American Journal of Otolaryngology最新文献

{"title":"Comprehensive analysis of Burkholderia species head and neck infections: A systematic review","authors":"Douglas P. Nanu ,&nbsp;Alejandro R. Marrero-Gonzalez ,&nbsp;Shaun A. Nguyen ,&nbsp;Jason G. Newman","doi":"10.1016/j.amjoto.2024.104544","DOIUrl":"10.1016/j.amjoto.2024.104544","url":null,"abstract":"<div><h3>Objective</h3><div>To report the first systematic review and meta-analysis of <em>Burkholderia</em> species infections of the head and neck to facilitate understanding of the disease's demographics, mortality rate, comorbidities associated, symptoms, and antibiotic treatments utilized.</div><div>Data Sources.</div><div>COCHRANE Library, CINAHL, PubMed, and Scopus.</div><div>Review Methods.</div><div>A systematic review and meta-analysis were performed using PRISMA reporting guidelines. Inclusion criteria included non-surgical patients who were diagnosed with any head and neck Burkholderia infection. Demographics included, patient age and gender. Symptoms, antibiotics given, bacteriology, comorbidities and mortality were analyzed. Meta-analysis of continuous measures (mean), and proportions (%) with a 95 % confidence interval (CI) was conducted. Studies were accessed for bias via the JBI appraisal tool.</div></div><div><h3>Results</h3><div>There were 740 studies screened with 45 studies (<em>N</em> = 132) being included. In total, 50.1 % were females (95 % CI: 43–57) with a mean patient age of 28.7 years (95 % CI: 25.9 to 31.5). Overall survival rate was 83.4 % (95 % CI: 77.5 to 88.4) and predominant localized symptoms were neck swelling at 38.4 % (95 % CI: 27.5 to 49.9), followed by neck abscess at 34.1 % (27.5 to 41.2) and head and neck suppurative lymphadenitis at 22.9 % (17.3 to 29.4). Main antibiotic treatments included: trimethoprim-sulfamethoxazole at 63.0 % (95 % CI: 55.9 to 69.8), ceftazidime at 47.9 % (40.7 to 55.1), and doxycycline at 26.7 % (10.7 to 33.5).</div></div><div><h3>Conclusion</h3><div><em>Burkholderia</em> infections exhibit diverse symptoms, which pose a challenge in diagnosis. Additionally, prescription of non-guideline antibiotics highlights the initial difficulty in identifying these organisms as the primary culprit of infection causing delayed treatment.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104544"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior nasal nerve surgical neurectomy versus ablation for chronic rhinitis","authors":"Sainiteesh Maddineni,&nbsp;Peter H. Hwang,&nbsp;Zara M. Patel,&nbsp;Jayakar V. Nayak,&nbsp;Michael T. Chang","doi":"10.1016/j.amjoto.2024.104553","DOIUrl":"10.1016/j.amjoto.2024.104553","url":null,"abstract":"<div><h3>Introduction</h3><div>For chronic rhinitis (CR) refractory to medical management, several ablative procedures exist that target the posterior nasal nerve (PNN). Here we compare outcomes of PNN surgical neurectomy to in-office ablative procedures.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with CR who trialed ipratropium at our center from 2013 to 2024 and received PNN ablation (cryoablation or radiofrequency) or neurectomy. We used the SNOT-22 questionnaire to assess outcomes, specifically evaluating the rhinologic subdomain: need to blow nose, sneezing, runny nose, nasal obstruction, loss of smell, cough, post-nasal discharge, and thick nasal discharge.</div></div><div><h3>Results</h3><div>Our cohort consisted of 55 patients, 34 receiving PNN ablation and 26 receiving surgical neurectomy (9 receiving both). Mean follow-up time was 243 ± 353 days. Surgical neurectomy (18.6 ± 5.5 to 14.9 ± 5.9, <em>p</em> = 0.02) were associated with significant SNOT-22 rhinologic domain improvements, and neurectomy was associated with significant rhinorrhea improvement (3.4 ± 1.6 to 2.4 ± 1.7, <em>p</em> = 0.04). Surgical neurectomy was associated with a greater decrease in sneezing (p = 0.04) scores than ablation, although there were no significant differences in total or rhinologic subdomain SNOT-22 scores between ablation and neurectomy. No clear improvements were observed in patients undergoing a neurectomy following ablation. Multivariable logistic regression analysis did not reveal any predictors of post-procedure improvement.</div></div><div><h3>Conclusion</h3><div>Both surgical neurectomy and in-office ablation were associated with improvements in rhinologic symptoms for patients with CR, although neurectomy may have increased benefit for specific symptoms like sneezing. There is limited evidence that secondary procedure after an initial ablation is beneficial.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104553"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of free flap reconstruction for mandibular ORN: Systematic review and meta-analysis","authors":"Soroush Farsi ,&nbsp;Anna Benafield ,&nbsp;Jade Dorman ,&nbsp;James Reed Gardner ,&nbsp;Hayden C. Hairston ,&nbsp;Rohan S. Rereddy ,&nbsp;Hayato Nakanishi ,&nbsp;Deanne King ,&nbsp;Susan C. Steelman ,&nbsp;Emre Vural ,&nbsp;Mauricio A. Moreno ,&nbsp;Jumin Sunde","doi":"10.1016/j.amjoto.2024.104508","DOIUrl":"10.1016/j.amjoto.2024.104508","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the success rates and complications associated with different free flap donor sites used in surgical reconstruction for mandibular osteoradionecrosis, providing insights to aid clinical decision-making.</div></div><div><h3>Data sources</h3><div>MEDLINE, Embase, Cochrane, and Web of Science.</div></div><div><h3>Review methods</h3><div>Comprehensive database searches were conducted up to October 2023. Three independent reviewers screened articles per PRISMA guidelines. This review is registered with PROSPERO (CRD42023456929). Meta-analysis, using inverse variance statistical method and a random effects model, was performed with OpenMeta software (Version 10.12, Brown University, USA). Study quality was assessed via the methodological index for non-randomized studies (MINORS).</div></div><div><h3>Results</h3><div>Nineteen full-text articles met inclusion criteria, encompassing 397 patients and 424 free flap procedures. Patients averaged 54.8 years old; 27.5 % were female. Squamous cell carcinoma was the main radiation indication (83.1 %). Flap types included fibula (63 %), iliac crest (36 %), scapula (3.7 %), and radial forearm (3.5 %). Symptoms of osteoradionecrosis appeared on average four years post-radiation therapy, with a mean dose of 6346 cGy. Pooled postoperative complication rate was 22.5 % (95 % CI 0.165–0.284, I²:48%). Radial forearm flaps had the lowest complication rate (13.5 %, 95 % CI 0.026–0.295, I²:0%), while scapula flaps had the highest (34.9 %, 95 % CI 0.039–0.66, I²:40.3 %). Fibula flaps had the lowest failure rate (3.3 %, 95 % CI 0.003–0.025, I²:0%), while iliac crest flaps had the highest (11.9 %, 95 % CI 0.022–0.260, I²:60.4 %).</div></div><div><h3>Conclusion</h3><div>The fibula is the preferred flap for mandibular reconstruction due to its low failure rate. Radial forearm flaps show the fewest complications. More robust, multi-institutional prospective studies are needed.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104508"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events of mepolizumab in the treatment of nasal polyps: A FDA database evaluation","authors":"Brooke Stephanian ,&nbsp;Kalena Liu ,&nbsp;Aida Martinez Salazar ,&nbsp;Elias Saba ,&nbsp;Jonathan Liang","doi":"10.1016/j.amjoto.2024.104517","DOIUrl":"10.1016/j.amjoto.2024.104517","url":null,"abstract":"<div><h3>Background</h3><div>Mepolizumab has shown significant efficacy in managing eosinophil-associated disorders such as eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Despite the advancements in treatment options for CRSwNP, traditional therapies often fail to prevent polyp recurrence and come with substantial side effects, emphasizing the need for ongoing evaluation of new therapeutic approaches and their safety profiles.</div></div><div><h3>Objectives</h3><div>Utilize the FDA Adverse Event Reporting System to identify and evaluate adverse effects related to the use of mepolizumab in treating CRSwNP.</div></div><div><h3>Methods</h3><div>From Q12021 until Q12023, the FDA Adverse Event Reporting System database was queried to identify mepolizumab adverse reactions (MARs), which were compared between the two treatment groups of interest, CRSwNP and asthma. Individual MARs (iMARs) were modeled using zero-truncated Poisson regression, while serious MARs and outcomes were modeled using logistic regression.</div></div><div><h3>Results</h3><div>For the CRSwNP-tx group, there were 80 MARs (16 serious MARs, 19 serious outcomes, 0 deaths). For the asthma-tx group, there were 4779 MARs (4308 serious MARs, 2334 serious outcomes, 124 deaths). 68,479 iMARs were observed, with 1198 iMARS in the CRSwNP-tx group. Common CRSwNP-tx iMARs were pulmonary (27.1 %), generalized (10.9 %), neurologic (9.9 %), and hematologic (9.0 %). Age &lt; 50, RR 1.63 [1.41, 1.90], and asthma, RR 5.73 [4.29, 7.66], were significant predictive factors for total iMAR, while sex, RR 1.00 [0.86, 1.16], was not. Within the CRSwNP-tx group, concurrent asthma treatment increased the odds of having a serious MAR by 11.77 [3.02, 53.74] and serious outcome by 26.58 [3.23, 605.81].</div></div><div><h3>Conclusion</h3><div>Mepolizumab treatment of CRSwNP is associated with fewer individual adverse reactions. Pulmonary reactions were, by far, the most common type of adverse reaction. Concurrent asthma treatment in CRSwNP-only-tx increases the number of reactions, and the seriousness of reactions and outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104517"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing machine learning in diagnosing complex hoarseness cases","authors":"Ariel Roitman ,&nbsp;Yiftach Edelstain ,&nbsp;Chen Katzir ,&nbsp;Hadas Ofir ,&nbsp;Nimrod Peleg ,&nbsp;Ilana Doweck ,&nbsp;Yoav Yanir","doi":"10.1016/j.amjoto.2024.104533","DOIUrl":"10.1016/j.amjoto.2024.104533","url":null,"abstract":"<div><h3>Purpose</h3><div>Traditional vocal fold pathology recognition typically requires expertise of laryngologists and advanced instruments, primarily through direct visualization. This study aims to augment this conventional paradigm by introducing a parallel diagnostic procedure. Our objective is to harness a machine-learning algorithm designed to discern intricate patterns within patients' voice recordings to distinguish not only between healthy and hoarse voices but also among various specific disorders.</div></div><div><h3>Materials and methods</h3><div>We employed a machine-learning algorithm, utilizing transfer learning on the HuBERT model with Saarbruecken Voice Database samples. The study was conducted in two stages: a binary classifier distinguishes healthy and hoarse voices, while a subsequent multi-class classifier identifies specific voice disorders. Data from 2103 sessions, including over 25,000 components, representing diverse pathologies and healthy individuals, was analyzed. The models were trained, validated, and tested with a focus on robustness and accuracy in diagnosis.</div></div><div><h3>Results</h3><div>The binary classifier achieved 82 % accuracy in distinguishing healthy from pathological voices. The multi-class algorithm which aims to identify specific laryngeal disorders obtained the highest accuracy (&gt;93 %) for Laryngeal Dystonia. Noteworthy is the persistent challenge posed by Laryngeal Dystonia, a condition lacking a definitive diagnostic modality.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate the feasibility of utilizing machine-learning algorithms to process voice samples, categorizing them into distinct pathologies. This approach holds potential for enhance patient triage, streamline diagnostics, and elevate overall patient care. Particularly valuable for challenging diagnoses, such as Laryngeal Dystonia, this method underscores the transformative role of machine learning in optimizing healthcare practices.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104533"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological outcomes of the facial artery musculomucosal flap for oral cavity reconstruction","authors":"Wojciech K. Mydlarz,&nbsp;Alia J. Mowery,&nbsp;Nicholas Scott-Wittenborn,&nbsp;Carole Fakhry,&nbsp;Shaun C. Desai","doi":"10.1016/j.amjoto.2024.104555","DOIUrl":"10.1016/j.amjoto.2024.104555","url":null,"abstract":"<div><h3>Background</h3><div>Facial artery musculomucosal (FAMM) flaps are used for reconstruction of oral cavity squamous cell carcinoma (OCSCC). This study evaluates the oncologic safety of the FAMM flaps for OCSCC reconstruction, given the need to preserve the facial artery and vein during elective neck dissection.</div></div><div><h3>Design &amp; methods</h3><div>Retrospective single surgeon case series of all patients undergoing FAMM flap reconstruction for OCSCC from 2016 through 2023. Case analysis included tumor location, classification and staging, surgical details, and post-operative outcomes including locoregional and overall disease control.</div></div><div><h3>Results</h3><div>Twenty-one patients underwent FAMM reconstruction after resection for OCSCC. Age ranged from 40 to 85 years old (mean 61), 15 (71 %) were male. Sixteen (76 %) patients underwent neck dissection. Follow-up ranged from 0 to 81 months (mean 28). One patient (5 %) recurred in ipsilateral neck level IV, one (5 %) had a second primary tumor, and three patients (14 %) developed distant metastases.</div></div><div><h3>Conclusions</h3><div>FAMM flap represents a safe and reliable option for reconstruction after OCSCC. In our series there was no significant increased risk of locoregional recurrence.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104555"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective review of infant-inducible laryngeal obstruction a subtype of paradoxical vocal fold motion: Evaluation and management","authors":"Emily S. Pascal,&nbsp;Aurora M. Maes,&nbsp;Karen Hawley","doi":"10.1016/j.amjoto.2024.104514","DOIUrl":"10.1016/j.amjoto.2024.104514","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a paucity of literature on pre-adolescent paradoxical vocal fold motion (PVFM), PVFM is a sub-type of inducible laryngeal obstruction. Studies typically focus on older patients, however the discovery of this entity in pre-adolescent pediatric patients has led to more questions about how this entity manifests differently and is treated differently in younger populations. Initially considered psychosomatic and commonly mistaken for asthma, PVFM etiology is now thought to be associated underlying neurologic conditions and may have irritant triggers with proposed mechanisms related to laryngeal hypersensitivity. Treatment is multimodal. Diagnosis is with flexible laryngoscopy and clinical exam but other modalities like functional endoscopic evaluation of swallow may provide more information than flexible laryngoscopy alone.</div></div><div><h3>Methods</h3><div>After obtaining IRB approval, a retrospective review of all charts of patients ages 0–18 months (pre-adolescent pediatric patients) who underwent flexible endoscopic evaluation of swallow and/or flexible laryngoscopy from 1/2013–8/2021 was performed. Twenty-four subjects diagnosed with PVFM were identified.</div></div><div><h3>Results</h3><div>The most common presenting symptom was stridor or coughing with feeds. 63 % were male, mean age at time of diagnosis was 3.4 months, and mean follow-up length was 11.4 months. Comorbidities included reflux (45 %), pulmonary diagnoses (25 %) and neurologic diagnoses (54 %). 16/24 subjects had otolaryngology diagnoses (laryngomalacia, tracheomalacia, subglottic stenosis, or ankyloglossia). 12/24 subjects were treated with conservative management such as anti-reflux medications or precautions. 33 % of patients treated with conservative management had complete symptom resolution. PVFM patients with neurologic comorbidities were more likely to require alternative feeding access (<em>p</em> &lt; 0.05). All 11 subjects who required surgical feeding access had neurologic diagnoses. 5/10 of patients with neonatal abstinence syndrome (NAS) required alternative feeding means, and 40 % tolerated oral feeds after medical management of NAS.</div></div><div><h3>Conclusion</h3><div>Our findings suggest PVFM is most commonly seen in pre-adolescent pediatric patients with medical comorbidities. Healthy pre-adolescent pediatric patients with PVFM frequently improved with conservative management. The differential diagnosis of the stridulous infant should include PVFM. It is imperative to consider nutritional access in PVFM patients with neurologic comorbidities.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104514"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hearing loss trajectory and prediction model for children with enlarged vestibular aqueduct","authors":"Lin Deng ,&nbsp;Xiaozhe Yang ,&nbsp;Xiaohua Cheng ,&nbsp;Cheng Wen ,&nbsp;Yiding Yu ,&nbsp;Yue Li ,&nbsp;Shan Gao ,&nbsp;Hui Liu ,&nbsp;Dongxin Liu ,&nbsp;Yu Ruan ,&nbsp;Jinge Xie ,&nbsp;Hui En ,&nbsp;Junfang Xian ,&nbsp;Lihui Huang","doi":"10.1016/j.amjoto.2024.104573","DOIUrl":"10.1016/j.amjoto.2024.104573","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore how hearing changes over time and the characteristics associated with progressive hearing loss in children with enlarged vestibular aqueduct (EVA), and develop a prediction model for anticipation of hearing progression probability.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 48 children (92 ears) diagnosed with EVA. A total of 314 audiograms were included in the analysis of hearing loss trajectories using linear mixed-effects model. Progressive hearing loss was defined based on the difference between the initial and final hearing threshold. All participants had underwent one or two gene detection methods, including deafness gene screening and <em>SLC26A4</em> whole coding exon sequencing.</div></div><div><h3>Results</h3><div>The pure-tone thresholds (PTTs) at frequencies of 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and the average are expected to increase by 0.34, 0.49, 0.54, 0.57, and 0.55 dB HL per each additional month. Age and genotypes have an interactive effect on PTT at frequencies of 500 Hz, 1000 Hz, and the average. The hazard ratio for the genotype without <em>SLC26A4</em> c.919-2 A &gt; G mutation was 4.91 (95 % confidence interval 1.76–13.7, <em>P</em> &lt; 0.01). This prediction model fitted using age, initial average PTT, midpoint size of vestibular aqueduct, incomplete partition type II, and genotypes of <em>SLC26A4</em> showed strong consistency and differentiation.</div></div><div><h3>Conclusion</h3><div>These findings reveal that the PTT would deteriorate over time in patients with EVA. The hearing threshold at high frequency and genotype without c.919-2 A &gt; G heterozygous mutation deteriorated relatively fast. Genotype is an important predictive factor and the nomogram helps to predict progressive hearing loss.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104573"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of nasal septal perforation following nasal packing for epistaxis in the emergency department","authors":"Radhika Duggal ,&nbsp;Mark Liu ,&nbsp;Trisha Shang ,&nbsp;Peng Ding","doi":"10.1016/j.amjoto.2024.104552","DOIUrl":"10.1016/j.amjoto.2024.104552","url":null,"abstract":"<div><h3>Introduction</h3><div>Nasal packing is commonly employed in the emergency department (ED) to manage epistaxis that does not respond to conservative treatments. However, this intervention may increase the risk of nasal septal perforation (NSP) due to reduced blood flow to the nasal septum. No prior study has explored the relationship between nasal packing and risk of NSP.</div></div><div><h3>Methods</h3><div>We examined all patients who received non-absorbable nasal packing in the ED at our institution, identifying 19 patients diagnosed with NSP post-treatment and 50 randomly selected patients without NSP for comparison. <em>t-</em>Tests and Chi square tests were utilized to compare numeric and categoric variables respectively and a multivariable logistic regression model was developed to assess risk factors.</div></div><div><h3>Results</h3><div>Baseline characteristics of individuals who developed NSP were similar to those of the comparison group, with the exception of tobacco use. Interestingly, individuals with NSP had a lower rate of tobacco use (21 % vs 64 % current/former users, <em>p</em> = 0.004). Univariable analysis revealed that patients with NSP had a longer mean duration of nasal packing (5 vs 3 days, <em>p</em> = 0.001). Multivariable analysis showed that each additional day of packing increased odds of NSP by 77 %, and bilateral packing, compared to unilateral, was associated with four times the odds of NSP.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that prolonged nasal packing increases the risk of NSP. Prospective, large-scale studies are needed to identify patients at risk for NSP after nasal packing in the ED and to inform guidelines on the removal of nasal packing.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104552"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical therapy for idiopathic facial paralysis: A systematic review","authors":"Eleni A. Varelas ,&nbsp;Sunder Gidumal ,&nbsp;Hannah Verma ,&nbsp;Dragan Vujovic ,&nbsp;Joshua D. Rosenberg ,&nbsp;Mingyang Gray","doi":"10.1016/j.amjoto.2024.104511","DOIUrl":"10.1016/j.amjoto.2024.104511","url":null,"abstract":"<div><h3>Purpose</h3><div>Idiopathic facial paralysis is a challenging condition that can significantly impact patients' quality of life. Treatment options include both medical to surgical management. The objective is to further understand and review the current literature on the effectiveness of physical therapy for treatment of idiopathic facial paralysis.</div></div><div><h3>Materials and methods</h3><div>MEDLINE, EMBASE, and Cochrane Library were searched. English-language studies assessing the outcomes of idiopathic facial paralysis in adults after completion of physical therapy were included for analysis.</div></div><div><h3>Results</h3><div>This study screened 778 studies, of which 12 met inclusion criteria. There were 228 patients included for analysis. Four studies, contributing 79 patients, included sex and age demographics, with a breakdown of 45 females and 34 males with an average age of 49.4 years. Objective outcomes were most frequently measured by utilizing the Sunnybrook Facial Grading System, followed by House-Brackmann Score and Facial Disability Index. All studies highlighted the positive result physical therapy had on facial rehabilitation.</div></div><div><h3>Conclusion</h3><div>The body of literature on physical therapy in treating idiopathic facial paralysis, although limited in size, strongly supports its use to accelerate recovery and minimize adverse outcomes. These findings suggest the addition of physical therapy in the management of patients with facial paralysis.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104511"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}