Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Competence of Senior Otolaryngology Residents with the Bedside Head Impulse Test-Has There Been Improvement After 5 Years of Competency By Design?","authors":"Danny A Lelli, Ryan Rourke, Darren Tse","doi":"10.1177/19160216241288817","DOIUrl":"10.1177/19160216241288817","url":null,"abstract":"<p><strong>Background: </strong>The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex. It is a critical component of the bedside assessment of dizzy patients and helps differentiate acute stroke from vestibular neuritis. A previous study on senior Otolaryngology residents showed poor competence in performing and interpreting the bHIT and called for specific evaluations in the Competency By Design (CBD) curriculum to remedy this. This study aimed to assess whether those competencies have improved after full implementation of CBD in residency programs.</p><p><strong>Methods: </strong>Thirty post-graduate year 4 Otolaryngology residents in Canada were evaluated on the use of the bHIT using a written multiple-choice question (MCQ) examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of bHIT performance were completed by 2 expert examiners (DT, DL) using the Ottawa Clinic Assessment Tool.</p><p><strong>Results: </strong>Only 6.7% (rater DT) and 20% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was moderate (0.55, intraclass correlation). Mean scores were 70% (13.4% standard deviation) for video interpretation and 59% (20.6% standard deviation) for multiple-choice questions. Video interpretation scores did not correlate with bHIT ratings (Pearson <i>r</i> = 0.11), but MCQs and bHIT ratings did correlate moderately (Pearson r = 0.52).Comparing to the prior study, residents performed worse on the bHIT (3.14 average score vs 3.64, <i>P</i> < .01) and fewer residents performed the bHIT independently (6.7% vs 22%-rater DT, 20% vs 39%-rater DL). Residents also performed worse on MCQs (58.7% vs 70.9%, P = 0.038), though similarly on video interpretation (70% vs 65%, <i>P</i> = .198).</p><p><strong>Conclusion: </strong>Fourth year OTL-HNS residents in Canada are not competent in performing the bHIT. These findings have implications for refining competency-based curricula in the evaluation of critical physical exam skills.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241288817"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatments of Pediatric Bilateral Vocal Fold Paralysis: A Systematic Review.","authors":"Noémie Nemry, Jérôme R Lechien","doi":"10.1177/19160216241291807","DOIUrl":"10.1177/19160216241291807","url":null,"abstract":"<p><strong>Objective: </strong>To review the current literature about surgical treatments of pediatric bilateral vocal fold paralysis (PBVFP).</p><p><strong>Methods: </strong>A systematic review of the current literature in PubMed, Scopus, and Cochrane Library regarding etiologies and management of PBVFP was performed until November 2023 according to PRISMA statements. Quality assessment was assessed with Methodological Index for Non-Randomized Studies (MINORS) tool.</p><p><strong>Results: </strong>Of the 211 screened articles, 26 were included accounting for 320 patients. The etiologies included idiopathic (42.2%), congenital (19.7%), neurological (16.9%), or post-surgical (9.5%) pediatric bilateral vocal cord paralysis (PBVCP). Patients were decannulated in 76.7% of cases without laryngeal procedure. Decannulation was achieved in 84.6%, 66.6%, 83.3%, 80.0%, and 62.5% of cases of laterofixation of the vocal fold, cricoid split approaches, partial or total arytenoidectomy, uni- or bilateral transverse cordotomy, and selective laryngeal reinnervation, respectively. Dyspnea/stridor relief, swallowing, or voice quality outcomes were used in some studies, which reported conflicting results. Revision and complications varied between studies, with complications mainly involving edema, granuloma, or aspirations. Revision was required in 6.4%, 12.9%, and 40.0% of cases that underwent laterofixation of the vocal fold, arytenoidectomy, and cricoid split procedures, respectively. There was substantial heterogeneity across studies in inclusion criteria, procedures, and outcomes.</p><p><strong>Conclusion: </strong>The management of PBVFP may involve several temporary or permanent surgical procedures that are associated with overall subjective improvements of symptoms, and laryngeal findings. The retrospective design of studies, the small number of cohorts, the lack of objective outcomes, and the differences between teams regarding procedure timing and features limit drawing reliable conclusions about the superiority of one technique over others.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241291807"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11489911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The First 100 Children Treated in a Newly Established Pediatric Vertigo Center.","authors":"Mohammed K Alnoury, Samer Salameh, Aleksandra Ostrovska, Joshua Gurberg","doi":"10.1177/19160216241265685","DOIUrl":"10.1177/19160216241265685","url":null,"abstract":"<p><strong>Background: </strong>Correctly diagnosing dizziness in children is essential for appropriate management; nevertheless, healthcare professionals face challenges due to children's limited ability to describe their symptoms and their cooperation during physical examination. The objective of this study is to describe the first 100 patients seen at a newly established pediatric vertigo center.</p><p><strong>Methods: </strong>This is a retrospective review of a consecutive series of 100 patients seen at our pediatric vertigo clinic in a tertiary referral center from August 2019 until June 2022. Comprehensive clinical data were collected. The diagnoses were established by 2 pediatric otolaryngologists based on validated diagnostic criteria. Trends in diagnosis, investigation, and treatment of these patients were analyzed.</p><p><strong>Results: </strong>A total of 100 children were included in the study. Vestibular migraine was the most common diagnosis (20%) followed by benign paroxysmal vertigo of childhood (14%). Eleven patients had combined pathologies. Fifteen out of 70 children (21%) had abnormal audiograms, 30 out of 48 children (62.5%) had abnormal vestibular testing, and 6 out of 31 (19%) patients had abnormal imaging. Fifty-one children received medical treatment, 23 received vestibular physiotherapy, and 9 patients had particle repositioning maneuvers; moreover, 17 of these patients received multimodal treatment.</p><p><strong>Conclusions: </strong>Our analysis suggests that imaging and audiology testing have relatively low yield in the assessment of pediatric vertigo. On the other hand, vestibular testing detected a high proportion of abnormalities, such as saccadic pursuit, vertical nystagmus, central positional nystagmus, and abnormal directional preponderance, particularly associated with vestibular migraine. Given the complexity of diagnosing vertigo in children, it is critical to establish multidisciplinary specialized centers capable of providing accurate diagnosis and treatment for these children.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241265685"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11311155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of Cisplatin Chemoradiation-Induced Ototoxicity in HPV-Positive Oropharyngeal Squamous Cell Carcinoma: A Case-Control Study.","authors":"John Jw Lee, Salahaldin Alamleh, Luna Jia Zhan, Katrina Hueniken, Mary B Mahler, Astrid Billfalk-Kelly, Joel Davies, M Catherine Brown, Anna Spreafico, Shao Hui Huang, Andrew Hope, Wei Xu, David P Goldstein, Geoffrey Liu","doi":"10.1177/19160216241248671","DOIUrl":"10.1177/19160216241248671","url":null,"abstract":"<p><strong>Background: </strong>Cisplatin-based chemoradiation is a standard treatment for many patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), an etiologically distinct subset of head and neck cancer. Although associated with good long-term survival, clinical risk factors for ototoxicity have been understudied in this population. This study aimed to evaluate clinical predictors associated with ototoxicity in HPV-positive OPSCC patients treated with cisplatin chemoradiation.</p><p><strong>Methods: </strong>This retrospective case-control study included 201 adult patients (>18 years) with histologically confirmed HPV-positive OPSCC who received cisplatin chemoradiation as their primary treatment from 2001 and 2019 at a single tertiary cancer center. Ototoxicity was determined using baseline and follow-up audiometry and the Common Terminology Criteria for Adverse Events v5.0 grading criteria (Grade ≥2). Multivariable logistic regression [adjusted odds ratio (aOR)] identified significant predictors that increased the odds of ototoxicity.</p><p><strong>Results: </strong>A total of 201 patients [165 males; median (IQR) age, 57 (11) years] were included in the study. The incidence of ototoxicity in the worst ear was 56.2%, with the greatest hearing loss occurring at high frequencies (4-8 kHz), resulting in a loss of 12.5 dB at 4 to 6 kHz and 20 dB at 6 to 8 kHz. High-dose cisplatin administration compared to weekly administration [aOR 4.93 (95% CI: 1.84-14.99), <i>P</i> = .003], a higher mean cochlear radiation dose [aOR 1.58 (95% CI: 1.12-2.30), <i>P</i> = .01], smoking history [aOR 2.89 (95% CI: 1.51-5.63), <i>P</i> = .001], and a 10 year increase in age [aOR 2.07 (95% CI: 1.25-3.52), <i>P</i> = .006] were each independently associated with increased odds of ototoxicity.</p><p><strong>Conclusions: </strong>Clinical predictors of ototoxicity in HPV-positive OPSCC patients treated with cisplatin-based chemoradiation include the use of a high-dose cisplatin regimen, higher cochlear radiation doses, a history of smoking, and older age. With the rising incidence of this malignancy in Western countries and overall improved survivorship, our research motivates future studies into risk stratification and earlier interventions to mitigate and reduce the risk of ototoxicity.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241248671"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free Flap Perfusion in Microvascular Head and Neck Reconstruction: Influence of the Number of Ischemia Intervals and Ischemia Duration-A Retrospective Study.","authors":"Mark Ooms, Philipp Winnand, Marius Heitzer, Florian Peters, Marie Sophie Katz, Johannes Bickenbach, Frank Hölzle, Ali Modabber","doi":"10.1177/19160216241265089","DOIUrl":"10.1177/19160216241265089","url":null,"abstract":"<p><strong>Background: </strong>In microvascular head and neck reconstruction, ischemia of the free flap tissue is inevitable during microsurgical anastomosis and may affect microvascular free flap perfusion, which is a prerequisite for flap viability and a parameter commonly used for flap monitoring. The aim of this study was to investigate the influence of the number of ischemia intervals and ischemia duration on flap perfusion.</p><p><strong>Methods: </strong>Intraoperative and postoperative flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation at 2 and 8 mm tissue depths, as measured with the O2C tissue oxygen analysis system, were retrospectively analyzed for 330 patients who underwent microvascular head and neck reconstruction between 2011 and 2020. Perfusion values were compared between patients without (control patients) and with a second ischemia interval (early or late) and examined with regard to ischemia duration.</p><p><strong>Results: </strong>Intraoperative and postoperative flap blood flow at 8 mm tissue depth were lower in patients with early second ischemia intervals than in control patients [102.0 arbitrary units (AU) vs 122.0 AU, <i>P</i> = .030; 107.0 AU vs 128.0 AU, <i>P</i> = .023]. Both differences persisted in multivariable analysis. Intraoperative and postoperative flap blood flow at 8 mm tissue depth correlated weakly negatively with ischemia duration in control patients (<i>r</i> = -.145, <i>P</i> = .020; <i>r</i> = -.124, <i>P</i> = .048). Both associations did not persist in multivariable analysis.</p><p><strong>Conclusions: </strong>The observed decrease in microvascular flap blood flow after early second ischemia intervals may reflect ischemia-related vascular flap tissue damage and should be considered as a confounding variable in flap perfusion monitoring.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241265089"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Transoral Versus Transcervical Surgical Approaches to Retropharyngeal Lymphadenectomy: A Scoping Review.","authors":"Sharon Tzelnick, Jillian Tsai, Ali Hosni, David P Goldstein, John R de Almeida, Christopher M K L Yao","doi":"10.1177/19160216241265092","DOIUrl":"10.1177/19160216241265092","url":null,"abstract":"<p><strong>Importance: </strong>A gap in knowledge exists concerning the functional outcomes and complications when comparing various surgical approaches for retropharyngeal lymph node (RPLN) metastases.</p><p><strong>Objective: </strong>To explore perioperative outcomes, functional outcomes, and complications associated in the treatment of RPLN metastases.</p><p><strong>Design: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the PubMed and Scopus databases.</p><p><strong>Review methods: </strong>We systematically searched 2 databases from inception to January 2023 for articles examining the treatment approaches and postoperative outcomes in the retropharyngeal space. We included English records about surgical approaches, complications, functional outcomes for patients >18 years old with retropharyngeal lymphadenopathy.</p><p><strong>Results: </strong>One-hundred ninety-nine articles were identified, of which 17 were included in the analysis. Three studies assessed RPLN dissection in the postradiation setting. We identified limited knowledge about functional outcomes and complications following surgery for retropharyngeal lymphadenopathy. Overall, acute postoperative dysphagia was documented in 35/170 patients (20.5%). However, the assessment of dysphagia was limited, and not described in the majority of studies. The overall rate of postoperative neuropathy and hematoma were 4.1% and 4.7%, respectively. No postoperative hematomas were documented in the transcervical approach.</p><p><strong>Conclusion: </strong>Our findings underscore the need for further research on postoperative outcomes following RPLN dissection. We recommend further studies focusing on objective swallow assessments and long-term outcomes of either surgical approaches.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241265092"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of a Non-Surgical Adhesive Bone Conduction Device on Temporal Processing Performance in Adults with Single Sided Deafness: A Pilot Study.","authors":"Li Qi, Elizabeth Hui, Desmond A Nunez","doi":"10.1177/19160216241296136","DOIUrl":"10.1177/19160216241296136","url":null,"abstract":"<p><strong>Background: </strong>There is a dearth of information on the effects of bone conductive devices on temporal processing in individuals with single-sided deafness (SSD). This study investigates the effect of an adhesive bone conductive device on temporal processing in adults with SSD.</p><p><strong>Methods: </strong>A prospective cohort study of temporal processing in adults with SSD was undertaken. Outcome measures were the pitch pattern test (PPT) and the duration pattern test (DPT) scores, sound field pure tone audiometric (PTA) averaged hearing thresholds, and word recognition scores (WRS). These were measured under 3 conditions: unaided in quiet, unaided in noise, and aided in noise. Eight SSD novice hearing amplification users were recruited.</p><p><strong>Results: </strong>The adhesive bone conduction device (BCD) resulted in a statistically-significant improvement (Wilcoxon signed ranks test, <i>P</i> = .018) in median [interquartile range (IQR)] PPT score, 65% (IQR = 35.5), and DPT score, 38% (IQR = 42.5) in noise.</p><p><strong>Conclusions: </strong>Adults with SSD demonstrated improved temporal processing scores with masking of the normal-hearing ear when using an adhesive BCD placed behind the deafened ear.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241296136"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Perceptions of Head and Neck Surgeons on the Role of Single-Entry Models in Managing Surgical Waitlists in Ontario: A Qualitative Study.","authors":"Justin Shapiro, Charlotte Axelrod, Ben B Levy, Saruchi Bandargal, Emily C Steinberg, Emily Wener, John de Almeida, Joel Davies, Brian Rotenberg, Antoine Eskander, Janet Chung, David Urbach, Yvonne Chan","doi":"10.1177/19160216241286793","DOIUrl":"10.1177/19160216241286793","url":null,"abstract":"<p><strong>Background: </strong>Long surgical wait times have long plagued health systems in Canada and abroad. This backlog and associated strain on health human resources has been exacerbated by the COVID-19 pandemic, affecting surgeries of varying degrees of urgency across all surgical specialties, including head and neck surgery. Single-entry models (SEMs) are being increasingly studied as one possible strategy to help manage surgical wait times, and a growing number of health systems have implemented SEMs within departments such as otolaryngology-head and neck surgery. We sought to evaluate the views of head and neck surgeons at all 8 designated head and neck cancer centers across Ontario on the role of SEMs in managing surgical backlogs.</p><p><strong>Results: </strong>We interviewed 10 Ontario head and neck surgeons on the role of SEMs in managing wait times within the field. The following themes were elicited from interview transcripts: (1) anticipated positive impact, (2) barriers to implementation, (3) patient experience, and (4) roadmap to implementation. Participants agreed that SEMs may have utility for certain types of surgeries if implemented to address local needs. They also believe this model would have the greatest impact if employed together with other approaches, such as increasing operating room time or nursing availability.</p><p><strong>Conclusion: </strong>Our results highlighted the necessity for a nuanced approach to single-entry model implementation in head and neck surgery. While participants recognized the utility of SEMs for high-volume and low-variation surgeries, participants remained divided on the optimal approach to triaging patients necessitating more complex oncologic treatments. Deliberate collaboration among stakeholder organizations and senior surgeons will be critical if SEMs are to succeed in an intricate and political healthcare environment.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241286793"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety of the Laryngeal Mask Airway in Adenotonsillectomy: A Systematic Review and Meta-Analysis.","authors":"Sami Khoury, Dorsa Zabihi-Pour, Jacob Davidson, Raju Poolacherla, Gopakumar Nair, Abhijit Biswas, Peng You, Julie E Strychowsky","doi":"10.1177/19160216241263851","DOIUrl":"10.1177/19160216241263851","url":null,"abstract":"<p><strong>Background: </strong>Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy.</p><p><strong>Method: </strong>Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed.</p><p><strong>Results: </strong>Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67).</p><p><strong>Conclusion: </strong>For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241263851"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologics in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis in Canada: Current Trends and Practice Patterns.","authors":"Alexie J Ouellette, Andrew Thamboo, Leigh J Sowerby, Christopher J Chin","doi":"10.1177/19160216241307551","DOIUrl":"10.1177/19160216241307551","url":null,"abstract":"<p><strong>Objectives: </strong>As the understanding of the pathophysiology of chronic rhinosinusitis has increased over the last few years, it has been discovered that biologic therapy targeting type 2 inflammatory molecules can be beneficial for those with difficult-to-treat chronic rhinosinusitis with nasal polyposis. Given the recency of biologics, there is somewhat limited evidence on when to prescribe these medications and who should receive them. A recent consensus paper published by a group of Canadian rhinologists gave recommendations regarding prescribing biologics to patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This study aimed to outline current practices and prescribing patterns of biologics for chronic rhinosinusitis in Canada and contrast this to existing guidelines.</p><p><strong>Materials/methods: </strong>An online survey was distributed to members of the Canadian Rhinology Group of the Canadian Society of Otolaryngology-Head and Neck Surgery. The survey contained 44 questions, with 17 questions covering various topics related to criteria for initializing biologic therapy, investigations ordered prior to initialization of a biologic, and follow-up schedules. The responses were subsequently compared to clinical guidelines.</p><p><strong>Results: </strong>Twenty-one physicians responded to the survey. One response was discarded for this analysis as the respondent did not prescribe biologics. The biologic agent of choice for the majority of physicians (85%) was Dupilumab (Dupixent). The most used patient-reported outcome measure used was the SNOT-22 (80%), and most physicians (90%) confirm that their patients have undergone adequate sinus surgery with a computed tomography (CT) scan prior to considering biologic therapy. Investigations ordered prior to therapy and follow-up schedules varied. Only 10% of respondents consistently refer their patients to a multidisciplinary clinic prior to prescribing biologics despite recommendations in guidelines, but 70% involve an allergist and/or a respirologist in the care of these patients.</p><p><strong>Conclusions: </strong>Most respondents follow the recommendations made by the Canadian and international guidelines [European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)]. The lack of multidisciplinary clinics across the country could be contributing to the low number of physicians using this resource for their patients despite recommendations. As our knowledge about biologics and CRSwNP improves, and with updated guidelines recently published, this survey should be expanded and repeated in the future to revaluate biologic prescribing practices in Canada.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241307551"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}