Laryngoscopic Procedures Research Articles

The effect of COVID-19 pandemic on routine surgical turnover in otolaryngology: a retrospective analysis of service dynamics utilizing finalized, cumulative data from a tertiary-care teaching institute in India.

To ascertain the effect of coronavirus (COVID-19) pandemic on routine (non-COVID) Otolaryngology and Head-Neck Surgery (ORL-HNS) turnover in a tertiary-care teaching institute, utilizing the cumulated, finalized dataset one year after the pandemic ceased to be a "public health emergency of international concern". In this retrospective analysis, annual routine turnover in the ORL-HNS categories (otology, rhinology/skull-base, head-neck/airway, emergency, miscellaneous) for the COVID-period (2020-21) were individually compared with pre-COVID (2017-19) data. Subsequently, categorical turnovers, along with the major surgeries in each category, were compared trimester-wise in the COVID-period. Data were interpreted statistically and explained graphically superimposing on the COVID timeline. Overall surgical turnover in 2020-2021 decreased by 64.11% and 34.59%, respectively, from the pre-COVID period. The decline was [62.3%, 78.05%, 59.96%, 65.14%] and [34.2%, 29.27%, 30.64%, 45.6%] in otology, rhinology/skull-base, head-neck/airway, and emergency surgeries, in 2020 and 2021, respectively. Significant decline, however, was only in rhinology/skull-base (p = 0.00012) for 2020, which again increased in 2021 (p < 0.00001). Tympanomastoid surgeries, endoscopic sinus/septal surgeries, direct laryngoscopic procedures and tracheostomy topped the respective categories. Despite the deadlier second wave in 2021, there was a statistically significant change in trimester-wise turnovers across categories from 2020 to 2021. Overall turnover in 2020 was lesser, the second and third (lockdown/unlock) trimesters being mostly affected. In the most comprehensive post-COVID service dynamics analysis, routine ORL-HNS turnover was apparently not found to be significantly affected by the pandemic except in rhinology/skull-base. However, trimester-wise comparison within the COVID-years revealed statistically significant changes in categorical turnovers from 2020 to 2021.

Assessment of simulated snoring sounds with artificial intelligence for the diagnosis of obstructive sleep apnea

BackgroundPerforming simulated snoring (SS) is a commonly used method to evaluate the source of snoring in obstructive sleep apnea (OSA). SS sounds is considered as a potential biomarker for OSA. SS sounds can be easily recorded, which is a cost-effective method for prescreening purposes. ObjectiveThis study aimed to validate the performance of artificial intelligence (AI) models using SS sounds for OSA diagnosis. MethodsAll participants underwent full-night polysomnography (PSG) monitoring at the sleep center. SS sounds of the participants were recorded during the laryngoscopy procedure. The audio data were processed via Python, and relevant features were extracted. OSA diagnostic models were developed using three machine learning (ML) algorithms and one deep learning (DL) algorithm. The diagnostic performance was evaluated by multiple indicators. ResultsA total of 465 participants were included. For the support vector machine algorithm, the accuracy values at apnea-hypopnea index (AHI) levels of 5, 15, and 30 per hour were 0.914, 0.887, and 0.807, respectively. For the K-nearest neighbor algorithm, the accuracy values at AHI levels of 5, 15, and 30 per hour were 0.896, 0.872, and 0.756, respectively. For the random forest algorithm, the accuracy values at AHI levels of 5, 15, and 30 per hour were 0.905, 0.881, and 0.804, respectively. For the audio spectrogram transformer algorithm, the accuracy values at AHI levels of 5, 15, and 30 per hour were 0.926, 0.887, and 0.830, respectively. ConclusionsOur study demonstrates that DL models can effectively screen and identify OSA with commendable performance. In addition, the identification ability of the DL models was better than that of any of the ML models.

Diagnostic Techniques for Infantile Subglottic Hemangiomas: A Scoping Review.

Infantile subglottic hemangioma (SGH) poses a risk of airway compromise if untreated. Traditionally, operative endoscopy (OH) diagnoses SGH, but since the discovery of beta-blockers' efficacy in treating infantile hemangiomas (IHs) in 2008, and advances in endoscopic technology, nonoperative methods have emerged. This review identifies endoscopic practices for diagnosing and monitoring infantile SGH during the oral beta-blocker treatment era. A comprehensive literature search in October 2022 and August 2023 covered PubMed, Embase, Cochrane Library, SCOPUS, and Web of Science. The search was limited to English-language studies published since 2008, considering this when propranolol was demonstrated as an effective treatment option for IH. The articles were screened for relevance based on predefined inclusion and exclusion criteria. After inclusion and exclusion criteria, sixty final studies were identified, describing 240 cases of infantile SGH. Most children were diagnosed using OE alone (73.3%; n = 176/240), 23.3% (n = 56/240) using office-based laryngoscopy procedures (OBPs) followed by OE, 3.3% using OBP alone (n = 8/240). There were no reported diagnostic endoscopy-related complications. Twenty-nine studies described using endoscopy plus diagnostic imaging to either confirm an SGH lesion, characterize the extent of disease spread, or rule out other causes of presenting symptoms. The proportion of infants diagnosed with OE alone decreased from 2008 to 2023. Operative endoscopy remains the SGH diagnostic standard, but OBP adoption is increasing. Further research is needed to determine the optimal SGH diagnosis and management approach. NA Laryngoscope, 2024.

Chronic Opioid Prescribing After Common Otolaryngology Procedures in Adults.

(1) Describe short and long-term opioid prescribing patterns and variation after common otolaryngologic procedures and(2) assess risk factors for chronic opioid use in this cohort. Retrospective cohort. Optum's deidentified Integrated Claims-Clinical data set. An adult cohort of patients undergoing common otolaryngology procedures from 2010 to 2017 was identified. Associations between procedure and other covariates with any initial opioid prescription and continuous opioid prescriptions were assessed with multivariable modeling. Opioid use was defined as continuous if a new prescription was filled within 30 days of the previous prescription. A time-to-event analysis assessed continuous prescriptions from the index procedure to end of the last continuous opioid prescription. Among a cohort of 19,819 patients undergoing predominately laryngoscopy procedures (12,721, 64.2%), 2585 (13.0%) received an opioid prescription with variation in receiving a prescription, daily dose, and total initially prescribed dose varying by procedure, patient demographics, provider characteristics, and facility type. Opioids were prescribed most frequently after tonsillectomy (45.4%) and least frequently after laryngoscopy with interventions (3.9%), which persisted in the multivariable models. Overall rates of continuous use at 180 and 360 days were 0.48% and 0.27%, respectively. Among patients receiving an initial opioid prescription, maintaining continuous prescriptions was associated with tonsillectomy procedures, age (adjusted hazard ratio [aHR]: 0.997 per year, 95% confidence interval [CI]: 0.993-0.999), opioid prescriptions 6 months preprocedure (aHR: 0.42, 95% CI: 0.37-0.47), and nonotolaryngology initial prescribers (aHRs: <1, P < .05). There is substantial variation in initial prescribing practices and continuous opioid prescriptions after common Otolaryngology procedures, but the overall rate of maintaining a continuous prescription starting after these procedures is very low. Level 3.

Prophylactic Intravenous Vs Topical Lidocaine to Blunt Stress Response During Laryngoscopy

Background: The stress response is a common phenomenon occurred during laryngoscopy. Although this response can be transient and less harmful in healthy individuals, it might be hazardous among the many patients with underline disorders. Aim of the study: The purpose of the study was to compare the two different routes for lidocaine to determine the blunt stress response during laryngoscopy. Study design: A randomized control study was designed. Method: This randomized control study design was performed in the Department of Anesthesia, Critical Care, and Pain Medicine at Aziz Bhatti Shaheed Teaching Hospital, Gujrat. The duration of the study was from February 2021 to Jun 2022. The participant of this study was 70 in number having age between 30-60 years and was divided into two groups via a computer-generated randomization sheet. The first group name, group-A contains 35 patients, single dose of 200mg intravenous lidocaine was given before the laryngoscopy procedure. The second group was group B consisted of 35 patients who had to receive the topical (spray) lidocaine in a single dose of 200mg. Results: Group-A patients who had received the IV, lidocaine had a systolic blood pressure mean ± SD value of 120.03 ± 9.72 with a p-value of 0.021 which indicate the systolic was under control. Diastolic pressure means ± SD value was 75.81 ± 10.46 with a P-value of 0.012 which shows the significant effect of lidocaine to reduce the pressure. Arterial pressure was measured with mean ± SD = 75.34 ± 9.61 value. Group B patients who received the topical lidocaine dose, shows a 140 ± 10.87 mean ± SD value of systolic blood pressure and diastolic blood pressure mean ± SD value was 85.42 ± 11.01 recorded. Arterial pressure with mean ± SD = 98.34± 9.13 value and significant p-value shows the higher arterial pressure. The use of topical lidocaine was not effectively controlling heart rate as indicated by mean ± SD = 99.87±10.14. Conclusion: Overall, the study suggests that prophylactic intravenous given laryngoscopy will provide a significantly positive response to handle the blunt stress response in a better way as compared to topical use of lidocaine. Keywords: laryngoscopy, Intravenous lidocaine, Topical lidocaine, Stress response

S3286 Dental Foreign Body Ingestion: What Happens Next?

Introduction: Foreign body ingestion during dental procedures is a rare complication that often leads to referral for medical treatment and potentially invasive procedures. Dental objects are the second most commonly ingested objects in adults and the majority enter the gastrointestinal tract. There is limited data available on the presentation and management of dental foreign body (DFB) ingestion. We aim to better define the clinical course after DFB ingestion and identify factors that influence clinical outcomes. Methods: This is a retrospective study of patients who presented to the Emergency Department after DFB ingestion between 2015 and 2020 at a single tertiary care center. Patients 18 years or older were included in the study. Data was collected through electronic medical record review including medical history, imaging, interventions, and timeline. Results: 23 patients met the study criteria and the mean age was 62.4 (SD 14.2). 11 (47.8%) were female and the majority identified as white or African American (Figure 1). On presentation, 20 patients were asymptomatic while 3 endorsed a foreign body sensation. Most underwent imaging (22, 95.7%), with all 22 having x-ray imaging and 3 (13.6%) a CT scan. The object was identified on x-ray in 16 patients. The most common object location on presentation was the small bowel (7, 43.8%) followed by stomach (5, 31.3%). 10 of the 19 objects on which descriptive data was available were labeled as sharp. Of the 23 patients, 7(30.4%) were admitted and GI was consulted for 8 (34.7%). Having a specialty consult was significantly associated with both hospital admission and undergoing an intervention (Table 1). Two patients underwent an endoscopy and one a laryngoscopy procedure. The object was removed in 2 (8.7%) and none required surgery. Conclusion: This study examines a unique patient cohort with DFB ingestion and provides an improved understanding of these patients’ clinical course. Patients who had a specialty consult were more likely to be admitted and have an intervention. This study did not reveal patient or object characteristics associated with increased risk of admission or procedure but was limited by a smaller sample size. Most patients who ingest DFBs are managed conservatively after aspiration is ruled out.Figure 1.: Race distribution of patient cohort.Table 1.: Comparison of patients with DFB ingestion who were admitted versus not admitted from the Emergency Department and those who underwent versus did not undergo a procedure.

Comparison of haemodynamic response to tracheal intubation with two different videolaryngoscopes: A randomized clinical trial

BackgroundEndotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. MethodsFifty ASA II...III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24...hours following extubation. ResultsThe hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p...=...0.024; p...=...0.012; p...=...0.030; p...=...0.009, respectively). In group analyses, T1...T2, T2...T3 and T1...T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1...T3) (p...=...0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p...<...0.001), but the duration of intubation and total intubation were similar (p...=...0.36; p...=...0.79). ConclusionsCompared to C-MAC, the hemodynamic response to ETI was less with Airtraq. Thus, Airtraq may be preferred in CABG patients for ETI.

Effectiveness Comparison of Using Macintosh Blade and Mccoy Blade For Endotracheal Intubation In Anesthesia Residents

Introduction: Laryngoscopy is one of the critical points in the intubation process and a mechanical trauma that provides noxious stimulation, affecting cardiovascular, respiratory, and intracranial changes. Practitioner competence is a significant factor that supports laryngoscope intubation procedures. That can influence the intubation duration and amount of mechanical trauma besides caused by laryngoscope type. Objective: To analyze the effectiveness of using Macintosh blade compared to McCoy blade in intubation laryngoscopy by Anesthesia Residents. Materials and Methods: This research is an experimental study in adult patients who underwent elective surgery at GBPT Dr. Soetomo Hospital. Intubation did by Anesthesia Residents at levels 5-9 using Macintosh or McCoy Laryngoscope and chosen randomly. The data of laryngeal visualization (Cormack Lehane), hemodynamics (blood pressure, pulse), pain scale (qNOX), intubation time length, and pain scale data (VAS) after extubation were taken during intubation laryngoscope. Result and Discussion: The study was conducted on 28 samples that met the criteria. Anesthesia Resident's competence levels based on the semester in both groups laryngoscopes were not different (p 0.868). Based on laryngeal visualization data laryngoscopy, the McCoy's blade had better visualization with CL 1 at 85.7% of the samples and p-value 0.020. This good visualization makes it possible to speed up the laryngoscope-intubation in the McCoy blade group with a significant difference of time compared to the Macintosh blade group. Hemodynamic parameters, there were significant differences for hemodynamics increase. In the Macintosh blade group, the blood pressure and pulse were significantly increased after laryngoscopy intubation. The pain scale during the intubation procedure, which was rated based on the qNOx score, showed a significant increase in the Macintosh blade group with a p-value of 0.003. The postoperative pain scale (VAS) was smaller in the McCoy blade group compared to the Macintosh group (p-value &lt;0.001). Conclusion: The ability to use both laryngoscopes at some levels of Anesthesia residents was equally good, and the use of McCoy Blade is more effective than Macintosh Blade in the intubation laryngoscopy procedure.

Cost Comparison of 2 Video Laryngoscopes in a Large Academic Center

Objective: Retrospective study examining hospital cost information of patients requiring endotracheal intubation with video laryngoscopy. Provide a practical cost assessment on use of the McGRATH and GlideScope video laryngoscopes (VLs). Methods: This study examined 52 hospital locations within a single, large university hospital, with most of those locations being hospital operating rooms. A total of 34 600 endotracheal intubations performed over 24 months, of which 11 345 were video laryngoscopies. Electronic medical records containing demographic data and information related to endotracheal intubation procedures, with monthly breakdowns between GlideScope and McGRATH intubations, were reviewed. Cost information calculated for equipment, blades, batteries, repairs, and subsequent analysis performed to determine cost differences between those 2 instruments during the COVID-19 period. Results: A total of 5501 video laryngoscopy procedures were performed using the McGRATH VL and 5305 were performed using the GlideScope VL. Costs over 24 months were $181 093 lower (55.5%) for McGRATH compared to GlideScope. The mean (SD) monthly costs for GlideScope blades were $3837 ($1050) and $3236 ($538) for years 1 and 2, respectively, vs $1652 ($663) and $2933 ($585) for McGRATH blades (P<.001). Most total cost differences were attributed to equipment and blade purchases, which were $202 595 (65.0%) higher for GlideScope. During the COVID-19 period, the use of the McGRATH increased to 61% of all video laryngoscopy cases, compared to 37% for GlideScope (P<.001). Blade cost difference for the COVID19 period was $128 higher for the McGRATH even though 293 more intubations were performed with that device. Conclusions: Use of the McGRATH resulted in a cost savings of 55% compared to the GlideScope, and its use was highest during the COVID-19 period, which may be explained by its more portable and practical features.

Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ?

Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability.

Proteomic and Genomic Methylation Signatures of Idiopathic Subglottic Stenosis.

Idiopathic subglottic stenosis (iSGS) is a chronic inflammatory condition that causes dyspnea and affects middle-aged women of White race and non-Latino or Hispanic ethnicity. To better characterize its phenotype and pathogenesis, we assessed the proteomic and genomic methylation signatures of subglottic tissue collected from iSGS patients compared to controls. Molecular analysis of clinical biospecimens. We collected subglottic tissue biopsies from 12 patients during direct laryngoscopy, immediately prior to surgical treatment of iSGS; as well as from 4 age-, sex-, and race/ethnicity-matched control patients undergoing other direct laryngoscopic procedures. We isolated protein and genomic DNA, acquired proteomic data using label-free quantitative mass spectrometry techniques, and acquired genome-wide methylation data using bisulfite conversion and a microarray platform. We compared molecular profiles across the iSGS and control groups, and with respect to clinical course in the iSGS group. Eight of the 12 iSGS patients underwent subsequent blood collection and plasma isolation for further assessment. Proteomic analysis revealed 42 differentially abundant proteins in the iSGS biopsies compared to controls, inferring enrichment of biological pathways associated with early wound healing, innate immunity, matrix remodeling, and metabolism. Proteome-based hierarchical clustering organized patients into two iSGS and one control subgroups. Methylation analysis revealed five hypermethylated genes in the iSGS biopsies compared to controls, including the biotin recycling enzyme biotinidase (BTD). Follow-up analysis showed elevated plasma BTD activity in iSGS patients compared to both controls and published normative data. iSGS exhibits distinct proteomic and genomic methylation signatures. These signatures expand current understanding of the iSGS phenotype, support the possibility of disease subgroups, and should inform the direction of future experimental studies. Not applicable Laryngoscope, 131:E540-E546, 2021.

Endoscopic Multimodal Approach to the Treatment of Airway Venous Malformations.

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Ultrasound measurement of laryngeal structures in the parasagittal plane for the prediction of difficult laryngoscopies in Chinese adults

BackgroundAbnormal laryngeal structures are likely to be associated with a difficult laryngoscopy procedure. Currently, laryngeal structures can be measured by ultrasonography, however, little research has been performed on the potential role of ultrasound on the evaluation of a difficult laryngoscopy. The present study investigated the value of laryngeal structure measurements for predicting a difficult laryngoscopy.ObjectiveThe main objective of this study was to explore the value of laryngeal structure measurements for predicting a difficult laryngoscopy.MethodsTwo hundred and eleven adult patients (over 18 years old) were recruited to undergo elective surgery under general anesthesia via endotracheal intubation. Ultrasound was utilized to measure the distance between the skin and thyroid cartilage (DST), the distance between the thyroid cartilage and epiglottis (DTE), and the distance between the skin and epiglottis (DSE) in the parasagittal plane. These metrics were then investigated as predictors for classifying a laryngoscopy as difficult vs easy, as defined by the Cormack and Lehane grading scale.ResultsMultivariate logistic regression showed that the DSE, but not DST or DTE, was significantly related to difficult laryngoscopies. Specifically, a DSE ≥ 2.36 cm predicted difficult laryngoscopies with a sensitivity and specificity of 0.818 (95% CI: 0.766–0.870) and 0.856 (95% CI: 0.809–0.904). Furthermore, when combining the best model constructed of other indicators (i.e. sex, body mass index, modified Mallampati test) to predict the difficult laryngoscopy, the AUC reached 93.28%.ConclusionDSE is an independent predictor of a difficult laryngoscopy; a DSE cutoff value of 2.36 cm is a better predictor of a difficult laryngoscope than other ultrasound or physiological measurements for predicting a difficult laryngoscope. Nevertheless, it’s more valuable to apply the best model of this study, composed of various physiological measurements, for this prediction purpose.

Tongue base varix as a source of oral bleeding

Rationale:Oral bleeding is usually diagnosed after by referral to other department for the differential diagnosis of hematemesis or hemoptysis. If a patient presents with blood in the oral cavity with no obvious source, generally upper airway, pulmonary, or gastroesophageal lesions are considered likely bleeding foci. The tongue base is an unusual site for laryngopharyngeal varices and only a few cases have been reported.Patient concerns:Although varix at the tongue base in patients with liver cirrhosis has been rarely described, physicians must consider variceal bleeding from the tongue base when presented with oral bleeding. In such cases, bleeding foci can be identified and controlled by laryngoscopy. We describe the case of a 42-year-old woman complaining of small amount of hemoptysis with variceal bleeding at the tongue base controlled by laryngoscopic excision and cauterization.Diagnosis:A diagnosis of tongue base varix was made based on medical history, clinical manifestations, laryngoscopic findings and pathologic features for the patient.Interventions:The successful laryngoscopic procedures were performed.Outcomes:The patient has shown no recurrent oral bleeding during follow-up.Lessons:Variceal bleeding in the tongue base is likely to cause serious massive hemorrhage. We need to consider this possibility when presented with a patient with intraoral bleeding but no evidence of hemoptysis or hematemesis.

Risk Factors for Lingual Nerve Injury Associated With Suspension Laryngoscopy.

This prospective study was designed to identify risk factors for lingual nerve injury as a complication of suspension laryngoscopy. Fifty-six adult patients (19 females and 37 males) who underwent microlaryngeal surgery (MLS) using the suspension laryngoscopy procedure under general anesthesia at our otorhinolaryngology department between January 2016 and January 2018 were enrolled in this study. All operations were performed using only a cold-steel microlaryngeal surgical set, and operations using laser and radiofrequency energy were not included. Unilateral or bilateral paresthesia, numbness of the tongue, and/or a change in taste sensation (dysgeusia) were considered to indicate lingual nerve injury. Operation time and difficulties during intraoperative intubation and/or suspension of the larynx were major risk factors for lingual nerve injury following suspension laryngoscopy ( P = .015 and P = .011, respectively). Difficulties in preoperative flexible fiberoptic examination and intraoperative laryngeal compression were not found as risk factors, and the associations were not significant. Additionally, females showed a higher complication rate of lingual nerve injury following suspension laryngoscopy than males. From a medical-legal standpoint, although lingual nerve injury is not a life-threatening complication, it is important to inform patients, especially those expected to undergo long-duration surgery.

Iatrogenic Lingual Neuralgia Following Laryngoscopy

Tongue pain attributed to lingual neuralgia has been reported following dental and oral surgical procedures. Lingual nerve insult through traction and compression during laryngoscopic examination has been proposed as possible etiology for lingual nerve neuralgia. We report a case of tongue ischemia during laryngoscopic procedure which resulted in lingual neuralgia. We recommend that intermittent release of pressure by relaxing the instrument or gag and monitoring the perfusion state of the tongue will reduce the risk of this lingual neuralgia.&#x0D; KEYWORDS: Lingual neuralgia, Laryngoscopy, Tongue ischaemia

Pharyngeal haemangioma – case report

Haemangiomas are vascular tumours rarely found in the otorhinolaryngological practice, especially in adults. We present the case of a 31-year-old female patient, accusing oral haemorrhage and mild dysphagia. Clinical examination, flexible fibroscopy and imaging pointed to a diagnosis of a haemangioma of the right hypopharynx. A microscopic laryngoscopy procedure was carried out, with intratumoral monopolar electrocauterization which led to a complete retraction of the tumour. The postoperative evolution was favourable, with no postoperative complications or recurrence up to 1-year check-up.

Steering Sheath for 2-Nostril Transnasal Office Laryngoscopy.

The aim was to study the feasibility of performing office-based laryngeal procedures employing a flexible hollow steerable sheath placed contralateral to the nostril through which a standard flexible video endoscope is placed. The study design included simulation of transnasal endoscopic laryngeal procedures evaluating the use of a flexible steering sheath in laboratory and clinic settings. Transnasal laryngeal procedures were performed in an otolaryngology office setting employing an airway-management-trainer mannequin and then repeated in a human cadaver lab with standard transnasal flexible video laryngoscopy. Video documentation assessed use of a lever-manipulated deflecting ureteral access sheath with an inner diameter of 2.97 mm, an outer diameter of 4.95 mm, and a length of 45 cm. Simulated transnasal laryngoscopy procedures deployed devices through the deflecting sheath to mimic vocal fold needle injection, biopsy with forceps, balloon dilation, and laser treatment to identify strengths and shortcomings to the technology and technique. Simulation was successful in appropriately directing instrumentation for all procedures tested. Shortcomings included limitations in steering capacity, greater length to the sheath than desirable for laryngeal procedures, and the need for additional assistants to perform procedures. Steering sheath technology is applicable to enhance in-office transnasal laryngoscopy procedures.

Simple method for obtaining the optimal laryngoscopic view in children: A prospective observational study

BackgroundHead and neck positioning has an important effect on laryngeal visualization during laryngoscopy. For small children and infants, a head-flat position is traditionally assumed; however, during laryngoscopy, the optimal head position may result in a superior laryngeal view in certain patients. MethodsWe investigated whether the alignment of the external auditory meatus and the sternal notch with a pillow with an individualized height is associated with improved laryngeal visualization during direct laryngoscopy in pediatric patients. We enrolled 49 pediatric patients (3 to 6years old) receiving general anesthesia. The percentage of glottic opening score and ease of handling the laryngoscope (range 0–10) were recorded before and after head positioning with the pillow. ResultsMost of the children, except two patients, needed a pillow beneath their head to align the external auditory meatus and the sternal notch. The percentage of glottic opening score was significantly higher after pillow adjustment compared to that in the neutral position (50 [20–80] vs. 90 [37.5–100]; p<0.0001). Handling of the laryngoscope improved with pillow adjustment (7 [6.0–8.0] vs. 9 [8.0–10.0]; p<0.0001). There were no significant complications during intubation. ConclusionsPositioning of the head in order to align it with the external auditory meatus and sternal notch was associated with superior laryngoscopic visualization in pediatric patients. This resulted, in a more straightforward laryngoscopic procedure. Trial registrationshttp://cris.nih.go.kr identifier: KCT 0001156

Safety of Adult Ambulatory Direct Laryngoscopy: Revisits and Complications.

Direct laryngoscopy, once an inpatient procedure, is now commonly performed in the outpatient setting. To ensure that safety follows the adoption of novel techniques and practice patterns, it is important to analyze the complication and revisit rates of these ambulatory surgery practices. To determine revisit rates and complications after ambulatory adult direct laryngoscopy procedures. This was a retrospective cross-sectional analysis of cases of adult patients who had undergone a direct laryngoscopic procedure extracted from multistate ambulatory surgery and hospital databases (State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011). The analysis was performed on December 1, 2014. Index cases were linked to the corresponding State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring within a 7-day postoperative window. All index cases were ambulatory surgery, without overnight stay or 23-hour observation. Adult patients who had undergone a direct laryngoscopy procedure. Direct laryngoscopy performed in an ambulatory setting. Patients who underwent flexible laryngoscopy, lesion destruction, laryngectomy, cordectomy, or a secondary nonlaryngoscopy procedure were specifically excluded. Data regarding sex, age, revisit occurrence with associated complications, and mortality were analyzed. A total of 7743 cases of ambulatory laryngoscopy were identified (mean age, 60.4 years; 61% were male). The 7-day revisit rate was 3.0% (232 revisits). Serious airway complications occurred in 0.27% of cases (n = 21) and accounted for 9.1% of revisits. The rates of other major complications and minor complications were 0.15% (n = 12) and 0.75% (n = 58), respectively. There were no cases of anoxic brain injury. Two deaths occurred at the time of the revisit (7-day mortality rate, 0.03%; 95% CI, 0.01%-0.09%). Adult ambulatory direct laryngoscopy has a favorable safety profile. Serious airway complications occur in fewer than 3 patients per 1000 cases. The risk of death following outpatient laryngoscopy is extremely low. Outpatient laryngoscopy is not universally suited for all patients, and careful preoperative selection and counseling are imperative.