Cold Instruments Research Articles

Aerosol generation during pediatric otolaryngological procedures

ObjectivesTo assess the extent of staff exposure to aerosol generation in common pediatric otorhinolaryngological procedures (tonsillotomies, adenoidectomies, and tympanostomies) and determine the surgical phases responsible for most aerosol generation in these procedures. MethodsAerosol generation was measured during 35 pediatric otolaryngological procedures using an Optical Particle Sizer that measures aerosol concentrations for particle sizes between 0.3 and 10.0 μm. The different phases of and instruments used in each procedure were logged. Operating room background aerosol levels and coughing were used as references. ResultsTotal aerosol concentrations were significantly higher during tonsillotomies and adenoidectomies when compared to tympanostomies (p = 0.011 and p = 0.042) and to empty room background aerosol concentrations (p = 0.0057 and p < 0.001). Aerosol concentration during tonsillotomies did not differ from coughing, which is considered as standard for high-risk aerosol procedures. During tympanostomies, aerosol concentrations were even lower than during perioperative concentrations. No statistically significant difference in aerosol generation comparing suction, electrocautery, cold instruments, and paracentesis was found. ConclusionAccording to the results of this study, tympanostomies are low-risk aerosol-generating procedures. On the other hand, pediatric tonsillotomies produced aerosols comparable to coughing, pointing to them being significantly aerosol-producing procedures and viral transmission is theoretically possible intraoperatively.

Searching for a Better Animal Model for Chronic Tympanic Membrane Perforation.

Chronic tympanic membrane perforation represents a prevalent otological condition, necessitating a reliable animal model for the validation and safety assessment of surgical techniques and materials employed in myringoplasty. This prospective study involved the establishment of chronic tympanic membrane perforation animal models in 16 chinchillas. A thermic myringotomy was conducted on the right ear (study group), followed by cold instrument myringotomy, coupled with the topical application of mitomycin C and dexamethasone solution on the left ear (control group). Results revealed that tympanic membrane perforations in the study group persisted for a minimum of 4 weeks in 93.7% of cases and extended to 12 weeks in 62.5% of the cases. In contrast, all tympanic membrane perforations in the control group were present at 4 weeks, with only 37.5% persisting after 12 weeks, although statistical tests did not find significant differences between the two groups (chi-square: p-value = 0.157, Kruskal-Wallis: p-value = 0.093, Mann-Whitney: p-value = 0.121). The thermic myringotomy employed to induce chronic tympanic membrane perforation in animals demonstrated efficiency and sustainability. This model, characterized by stability and reproducibility, holds promise for future experimental applications in the field.

Cold Instruments, Warm Outcomes: A Decade of Supraglottoplasty in Managing Children with Moderate and Severe Laryngomalacia

Objective: The study aims to review the clinical outcomes of supraglottoplasty in moderate and severe laryngomalacia. Methods: This is a retrospective study. Demographic and clinical data of children diagnosed with moderate and severe laryngomalacia who underwent supraglottoplasty between 2012 and 2021 were retrieved from the computerized patient record system of Hospital Sultanah Bahiyah. The surgical procedure of supraglottoplasty was mainly performed with cold instrument, with occasional assistance from a microdebrider. Study outcome includes complete stridor resolution, weaning from tube feeding, and weaning from respiratory support post supraglottoplasty. Results: 124 children were included in the study. Complete stridor resolution was achieved in 64.51% (n=80) 1-month post-surgery and 86.29% (n=107) 3-months post-surgery. Half of the children with tube feeding pre-operatively could be weaned off to oral feeding within 1-month post-surgery. All the children with oral feeding maintained oral feeding post-surgery. All the children with no or low respiratory support (nasal prong oxygen) pre-operatively were able to be weaned down to room air within 1-month post-surgery. Within the group of children with high respiratory support (high-flow nasal cannula, non-invasive ventilation, and endotracheal intubation) pre-operatively, half were weaned down to room air within 1-month post-surgery. None of the children with isolated laryngomalacia required tracheostomy after supraglottoplasty. All laryngomalacia patients who required tracheostomy after supraglottoplasty were associated with either synchronous airway lesions or medical comorbidities. Only 3 cases (2.42%) required revision supraglottoplasty with a maximum of one revision. Conclusions: We conclude that supraglottoplasty contributes to substantial clinical improvement in moderate and severe laryngomalacia. Supraglottoplasty facilitated weaning down of respiratory support and tube feeding in laryngomalacia with respiratory difficulty and feeding intolerance.

Laryngomalacia and Obstructive Sleep Apnea in Children: From Diagnosis to Treatment.

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO2 LASER, transoral robotic surgery, or the microdebrider.

Classic techniques used in laser microsurgery of chronic diseases of the larynx: a literature review

The topicality of the issue of treating chronic diseases of the larynx is beyond dispute. Given the increased load on the vocal apparatus, no downward trend in disease incidence is observed. The percentage of patient visits to an otorhinolaryngologist with complaints of prolonged changes in voice timbre, vocal fatigue, and difficulties with voice control is 7–12%. Chronic productive formations of the larynx account for up to 55–70% of pathologies in the proliferative upper respiratory disease pattern. If not treated promptly, chronic diseases of the larynx can significantly affect a person’s ability to speak, swallow and breathe normally. Today, various methods for surgical treatment of chronic diseases of the larynx are used: both classical cold instruments and high-energy laser systems. The history of laser medicine dates from the late 1960s and is associated with the introduction of a high-intensity device emitting a photon stream in the infrared range into medical practice. The first carbon dioxide lasers were difficult to use (they were large in size and had complex technical settings), but at the same time they showed high resection and coagulation qualities, and it earned them their popularity. Over 3 thousand new laser devices representing a practical interest for laryngeal surgery have appeared on the medical market for more than 60-year period. Despite the fact that fundamental research demonstrates the positive results of phonosurgery with high-power devices, many otolaryngologists continue be in awe of lasers. The article presents the results of the use of traditional devices in phonosurgery for chronic diseases of the larynx and draws conclusions about the effectiveness and safety of high-power devices.

Diode Laser for Juvenile Recurrent Respiratory Papillomatosis: A Case Series of 13 Patients.

Juvenile recurrent respiratory papillomatosis (JRRP) is the most common benign tumor in the larynx. It is uncommon; however, it is potentially life-threatening because it compromises the respiratory tract and required several surgeries to manage recurrences. Currently, the carbon dioxide laser is the treatment of choice. There are no studies about the role of the diode laser which is easy to use and has lower usage cost. This case series presentation reported on the therapeutic effects and recurrence rate of JRRP when using Diode laser. This is a case series presentation of 13 children, who were diagnosed with JRRP and operated for laryngeal papillomatosis with Diode laser in Otorhinolaryngology and Head and Nick Surgery Department et al. Mouwasat Hospital, Damascus, Syria between 2015 and 2022. 13 children required 56 surgeries at a rate of 1-2 surgeries/year, mean number of surgeries for each child was 4.31. That suggests that Diode laser might have a role in reducing the number of surgeries compared to a study used cold instrument and CO2 laser. The complications rate was 30.8%, which is considered a high rate compared to the other studies. In conclusion, we encourage using it when the CO2 laser device is not available. However, we suggest, reducing the power as low as possible and avoiding of two opposing raw surfaces, especially at the anterior commissure and deep excision. Further longitudinal studies are recommended to validate these results.

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

High temperature atomic oxygen testing for ESA’s Envision mission to Venus

EnVision will be ESA’s next Venus orbiter, providing a holistic view of the planet from its inner core to upper atmosphere to determine how and why Venus and Earth evolved so differently. The spacecraft will be equipped with a suite of instruments including a sounder to reveal underground layering, and spectrometers to study the atmosphere and surface. The thermal fluxes in orbit around Venus are high, the solar flux at Venus distance is twice its value on Earth (around 2600 W/m2), and the reflected sunlight flux has a similar order of magnitude due to the albedo. Besides, there will also be an aerobraking phase, when a third thermal flux, the aerothermal flux, needs to be considered, with a similar order of magnitude as the two others. These high total thermal fluxes, together with the cold instruments’ requirements and high-power dissipation make the thermal environment a design driver for the mission. The chemistry of the atmospheric environment during aerobraking needs also to be taken into account. Atomic oxygen exists in Venus atmosphere at the altitude range foreseen for aerobraking, with densities of up to 1017 oxygen atoms per cubic metres at aerobraking altitudes. Though the concentrations are small, their accumulation over up to 2000 atmospheric passes lead to total atomic oxygen fluences on the exposed spacecraft surfaces which are comparable to those encountered on typical Low Earth orbiting satellites (upwards of 1021 atomscm-2). This drives the selection of spacecraft materials on the most exposed surfaces. Whilst significant data exists about atomic oxygen erosion effects on materials for Low Earth Orbit, there is little knowledge about high temperature atomic oxygen effects on materials under environmental conditions representative of the Venus atmosphere. To analyse the potential risks for the Envision mission, and to assist the designers in selecting the best materials, an atomic oxygen test campaign is being performed in the ESA ESTEC atomic oxygen ground-based simulator (LEOX facility). The facility has been adapted so that material samples can be simultaneously exposed to atomic oxygen and high temperatures up to at least 200°C. For the test campaign, the Envision instrument teams and designers of the prospective satellite systems are providing candidate materials to be exposed. This includes a variety of materials to be utilised on the outside of the satellite such as thermal control coatings, optical materials, coatings for appendages and antennas and multi-layer insulation. The paper describes the modifications to the facility and the first results of the testing which has been performed.

Endoscopic surgery under tubeless anesthesia and spontaneous breathing for a congenital laryngeal web in an infant: a case report.

Congenital laryngeal webs are rare and defined as a thick epithelium-covered fibrous tissue lying between the vocal folds; the anterior glottis is the most common site of involvement, with possible extension to the subglottic region. The association with chromosome 22q11.2 deletion syndrome has been reported. Symptoms are abnormal/absent cry and airway obstruction since birth. Management strategies range from endoscopic division with cold instruments to open surgery for severe webbing. In case of endoscopic surgery, the need of tubeless anaesthesia and spontaneous breathing is fundamental to obtain the best surgical outcome. We here describe the case of a 4-month-old female patient affected by a type II glottic web according to Cohen, treated by means of simple endoscopic division in spontaneous breathing.

Two-centre experience in the treatment of thyroglossal duct remnants using the modified muscle-sparing Sistrunk technique

The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate. A total of 110 consecutive patients (62 (56.4%) male, 48 (43.6%) female) who underwent a modified muscle-sparing Sistrunk procedure were included in the study. Their mean age at presentation was 26.9 ± 18.9 years. A modified muscle-sparing Sistrunk procedure using cold instruments, electrocautery, and a harmonic scalpel was performed in all patients. Recurrence was recorded in six (5.5%) patients. The median hospital stay was 2 days (range 1–7 days), and the median follow-up duration was 7 years (range 2–13 years). There was no significant difference in recurrence rate between the conventional and modified muscle-sparing Sistrunk procedure in primary TDRs. The study findings showed that the modified muscle-sparing Sistrunk procedure had low recurrence and complication rates in the context of primary TDR.

Tongue base schwannoma: case presentation and literature review

BackgroundSchwannoma, also known as perineural fibroblastoma, neuroma, or neurilemmoma, is a slow growing benign tumor that exceptionally raises in oral cavity. It mainly affects the second and third decade and can be life-threatening if it becomes large. Developing in youth is unusual.Case presentationA 16-year-old teenager presenting with relatively rapidly growing tongue base tumor which radiologic investigations revealed features of benign tumor, surgery was performed through a standard transoral approach and pathology with immunohistochemistry examination confirmed the diagnosis of schwannoma with no evidence of malignant transformation.ConclusionOral cavity schwannoma is rare, and the prevailing oral location is the tongue. This particular site holds many risks related to impact symptoms or to anesthesia and securing airways. We performed a trans-oral resection of a tongue base schwannoma using a cold instrument. As the tumor is well encapsulated, this approach seems convenient and less invasive for complete surgical excision.

Assessing Feasibility and Safety of Using Ultrasonic Bone Aspirator for Revision Endoscopic Sinus Surgery

Background and Objectives: This study introduced and evaluated the efficacy of an ultrasonic bony aspirator (UBA) in revision endoscopic sinus surgery and compared the outcomes to those of the traditional cold instrument approach.Methods: This retrospective study enrolled 57 patients who underwent revision endoscopic sinus surgery between June 2010 and December 2017, 17 patients with a UBA approach and 40 patients with traditional instruments.Results: Median Lund–Kennedy scores showed a statistically significant difference between the two groups at 3 months (p=0.004). Synechiae occurred in 17.6% and 35% of cases in the UBA and traditional groups, respectively. The mean operative time was significantly shorter in the traditional group (p=0.001).Conclusion: The use of a UBA in revision endoscopic sinus surgery was safe and effective.

Powered versus Cold Instruments in Rhinoplasty: A Perspective.

Rhinoplasty surgeons must continually strive to refine and improve their results. Improvement may be borne out of new surgical techniques, alternative perioperative medicines, or through the application of new technologies. One technology that has recently gained popularity are piezoelectric osteotomes (POs). These instruments offer a powered alternative to the traditional chisel osteotome. This article provides a history of these two modalities, reviews the most recent data surrounding piezoelectric osteotomy, and provides a framework to compare the pros and cons of each osteotomy option.

Uterine perforation during intrauterine procedures and its management.

Uterine perforation is a potential, not rare complication of all intrauterine procedures and may be associated with injury of surrounding organs and structures. The incidence, risk factors, possible prevention, dia-gnosis, management and impact on future reproduction is reviewed here. Systematic review of available sources on the topic was carried out using the PubMed database and textbooks of Czech authors. Some risk factors that make access to the uterine cavity difficult may be prevented, however, others remain unpreventable. For patients in whom the perforation occurred during sondage, dilatation or insertion of blunt and cold instrument, without significant bleeding and who are hemodynamically stable, observation is recommended rather than immediate abdominal exploration. The exception are young women planning pregnancy in whom endoscopic suture is indicated. Abdominal exploration is required in patients who have been injured by electrosurgical or sharp device, laser, vacuum curette, who are hemodynamically unstable or show signs of severe bleeding or visceral injury.

Aerosol Generation During Otologic Surgery.

ObjectiveTo assess whether aerosol generation occurs during otologic surgery, to define which instruments are aerosol generating, and to identify factors that enhance safety in protection against airborne pathogens, such as severe acute respiratory syndrome coronavirus 2.Study DesignAn observational prospective study on aerosol measurements during otologic operations recorded between August and December 2020.SettingAerosol generation was measured with an Optical Particle Sizer as part of otologic operations with anesthesia. Particles with a size range of 0.3 to 10 μm were quantified. Aerosol generation was measured during otologic operations to analyze aerosols during drilling in transcanal and transmastoid operations and when using the following instruments: bipolar electrocautery, laser, suction, and cold instruments. Coughing is known to produce significant concentration of aerosols and is commonly used as a reference for high-risk aerosol generation. Thus, the operating room background concentration and coughing were chosen as reference values.PatientsThirteen otologic operations were included. The average drilling time per surgery was 27.00 minutes (range, 2.00–71.80 min).InterventionDifferent rotation speeds during drilling and other instruments were used.Main Outcome MeasuresAerosol concentrations during operations were recorded and compared with background and cough aerosol concentrations.ResultsTotal aerosol concentrations during drilling were significantly higher than background (p < 0.0001, d = 2.02) or coughing (p < 0.0001, d = 0.50). A higher drilling rotation speed was associated with higher particle concentration (p = 0.037, η2 = 0.01). Aerosol generation during bipolar electrocautery, drilling, and laser was significantly higher than with cold instruments or suction (p < 0.0001, η2 = 0.04).ConclusionHigh aerosol generation is observed during otologic surgery when drill, laser, or bipolar electrocautery is used. Aerosol generation can be reduced by using cold instruments instead of electric and keeping the suction on during aerosol-generating procedures. If drilling is required, lower rotation speeds are recommended. These measures may help reduce the spread of airborne pathogens during otologic surgery.

Endoscopic treatment of anterior laryngeal web using keel designed from ePTFE followed by voice therapy: a refined technique

BackgroundTreatment of laryngeal web is challenging due to possibility of recurrence and affected voice quality. Optimal treatment of laryngeal web should emphasize on improving both airway and vocal function. We refined the traditional endoscopic method using a new keel designed from expanded polytetrafluoroethylene (ePTFE) membrane. Our objective is to evaluate the voice outcomes following the endoscopic treatment and voice therapy.ResultsTen subjects presented with anterior laryngeal web. Auditory perceptual assessment, stroboscopic examination and acoustic studies were performed pre- and postoperatively. Endoscopic excision of laryngeal web was performed with cold instruments. An individually designed ePTFE keel was fixed by Nylon thread 2–0 at the anterior commissure and tied subcutaneously in the neck. The keel left for 3–5 weeks followed by voice therapy using abdomino-diaphragmatic breathing exercise and relaxation method. Vocal parameters measured were perceptual voice quality using Grade-Roughness-Breathiness-Asthenia-Strain voice scale (GRBAS), stroboscopic score, fundamental frequency (F0), jitter, shimmer, pitch perturbation question (PPQ), amplitude perturbation question (APQ) and harmonics-to-noise ratio (HNR). Significant decrease in GRBAS (P < 0.001) and significant increase in stroboscopic scores (P < 0.001) were noticed after operation and voice therapy. Also, acoustic voice parameters showed significant improvements. The mean jitter, shimmer, PPQ and APQ showed significant decrease (p = 0.0028, 0.0032, 0.0026, 0.0014, and 0.006 respectively). Overall, 90 % of our subjects have satisfactory voice outcome.ConclusionEndoscopic excision of anterior laryngeal with cold instrument followed by ePTFE keel fixation achieved good long-term voice results. The ePTFE is soft biocompatible material which does not make reaction. The keel should be left in place for sufficient period of time (3–5 weeks). This ensures perfect healing with less or no recurrence. Absence of foreign body reactions in the vocal folds is important for mucosal integrity and good voice outcome. So, the ePTFE could be good alternative for laryngeal keel. Hyperfunctional dysphonia with ventricular hypertrophy may develop in longstanding anterior laryngeal web which needs intensive voice therapy after operation. Our treatment targeted both the organic etiology of dysphonia and the underlying cause of the possible associated functional element of dysphonia.

A modular surgical simulator for microlaryngoscopy using standard instruments and the carbon dioxide laser.

ObjectiveBuild a microlaryngoscopy surgical simulator for endoscopic laryngeal surgery using standard microsurgical instruments and a CO2 laser.Study designAnatomical modeling, CAD design and 3D printed manufacturing.Subjects and methodsWe created a modular design for a microlaryngoscopy simulator in CAD software. Components include plastic and stainless‐steel models of a standard operating laryngoscope and a cassette system for mounting porcine or synthetic models of the vocal folds. All simulator parts, including the metallic laryngoscope model, were manufactured using 3D printing technology. Tumors were simulated in porcine tissue models by injecting a soy protein‐based tumor phantom. Residents and faculty in the Louisiana State University otolaryngology department evaluated the system. Each participant performed microlaryngoscopy with laser resection on a porcine larynx and cold instrument procedures on synthetic vocal folds. Participants scored the simulator using a 5‐point Likert scale.ResultsThe microlaryngeal surgical simulator demonstrated in this project is realistic, economical, and easily assembled. We have included 3D printed parts files and detailed assembly instructions that will enable educators interested in surgical simulation to build the device.Participants in the simulator evaluation session felt that the simulator faithfully represented the procedure to resect vocal fold lesions using a CO2 laser. The synthetic model allows the trainee to develop hand‐eye coordination while using standard laryngeal instruments.ConclusionsThe simulator described herein will enable surgeons to acquire the surgical skills necessary to perform operative microlaryngoscopy prior to operating on live patients.

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

ObjectivesAfter surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. MethodsThis randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3–6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. ResultsFive children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). ConclusionWhile we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab.Clinicaltrials.gov Identifier: NCT02555800.

Effects of Different Voice Rest on Vocal Function After Microlaryngeal Surgery: A Systematic Review and Meta-Analysis.

To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest. Systematic review and meta-analysis. The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis. Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p=0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p=0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p=0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p=0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p=0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p=0.01, respectively) in the short-duration group. The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest. 1 Laryngoscope, 133:154-161, 2023.

A Patient with Juvenile Recurrent Respiratory Papillomatosis Complicated by Laryngeal Stenosis after Laryngeal Microsurgery: A Clinical Case

BACKGROUND: The relevance of the problem of juvenile respiratory papillomatosis lies in the recurrent course of the disease in young children. This can lead to the development of respiratory stenosis, requiring repeated, in some cases, monthly surgical treatments for endolaryngeal removal of papillomas, which sometimes leads to persistent scar stenosis of the larynx. We present clinical case of achieving remission of recurrent juvenile papillomatosis of the larynx. CLINICAL CASE: Patient, 5 years old, who applied in February 2016, was hospitalized in the ENT department with severe dyspnea, laryngoscopy revealed laryngeal papillomatosis with 3–4 grade stenosis. Over the past 10 months, the patient has undergone laryngeal surgery 6 times using cold instruments and a CO2 laser due to papillomatosis. Taking into account the recurrent nature of the course of the disease, the patient is administered to consult an allergist-immunologist. Based on the anamnesis and the results of the tests, the immunologist-allergist diagnosed: Primary immunodeficiency, unspecified (insufficiency in the production of specific antibodies), persistent allergic rhinitis, in the stage of incomplete remission and prescribed treatment. The patient was operated twice from 2017 to 2018 for a developed post-operative complication – cicatricial stenosis of the larynx. With these surgical repairs, no recurrence of laryngeal papillomatosis was detected. Furthermore, in 2021, according to endovideolaryngoscopy, remission was confirmed. R In this clinical case, we managed to achieve remission of laryngeal papillomatosis in a patient after surgery and treatment by an immunologist. Allergen elimination and immunocorrection helped us achieve deep remission. Surgical treatment eliminated laryngeal stenosis, recovering breathing and voice quality. Furthermore, this clinical case demonstrates the importance of studying the immune status in patients with laryngeal papillomatosis. CONCLUSION: The results obtained by us show the need for the use of immunomodulators in these patients. All children with prolonged hoarseness should undergo laryngoscopy, which will allow diagnosing laryngeal papillomatosis at earlier uncomplicated stages of the disease. Treatment of laryngeal papillomatosis should be comprehensive and in addition to surgical treatment should include differential immune correction. RESULTS AND DISCUSSION: In the above clinical case, we managed to achieve remission of laryngeal papillomatosis in a patient after surgery and treatment by an immunologist. Allergen elimination and immunocorrection helped us achieve deep remission. Surgical treatment eliminated laryngeal stenosis, recovering breathing and voice quality. Furthermore, this clinical case demonstrates the importance of studying the immune status in patients with laryngeal papillomatosis. The results obtained by us show the need for the use of immunomodulators in these patients. All children with prolonged hoarseness should undergo laryngoscopy, which will allow diagnosing laryngeal papillomatosis at earlier uncomplicated stages of the disease. Treatment of laryngeal papillomatosis should be comprehensive and in addition to surgical treatment should include differential immune correction.