 950-953, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204669

RESUMO

In this study, we sought to explore the feasibility of using ultrasonography to evaluate airway anomalies in awake children with previous airway reconstruction. For the month of December 2018, we reviewed the medical records of patients aged <18 years old with prior airway reconstruction who had an outpatient appointment and a microlaryngoscopy and bronchoscopy within 24 hours of each other. Four patients met inclusion criteria and were enrolled. Sonographic airway images and measurements were obtained during the outpatient appointment and compared with those obtained during endoscopy. Ultrasound identified extraluminal stents and glottic, subglottic, and tracheal pathology. Subglottic measurements obtained sonographically were within 0.1 to 0.5 mm of the outer diameter of the appropriate endotracheal tubes. Ultrasound did not visualize tracheotomy tubes or posterolateral pathology. Our findings lay the foundation for expanding the role of ultrasound in pediatric airway assessment, keeping in mind its apparent inability to visualize posterolateral airway pathology.


Assuntos
Glote/diagnóstico por imagem , Laringoestenose/diagnóstico , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/diagnóstico por imagem , Estenose Traqueal/diagnóstico , Ultrassonografia/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Glote/cirurgia , Humanos , Laringoestenose/cirurgia , Masculino , Projetos Piloto , Estudos Retrospectivos , Traqueia/cirurgia , Estenose Traqueal/cirurgia
12.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 107-111, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090552

RESUMO

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, produc- ing favorable results with good applicability in otolaryngology clinical practice.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Faringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/cirurgia , Músculos Faríngeos/cirurgia , Registros Médicos , Estudos Retrospectivos , Estudos Longitudinais , Resultado do Tratamento
13.
Ann Otol Rhinol Laryngol ; 129(7): 669-676, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32028778

RESUMO

BACKGROUND: Open partial laryngeal surgery (OPLS) represents a wide array of procedures that can be fitted to treat different types of laryngeal cancer (LC). We would like to present our 30-years' institutional experience, to analyze survival outcomes and to critically discuss prognostic factors. METHODS: We reviewed all cases of OPLS performed at our Institution from 1982 to 2016 for LC. Survival analysis by Kaplan-Meier estimate was performed and prognostic variables by multivariate analysis were identified. RESULTS: Mean follow-up time was 68.3 months, 30-day mortality 0.2%, subsequent functional total laryngectomy (TL) was 1.01%. Over 80% of cases were stage I to II. We had 25 local, 62 regional and eight distant recurrences. Local control was 94.9%, overall survival (OS) was 83.4% and disease-specific survival (DSS) was 87.7%. The two major risk factors significantly associated with the risk of death were cT and cN stage. CONCLUSIONS: We have confirmed that OPLS represents an oncologically sound option in the treatment of LC despite the emergence of non-surgical strategies and new transoral mininvasive techniques. Our results highlight that accurate staging, correct selection of the patient and a strong surgical expertise are of paramount importance in this type of surgery.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Neoplasias Ósseas/secundário , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Modelos Logísticos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Esvaziamento Cervical , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Prognóstico , Fatores de Risco , Terapia de Salvação , Taxa de Sobrevida , Adulto Jovem
14.
Otolaryngol Head Neck Surg ; 162(4): 572-580, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32093566

RESUMO

OBJECTIVE: To examine the effects of the extent of endoscopic sinus surgery (ESS) on pulmonary health, including the pulmonary exacerbations and lung function in patients with cystic fibrosis (CF). STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary health care center. SUBJECTS AND METHODS: A retrospective review of patients with CF who underwent ESS at St. Michael's Hospital between 1999 and 2016 was performed. Two groups of patients were identified based on the surgical extent: (1) complete (maxillary antrostomy, complete ethmoidectomy, sphenoidotomy, and frontal sinusotomy) and (2) limited (any ESS that involved less than complete). Primary outcomes included the number of pulmonary exacerbations (the use of oral or intravenous [IV] antibiotics), number of hospital admissions and hospital days during a 2-year pre- and postoperative period, and pulmonary function outcomes during a 1-year pre- and postoperative period. RESULTS: There were 70 procedures (30 complete and 40 limited) among 57 patients. Baseline characteristics were similar between the groups. Complete ESS group had a significant reduction in the oral antibiotic use compared to the limited ESS group (median, -1.0 [interquartile range (IQR), -2 to 0] in complete vs 0 [IQR, -1 to 1] in limited, P = .028). There was no difference in the use of IV antibiotics, number and duration of admissions, or rate of lung function change between the 2 groups. CONCLUSION: Complete ESS may reduce mild forms of pulmonary exacerbations as shown in the decreased use of oral antibiotics. Overall, ESS does not significantly modify pulmonary outcomes in patients with CF.


Assuntos
Endoscopia/métodos , Rinite/cirurgia , Sinusite/cirurgia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Doença Crônica , Estudos de Coortes , Fibrose Cística/complicações , Feminino , Humanos , Pneumopatias/epidemiologia , Pneumopatias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Rinite/complicações , Sinusite/complicações , Resultado do Tratamento , Adulto Jovem
16.
Ann Otol Rhinol Laryngol ; 129(5): 512-516, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31888343

RESUMO

BACKGROUND: Prior studies have demonstrated associations between serum eosinophilia and chronic rhinosinusitis (CRS) pathogenesis. However, the association of serum eosinophilia with histopathology profiling in CRS has not been fully delineated and may help better characterize CRS disease burden prior to surgery. METHODS: A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Complete blood count (CBC) with differential was drawn within 4 weeks prior to FESS. Serum eosinophilia was defined as >6.0% (>0.60 th/µL). Histopathology variables were compared among patients. RESULTS: A total of 177 CRS patients (37 with serum eosinophilia and 140 with normal serum eosinophilia) were analyzed. Compared to CRS patients with normal serum eosinophil counts, CRS patients with serum eosinophilia demonstrated increased polypoid disease (67.6% vs 35.0%, P < .001), eosinophil aggregates (45.9% vs 20.7%, P = .003), and eosinophils per high-power field (>5/HPF) (67.6% vs 40.7%, P = .003). CONCLUSION: CRS patients with serum eosinophilia demonstrated severe disease burden on histopathology with high levels of polypoid disease and tissue eosinophilia. However, a considerable number of patients without serum eosinophilia demonstrated eosinophilic disease on histopathology, indicating that preoperative serum eosinophilia alone could not be reliably used to predict eosinophilic CRS. LEVEL OF EVIDENCE: 4.


Assuntos
Eosinofilia/sangue , Eosinófilos/patologia , Rinite/complicações , Sinusite/complicações , Doença Crônica , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Período Pré-Operatório , Estudos Retrospectivos , Rinite/sangue , Rinite/diagnóstico , Índice de Gravidade de Doença , Sinusite/sangue , Sinusite/diagnóstico
17.
Otolaryngol Head Neck Surg ; 162(1): 64-72, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31613686

RESUMO

OBJECTIVE: Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL). STUDY DESIGN: Cross-sectional study. SETTING: HNC survivorship clinic. SUBJECTS AND METHODS: We identified 214 survivors who completed treatment ≥1 year prior to evaluation in the clinic. Self-reported neck impairment was measured using the Neck Disability Index. QOL was measured using the University of Washington QOL Questionnaire, with physical and social subscale scores calculated. Regression analysis and trend tests were employed to explore associations. RESULTS: Over half of survivors (54.2%) reported neck disability. The odds of neck disability in survivors who received nonsurgical treatment and those who received surgery plus adjuvant treatment were 3.46 and 4.98 times higher compared to surgery alone (P = .008, P = .004). Survivors who underwent surgery only had higher physical and social QOL than those who received nonsurgical treatment (physical QOL: P < .001, social QOL: P = .023) and those who received surgery plus adjuvant treatment (physical QOL: P < .001, social QOL: P = .039). CONCLUSION: This study revealed a high prevalence of neck disability following nonsurgical treatment. While neck disability is an established sequela of surgical resection, the impact of nonsurgical treatment has gone unrecognized. Early identification and intervention to prevent progression of neck disability are crucial to optimize QOL.


Assuntos
Tratamento Conservador/efeitos adversos , Neoplasias de Cabeça e Pescoço/terapia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Qualidade de Vida , Sobreviventes , Centros Médicos Acadêmicos , Adulto , Idoso , Intervalos de Confiança , Estudos Transversais , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Esvaziamento Cervical/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Estados Unidos
18.
Otolaryngol Head Neck Surg ; 162(1): 137-141, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638866

RESUMO

OBJECTIVE: Balloon sinuplasty utilization has increased significantly since its introduction over a decade ago. However, the most common associated complications are still unknown. The objective of this study was to analyze adverse events related to balloon sinuplasty. STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: Food and Drug Administration's MAUDE database (Manufacturer and User Facility Device Experience; 2008-2018). SUBJECTS AND METHODS: The MAUDE database was searched for all reports on adverse events involving balloon sinuplasty devices from the 3 leading manufacturers: Acclarent, Entellus, and Medtronic. Reported events were reviewed and categorized. RESULTS: During the study period, there were 211 adverse events from 208 reports divided into the following categories: patient related (n = 102, 48.3%), device related (n = 101, 47.9%), and packaging related (n = 8, 3.8%). Four periprocedural deaths were reported but were not clearly associated with technical complications. The most common device-related complications were guide catheter malfunction (39.6%), balloon malfunction (38.6%), and imprecise navigation (17.8%). The most common patient-related complications were cerebrospinal fluid leak (36.3%), eye swelling (29.4%), and epistaxis (11.8%). A lateral canthotomy was performed in 30.0% of eye-swelling complications. Sixty percent of eye complications occurred during balloon dilation of the maxillary sinus. The years 2014 (n = 48) and 2012 (n = 32) had the highest number of adverse events reported as compared with all other years. CONCLUSION: The most common adverse events associated with balloon sinuplasty include balloon malfunction, guide catheter malfunction, cerebrospinal fluid leak, and significant eye swelling. Health care providers should discuss these possible complications when consenting patients for balloon sinuplasty.


Assuntos
Cateterismo/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Fatores Etários , Cateterismo/efeitos adversos , Estudos Transversais , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Recidiva , Estudos Retrospectivos , Rinite/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Sinusite/diagnóstico , Estados Unidos , Adulto Jovem
19.
Ann Otol Rhinol Laryngol ; 129(3): 230-237, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31635473

RESUMO

OBJECTIVE: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. METHODS: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. RESULTS: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI (P < .001), ASA class (P = .004), ethnicity (P = .008), operative time (P < .001), and reoperation (P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. CONCLUSIONS: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Grupos de Populações Continentais/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neurocirurgiões/estatística & dados numéricos , Duração da Cirurgia , Otorrinolaringologistas/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
20.
Int J Pediatr Otorhinolaryngol ; 128: 109721, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31639621

RESUMO

Morquio syndrome (Mucopolysaccharidosis IVA) is an autosomal recessive lysosomal storage disease with manifestations ranging from mild to severe phenotype. Mechanical spinal cord injury and airway insufficiency are major causes of mortality. A 17-year-old male patient with severe Morquio syndrome presented with cervical and upper thoracic spinal stenosis with spinal cord myelopathy, and progressive severe tracheal stenosis. Coordinated care among otolaryngology, orthopedic surgery, neurosurgery, anesthesiology, cardiovascular surgery, radiology, and pulmonology teams facilitated the successful planning and execution of two major surgical interventions in rapid succession. This is the first description of a successful coordinated spine and airway repair in the literature.


Assuntos
Mucopolissacaridose IV/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Equipe de Assistência ao Paciente/organização & administração , Estenose Espinal/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Humanos , Masculino , Modelos Anatômicos , Impressão Tridimensional , Doenças da Medula Espinal/cirurgia , Cirurgia Assistida por Computador , Vértebras Torácicas/cirurgia
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