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Chang CF, Kuo YL, Hsu YB. Transcutaneous Laryngeal Ultrasound for Assessing Hyaluronic Acid Status in Patients Undergoing Injection Laryngoplasty. Laryngoscope 2024. [PMID: 38953589 DOI: 10.1002/lary.31614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE Injection laryngoplasty (IL) with hyaluronic acid (HA) is an effective treatment for patients with glottic insufficiency. The duration of HA maintenance in the vocal fold remains unknown. In this study, transcutaneous laryngeal ultrasound (TLUS) was used to evaluate the absorption and migration of HA after IL. Subsequent management might be provided based on the TLUS finding. METHODS Patients diagnosed with unilateral vocal fold paralysis (UVFP) or vocal fold atrophy were recruited. All patients underwent IL with HA in an office-based setting along with TLUS to monitor the status of HA. The schedule of TLUS included assessments before and after IL until non-visualization. RESULTS The study population comprised 38 women and 17 men. Of the patients, 54.1% underwent IL for UVFP, whereas 45.9% underwent IL for vocal fold atrophy. Multivariate Cox regression analysis for factors affecting HA absorption revealed that the cause of injection was the most important independent predictor (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.03-4.46; p = 0.040). The duration of HA maintenance was significantly longer in patients with UVFP than in those with vocal fold atrophy (8.77 vs. 4.70 months, HR, 2.33; 95% CI, 5.47-8.18; p = 0.002). CONCLUSION TLUS is an objective assessment method for patients undergoing IL with HA. Subsequent tailor-made management could be offered based on the TLUS findings during follow-up. For patients at high risk of upper respiratory tract infection or who are intolerant to flexible nasopharyngoscopy, TLUS can be used as an alternative tool to evaluate the condition of the glottis after IL with HA. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2024.
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Affiliation(s)
- Chia-Fan Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Yen-Ling Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Otorhinolaryngology, National Yang Ming Chiao Tung University Hospital, Yilan City, Taiwan
| | - Yen-Bin Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Yao J, Zhou F, Gao N. Quantitative Assessment of True Vocal Fold Movement by the Lateral-Approach Laryngeal Ultrasonography: A Pilot Study. J Voice 2024:S0892-1997(24)00175-9. [PMID: 38937190 DOI: 10.1016/j.jvoice.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/27/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/OBJECTIVES Ultrasonography is a new method for subjective and qualitative assessment of true vocal fold movement, and true vocal fold visualization with the lateral approach could be better than that with the anterior approach. Our aim was to explore the feasibility of lateral-approach ultrasonography in objective and quantitative assessment of true vocal fold movement. METHODS The lateral-approach laryngeal ultrasonography was performed during calm breathing and breath-holding on young healthy adult volunteers in Shanghai, China. The morphology and anatomical position of false vocal fold, true vocal fold, and arytenoid cartilage were observed and measured through the ultrasonic self-contained measurement function. All parameters, including the distance from false vocal fold to thyroid cartilage lamina, true vocal fold length, and the distance from true vocal fold to thyroid cartilage lamina, were obtained at the end of the calm inspiratory and breath-holding phases. Data were analyzed using a t test (P < 0.05). RESULTS Forty healthy adult volunteers (age 20 to 34 years, body mass index 19.5 to 23.8 kg/m2, 20 males and 20 females) with satisfactory ultrasonic images were included in the study. There were no significant differences in all laryngeal parameters between the left and right sides in either phase (P > 0.05). From the end of the calm inspiratory phase to the breath-holding phase, changes in all laryngeal parameters were significantly different (P < 0.05), regardless of gender. CONCLUSIONS This study demonstrated that the lateral-approach laryngeal ultrasonography seemed feasible to quantify and objectively assess true vocal fold movement, utilizing differences between laryngeal parameters before and after true vocal fold movement.
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Affiliation(s)
- Jing Yao
- Department of Ultrasound Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fusheng Zhou
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nan Gao
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China.
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Sartini S, Ferrari L, Cutuli O, Castellani L, Bagnasco M, Moisio Corsello L, Bracco C, Cristina ML, Arboscello E, Sartini M. The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment. J Clin Med 2024; 13:750. [PMID: 38337444 PMCID: PMC10856192 DOI: 10.3390/jcm13030750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Acute respiratory failure (ARF) is a challenging condition that clinicians, especially in emergency settings, have to face frequently. Especially in emergency settings, many underlying diseases can lead to ARF and life-threatening conditions have to be promptly assessed and correctly treated to avoid unfavorable outcomes. In recent years, point-of-care ultrasound (POCUS) gained growing consideration due to its bedside utilization, reliability and reproducibility even in emergency settings especially in unstable patients. Research on POCUS application to assess ARF has been largely reported mainly with observational studies showing heterogeneous results from many different applications. This narrative review describes the wide potentiality of POCUS to face airways and breathing life-threatening conditions such as upper airway management, pulmonary and pleural pathologies and diaphragm impairment. We conducted extensive research of the literature to report from major studies to case reports deemed useful in practical clinical utilization of POCUS in ARF. Due to the huge amount of the literature found, we focused on airways and breathing assessment trying to systematize the evidence according to clinical care of ARF in emergency settings. Further studies, possibly trials, should determine how POCUS is crucial in clinical practice in terms of standard of care improvements, patient safety and cost-benefit analysis.
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Affiliation(s)
- Stefano Sartini
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Lorenzo Ferrari
- Emergency Medicine Post-Graduate School, University of Genoa, Via Balbi 5, 16126 Genoa, Italy;
| | - Ombretta Cutuli
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Luca Castellani
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Maddalena Bagnasco
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
- Emergency Medicine Post-Graduate School, University of Genoa, Via Balbi 5, 16126 Genoa, Italy;
| | - Luca Moisio Corsello
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Cristina Bracco
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
| | - Eleonora Arboscello
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
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Lu YA, Tsai YC, Lin WN, Pei YC, Fang TJ. Pathophysiological Mechanisms Underlying Unilateral Vocal Fold Paralysis in Female Patients: An Ultrasonographic Study. Clin Exp Otorhinolaryngol 2023; 16:395-402. [PMID: 37857353 DOI: 10.21053/ceo.2023.01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal fold paralysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFP patients to investigate the pathophysiologic mechanisms of UVFP. METHODS In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measured using B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. RESULTS Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA) muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respectively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side, as observed through LEMG, correlated with the VF length during the resting phase (R=0.368, P=0.050) and CDVL values (R=0.627, P=0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlated with the normalized phonatory vocal length change (nPLC; R=0.621, P=0.041) on the paralyzed side. CONCLUSION CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFP cases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The findings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngeal nerve injury and offer valuable insights into the pathophysiology of UVFP.
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Affiliation(s)
- Yi-An Lu
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Chen Tsai
- Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Yao J, Zhou F, Cai L, Zhang G, Lin L, Zhao X, Gao N. Can Transcutaneous Laryngeal Ultrasonography Systematically Quantify Vocal Fold Movement?-A Feasibility Study. J Voice 2023:S0892-1997(23)00297-7. [PMID: 37867072 DOI: 10.1016/j.jvoice.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Several studies have assessed adult vocal fold movement using transcutaneous laryngeal ultrasonography (TLUSG) during the perioperative period of thyroidectomy. However, the movement was not objectively quantified. This study aimed to provide a feasible and objective method for assessing vocal fold movement using TLUSG. STUDY DESIGN Feasibility study. METHODS TLUSG was performed during calm breathing and breath-holding in healthy adult volunteers. The morphology and anatomy of the larynx were observed and measured using an ultrasonic self-contained measurement function. At the end of the calm inspiratory and breath-holding phases, vocal fold angle, vocal fold length, distance from vocal process to the midline, distance from anterior vocal commissure to arytenoid cartilage, distance from false vocal fold to the midline, and distance from the anterior horn of thyroid cartilage to false vocal fold were measured. Data were analyzed using a t test (significance <0.05). RESULTS The ultrasonic images were satisfactory in all 40 healthy adult volunteers (age 19-35 years; body mass index 18.55-23.93 kg/m2; 20 men and 20 women). There were no significant differences in all laryngeal parameters between the left and right sides in both phases (P > 0.05). Moreover, all differences in laryngeal parameters between the end of the calm inspiratory phase and the breath-holding phase were statistically significant (P < 0.05), regardless of sex. CONCLUSION The relevant positional parameters of the vocal fold, arytenoid cartilage, and false vocal fold and their differences before and after vocal fold movement in healthy adult volunteers can be obtained objectively using TLUSG.
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Affiliation(s)
- Jing Yao
- Department of Ultrasound Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fusheng Zhou
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lihui Cai
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guoliang Zhang
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lin Lin
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xia Zhao
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Nan Gao
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China.
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Vance D, Shah P, Sataloff RT. COVID-19: Impact on the Musician and Returning to Singing; A Literature Review. J Voice 2023; 37:292.e1-292.e8. [PMID: 33583675 PMCID: PMC7808728 DOI: 10.1016/j.jvoice.2020.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing. METHODS A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020. CONCLUSION COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.
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Affiliation(s)
- Dylan Vance
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Priyanka Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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Subbotina MV. [Diagnostic efficiency of transcutaneous ultrasound scanning and Dopplerography in laryngeal pathology]. Vestn Otorinolaringol 2023; 88:27-33. [PMID: 37970767 DOI: 10.17116/otorino20238805127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To assess the efficiency and the place of grey scale ultrasound and color Doppler sonography of the larynx in the diagnosis of laryngeal pathology. MATERIAL AND METHODS A prospective blind cohort examination in B-mode laryngeal ultrasound (LUS) and color Doppler imaging (CDI) with linear scanning transducer 7-15 MHz was performed in 120 patients aged from 6 months to 52 years (average age 7.6±5.8 years, Me 6 year) and in 40 patients without laryngeal pathology (average age 7.0±5.0 years). The patients presented with complaints of voice and/or stridor. The diagnosis was verified by followed laryngoscopy. RESULTS Laryngeal papillomas, hemangiomas, scarring and vocal fold's nodules were identified as hyperechoic formations. Color Doppler sonography made it possible to visualize them better: small formations were highlighted in color and the space around the large ones was colored. There were paradoxical movements of the hyperechoic arytenoid cartilages during inspiration to the anterior commissure in patients with laryngomalacia. Color Doppler ultrasonography revealed changes during phonation in patients with functional dysphonia. The sensitivity and specificity of LUS were 58% (95% CI 48-66) and 98% (95% CI 87-99) compared with laryngoscopy in the detection of laryngeal pathology, but laryngeal CDI - 81% (95% CI 72-87) and 98% (95% CI 87-99) respectively. CONCLUSION Ultrasound of the larynx in B-mode has a diagnostic efficiency of 67.5%, and in CDI mode - 85% for ruling in laryngeal pathologies compared to laryngoscopy. So, this method is a modern affordable, non-invasive and informative diagnostic tool for the detection of laryngeal diseases, especially in those cases, when it is impossible to carry out a laryngoscopy.
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Affiliation(s)
- M V Subbotina
- Irkutsk State Medical University Ministry of Healthcare of Russia, Irkutsk, Russia
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Wolff S, Gałązka A, Borkowski R, Dedecjus M. Factors Associated With Injury to Recurrent Laryngeal Nerve in Patients Undergoing Surgery for Thyroid Cancer: A Single-centre Study Using Translaryngeal Ultrasound. J Voice 2022:S0892-1997(22)00240-5. [PMID: 36216721 DOI: 10.1016/j.jvoice.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
AIMS Intraoperative injury to the recurrent laryngeal nerve (RLN) is a serious complication occurring more frequently in patients with thyroid cancer than in those with benign thyroid diseases. However, data on the risk factors for RLN injury among patients with thyroid cancer are scarce. Currently, RLN injury is diagnosed by laryngoscopy, but translaryngealultrasonography (TLUS), which is less invasive, appears to have a similar accuracy. Herein, we analysed risk factors ofintraoperative RLN injury in patients with thyroid cancer and assessed the diagnostic performance of TLUS. PATIENTS AND METHODS In this prospective study, we enrolled patients undergoing surgery for thyroid cancer from October 2020 to October 2021. Medical and surgical variables were analysed as risk factors of RLN injury. TLUS was compared with laryngoscopy in diagnosing RLN injury. RESULTS There were 185 patients who underwent 196 surgeries. Of all surgeries, 23 (11.7%) caused RLN injury ascertained on laryngoscopy. Compared with laryngoscopy, TLUS displayed high sensitivity (97.7%; 95%CI: 94.3%-99.4%) and specificity (100%; 95% CI: 82.4%-100%). Before surgery, medical and surgical characteristics did not differ significantly between patients with or without RLN injury, but RLN entrapment by tumour was more frequent in those with the injury (P < 0.001). The risk of RLN injury was increased in patients undergoing thyroidectomy with lateral neck dissection (OR = 4.53; 95% CI: 1.29-14.32) and in those with lymph node metastases (OR = 2.76; 95% CI: 1.03-7.01). CONCLUSION Intraoperative RLN injury in patients with thyroid cancer is more common after operations requiringgreater resections and with lymph node involvement. TLUS could be used to diagnose RLN injury.
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Affiliation(s)
- Sylwia Wolff
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Warsaw, Poland
| | - Adam Gałązka
- Department of Head and Neck Cancer Clinic, National Institute of Oncology Maria Sklodowska-Curie Memorial Institute, Warsaw, Poland.
| | - Rafał Borkowski
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Warsaw, Poland
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Warsaw, Poland
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Sciancalepore PI, Anzivino R, Petrone P, Petrone D, Quaranta N. Clinical usefulness of transcutaneous laryngeal ultrasonography in otolaryngology practice during COVID-19 pandemic: a literature review. J Ultrasound 2022; 26:1-12. [PMID: 36094753 PMCID: PMC9466352 DOI: 10.1007/s40477-022-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
As a consequence of the outbreak of SARS-CoV-2, the clinical practice of otolaryngologists underwent profound transformations. Non-aerosol-generating procedures have been researched and implemented. Transcutaneous laryngeal ultrasonography (TLUSG) provides a rapid and noninvasive method to assess laryngeal function and can support the management of laryngeal disorders. With the aim of investigating the clinical usefulness of TLUSG in otolaryngology practice, a review of the literature published on PubMed, Cochrane Library and Ovid/ Medline databases was performed up to March 2022. 38 studies were eligible to be included in the review. The selected papers were divided into six topics of interest: evaluation of vocal cords function, diagnosis of laryngeal disorders in infants and children, evaluation of swallowing disorders, assessment of laryngeal cancer and other laryngeal lesions, ultrasound-guided cricothyroidotomy, ultrasound-guided laryngeal electromyography. The results of this review demonstrated that TLUSG, applied to ENT practice, can be a valid method for dynamic laryngeal assessment and airway management, since it is time-efficient, non invasive, well tolerated and easily performed.
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Affiliation(s)
| | - Roberta Anzivino
- Department of Otorhinolaryngology, Di Venere Hospital, ASL BA, Bari, Italy
| | | | - Domenico Petrone
- Department of Otorhinolaryngology, Di Venere Hospital, ASL BA, Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
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Derlatka-Kochel M, Kumoniewski P, Majos M, Ludwisiak K, Pomorski L, Majos A. Pre- and Postoperative Ultrasound and MRI Examinations in Assessing Vocal Folds in Patients with Goiter. Diagnostics (Basel) 2022; 12:diagnostics12061362. [PMID: 35741172 PMCID: PMC9221659 DOI: 10.3390/diagnostics12061362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Aim of the study: To determine the value of dynamic examinations ultrasound (US) and MRI in the 1.5T field in the assessment of the mobility of vocal folds (VF) in comparison to laryngoscopy in patients with thyroid gland resection. Materials and methods: A total of 44 patients with goiter, before and after thyroidectomy, were subjected to videolaryngoscopy and dynamic examinations of the vocal folds using ultrasound and the following MRI sequences: generic gradient echo (GRE) and true fast imaging with steady-state precession (TRUFI). The qualitative and quantitative data were analyzed, i.e., the angles of deviation from the midline of the vocal folds and the area of the right and left rima glottidis compartments. Results: The analysis of qualitative data showed that the results obtained by laryngoscopy, US and MRI are independent of the diagnostic method used in the group of patients pre and post thyroidectomy. Between the pre- and postoperative examinations in the group of paralyzed vocal folds, statistically significant differences were found in the minimum and maximum values of the angles for the MRI-GRE and MRI-TRUFI sequences and the maximum value of the angles in the US examination, but also in the maximum value of the area of the glottis compartments in both MRI-GRE and MRI-TRUFI dynamic sequences and the minimum value of the area in the sequence MRI-GRE. Statistically significant differences were found in both MRI sequences during phonation, both for the value of the angles and the area of the affected vocal folds. However, no statistically significant differences were found in the values of the angles or the areas in both vocal fold imaging methods without identified mobility abnormalities. Conclusions: Ultrasound and MRI examinations using dynamic sequences have a similar diagnostic value to laryngoscopy in the assessment of vocal fold paralysis in patients with goiter. The GRE sequence seems to be the most reliable one in determining vocal fold paralysis, and the most reliable parameter is the maximum area of the rima glottidis compartment. The inclusion of dynamic short sequences widely available in 1.5T scanners in standard neck examination protocols represents a novelty of the method and a promising diagnostic perspective in the diagnosis of vocal fold paralysis.
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Affiliation(s)
- Magdalena Derlatka-Kochel
- Department of Radiologic and Isotopic Diagnositcs and Therapy, Medical University of Lodz, 90-419 Lodz, Poland; (M.D.-K.); (K.L.); (A.M.)
| | - Paweł Kumoniewski
- Department of General and Oncological Surgery, Medical University of Lodz, 90-419 Lodz, Poland; (P.K.); (L.P.)
| | - Marcin Majos
- Department of Radiologic and Isotopic Diagnositcs and Therapy, Medical University of Lodz, 90-419 Lodz, Poland; (M.D.-K.); (K.L.); (A.M.)
- Correspondence:
| | - Kamil Ludwisiak
- Department of Radiologic and Isotopic Diagnositcs and Therapy, Medical University of Lodz, 90-419 Lodz, Poland; (M.D.-K.); (K.L.); (A.M.)
| | - Lech Pomorski
- Department of General and Oncological Surgery, Medical University of Lodz, 90-419 Lodz, Poland; (P.K.); (L.P.)
| | - Agata Majos
- Department of Radiologic and Isotopic Diagnositcs and Therapy, Medical University of Lodz, 90-419 Lodz, Poland; (M.D.-K.); (K.L.); (A.M.)
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Brekka AK, Vollsæter M, Ntoumenopoulos G, Clemm HH, Halvorsen T, Røksund OD, Andersen TM. Adjustments of non-invasive ventilation and mechanically assisted cough by combining ultrasound imaging of the larynx with transnasal fibre-optic laryngoscopy: a protocol for an experimental study. BMJ Open 2022; 12:e059234. [PMID: 35613803 PMCID: PMC9134209 DOI: 10.1136/bmjopen-2021-059234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Application of non-invasive positive airway pressure may provoke laryngeal responses that obstruct the airways, especially in patients with disturbed laryngeal control. To control and adjust for this, transnasal fibre-optic laryngoscopy (TFL) is used to visualise laryngeal movements during therapeutic interventions. Being an invasive procedure, this may be unpleasant for patients. The aim of this study is to evaluate if ultrasound (US) imaging of the larynx may be used as an alternative less invasive diagnostic tool for evaluating the upper airway responses to non-invasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). METHODS AND ANALYSIS This protocol presents an experimental cross-sectional study of a novel method to study laryngeal responses in adult healthy volunteers (n=30). The participants will be assessed with simultaneous TFL and laryngeal US imaging (anterior and lateral approaches) during NIV and MI-E therapy. Additionally, airflow and pressure signals will be registered during the procedures. The primary outcome is whether laryngeal US is a feasible method to study laryngeal responses and, if so, to compare the laryngeal responses visualised with TFL and US. The participants' perception of the examinations will be recorded. Secondary outcomes include airflow curve shapes and calculated ventilation volumes during the interventions. ETHICS AND DISSEMINATION The study has been approved by The Regional Committee for Medical Research Ethics in Norway, and registered in ClinicalTrials.gov. Results will be disseminated through peer-reviewed journals, presentation of scientific abstracts at international medical conventions and oral presentations in relevant medical conventions. TRIAL REGISTRATION NUMBER NCT04586855.
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Affiliation(s)
| | - Maria Vollsæter
- Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - George Ntoumenopoulos
- Department of Physiotherapy, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Hege Havstad Clemm
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tiina Maarit Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Abstract
Background Ultrasonography has become an essential tool for the evaluation and management of thyroid and parathyroid diseases. Its applications extend beyond neck endocrine conditions to a multitude of pathologies within the head and neck region. Objectives Our study aimed to: (1) provide a broad review of neck ultrasonography and key findings in neck endocrine diseases; (2) support skilled performance office-based diagnostic ultrasonography and its varied applications. Materials and methods A review of the current literature was supplemented with clinical examples of key ultrasonographic findings. Results Current applications and key findings of ultrasonography in the diagnosis and management of neck endocrine conditions are reviewed. Conclusion Ultrasonography is a fundamental component in the evaluation and management of neck endocrine diseases. The reader is encouraged to use this review to enhance office-based performance and application of ultrasonography. Video online The online version of this article contains 11 additional videos. They are provided to illustrate some of the dynamic aspects of US performance. The article and the videos are available online (10.1007/s00106-022-01162-0). The videos can be found in the article back matter as “Electronic Supplementary Material”.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California, 2233 Post Street, 3rd Floor, San Francisco, CA, USA.
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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13
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Wolff S, Gałązka A, Borkowski R, Gorzelnik A, Dedecjus M. Application of Translaryngeal Ultrasound (TLUS) in Patients with Neck Surgery-A Single-Centre, Prospective Cohort Study on Technique Evaluation. J Clin Med 2022; 11:1691. [PMID: 35330020 PMCID: PMC8953745 DOI: 10.3390/jcm11061691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The primary objective of this study was to assess the value of translaryngeal ultrasound (TLUS) in assessing vocal fold (VF) function in patients after thyroid, parathyroid and neck lymph node surgery. METHODS A total of 219 patients that underwent 230 surgical procedures were enrolled in this prospective study. The study was conducted from October 2020 to October 2021. Patients' VFs were analysed independently with TLUS and laryngoscopy before and after the surgery. Various TLUS variables, such as vocal folds displacement velocity (VFDV), arytenoids symmetry and angle between VFs, were measured. The questionnaire evaluating discomfort caused to patients by both methods was conducted. RESULTS Of the 230 surgeries in this study, 85% were from oncological indications. The incidence of RLN injury was 10.4%. The accuracy of TLUS compared to laryngoscopy was 98.3%, with sensitivity 98.1%, specificity 100%, PPV 100% and NPV 83.3%. Laryngoscopy was found to cause significantly more discomfort than TLUS. VF visibility was lower in men; smokers; and patients with higher BMI (32 vs. 28 kg/m2), multifocal cancer, higher left lobe volume and higher fT3 levels. Arytenoid symmetry VFDV was lower for "e" and "i" right side and "i" left side in injured/disabled VFs/RLN. CONCLUSIONS TLUS can be an excellent and non-invasive method of VF evaluation in most patients. There are some technical aspects that can improve its accuracy. Sometimes, RLN injury after the surgery, especially among oncological patients, is unavoidable. Therefore, it is vital to diagnose dysphonia early with convenient methods, such as TLUS.
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Affiliation(s)
- Sylwia Wolff
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Roentgena 5 st., 02-781 Warsaw, Poland; (S.W.); (R.B.); (M.D.)
| | - Adam Gałązka
- Department of Head and Neck Cancer Clinic, National Institute of Oncology Maria Sklodowska-Curie Memorial Institute, Roentgena 5 st., 02-781 Warsaw, Poland;
| | - Rafał Borkowski
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Roentgena 5 st., 02-781 Warsaw, Poland; (S.W.); (R.B.); (M.D.)
| | - Anna Gorzelnik
- Department of Head and Neck Cancer Clinic, National Institute of Oncology Maria Sklodowska-Curie Memorial Institute, Roentgena 5 st., 02-781 Warsaw, Poland;
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Roentgena 5 st., 02-781 Warsaw, Poland; (S.W.); (R.B.); (M.D.)
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14
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Sikha DSB, Prakash DNB, Thomas DNC, John DJA, Mathews DSS, Mannam DP, George DP. ROLE OF ULTRASONOGRAPHY IN UPPER AIRWAY ASSESSMENT FOR DECANNULATING TRACHEOSTOMY IN ACQUIRED BRAIN INJURY - A PILOT STUDY. Arch Phys Med Rehabil 2022; 103:2174-2179. [PMID: 35202583 DOI: 10.1016/j.apmr.2022.01.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the findings of ultrasonography of the upper airway with flexible fiberoptic laryngoscopy and determine the efficacy of transcutaneous laryngeal ultrasonography for decannulation. DESIGN Prospective cross sectional study SETTING: Tertiary care referral centre in South India PARTICIPANTS: Twenty- four patients with acquired brain injury MAIN OUTCOME MEASURES: Participants underwent an airway assessment by ultrasonography followed by assessment of airway by flexible laryngoscopy done within the next 72 hours. RESULTS Vocal cord assessment by ultrasonography revealed a sensitivity of 81.2% and specificity of 87.5%. A statistically significant association between vocal cord mobility as assessed by ultrasonography and decannulation was observed (sensitivity of 81.25%, specificity of 87.5%, p= 0.002). Although aspiration was not assessed by ultrasonography, a statistically significant association was observed between vocal cord mobility on ultrasonography and aspiration as assessed by laryngoscopy (sensitivity of 81.25%, specificity of 87.5%, p= 0.011). CONCLUSION Laryngeal ultrasonography is an emerging diagnostic modality with a potential role for assessing vocal cord mobility and airway prior to decannulation in centres which lack the expertise and the infrastructure to perform a flexible laryngoscopy.
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Affiliation(s)
- Dr Samuel Barnabas Sikha
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Navin B Prakash
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Naveen Cherian Thomas
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Judy Ann John
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India.
| | | | - Dr Pavithra Mannam
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Philip George
- Department of E.N.T, Christian Medical College, Vellore, Tamil Nadu, India
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Allen JE, Clunie G, Ma JKY, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer A. Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study. Dysphagia 2022; 37:1586-1598. [PMID: 35201387 PMCID: PMC8867131 DOI: 10.1007/s00455-022-10413-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1-13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.
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Affiliation(s)
- Jodi E. Allen
- The National Hospital for Neurology and Neurosurgery, Therapy & Rehabilitation Services, 2nd Floor 8-11 Queen Square, London, WC1N 3BG UK
| | - Gemma Clunie
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Joan K.-Y. Ma
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Margaret Coffey
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Katharina Winiker
- Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, 9400 Rorschach, Switzerland
| | - Sally Richmond
- Imaging Department, University College London Hospitals, London, UK
| | - Soren Y. Lowell
- Communication Sciences & Disorders Department, Syracuse University, Syracuse, NY USA
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
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16
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Derlatka-Kochel M, Majos M, Ludwisiak K, Majos A. The value of 1.5T MRI in the evaluation of vocal fold mobility in patients with goiter. Eur J Radiol Open 2021; 8:100368. [PMID: 34307788 PMCID: PMC8283317 DOI: 10.1016/j.ejro.2021.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
The laryngoscopic examination remains the gold standard in the perioperative evaluation of the mobility of the vocal folds in patients with goiter. During the COVID-19 pandemic, many medical procedures, including laryngoscopy are optimized in terms of epidemiological safety. Therefore, it seems deeply justified to implement methods like i.e. ultrasound or MRI which can provide the diagnostic information usually obtained via laryngoscopic examination. Aim of the study To determine the value of dynamic MRI examination in the 1.5 T field in the assessment of the mobility of vocal folds in patients with goiter compared to healthy people and in relation to ultrasound examinations and routine laryngoscopy. Materials and methods 35 healthy volunteers and 44 patients with goiter were subjected to videolaryngoscopy, dynamic examinations of the vocal folds during respiration and phonation using ultrasound and the MRI sequences: generic gradient echo (GRE) and true fast imaging with steady-state precession (TRUFI). The qualitative and quantitative data were analyzed, i.e. the angles of deviation from the midline of the vocal folds and the area of the right and left rima glottidis compartments. Results No statistically significant differences were found between the groups of healthy volunteers and patients with goiter in the values of the angles of deviation of the vocal folds with the use of ultrasound and two MRI dynamic sequences - GRE and TRUFI. There were also no statistically significant differences in the areas of the rima glottidis compartments between these two groups with the use of two MRI dynamic sequences - GRE and TRUFI. Among the analyzed parameters, the maximum size of each rima glottidis compartment was the only one to show features of sexual dimorphism and was significantly higher in men (GRE p < 0.001 and TRUFI p = 0.001). There was no correlation between the size of the minimum and maximum rima glottidis compartment and the total volume of the thyroid lobes in patients with goiter for the GRE and TRUFI sequences. Conclusions MRI is a promising tool for the objective assessment of the mobility of the vocal folds in patients with goiter, as well as for the qualification for treatment and monitoring its effects. It is particularly important during an epidemiological emergency due to its safety compared to laryngoscopy. The presence of the goiter and its volume do not limit the possibility of performing dynamic imaging studies of the vocal folds and do not affect the surface area of the glottis.
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Affiliation(s)
| | - Marcin Majos
- Zakład Diagnostyki i Terapii Radiologicznej i Izotopowej, Uniwersytet Medyczny w Łodzi, Poland
| | - Kamil Ludwisiak
- Zakład Diagnostyki i Terapii Radiologicznej i Izotopowej, Uniwersytet Medyczny w Łodzi, Poland
| | - Agata Majos
- Zakład Diagnostyki i Terapii Radiologicznej i Izotopowej, Uniwersytet Medyczny w Łodzi, Poland
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17
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Fung MMH, Lang BHH. A prospective study comparing the midline and lateral trans-laryngeal ultrasonography approaches in vocal cord assessment before and after thyroid and neck surgeries. Am J Surg 2021; 223:676-680. [PMID: 34238589 DOI: 10.1016/j.amjsurg.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/27/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION It is unclear if placing an ultrasound probe along each thyroid cartilage lamina (i.e. the lateral approach) can improve vocal cord (VC) visualization over in the midline (i.e. the midline approach) in trans-larygeal ultrasonography (TLUSG). This study compared VC visualization rates and diagnostic accuracy between the two approaches. METHODS Consecutive patients undergoing surgery had their VCs assessed by the two TLUSG approaches and flexible laryngoscopy within the same session. VC visualization rates and diagnostic accuracy of each approach were calculated and compared. RESULTS Ninety patients (or 180 VCs) were analyzed. The lateral approach had significantly better overall VC visualization rate than the midline approach (93.3% vs. 82.2%, p=<0.001), especially for males (75.0% vs. 33.3%, p = 0.002). Both approaches had comparable accuracy (100% vs. 99.4%). CONCLUSIONS The lateral approach should be preferred because of the significantly better VC visualization rate and comparable accuracy to the midline approach.
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Affiliation(s)
- Matrix Man Him Fung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Brian Hung-Hin Lang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Dharmarajan H, Belsky MA, Anderson JL, Sridharan S. Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach. Ann Otol Rhinol Laryngol 2021; 131:12-26. [PMID: 33779296 PMCID: PMC8010376 DOI: 10.1177/00034894211005937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To analyze trends in otolaryngology consultations and provide algorithms to
guide management during the COVID-19 pandemic. Methods: A retrospective cohort study at a single institution tertiary care hospital.
A total of 95 otolaryngology consultations were performed from March 1, 2020
to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019
to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data
collected included patient demographics, COVID-19 status, reason for
consult, location of consult, type of consult, procedures performed, need
for surgical intervention, length of hospital stay and recommended follow
up. Results: Patient populations in the pre-COVID-era and COVID-era were similar in terms
of their distribution of demographics and chief complaints. Craniofacial
trauma was the most common reason for consultation in both periods, followed
by vocal fold and airway-related consults. We saw a 21.5% decrease in the
rate of consults seen per month during the COVID-era compared to the
6 months prior. Review of trends in the consult workflow allowed for
development of several algorithms to safely approach otolaryngology consults
during the COVID-19 pandemic. Conclusions: Otolaryngology consultations provide valuable services to inpatients and
patients in the emergency department ranging from evaluation of routine
symptoms to critical airways. Systematic otolaryngology consult service
modifications are required in order to reduce risk of exposure to healthcare
providers while providing comprehensive patient care.
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Affiliation(s)
- Harish Dharmarajan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Anderson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shaum Sridharan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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19
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Wu H, Hu D, Chen X, Zhang X, Xia M, Chai X, Wang S, Zhang W. The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study. BMC Anesthesiol 2021; 21:28. [PMID: 33494705 PMCID: PMC7829489 DOI: 10.1186/s12871-021-01253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. Methods Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. Results Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286–0.612) and its OR value was 10.09 (95%CI: 4.19–24.28), sensitivity was 0.469 (95%CI: 0.325–0.617), specificity was 0.929 (95%CI: 0.877–0.964), positive predictive value was 0.676 (95%CI: 0.484–0.745), negative predictive value was 0.847 (95%CI: 0.825–0.865). Conclusion Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. Trial registration The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).
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Affiliation(s)
- Hao Wu
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Dandan Hu
- Department of Oncology, First Affiliated Hospital of the University of Science and Technology of China, Provincial Cancer Hospital, Hefei, Anhui, China
| | - Xu Chen
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Xuebing Zhang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Min Xia
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Xiaoqing Chai
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Wei Zhang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China.
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20
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Neck Ultrasound: Anatomical Landmarks for Safe Performance of Neck RFA. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00316-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Sciancalepore PI, Anzivino R, Petrone P, Petrone D, Quaranta N. Transcutaneous laryngeal ultrasonography: A promising tool for otolaryngologists during COVID-19. Am J Otolaryngol 2021; 42:102772. [PMID: 33099229 PMCID: PMC7574724 DOI: 10.1016/j.amjoto.2020.102772] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
Purpose With the current COVID-19 outbreak, otolaryngologists are most exposed to the risk of infection due to the nature of the specialty.This is why they are required to find safer diagnostic alternatives minimizing aerosol-generating procedures. The aim of this study is to explore the accuracy of transcutaneous laryngeal ultrasonography (TLUSG) in order to assess vocal fold movement. Materials and methods We performed blindly both TLUSG and flexible fiberoptic laryngoscopy(FFL) on 38 patients, from March to June 2020. Patients were divided into two groups:the former with normally mobile vocal folds and the latter with unilateral vocal fold paralysis. Results On FFL findings, 10/38 patients (26,31%) had unilateral vocal fold paralysis; on TLUSG results, 9/38 patients (23.68%) presented impaired vocal fold motion. In comparison to laryngoscopy, the sensitivity, specificity, positive predictive value and negative predictive value of TLUSG for assessment of vocal fold mobility was 80%, 96.42%, 88.88%, 93.10% respectively. A significant association between the two techniques was found on the Chi-square test: X2 = 19.7722 (p value <0.00001). Cohen's K value showed a substantial agreement: K = 0,79. Conclusion Although TLUSG could undoubtedly not replace laringoscopy, it represents a noninvasive and useful diagnostic tool for otolaryngologists especially during covid-19 pandemic.Data collected about its high sensitivity and specificity suggest that TLUSG could be a reliable method to screen vocal fold paralysis without performing aerosol-generating procedures, thus providing clear visualization of laryngeal real-time movements, even in non-compliant or high-risk infection patients. Our results allow us to consider TLUSG as part of the preoperative assessment of vocal folds in patients undergoing thyroidectomy.
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22
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Benito DA, Pasick LJ, Mulcahy CF, Rajasekaran K, Todd-Hesham H, Joshi AS, Goodman JF, Thakkar P. Local spikes in COVID-19 cases: Recommendations for maintaining otolaryngology clinic operations. Am J Otolaryngol 2020; 41:102688. [PMID: 32854044 PMCID: PMC7439996 DOI: 10.1016/j.amjoto.2020.102688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 01/12/2023]
Abstract
The Coronavirus Disease-2019 (COVID-19) pandemic has created an unprecedented economic and public health crisis in the United States. Following efforts to mitigate disease spread, with a significant decline in some regions, many states began reopening their economies. As social distancing guidelines were relaxed and businesses opened, local outbreaks of COVID-19 continue to place person on healthcare systems. Among medical specialties, otolaryngologists and their staff are among the highest at risk for becoming exposed to COVID-19. As otolaryngologists prepare to weather the storm of impending local surges in COVID-19 infections there are several practical measures that can be taken to mitigate the risk to ourselves and our staff.
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Affiliation(s)
- Daniel A Benito
- Division of Otolaryngology - Head & Neck Surgery, George Washington University School of Medicine, United States of America.
| | - Luke J Pasick
- Department of Otolaryngology - Head & Neck Surgery, University of Miami Miller School of Medicine, United States of America
| | - Collin F Mulcahy
- Division of Otolaryngology - Head & Neck Surgery, George Washington University School of Medicine, United States of America
| | - Karthik Rajasekaran
- Department of Otolaryngology - Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, United States of America
| | - Hosai Todd-Hesham
- Division of Otolaryngology - Head & Neck Surgery, George Washington University School of Medicine, United States of America
| | - Arjun S Joshi
- Division of Otolaryngology - Head & Neck Surgery, George Washington University School of Medicine, United States of America
| | - Joseph F Goodman
- Division of Otolaryngology - Head & Neck Surgery, George Washington University School of Medicine, United States of America
| | - Punam Thakkar
- Division of Otolaryngology - Head & Neck Surgery, George Washington University School of Medicine, United States of America
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23
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Grayson JW, McCormick JP, Thompson HM, Miller PL, Cho DY, Woodworth BA. The SARS-CoV-2 pandemic impact on rhinology research: A survey of the American Rhinologic Society. Am J Otolaryngol 2020; 41:102617. [PMID: 32574897 PMCID: PMC7301141 DOI: 10.1016/j.amjoto.2020.102617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has radically shifted healthcare operations within hospitals and universities across the globe. However, the effect of the COVID-19 pandemic on research endeavors and clinical trials is unclear. OBJECTIVE This study investigates the impact of the COVID-19 pandemic on basic science and clinical research within the rhinology community. METHODS A cross-sectional study was designed utilizing an 8-question survey to identify changes to rhinology research. Questions evaluated the impact of the COVID-19 pandemic on administrative research support and staffing, basic science research, clinical trials and resident research involvement. RESULTS Seventy-one participants responded to the survey (8.5% response rate). Most respondents noted changes in IACUC/IRB approval (faster, 33%; slower, 31%). Of those who employed laboratory personnel, 64% were able to continue staff employment with full salary. The majority of animal research and in vitro studies were halted (64% and 56%, respectively), but animal care and cell line maintenance were allowed to continue. Clinical trial enrollment was most commonly limited to COVID derived studies (51%). Forty-seven percent of respondents noted increased resident research participation. CONCLUSION The rapid spread of the SARS-CoV-2 virus has markedly impacted rhinology-related research. Maintaining safe workplace practices as restrictions are lifted will hopefully mitigate the spread of the virus and allow research productivity to resume.
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Affiliation(s)
- Jessica W Grayson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Justin P McCormick
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Harrison M Thompson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Peter L Miller
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Do-Yeon Cho
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Bradford A Woodworth
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
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24
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Baird BJ, Sung CK. Coronavirus Disease-19: Challenges Associated with the Treatment of Head and Neck Oncology and Laryngology Patients in the Coronavirus Disease-19 Era. Otolaryngol Clin North Am 2020; 53:1159-1170. [PMID: 33039099 PMCID: PMC7442893 DOI: 10.1016/j.otc.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This review explores the changes to practice associated with COVID-19 for providers treating patients with head and neck cancer and laryngeal pathology. The aim of the review is to highlight some of the challenges and considerations associated with treating this patient population during the pandemic. Additionally, it seeks to discuss some of the areas of concern related to ramping up clinical volume.
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Affiliation(s)
- Brandon J Baird
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 South Maryland Avenue, MC 1035, Chicago, IL 60637, USA.
| | - C Kwang Sung
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94304, USA
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25
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Smith JD, Chen MM, Balakrishnan K, Sidell DR, di Stadio A, Schechtman SA, Brody RM, Kupfer RA, Rassekh CH, Brenner MJ. The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. Otolaryngol Head Neck Surg 2020; 163:934-937. [PMID: 32571147 DOI: 10.1177/0194599820936615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Samuel A Schechtman
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert M Brody
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Christopher H Rassekh
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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