Australian Journal of Otolaryngology最新文献

{"title":"Partial laryngeal atresia in patients with 22q11 deletion syndrome: findings and surgical outcomes","authors":"Alessandra Locatelli Smith, H. Herbert, T. Uwiera, S. Vijayasekaran","doi":"10.21037/ajo-20-81","DOIUrl":"https://doi.org/10.21037/ajo-20-81","url":null,"abstract":"Background: 22q11.2 deletion syndrome (22q11.2DS) is a chromosomal disorder with a multisystem set of symptoms varying in clinical expression. Patients are at increased risk of airway anomalies, being partial laryngeal atresia (PLA) one of the most common. Surgical management of the airway secondary to PLA varies according to the severity of the airway obstruction and comorbidities. This analysis aimed to assess these findings and surgical outcomes of patients with a 22q11.2DS who presented with PLA. Methods: Retrospective review of patients with 22q11.2 DS with a diagnosis of PLA between 2009 and 2020. The patient’s age, symptoms, associated clinical anomalies, microlaryngoscopy and bronchoscopy (MLB) findings, Cohen’s laryngeal atresia classification, surgical technique and the need for tracheostomy, and degree of dysphagia, were evaluated. Results: Ten patients aged between 4 days and 17 months were identified, 8 underwent surgery to treat atresia. The main presenting symptoms were stridor (75%), dysphonia (62%), and dysphagia (85%). Clinical comorbidities were cardiac pathology (75%), craniofacial anomalies (50%), global development delay (62.5%), palate defects (75%), and immunodeficiency (50%). Classification: 33% Cohen type I, 11% type II and 56% type III. Three had synchronous airway anomalies. Surgical procedures included endoscopic web division (n=3), laryngotracheal reconstruction (LTR) with anterior cartilage graft (n=4), and slide thyro-crico-tracheoplasty (n=1). Three patients required a peri-operative tracheostomy. At the last MLB, all patients were sized with an age-appropriate airway and were free of tracheostomy. Conclusions: Laryngeal atresia is a common abnormality in 22q11.2DS and a careful endoscopic airway evaluation should be mandatory in case of stridor. Dysphonia and dysphagia are common in this group. While children with mild laryngeal obstruction are successfully treated with an endoscopic procedure, patients with severe obstruction will require open airway reconstruction. LTR should be considered at a young age among these patients to avoid long term tracheostomy complications.","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115899836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inverted papilloma of the temporal bone: recent experience and a systematic review of management","authors":"T. McLean, Kaman Dhillon, B. Lyons, R. Briggs","doi":"10.21037/AJO-20-74","DOIUrl":"https://doi.org/10.21037/AJO-20-74","url":null,"abstract":"Background: Inverted papilloma (IP) is an uncommon tumour that usually arises in the sinonasal cavity, however rarely it may involve the temporal bone. Its scarcity has meant there is a limited understanding of this disease and an ill-defined approach to management. Methods: An institutional experience with two cases of this rare condition is presented followed by a systematic review of the literature regarding management of IP of the temporal bone (IPTB). A review of the literature was performed for IPTB with collation and analysis of clinical, pathologic, and treatment outcomes. Results: Fifty suitable studies were identified, containing a total of 57 cases, including the two cases presented in this review, of IPTB for analysis. The mean age at presentation was 53.4 years (SD: ±16.3) and the male to female ratio was 1:0.9. Dysplasia or malignancy was seen in 42.1% of cases, and human papilloma virus (HPV) positivity in 43.4% of cases tested. 94.7% of cases were treated by various surgical approaches, with radiation or chemotherapy or both being used in 26.3% of cases. Subgroup analysis of primary and secondary IPTB showed differences in clinicopathologic features and treatment outcomes. Discussion: Complete surgical excision is the recommended management, but the ideal approach is yet to be defined. Adjuvant therapy should primarily be considered in the setting of malignant transformation.","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131026902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of a surgical simulation tool for airway graft carving using 3D-printing technology","authors":"Yael D Friedland, Tricia Cheah, D. Zopf, J. Ha","doi":"10.21037/AJO-20-48","DOIUrl":"https://doi.org/10.21037/AJO-20-48","url":null,"abstract":"Practical experience is an important component of surgical training. However, acquiring certain procedural skills can be challenging. This is true for laryngeal and airway reconstruction (1). In addition to complex techniques and unique instrumentation required, the high acuity and low frequency of these surgeries means gaining adequate exposure can be difficult (2). Understandably, the use of simulation models is emerging as an effective tool in surgical education. Simulation allows for trainees to develop skills outside of the operating theatre—providing a safe, low-risk environment (1,3). There have been multiple Original Article","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124106267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tonsillectomy: does proximity from otolaryngology care influence the intra-operative or post-operative plan?","authors":"Rebecca Anning, Daron Cope, Alexander Treble, N. Jefferson","doi":"10.21037/ajo-21-9","DOIUrl":"https://doi.org/10.21037/ajo-21-9","url":null,"abstract":"Background: Tonsillectomy is one of the most common surgical procedures undertaken by Otolaryngologists. In Australia and New Zealand, decisions regarding clinical care may be influenced by the large geographic area serviced. The aim of this research was to identify if proximity from otolaryngology care influences intraoperative or postoperative management in tonsillectomy patients, particularly in regard to disposition. Secondary goals were to highlight trends in surgical demographics, technique and postoperative care. Methods: A 29-item survey examining preferences when performing tonsillectomy was sent to Fellows of the Australian and New Zealand Society of Otolaryngology Head and Neck Surgery (ASOHNS and NZSOHNS). Data was compiled and analysed using Microsoft ExcelTM. Results: A response rate of 33.1% in Australia (n=162/490) and 24.4% in New Zealand was achieved (n=32/131). Of the cohort, 61.7% of Australian and 25.0% of New Zealand surgeons would not offer tonsillectomy to patients if they resided more than 1 hour from an Ear, Nose and Throat (ENT)-serviced hospital and intended to go home on day 1 postoperatively. Australian surgeons were more inclined to counsel patients to remain for 10–14 days than colleagues in New Zealand (52.6% vs. 9.4%). The majority of surgeons did not alter their operative technique (85.0% of Australians and 90.1% of New Zealand Surgeons). Conclusions: Australian surgeons are more likely to counsel patients to remain in close proximity post tonsillectomy. Postoperative proximity to ENT services did not instigate a change in operative technique or analgesic regime for either children or adults. Disparities in preferred surgical technique and analgesia were identified.","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126861121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laryngeal Botox injection in recalcitrant cases of chronic cough","authors":"L. Cook, T. Athanasiadis","doi":"10.21037/AJO-21-1","DOIUrl":"https://doi.org/10.21037/AJO-21-1","url":null,"abstract":"Background: Chronic cough is a common and often diagnostically challenging symptom seen by clinicians across multiple specialties. We aimed to assess the effect of laryngeal botulinum toxin A (Botox) injection for cases of neurogenic cough. Methods: Patients were recruited through a specialist laryngology clinic in Adelaide, Australia. Cases of recalcitrant chronic cough were identified using our Adelaide Protocol and treatment with laryngeal Botox injection was offered to these patients. Validated questionnaires assessing cough severity and quality of life were recorded before and 6 weeks after treatment, which consisted of electromyography (EMG) guided injection of 1.0–2.0 units of Botox bilaterally to the thyroarytenoid muscles. Results: Of 268 patients referred to our chronic cough clinic, 22 were offered laryngeal Botox injection, with 20 proceeding to treatment. 17 were female, with an age median of 62.5 and average symptom duration of 2 years. After treatment with Botox, Cough Severity Scale improved from an average of 7.1 to 2.5, Leicester Cough Questionnaire (LCQ) improved from 10.8 to 14.9 and Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) improved from 9.1 to 14.4. Symptoms resolved after the Botox wore off for 14 of the 20 patients. Complications included minor dysphonia and dysphagia. Conclusions: Our study shows that laryngeal Botox injection is a successful option in the treatment of recalcitrant chronic cough. 8","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121572475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in revision stapes surgery: ionomeric bone cement vs. malleostapedotomy in incus necrosis","authors":"B. McOwan, J. Lim, Wen-Shen Lee, Mark McOwan, Tim Mclean, A. Mitchell-Innes, R. Briggs","doi":"10.21037/AJO-20-83","DOIUrl":"https://doi.org/10.21037/AJO-20-83","url":null,"abstract":"Department of Otolaryngology, Alfred Health, Melbourne, Australia; The Royal Victorian Eye and Ear Hospital, Melbourne, Australia; The University of Melbourne, Melbourne, Australia Contributions: (I) Conception and design: R Briggs, A Mitchell-Innes, B McOwan; (II) Administrative support: R Briggs, A Mitchell-Innes, T McLean; (III) Provision of study materials or patients: R Briggs; (IV) Collection and assembly of data: B McOwan, JWJ Lim; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Dr. Benjamin McOwan. 19 Waterside Close Miners Rest VIC 3352, Melbourne, Australia. Email: mcowanbresearch@gmail.com; Prof. Robert Briggs. Suite 222, 100 Victoria Pde, East Melbourne, VIC 3002, Melbourne, Australia. Email: rjbriggs@melbourne-ear.com.","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122409181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Audiometric assessment in noise-induced hearing loss","authors":"Olivia M. Galioto, Emily Logan Pearse, P. Fagan","doi":"10.21037/ajo-21-32","DOIUrl":"https://doi.org/10.21037/ajo-21-32","url":null,"abstract":"","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116998234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Audiometric hearing results after ossicular chain reconstruction with partial titanium clip prostheses","authors":"N. Reyes-Chicuellar, A. Noor, T. Kertesz","doi":"10.21037/ajo-19-2","DOIUrl":"https://doi.org/10.21037/ajo-19-2","url":null,"abstract":"The prosthesis designed as a partial ossicular replacement prosthesis (PORP) be placed the intact stapes capitulum Design developments led to the newer Clip-Piston Dresden Prosthesis (Clip) which features a spring-loaded fastening mechanism to secure the coupling to a mobile stapes 2). The design is reported to reduce dislocation and extrusion of prosthesis with superior audiological outcomes. The purpose of this study is to compare postoperative audiological outcomes and complications of the Clip prosthesis with the Bell prosthesis. Abstract Objective: This paper reviews the outcomes of partial ossicular chain reconstruction using the Kurz Clip-Piston Dresden prosthesis (Clip) in comparison to the earlier generation Bell prosthesis (Bell). Study design: A retrospective monocentric chart review. Subjects and Methods: All patients undergoing ossicular chain reconstruction between 1 January 2014 and 31 December 2018. Results: The overall PTA improved by 20 dB +/- 0.63 (preop: 52.6 +/- 19, postop: 32.6 +/- 14.8). The overall ABG improvement was 33.9 +/- 11.4 (preop: 13 +/- 7.6, postop: 20.7 +/- 3.8). The overall results of Clip being better (96%) than the results for Bell prosthesis (82%). A successful postoperative ABG of <20 dB was obtained in 91% of the patients (n=39). The Clip prosthesis had a significantly higher success rate of 96% (n=26) in comparison to the Bell prosthesis which was successful in 82% of patients (n=14) (p< 0.001). Results showed a low complication rate. One revision procedure (2.3%) to modify the length was needed with a Clip prosthesis and one revision procedure was required in the Bell group due to extrusion; it was replaced with a Clip prosthesis Conclusion: Clip prosthesis demonstrates promising outcomes partial ossicular chain reconstruction with higher rates of postoperative air-bone Gap reduction and minimal complications.","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122705420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice patterns in myringoplasty surgery among Australian surgeons","authors":"Caitlin Chidlow, Sarah L. Prunty, A. Hinton-Bayre, Soumya Shubhraj, J. Renton, J. Kuthubutheen","doi":"10.21037/ajo-19-5","DOIUrl":"https://doi.org/10.21037/ajo-19-5","url":null,"abstract":"Myringoplasty is a commonly performed procedure in otolaryngology. It is used to treat symptomatic perforations of the tympanic membrane. Despite the prevalence of this procedure, there is a lack of consensus on best practice and significant variation globally. Most of the recent literature relates to outcomes and success rates of myringoplasties rather than the actual practices or variations between surgeons. Several recent articles from Europe and the UK looked specifically at different factors affecting outcomes, but again there was little focus on actual variations in practices (1-3). There is a significant amount of published international data regarding the effectiveness of the different factors such as approach, choice of graft material and length of stay, but a relative paucity on how often particular techniques have been used (4-10). This has the potential to affect uptake of new techniques, and adoption of evidenced based practice. For example, it is unknown if the recent increase in the popularity of endoscopic ear surgery has actually translated to surgical practice. In the 2018–2019 period 1,715 myringoplasties were performed in Australian hospitals (11). Myringoplasty Original Article","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128445143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for dysphagia: a patient centered perspective","authors":"T. Napier, P. Ross, S. Greig, A. Smedley, R. Allison","doi":"10.21037/ajo-19-52","DOIUrl":"https://doi.org/10.21037/ajo-19-52","url":null,"abstract":"Pharyngeal pouch, also known as Zenker’s diverticulum, is an uncommon cause of dysphagia with an estimated incidence of 1:100,000 (1,2). The condition was first described by Ludlow in 1769 and then again in 1877 with a case series of 34 patients by Zenker and his colleague Von Ziemssen (3). Pharyngeal Pouches are an outpouching of mucosa and submucosa through an area of weakness in the posterior pharyngeal wall between the cricopharyngeus muscle and the oblique fibers of the inferior pharyngeal constrictor muscle. There is no clear consensus on the exact pathophysiology underlying this disorder although several hypotheses have been generated (1-8). Historically treatment of a pharyngeal pouch has been via a transcervical cricopharyngeal myotomy and resection or pexy of the diverticulum (3). An endoscopic approach is now the more frequently employed technique, either with the use of an endostapler or with a variety of other endoscopic tools including laser, diathermy or simple sharp division of the common wall of the diverticulum. The open approach is typically reserved for recurrent pouches or those patients who are unsuitable for an endoscopic approach. The rational behind the increased use of the endoscopic approach is shorter operative time, less extensive surgery and shorter hospital stays with similar rates of complications overall (2,4,7,9-12). Much of the research has aimed to delineate operative techniques in terms of feasibility, operative time, length of hospital admission, post-operative complications and rates of recurrence. However, there is a lack of original Original Article","PeriodicalId":165885,"journal":{"name":"Australian Journal of Otolaryngology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115809596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}