European Archives of Oto Rhino Laryngology 2020-12-01

Author’s reply: Laryngopharyngeal reflux as a potential cause of persistent local neck symptoms after total thyroidectomy

C Cipolla,E Fiorentino

Publicatie 01-12-2020


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Correction to: Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborative study

I Dallan,C Cambi,E Emanuelli,D Cazzador,FR Canevari,D Borsetto,JR Tysome,NP Donnelly,M Rigante,C Georgalas,I Alobid,G Molteni,D Marchioni,AK Shahzada,M Scarano,V Seccia,E Pasquini

Publicatie 01-12-2020


In the original publication of the article, the following affiliation “Medical school, University of Nicosia, Nicosia, Cyprus” of the author “Christos Georgalas” was missed and included in this correction.

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Correction to: Total thyroidectomy with therapeutic level II–IV neck dissection for papillary thyroid carcinoma: level VI recurrence patterns

NN Carmel-Neiderman,I Duek,D Amsterdam,A Wengier,B Kuzmenko,B Ringel,A Warshavsky,U Shapira,G Horowitz,E Izkhakov,DM Fliss

Publicatie 01-12-2020


The original article can be found online.

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Author’s Reply to Letters to the Editor: “A comparison of endoscopic transtympanic myringoplasty and endoscopic type I tympanoplasty for repairing medium- to large-sized tympanic membrane perforation: a randomized clinical trial”

V Atchariyasathian,R Suwannajak,Y Plodpai,P Pitathawatchai

Publicatie 01-12-2020


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Two-drape closed pocket technique: minimizing aerosolization in mastoid exploration\xa0during COVID-19 pandemic

A Das,S Mitra,S Kumar,A Sengupta

Publicatie 01-12-2020


Abstract Background Mastoidectomy is associated with extensive bone-drilling which makes it a major aerosol generating procedure. Considering the ongoing COVID-19 global pandemic, it is essential to devise methods to minimize aerosolization and hence ensure safety of the healthcare workers during the operative procedure. Methods Two disposable surgical drapes are used to create a closed pocket prior to commencement of mastoid bone-drilling. This limits aerosolization of bone-dust in the external operating theatre environment. Conclusion Two-drape closed pocket technique is an easy, cost-effective and safe method to limit aerosolization of tissue particles during mastoidectomy.

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Pharyngo-esophageal complications of Ryle tube insertion in neonates: management and fate

AM Refaat,MN Kotby

Publicatie 01-12-2020


Abstract Introduction The following provides clinical reporting of seven neonates with iatrogenic pharyngeal trauma due to forceful untrained use of nasogastric feeding tube. A range of symptoms were observed beginning with excessive frothy secretions culminating in more severe pneumothorax in some. These cases are presented in the context of an exhaustive literature review producing only 50 similar cases worldwide. Special attention is paid toward accurate diagnosis, prognosis, and guidance on most effective modes of treatment. Patients and Methods Using Medtronic flexible nasopharyngolaryngeal endoscope, examination of the presented neonates was done in the neonatal care unit. Some neonates underwent videofluroscopic study. Conclusion Ryle tube insertion in neonates could result in range of complications that could be easily avoided and managed.

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Endoscopic transtympanic myringoplasty should be cautious for repairing large perforation

Z Lou

Publicatie 01-12-2020


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Laryngopharyngeal reflux after thyroidectomy

JR Lechien,M Verhasselt,D Dequanter,A Rodriguez,S Saussez

Publicatie 01-12-2020


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Author’s response to the letter of the editor regarding the “Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors”

G Psychogios,C Bohr,J Constantinidis,M Canis,V Vander Poorten,J Plzak,A Knopf,C Betz,O Guntinas-Lichius,J Zenk

Publicatie 01-12-2020


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Change in Warthin’s tumor incidence: a 20-year joinpoint trend analysis

O Tunç,B Gönüldaş,Y Arslanhan,M Kanlıkama

Publicatie 01-12-2020


Abstract Purpose The incidence of Warthin’s tumor (WT) has increased worldwide. In this study, we aimed to evaluate the incidence of WT in our hospital, which provides health care for an extremely large population. Methods We retrospectively evaluated 573 patients, comprising 345 males and 228 females, who all experienced parotid tumor for the past 20 years. Patients with WT that were operated in the last 20 years were evaluated according to the number of patients per year to determine the annual WT increase trend. Results In the distribution of WT over the years of surgery, the ratio of WT to all tumors irregularly changed. Furthermore, the total number of parotidectomies per year increased in time. We investigated whether WT had any increasing trend over the years. The annual percentage change (APC) of WT was calculated, and according to the segmented regression analysis, the APC was insignificant (APC = 4.3, 95% CI = − 3.6–12.9, P = 0.300). Conclusion The incidence of WT has increased across the world. However, in our study, no significant APC was observed according to the segmented regression analysis.

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Changes in the use of Otorhinolaryngology Emergency Department during the COVID-19 pandemic: report from Lombardy, Italy

F Elli,M Turri-Zanoni,AD Arosio,A Karligkiotis,P Battaglia,P Castelnuovo

Publicatie 01-12-2020


Abstract Purpose This paper aims to report the impact of COVID-19 outbreak on Emergency Ear nose and Throat (ENT) activity, in Lombardy (Italy), during COVID-19 pandemic. Methods The number of accesses to Emergency Department requiring ENT consultations between February 21st and May 7th, 2020, was retrospectively collected, along with the conditions treated. Data were stratified in 1-week time spans, to evaluate the evolving trends during the on-going epidemic and a comparison with the two previous years was performed. Results A significant reduction in the number of consultations performed during the pandemic was observed, as high as − 91% compared to the same period of 2018. Conclusion Multiple reasons can explain such a reduction of Emergency ENT consultations, not least the fear of potentially being infected by SARS-CoV-2 by while accessing the hospital. The analysis performed might be useful as a starting point for a future reorganization of first aid consultations once the epidemic will be resolved.

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Regarding the “Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors”

D Tretiakow,A Skorek

Publicatie 01-12-2020


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A model to predict postoperative complications for otorhinolaryngology and maxillofacial surgery procedures in elderly patients

LG Locatello,LV Comini,A Bettiol,A Vannacci,G Spinelli,G Mannelli

Publicatie 01-12-2020


Abstract Purpose All kinds of ear, nose, and throat and maxillofacial surgery (ENT/MFS) procedures are being increasingly performed in the elderly although old age is a major risk factor for increased postoperative complications. With only scarce evidence on the topic, surgeons are asked to critically evaluate their procedures’ indications and outcomes to balance the treatment risks and benefits. Our primary aim was to identify predictive factors for surgical outcomes in this setting and to create a predictive model for a tailored risk assessment. Methods We analyzed a case series of 435 patients from an institutional clinical database at our academic tertiary care center. Multivariate logistic regression was used to identify all possible covariates and nomograms using stepwise backward method were generated. The performance was assessed by calibration curves and c-index. Results Overall complication rate was 18.3% within the first 30 days and the need for re-intervention was 5.9%. For those under general anesthesia, we identified specific risk factors and developed three risk-predicting models of overall, early, and late complications. All of the nomograms showed satisfactory accuracy with a c-index of 0.83, 0.75, 0.86, and 0.82, respectively. Conclusion Using clinical preoperative variables, we constructed a model for predicting major adverse events in ENT/MFS patients. In our experience, patients over 65 showed a non-negligible risk for postoperative complications depending on several factors. Such tools might help in decision-making, by increasing the risk-awareness of clinicians, to better address peri-operative and post-operative care of these patients.

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Surgical options in suprastomal collapse-induced severe airway obstruction

SS Onder,A Ishii,K Sandu

Publicatie 01-12-2020


Abstract Purpose A single institutions experience with various surgical options in the treatment of severe suprastomal collapse (SSC). Methods The study included 18 tracheostomized children with SSC treated between January 2012 and December 2018. Data included: patient demography, initial airway lesions, comorbidities, indication and age at tracheostomy, prior airway surgery, stomal demography, type of surgery, postoperative management, complications and treatment outcomes. Results Four techniques were used to correct SSC. The surgical choice was dependent on stoma demography and associated airway lesions. Excision was done in eight patients and rib cartilage augmentation in five. Three patients had single stage tracheal resection and anastomosis. Two patients received stomal rigidification and temporary placement of Montgomery T tube. Three patients with anterior rib graft augmentation required additional lateral tracheal wall rigidification. Three patients (two with cartilage augmentation, and one with stomal rigidification) developed minimal granulation tissue in the postoperative period. Complete SSC resolution was seen in all except two patients who had a partial response to the treatment. All patients were successful decannulated and are currently asymptomatic. Conclusion Decannulation failures may be due to severe suprastomal collapse that could be either unique or associated with obstructing laryngotracheal lesions. Therefore, it is essential to select the most appropriate surgical treatment to obtain overall favorable outcomes.

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Nasal versus oronasal mask in patients under auto-adjusting continuous positive airway pressure titration: a real-life study

RLM Duarte,BA Mendes,TS Oliveira-E-Sá,FJ Magalhães-da-Silveira,D Gozal

Publicatie 01-12-2020


Abstract Purpose Mask type (nasal versus oronasal) can affect the optimal pressure required to correct the apnea/hypopnea index (AHI) in obstructive sleep apnea (OSA) subjects treated with CPAP. Our objective was to evaluate if mask type influenced CPAP titration outcomes in OSA patients. Methods A retrospective study of individuals with a baseline AHI ≥ 15.0/h, who received an auto-adjusting CPAP titrating device (S9 AutoSet ResMed®) in a sleep-lab setting. The mask type oronasal (OM) or nasal (NM) was always selected by the patients. Optimal pressure requirements, leak, and residual AHI were compared based on mask type. Results Overall, 436 patients were included: 283 with NM (64.9%) and 153 with OM (35.1%). At baseline, NM and OM cohorts had similar AHI (p = 0.160). Patients allocated to the OM cohort had a higher 95th percentile pressure, a higher 95th percentile leak, and a higher residual AHI than those with a NM: pressure requirement: 12.9 cm H2O (IQR: 10.6–15.0) versus 10.7 cm H2O (IQR: 9.2–12.3); leak: 21.6 L/min (IQR: 9.6–37.2) versus 9.6 L/min (IQR: 3.6–19.2); and residual AHI: 4.9/h (IQR: 2.4–10.2) versus 2.2/h (IQR: 1.0–4.4), respectively (p < 0.001 for all). Conclusions CPAP mask type based on individual preferences exerts profound effects on optimal CPAP pressures and efficacy. Patients titrated with OM showed higher pressure requirements, had higher a leak, and higher residual AHI when compared to NM, which may adversely impact treatment adherence and other health outcomes.

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Strategies to overcome limitations in Otolaryngology residency training during the COVID-19 pandemic

F Bandi,A Karligkiotis,J Mellia,S Gallo,M Turri-Zanoni,P Battaglia,P Castelnuovo

Publicatie 01-12-2020


Abstract Purpose The COVID-19 pandemic has produced an unequaled human crisis forcing a radical reorganization in the healthcare system. Otolaryngologists are at high risk of exposure, and changes in medical and surgical activities have reduced the learning opportunity for residents and fellows. We believe that even during COVID-19 crisis it is mandatory to guarantee an optimal training, and here, we propose some strategies, based on our experience, to further increase our trainees’ learning curve. Methods We asked our trainees to fill out an electronic survey about several aspect of their training: a first section focused on the reduction of clinical activities and the perceived impact of the pandemic on residents’ skills; the second part outlined the type of attended training activity and the perceived benefit. Results Surgical training has been reported by our residents as the activity perceived to be the most contracted during the pandemic. According to residents’ opinion the most useful activities were dissection (n = 8, 53.4% residents) and online journal clubs/webinars (n = 7, 46.6% of residents). Residents’ suggestions included actively participating to tracheostomy procedures on SARS-CoV-2 positive patients, attending lessons held by senior consultants on basic ENT topics and promoting collegial discussion of inpatient clinical cases. Conclusion Building on this dramatic experience, we must be ready for a global restructuring of the residency program to provide an adequate trainee education for the future surgeons.

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Examination of the possible relation of the superior semicircular canal morphology with the roof thickness of the glenoid fossa and bone changes of the temporomandibular joint

G Akay,MS Karataş,Ö Karadağ,CÖ Üçok,K Güngör

Publicatie 01-12-2020


Abstract Purpose This study sought to assess the relationships between a morphological characteristic of the superior semicircular canal (SSC) and both the roof thickness of the glenoid fossa (GF) and bone changes of the temporomandibular joint (TMJ) on three-dimensional images. Methods Cone-beam computed tomography (CBCT) images of 200 individuals (105 females and 95 males; 400 temporal bone regions) were examined by two different observers. The correlations between the bone thickness overlying the SSC and the thickness of the roof of the GF with TMJ’s bone pathologies were analyzed. Results The superior semicircular canal dehiscence (SSCD) was significantly associated with dehiscence of the roof of the GF. The relationship between the dehiscence of the SSC and the roof thickness of the GF was found to be strongly correlated (p < 0.05). There were no statistically significant differences between the bone changes of TMJ and the presence or absence of the SSCD. Conclusions A correlation between the bone thickness overlying the SSC and the roof thickness of the GF was found. However, there was no relationship between the bone thickness overlying the SSC and bone changes of TMJ.

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The effect of partial and total laryngectomy on couples’ sexual functions in men with larynx cancer

H Gür,S Çayan,E Akbay,EK Dölek,C Özcan,K Görür

Publicatie 01-12-2020


Abstract Purpose To investigate effect of total or partial laryngectomies with or without adjuvant treatments on couples’ sexual functions. Methods The study included 39 male patients with laryngeal cancer and their female partners who were sexually active. Twenty-six patients underwent total laryngectomy, and 13 had partial laryngectomy. Sexual functions were assessed with the International Index of Erectile Function (IIEF-5) questionnaire for erectile functions, the Male Sexual Health Questionnaire (MSHQ-4) for ejaculatory functions and the Female Sexual Function Index (FSFI) for female partners’ sexual functions. Results The mean IIEF score significantly decreased from 21.51 ± 8.78 to 16.13 ± 9.6 after the surgery (p = 0.000). The mean MSHQ score significantly decreased from 12.95 ± 3.14 to 10.32 ± 4.59 after the surgery (p = 0.000). To investigate risk factors that might predict decreasing in post-operative erectile and ejaculatory function of the male patients, presence of pre-operative erectile dysfunction (p = 0.04) and additional treatment with chemo-radiation therapy were the predictors for decreases in erectile (p = 0.006) and ejaculatory functions (p = 0.036). The mean FSFI total score significantly decreased from 25.83 ± 7.42 to 13.45 ± 10.09 after the surgery (p = 0.000). Conclusion Laryngectomies have negative impact on male erectile and ejaculatory functions, and also have negative effect on female partners’ sexual functions. Presence of pre-operative erectile dysfunction and additional chemo-radiation therapy were the predictors to decrease in erectile and ejaculatory functions after surgery. Therefore, male patients and their female partners should be informed in light of these findings before laryngeal surgery and adjuvant therapy.

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Evaluation of percutaneous dilatational tracheostomy under laryngosuspension

M Moulin,MP Aboussouan,PF Castellanos,I Atallah

Publicatie 01-12-2020


Abstract Purpose To describe the technique and outcomes of percutaneous tracheostomy under laryngosuspension. Methods A consecutive series of patients who underwent percutaneous tracheostomy under laryngosuspension were reviewed for outcomes. The procedure is performed under general anesthesia and laryngosuspension. An 8.5 oral endotracheal tube is inserted and the cuff is inflated in the supraglottis, allowing access to the whole trachea and subglottis. The tube is taped to the laryngoscope. A rigid endoscope is inserted in the endotracheal tube through a swivel connector connected to the tube and the ventilation circuit. Percutaneous tracheostomy kit is used to perform dilatational tracheostomy at the desired level of the trachea under direct visual endoscopic control. Results Forty-eight patients underwent percutaneous tracheostomy under laryngosuspension. Thirty-two cases were performed in an emergency after securing the airway with endotracheal intubation. In all other cases, tracheostomy was performed as a part of an elective procedure affecting the airway or in patients requiring prolonged ventilation. More than half of patients were considered high risk by virtue of one or more of the following: morbid obesity, prior neck surgery, prior neck radiotherapy, progressive head and neck cancer, or laryngotracheal stenosis. Complications occurred in seven cases. Conclusion Percutaneous tracheostomy under laryngosuspension has the advantage of optimal control of patient ventilation and hemostasis throughout the procedure. High-quality endoscopic vision and easy access to the airway under laryngosuspension allow tracheostomy to be performed with maximum safety.

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In-office endoscopic nasal polypectomy: prospective analysis of patient tolerability and efficacy

J Viera-Artiles,P Corriols-Noval,E López-Simón,R González-Aguado,D Lobo,R Megía

Publicatie 01-12-2020


Abstract Purpose In-office rhinologic procedures have become popularised in the last decade, especially in North America. Endoscopic nasal polypectomy under local anaesthesia offers instant relief in selected patients with obstructive chronic rhinosinusitis with nasal polyps. We aimed to analyse patient tolerability during the procedure while measuring its effectiveness. Methods A prospective study of patients who underwent in-office microdebrider-assisted polypectomy under local anaesthetic from September 2018 to November 2019 in a Spanish tertiary hospital was performed. The tolerability was measured by monitoring vital signs during the procedure and using a visual analogue scale posteriorly. The effectiveness was calculated through patient-reported outcomes (SNOT-22) and endoscopic evaluation 1 and 6 months follow-up. Results Forty-four patients were included, with a mean age of 60.7 years. The mean visual analogue scale score was 2.76 out of 10 points. Vital signs were steady overall, with a statistically significant reduction (p < 0.001) in systolic pressure during the procedure. Presyncope and epistaxis were among the few mild complications. However, we registered one major complication that required intensive care admission. There was a 64% reduction in the SNOT-22 score in the first month, with a maintained effect after 6 months. Patients with asthma and a higher polyp load were the subgroups that required more time to achieve significant improvement. Conclusions In-office polypectomy is a very effective technique that alleviates obstructive symptoms in patients with nasal polyposis, and it is generally safe and well tolerated when performed by an expert. However, rhinologists must be aware of potentially severe complications.

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