Ablation of cervical inlet patch for the treatment of globus sensation: A case report

We present a case of a medically resistant cervical inlet patch causing persistent globus and symptoms of laryngo-pharyngeal reflux, successfully treated with CO2 laser ablation.

Expiratory Muscle Strength Training in patients After Total Laryngectomy; A Feasibility Pilot Study

OBJECTIVES

Expiratory muscle strength training (EMST) is a threshold based device-driven treatment for improving expiratory pressure. EMST proved to be effective in different patient groups to improve cough function. To date, EMST has not been tested in the total laryngectomy population (TL).

METHODS

This prospective, randomized case-series study examined feasibility, safety, and compliance of EMST in a group of TL participants and its effects on pulmonary function, physical exertion, fatigue, and vocal functioning. Ten TL participants were included in the study to perform a 4 till 8 weeks of EMST. Objective and subjective outcome measures included manometry, spirometry, cardio pulmonary exercise testing (CPET), voice recordings, and patient reported outcome measures. Group means were reported and estimates of the effect are shown with a 95% confidence interval, using single sample t-tests.

RESULTS

Nine participants completed the full study protocol. Compliance to the training program was high. All were able to perform the training, although it requires adjustments of the device and skills of the participants. Maximum expiratory pressure (MEP) and vocal functioning in loudness improved over time. After EMST no changes were seen in other objective and subjective outcomes.

CONCLUSIONS

EMST appears to be feasible and safe after total laryngectomy. MEP improved over time but no improvement in the clinically relevant outcome measures were seen in this sample of relatively fit participants. Further investigation of the training in a larger group of participants who report specifically pulmonary complaints is recommended to investigate if the increase in MEP results in clinical benefits.

LEVEL OF EVIDENCE

4.

Are All Manikins Created Equal? A Pilot Study of Simulator Upper Airway Anatomic Fidelity

This study evaluates the anatomic fidelity of several commercially available pediatric and adult manikins, including airway task trainers, which could be used in aerodigestive procedure training. Twenty-three experienced otolaryngologists assessed the aerodigestive anatomy of 5 adult and 5 pediatric manikins in a passive state, using rigid and flexible endoscopy. Anatomic fidelity was rated on a 5-point scale for the following: nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea, esophagus, and neck. Mean scores and standard deviations were tabulated for each manikin at each anatomic site. Ratings by survey participants demonstrated variation in the anatomic fidelity of the aerodigestive tract in a range of manikins. Radar chart display of the results allows comparison of manikin fidelity by anatomic site. Differences in scores may allow instructors to select manikins with the best anatomic fidelity for specific educational purposes, and they may contribute to recommendations to improve future manikin design.

Esophageal wishbone extraction: not for the chicken-hearted

OBJECTIVE

Ingestion of foreign bodies in the pediatric population is common and in the majority of cases involves spontaneous passage through the esophagus; however, they can become lodged in spaces of anatomical narrowing. Sharp foreign bodies are of particular concern due to a higher chance of perforation and other complications. The goal of this case report is to describe the safe removal of a chicken wishbone and 3 alternate options in the event that the initial choice was unsuccessful.

METHODS

We report the case of a 2-year-old boy who presented to our pediatric tertiary center after unsuccessful endoscopic removal of a chicken wishbone from the esophagus.

RESULTS

Radiologically, the wishbone was oriented with the tines pointing up. Endoscopic examination revealed the tips of both tines to be embedded deeply into the lateral walls of the esophageal mucosa. Esophagoscopy and protecting the sharp points of the wishbone were used to successfully extract the intact wishbone.

CONCLUSION

Previous techniques have involved cutting the bone; however, in this case, tension was so high that it was felt that cutting the bone would result in perforation. Proper management of such cases requires planning and often multiple strategies.