Otolaryngol Head Neck Surg Research Articles

Outcomes of tracheal resection and anastomosis in patients with tracheal stenosis: a clinical perspective

BackgroundTracheal stenosis results from an altered inflammatory response to mucosal damage, which leads to impairment of breathing and can even be fatal if not treated promptly (Ind J Otolaryngol Head Neck Surg 73(4):447–454, 2020). ENT and head and neck surgeons face difficulties while treating tracheal stenosis. Mechanical stress from extended endotracheal intubation or tracheostomy, combined with hypoxic metabolic disturbances during an underlying event, is the most frequent cause of tracheal stenosis (Al-Azhar Int Med J 3(10):149-57, 2022). The main objective of the study is to assess the outcomes of tracheal resection and anastomosis in patients who presented with tracheal stenosis. This emphasizes the need for proper case selection and timely surgical intervention to relieve the airway obstruction and to ensure the effectiveness of tracheal resection and anastomosis as the less morbid approach by avoiding a midline sternotomy.The study was conducted in a tertiary care center on 25 patients who were admitted in ENT ward from the year 2011 to year 2021. Case records of those patients who underwent tracheal resection and anastomosis were analyzed on a retrospective basis. Detailed history taking and clinical examination with appropriate investigations like flexible bronchoscopy, computed tomography with 3-dimensional reconstruction, video laryngoscopy, direct laryngoscopy, and lung function tests were carried out for all the patients in the study as required. An evaluation of GERD was also done. Appropriate surgical procedure was done with regular post-operative follow-up for 18 months.ResultsIn our study, 92% of patients had satisfactory outcomes following tracheal resection and anastomosis, while some patients experienced minor complications. In 8% of patients, the primary surgery failed, among whom one patient underwent revision surgery and is doing well. The other patient with post-traumatic stenosis with a long stenotic segment underwent Shiann Yann Lee procedure in an outside center which resulted in failure following which T tube insertion was done. The patient showed improvement and was decannulated after a month.In our study of 25 patients with tracheal stenosis, postoperative complications occurred and were managed accordingly. However, there was no significant correlation between these complications and patient age, sex, extent of stenosis, preoperative Cotton-Myer grading, or the type of surgical procedure performed. This lack of correlation may be attributed to the limited sample size.ConclusionTracheal resection and anastomosis are challenging procedures and should be done only in centers with experience. Standard treatment consists of resection of the stenotic segment with end-to-end anastomosis. The geometry of the ends to be anastomosed is matched properly to avoid gaps or weak points and for air-tight seal anastomosis.

Is There a Role for Adjuvant Therapy in Patients with Large Juvenile Nasopharyngeal Angiofibromas?

The LaryngoscopeEarly View Triological Society Best Practice Is There a Role for Adjuvant Therapy in Patients with Large Juvenile Nasopharyngeal Angiofibromas? Charles A. Riley MD, Corresponding Author Charles A. Riley MD [email protected] orcid.org/0000-0002-1993-7018 Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA Send correspondence to Charles A. Riley, MD, Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. Email: [email protected]Search for more papers by this authorDavid A. Gudis MD, David A. Gudis MD orcid.org/0000-0002-1938-9349 Department of Otolaryngology – Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York City, New York, USASearch for more papers by this author Charles A. Riley MD, Corresponding Author Charles A. Riley MD [email protected] orcid.org/0000-0002-1993-7018 Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA Send correspondence to Charles A. Riley, MD, Department of Otolaryngology—Head and Neck Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. Email: [email protected]Search for more papers by this authorDavid A. Gudis MD, David A. Gudis MD orcid.org/0000-0002-1938-9349 Department of Otolaryngology – Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York City, New York, USASearch for more papers by this author First published: 30 May 2023 https://doi.org/10.1002/lary.30797 Editor's Note: This Manuscript was accepted for publication on May 18, 2023 The authors have no other funding, or financial relationships to disclose. The authors whose names are listed above certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. BIBLIOGRAPHY 1McAfee WJ, Morris CG, Amdur RJ, Werning JW, Mendenhall WM. Definitive radiotherapy for juvenile nasopahryngeal angiofibroma. Am J Clin Oncol. 2006; 29(2): 168- 170. 2Mallick S, Benson R, Bhasker S, Mohanti BK. Long-term treatment outcomes of juvenile nasopharyngeal angiofibroma treated with radiotherapy. Acta Otorhinolaryngol Ital. 2015; 35(2): 75- 79. 3Amdur RJ, Yeung AR, Fitzgerald BM, Mancuso AA, Werning JW, Mendenhal WM. Radiotherapy for juvenile nasopharyngeal angiofibroma. Pract Radiot Oncol. 2011; 1(4): 271- 278. 4Thakar A, Gupta G, Bhalla AS, et al. Adjuvant therapy with flutamide for presurgical volume reduction in JNA. Head Neck. 2011; 33(12): 1747- 1753. 5Labra A, Chavolla-Magana R, Lopez-Ugalde A, Alanis-Calderon J, Huerta-Delgado A. Flutamide as a preoperative treatment in juvenile angiofibroma (JA) with intracranial invasion: report of 7 cases. Otolaryngol Head Neck Surg. 2004; 130(4): 466- 469. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Tonsillectomy in adults—to do or not to do

Recurrent acute tonsillitis describes the repeated occurrence of acute bacterial infections of palatine tonsils with symptom-free intervals. Acute tonsillitis accounts for around a third of respiratory tract infections in primary care among people of all ages, 1 Petersen I Johnson AM Islam A Duckworth G Livermore DM Hayward AC Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007; 335: 982 Crossref PubMed Scopus (210) Google Scholar with an estimated 600 million symptomatic cases of group A streptococcus tonsillitis worldwide annually. 2 Carapetis JR Steer AC Mulholland EK Weber M The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005; 5: 685-694 Summary Full Text Full Text PDF PubMed Scopus (1995) Google Scholar Recurrent episodes occur in 12% of patients with tonsillitis—ie, around 12 000 per 100 000 people. 3 Kvestad E Kværner KJ Røysamb E Tambs K Harris JR Magnus P Heritability of recurrent tonsillitis. Arch Otolaryngol Head Neck Surg. 2005; 131: 383-387 Crossref PubMed Scopus (26) Google Scholar Beyond the relation to group A streptococcus infections, little is known about risk factors for the development of recurrent acute tonsillitis. 4 Roberts AL Connolly KL Kirse DJ et al. Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage. BMC Pediatr. 2012; 12: 3 Crossref PubMed Scopus (97) Google Scholar Recurrent acute tonsillitis could be a genetic immunosusceptibility disease because patients younger than 12 years show some subclinical antibody deficiency and aberrant T-cell function 5 Dan JM Havenar-Daughton C Kendric K et al. Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Sci Transl Med. 2019; 11eaau3776 Crossref PubMed Scopus (1) Google Scholar and many undergo tonsillectomy. More than 30 000 tonsillectomies are performed annually in the UK. 6 Keltie K Donne A Daniel M et al. Paediatric tonsillectomy in England: a cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008–2019). Clin Otolaryngol. 2021; 46: 552-561 Crossref PubMed Scopus (16) Google Scholar Tonsillectomy can produce severe postoperative pain, complicated by postoperative bleeding which can result in death in rare cases. Clearly, we need evidence-based policies to guide health-care professionals for the indication of tonsillectomy. 7 Mandavia R Schilder AGM Dimitriadis PA Mossialos E Addressing the challenges in tonsillectomy research to inform health care policy: a review. JAMA Otolaryngol Head Neck Surg. 2017; 143: 943-947 Crossref PubMed Scopus (10) Google Scholar Unfortunately, not much has changed in the past 40 years. National guidelines are still based on the Paradise criteria from 1984, 8 Paradise JL Bluestone CD Bachman RZ et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children—results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984; 310: 674-683 Crossref PubMed Google Scholar stating that a tonsillectomy is indicated when around seven or more treated tonsillitis episodes occur in 1 year. The Paradise criteria were based on paediatrics clinical trials and later extrapolated for adult guidelines without any justifying research in the adult population. Thus, the 2014 Cochrane Review concluded that the effectiveness of tonsillectomy is low. 9 Burton MJ Glasziou PP Chong LY Venekamp RP Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014; 2014CD001802 PubMed Google Scholar Until now, there was no basis to make confident decisions using national guidelines. 7 Mandavia R Schilder AGM Dimitriadis PA Mossialos E Addressing the challenges in tonsillectomy research to inform health care policy: a review. JAMA Otolaryngol Head Neck Surg. 2017; 143: 943-947 Crossref PubMed Scopus (10) Google Scholar Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trialCompared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis. Full-Text PDF Open Access

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

Long-term outcome of cochlear implantation on speech perception and quality of life

BackgroundCochlear implantation (CI) is currently a well-established method for restoring hearing to people with profound hearing loss (Blamey and Artieres, Audiol Neurotol 18:36-47, 2013; Holden and Finley, Ear Hear 34:342-360, 2013).Cochlear implantation not only affects hearing abilities, speech perception, and production, but also has an outstanding impact on the social life, activities, and self-esteem of each patient. The Nijmegen Cochlear Implant Questionnaire (NCIQ) and Parents’ Views and Experiences with pediatric Cochlear Implant Questionnaire (PVECIQ) have been developed to assess the quality of life in such patients (Damen and Beynon, Otolaryngol Head Neck Surg 136:597-604, 2007; Hirschfelder and Gräbel, Otolaryngol Head Neck Surg 138:357-362, 2008).The long-term outcome of cochlear implantation (CI) in Egypt and its influence on patients’ lives have not been investigated. This study was designed to evaluate the long-term effect of CI on speech perception and to assess the quality of life (QoL) and get insight about major problems encountered by these patients over years.MethodsForty adults and children CI users of least 5 years of CI experience were subjected to full history taking and CI outcome measures: CI questionnaires, aided sound field pure tone audiometry, and speech perception tests.ResultsThrough QoL questionnaires, the highest scores were obtained in the physical functioning domain than in the psychological and social domains in adults, while for children, the highest scores were obtained in the general domain than in the communication and self-reliance domains. No statistically significant correlation was found between QOL questionnaires and speech tests.ConclusionAudiological evaluation including speech perception tests is not enough to reflect the true performance of CI subjects in everyday listening situations. The Arabic versions of QoL questionnaires were complementary to other outcome CI measures. Long-term evaluation for CI users is crucial.

Neonatal stridor presents at home – vocal fold paralysis as rare presenting feature of CHARGE syndrome

Abstract Objectives To present an unusual presentation and diagnosis of CHARGE syndrome with vocal fold paralysis, a rarely associated congenital laryngeal anomaly, as the presenting feature. Case presentation A four-day old, full-term, male infant born via uncomplicated vaginal delivery with a nursery course significant for failed hearing screen presented to an emergency department (ED) with respiratory distress and worsening stridor. He was transferred to a level III neonatal intensive care unit (NICU) for further evaluation and required intubation due to progressive hypercarbia. Laryngoscopy revealed left-sided unilateral vocal fold paralysis (VFP). He underwent further evaluation that included a normal MRI brain, neck and chest. Genetics was consulted with concern for dysmorphic features on physical exam. Following gene panel testing, VFP was attributed to known association with CHARGE syndrome. Airway edema was noted on laryngoscopy that prevented extubation until two months of age. Further features of CHARGE syndrome identified included colobomas, glaucoma, sensorineural hearing loss, and genital abnormalities. He was discharged in room air and following gastrostomy tube placement with otolaryngology follow up. Conclusions Although choanal abnormalities are classically associated with CHARGE syndrome, other upper airway anomalies such as VFP may be present. VFP is a rarely reported anomaly in association with CHARGE syndrome (Naito Y, Higuchi M, Koinuma G, Aramaki M, Takahashi T, Kosaki K. Upper airway obstruction in neonates and infants with CHARGE syndrome. Am J Med Genet 2007;143A:1815–20; Morgan D, Bailey M, Phelps P, Bellman S, Grace A, Wyse R. Ear-nose-throat abnormalities in the CHARGE association. Arch Otolaryngol Head Neck Surg 1993;119:49–54).

Skin in the Game: An Analysis of Venture Capital Investment in Dermatology from 2002 to 2021

Skin in the Game: An Analysis of Venture Capital Investment in Dermatology from 2002 to 2021

ODP485 Hyperthyroidism with Concurrent Thyroid Cancer: Causal Relation or Incidental Association?

Abstract Introduction Thyrotoxicosis caused by Graves’disease (GD),toxic multinodular goiter (TMG) andtoxic adenoma (TA) can be associated with thyroid carcinoma; furthermore, tumors arisen in hyperthyroid tissue show an aggressive behavior (1). Objective To determine the incidence of thyroid carcinoma in thyrotoxic patients who underwent thyroidectomy and to analyzethe relationship between thyroid cancer, hyperthyroidism and outcomes of hyperthyroid versus euthyroid patients. Materials and Methods We retrospectively studied 304 consecutive hyperthyroid patients who underwent total thyroidectomy, presented in our institute between 2016 and 2021. The indications for surgery were GD (n=167, 3 of them were classified as Bethesda V on the basis of fine needle aspiration biopsy cytological examination prior to surgery), TMG (n=117) and TA (n=20). Results The incidence ofthyroid carcinoma in hyperthyroid patients was 18.1% (n=55) and was more common in patients with TMG (19.7%) and GD (18.6%), than in those with TA (5%). According to the post-surgical histological examination 41 patients were diagnosed with papillary thyroid carcinoma (92.7%), 2 patients were diagnosed with follicular thyroid carcinoma (3.6%), 1 patient with undifferentiated thyroid carcinoma (1.8%), and another patient with medullary thyroid carcinoma (1.8%). Papillary thyroid microcarcinoma accounted for 58.2% of all histological types. Lymph node involvement was found in 22% of the patients with GD, in 13% of those with TMG, and in none of those with TA. Distant metastases were found in 2 patients with GD and in other 2 patients with TMG. Compared with a similar group of 120 euthyroid patients who underwent surgery for thyroid cancer during the same time period, the patients with hyperthyroidism have a 3.4 times greater risk for developing lymphovascular metastases compared to euthyroid subjects (23.6% vs 8.3%, p=. 008). Conclusion Our study showed that thyroid cancers in hyperthyroid patients have an aggressive behaviour, with a worse prognosis than euthyroid patients. A carefully evaluation of all patients with hyperthyroidism is needed to exclude the presence of concurrent malignancy. Routine thyroid ultrasonographic (US) scans and US-guided FNAB should be considered for complete evaluation of hyperthyroid patients. Reference: Medas F, Erdas E, Canu GL, Longheu A, Pisano G, Tuveri M, Calò PG. Does hyperthyroidism worsen prognosis of thyroid carcinoma? A retrospective analysis on 2820 consecutive thyroidectomies. J Otolaryngol Head Neck Surg.2018 Jan 22;47(1): 6. Presentation: No date and time listed

Long-term quality-of-life impairment in patients with more than 1-year COVID-19-related olfactory dysfunction.

Long-term quality-of-life impairment in patients with more than 1-year COVID-19-related olfactory dysfunction.

Advances and future directions in the care of patients with facial paralysis

Advances and future directions in the care of patients with facial paralysis

Duration of positive airway pressure adherence: how much PAP is enough?

Duration of positive airway pressure adherence: how much PAP is enough?

Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests.

The clinical performance of home sleep apnea tests (HSATs) can be described by their (diagnostic) accuracy, defined as the percentage agreement with the obstructive sleep apnea severity category (normal, mild, moderate, and severe) based on polysomnography. Rather than reporting on accuracy, there has been a strong reliance in the literature to report correlation coefficients between the apnea-hypopnea index of HSATs and polysomnography to support claims of diagnostic performance. This is surprising, as it has been well described that correlation coefficients are inadequate to evaluate equivalence between 2 parameters. The aim of this study was to systematically investigate the magnitude of the discrepancies between correlation coefficients and diagnostic accuracy reported in or retrievable from HSAT validation studies. We compared the discrepancy between accuracy and apnea-hypopnea index correlation coefficients of all validation papers that met the inclusion criteria. A total of 20 papers were retained, representing a participant pool of 1,652. The weighted average apnea-hypopnea index correlation across all 20 papers was 0.82 and the weighted average accuracy was 0.61, highlighting a discrepancy of 0.21 and an overall misdiagnosis rate of 39%. The results of our study confirm the need for increased scientific rigor in selecting primary performance endpoints to support clinical performance claims of HSATs. Massie F, Van Pee B, Bergmann J. Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med. 2022;18(3):871-876.

Opioids and obstructive sleep apnea.

Freire C, Sennes LU, Polotsky VY. Opioids and obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):647-652.

A CASE OF TURBAN PIN INHALATION SYNDROME IN A YOUNG WOMAN

TOPIC: Cultural Diversity TYPE: Medical Student/Resident Case Reports INTRODUCTION: Turban Pin Inhalation Syndrome (TPIS) is mainly reported in countries in the Middle East with increased prevalence in younger females [1]. Incidences can be found in diverse cultural populations such as intercity areas like New York City. CASE PRESENTATION: A 38 year old woman with no past medical history presents to the emergency room an hour after accidentally inhaling a hair pin. Patient sensed something stuck in her throat and admitted to persistent hoarseness. Patient denies radiating pain, shortness of breath, chest pain, or hemoptysis. Physical exam reveals normal vitals. Patient is sitting comfortably with no respiratory distress, wheezing, drooling, or stridor. X-ray reveals a pin in the left main bronchus without pneumothorax or pneumomediastinum. After obtaining informed consent for flexible bronchoscopy, the patient was intubated and the pin was removed with three pronged forceps via flexible bronchoscopy in the emergency room (ER). Patient was discharged directly from the ER after successful extubation. DISCUSSION: Patients with TPIS usually present to the ER after accidentally inhaling pins held in their mouth while adjusting their scarves. Patients experience a brief episode of intense coughing and a feeling of suffocation, which is known as penetration syndrome. Patients are typically asymptomatic shortly afterwards, which leads to delay in seeking treatment. Early intervention is important because of the risk of distal mobilization or penetration through the bronchial wall or lung parenchyma leading to pneumothorax or pneumomediastinum. The average time between inhalation and surgery is 10 days. Longer term complications include granuloma formation into bronchial tree, recurrent pneumonia, obstructive emphysema, pleural effusion, bronchiectasis, and pulmonary abscess. Diagnosis is confirmed via X-ray that shows a linear opacity. In some reports, pins are located in the right main bronchus, but in other studies, there is no predilection for either side [1]. Rigid bronchoscopy is the standard modality to retrieve the pin, but would require removal in the operating room [1, 2, 3]. Flexible bronchoscopy can be used to retrieve the foreign body inhalation at bedside, which saves time and is more efficient in terms of logistics. If physicians are unable to retrieve the pin via bronchoscopy, more invasive measures would be used to retrieve the pin such as thoracotomy or parenchymal resection. CONCLUSIONS: Incidences of TPIS are not only in the Middle East, but also can be found in multi-cultural areas. These patients can present to intercity hospitals where they can undergo pin removal via flexible bronchoscopy and can be discharged the same day from the ER. REFERENCE #1: N. Rizk, N.E. Gwely, V.L. Biron, U. Hamza. Metallic hairpin inhalation: a healthcare problem facing young Muslim females. J Otolaryngol Head Neck Surg, 43 (2014 Aug 2), p. 21 REFERENCE #2: O. Ilan, R. Eliashar, N. Hirshoren, K. Hamdan, M. Gross. Turban pin aspiration: new fashion, new syndrome. Laryngoscope, 122 (4) (2012 Apr), pp. 916-919 REFERENCE #3: O. Dikensoy, C. Usalan, A. Filiz. Foreign body aspiration: clinical utility of flexible bronchoscopy. Postgrad Med J, 78 (2002), pp. 399-403 DISCLOSURES: No relevant relationships by Amanda Eng, source=Web Response No relevant relationships by rattan patel, source=Web Response

KOMMERELL DIVERTICULUM: A RARE BUT POTENTIALLY LIFE THREATENING ANOMALY

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Kommerell diverticulum and aberrant subclavian artery are rare anomalies of the aortic branches in the upper mediastinum. We are presenting a case of a patient incidentally diagnosed with Kommerell diverticulum and aberrant left subclavian artery. CASE PRESENTATION: A 61-year-old male with hypertension and heart failure with preserved ejection fraction, presented to the cardiology clinic after overnight hospitalization for one episode of short-lasting midline chest and left arm pain while resting. He had a history of multiple episodes of non-exertional chest pain and exertional dyspnea, dysphagia and occasional wheezing. Stress test was negative for reversible perfusion defect and showed normal left ventricular ejection fraction. A recently performed transthoracic echocardiogram showed dilated aortic root and possible bicuspid aortic valve. Computed tomography angiogram (CTA) of aorta was performed for further evaluation. CTA aorta revealed a right sided aortic arch and aberrant left subclavian artery with a diverticulum of Kommerell. The patient is being closely followed up outpatient to prevent any potential complications. DISCUSSION: Aberrant left subclavian artery (ALSA) is seen in 0.05-0.1% population and a right aortic arch (aortic arch traversing over the right bronchus) is seen in 0.5% population. These anomalies can be associated with DiGeorge syndrome (deletion of chromosome 22q11.2) and conotruncal congenital heart disease. They can incompletely encircle the trachea and esophagus, creating a partial vascular ring and causing dyspnea, wheezing and dysphagia. In many cases, the ALSA arises from a vascular structure called Kommerell diverticulum (KD), most often derived from a remnant of the fourth aortic arch. KD is similar to the ascending aorta in diameter, and can compress the trachea and esophagus, producing the symptoms mentioned above. It can also cause complications like recurrent pneumonia, aortic dissection or fatal mediastinal hemorrhage from aneurysmal rupture of the diverticulum. CONCLUSIONS: Aneurysms of aberrant subclavian arteries need surgical and/or endovascular resection to decrease mortality. Hence, early diagnosis with close monitoring is crucial in patients with Kommerell diverticulum and aberrant subclavian artery. REFERENCE #1: Adams MT, Wilhelm M, Singh N, Andersen C. Right Aortic Arch With Kommerell Diverticulum: A Rare Cause of Dysphagia. JAMA Otolaryngol Head Neck Surg. 2014;140(6):560-562. doi:10.1001/jamaoto.2014.417 REFERENCE #2: Bhatt TC, Muralidharan CG, Singh G, Jain NK. Kommerell's diverticulum: A rare aortic arch anomaly. Med J Armed Forces India. 2016;72(Suppl 1):S80-S83. doi:10.1016/j.mjafi.2016.09.003 DISCLOSURES: No relevant relationships by surya Aedma, source=Web Response No relevant relationships by Pranav Mahajan, source=Web Response No relevant relationships by Riddhi Upadhyay, source=Web Response No relevant relationships by Karen Wiarda, source=Web Response

Full thickness vs sliced mosaic cartilage graft in tympanoplasty: a comparative study

BackgroundTympanoplasty is one of the most performed procedures in otorhinolaryngology—head and neck surgery. Reconstruction of hearing is one of its targeted goals (Jeffery et al., J Otolaryngol Head Neck Surg 46:48, 2017). Closure of tympanic membrane was accomplished by various grafts. Temporalis fascia is commonly used in tympanoplasty but it could not withstand pressure variations due to its low elasticity (Sözen et al., J Craniofac Surg 23:e280-e283, 2012). Cartilage was preferred in this condition owing to its rigidity (Zhang et al., Otol Neurotol 32:1234-1238, 2011). However, this rigid character is thought to hinder the acoustic transfer through the cartilage (Bozdemir et al., ORL J Otorhinolaryngol Relat Spec 74:28-32, 2012).This study was conducted to determine the acoustic characteristics of sliced mosaic cartilage tympanoplasty.ResultsComparable success rates were found among the 2 groups at 3 months postoperatively; 14 cases (88%) in group 1 and 20 cases (91%) in group 2. One year postoperatively, two cases with healed perforation in group 2 showed re-perforation; resulting in decreasing success rate to 81%, in contrast to constant success rate (88%) in the corresponding follow-up in group 1. However, the difference between the two groups remained insignificant (P = 1 in both follow ups).ConclusionUsing split thickness cartilage slices arranged in mosaic pattern in type I tympanoplasty successfully overcame the hindering effect of cartilage on acoustic transfer, with no fear regarding take rate or complications.

Mentorship: A Millennia-Old Remedy for Learner Success Amidst the COVID-19 Pandemic

Mentorship: A Millennia-Old Remedy for Learner Success Amidst the COVID-19 Pandemic

Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study.

Obstructive sleep apnea (OSA) is a multilevel problematic disease. Major septal deviation (SD) can lead to severe nasal congestion, which, in turn, can lead to sleep apnea. Although SD seems to be related to OSA, very few studies have quantitatively examined this relationship. In this study, we investigate this using a 9-year large-scale cohort study. The SD group was selected out of 1 million individuals randomly extracted by the National Health Insurance Service. The non-SD group was obtained through propensity score matching considering several variables. The primary end point was OSA diagnosis. The study (SD) group included 11,238 individuals and the non-SD group (control group) included 22,476 persons. The overall hazard ratio for OSA in the SD group was 4.39 (95% confidence interval [CI]: 3.56-5.42). In subgroup analysis, the hazard ratio for OSA of male individuals was 3.77 (95% CI: 2.83-5.03), high economic status was 1.27 (95% CI: 1.05-1.56), metropolitan area was 1.31 (95% CI: 1.07-1.62), young age was 0.79 (95% CI: 0.64-0.98), hypertension was 1.00 (95% CI: 0.37-2.7), and diabetes mellitus was 2.44 (95% CI: 1.15-5.21). In the SD group, the hazard ratio for OSA after septoplasty was 0.71 (95% CI: 0.54-0.94). From long-term follow-up, the prevalence of OSA was 4.39 times higher in the SD group compared with the control group. This phenomenon was more pronounced with increasing body mass index and decreased significantly after septoplasty. Yeom SW, Chung SK, Lee EJ, etal. Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study. J Clin Sleep Med. 2021;17(10):2099-2106.

Symptoms: Sudden Hearing Loss and Facial Paralysis

Symptoms: Sudden Hearing Loss and Facial Paralysis

Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration?

The first-choice therapy for adults with moderate/severe obstructive sleep apnea is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. This cross-sectional study was conducted in adults diagnosed with moderate/severe obstructive sleep apnea [baseline apnea-hypopnea index (AHI) ≥ 15.0 events/h] who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep laboratory setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values delineated during the titration; all P-values > .005. However, the median residual AHI was significantly higher in males vs females: 2.7 events/h vs 2.2 events/h (P = .008). Body mass index (β: 0.292, P < .001), baseline AHI (β: 0.167, P < .001), and age (β: 0.065, P = .035) were independent predictors of the therapeutic CPAP level settings. Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95thpercentile CPAP requirement during an auto-adjusting CPAP titration. Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration? JClin Sleep Med. 2021;17(9):1815-1820.