Usefulness of a newly developed endoscope for the observation of the posterior tracheal wall

Objective

Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults.

Methods

Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two-step angulation endoscope (two-AE) with a two-step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t-test were used for statistical analysis. Kappa coefficients and concordance rates were calculated.

Results

The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two-AE (p < .001), compared to only three of 20 participants with the CE. The time to observation of the posterior tracheal wall for examiners 1 and 2 was 13.3 ± 6.5 and 12.0 ± 6.7 s, respectively, with no difference between groups (p = .400). The kappa coefficients of examiners 1 and 2 and between the examiners were 0.444, 0.643, and 0.643, respectively, with concordance rates of 90%, 95%, and 95%, respectively.

Conclusion

Regardless of the examiner's years of experience, we observed that the two-AE could observe the posterior tracheal wall.

Level of Evidence

Step 5.

Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine

(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients’ age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root’s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.

Evaluation of swallowing function in patients with oropharyngeal secretions

Background

Several studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. However, no previous studies have evaluated the accumulation of saliva and swallowing dynamics.

Objective

The objective of this study was to examine the factors related to decreased function that result in saliva accumulation based on images from videofluoroscopic examination of swallowing (VF) performed on the same day as videoendoscopic examination of swallowing (VE).

Methods

This retrospective study investigated 47 patients with dysphagia who underwent VF and VE on the same day. Saliva accumulation in the pharynx was assessed on VE and classified by the Murray secretion scale. Pharyngeal residue was assessed on VF. In addition, displacement of the hyoid bone and larynx on swallowing and the opening size of the esophageal orifice were measured, and contact between the base of the tongue and the posterior pharyngeal wall was examined on VF.

Results

Moderate correlations were found between saliva accumulation and perpendicular displacement of the larynx and upper esophageal sphincter opening. The percentage of patients showing contact between the base of the tongue and the posterior pharyngeal wall was significantly greater in those with a saliva accumulation score of 0 or 1.

Conclusion

Less laryngeal elevation and upper esophageal sphincter opening and absence of contact between the base of the tongue and the posterior pharyngeal wall when swallowing tended to result in accumulation of saliva in the pharynx.

Aural stimulation with capsaicin ointment improved swallowing function in elderly patients with dysphagia: a randomized, placebo-controlled, double-blind, comparative study

Objective

The aim of this study was to assess whether aural stimulation with ointment containing capsaicin improves swallowing function in elderly patients with dysphagia.

Study design

A randomized, placebo-controlled, double-blind, comparative study.

Settings

Secondary hospital.

Patients and methods

Twenty elderly dysphagic patients with a history of cerebrovascular disorder or Parkinson’s disease were randomly divided into two groups: 10 receiving aural stimulation with 0.025% capsaicin ointment and 10 stimulated with placebo. The ointments were applied to the external auditory canal with a cotton swab. Then, swallowing of a bolus of blue-dyed water was recorded using transnasal videoendoscopy, and the swallowing function was evaluated according to both endoscopic swallowing scoring and Sensory-Motor-Reflex-Clearance (SMRC) scale.

Results

The sum of endoscopic swallowing scores was significantly decreased 30 and 60 min after a single administration in patients treated with capsaicin, but not with placebo. Reflex score, but not Sensory, Motion and Clearance scores, of the SMRC scale was significantly increased 5, 30 and 60 min after single administration in patients treated with capsaicin, but not with placebo. No patient showed signs of adverse effects.

Conclusion

As capsaicin is an agonist of the transient receptor potential vanilloid 1 (TRPV1), these findings suggest that improvement of the swallowing function, especially glottal closure and cough reflexes, in elderly dysphagic patients was due to TRPV1-mediated aural stimulation of vagal Arnold’s nerve with capsaicin, but not with a nonspecific mechanical stimulation with a cotton swab.

Half a century of equine reproduction research and application: A veterinary tour de force

Over the past 50 years, per season pregnancy rate in Thoroughbred mares have risen from 70 to >90% and foaling rates from 55 to >80%. Some of the significant pharmacological treatments and diagnostic methods which have driven this marked improvement in breeding efficiency are reviewed. They include the application of artificial lighting to hasten the onset of ovulatory oestrous cyclicity in early Spring, rapid steroid hormone assays to aid in determining the stage and normality of the mare's cycle, prostaglandin analogues, synthetic progestagens and Gonadotrophin-releasing Hormone (GnRH) analogues to better control and manipulate her cycle to good effect, transrectal ultrasound scanning to monitor follicle growth, endometrial architecture and ovulation and to allow accurate, early pregnancy diagnosis thereby enabling successful ablation of one of twin conceptuses. Also, flexible videoendoscopy to monitor physiological and pathological changes in the uterine endometrium and rigid laparoscopy to apply prostaglandin to the oviducts to dislodge and clear suspected blockages of them to restore fertility. The outbreak of Contagious Equine Metritis in Newmarket in the spring of 1977 and the swabbing-related changes to mare and stallion management, plus the improved veterinary hygiene methods, which followed are also recounted. The past half century has witnessed many technical and therapeutic advances that have enhanced tremendously the diagnostic and treatment capabilities of studfarm veterinary surgeons. They, in turn, have improved greatly the efficiency of breeding Thoroughbreds and other types of horses.

Animal facility videoendoscopic intubation station: tips and tricks from mice to rabbits

Endotracheal intubation of laboratory animals is a common procedure shared by several research fields for different purposes, such as mechanical ventilation of anaesthetized animals, instillation of cytotoxic nanoparticles, infectious agents or tumour cells for induction of disease models, and even for diagnostic and therapeutic purposes. These different research purposes, achieved in different animal models, require technical expertise and equipment that suits every research need from animal facilities. In this short report we propose a videoendoscopic intubation station that could be shared among the most common laboratory animals, namely the mouse, rat, guinea pig and rabbit, from neonates to adult animals. This report aims to contribute to the reduction of animals excluded from experiments due to false paths during direct and blind intubations and to the refinement of procedures by replacing surgical approaches such as tracheotomy.

Correlations between videoendoscopy and sonotubometry of eustachian tube opening during a swallow

OBJECTIVES/HYPOTHESIS

Describe the relationship between the magnitude of eustachian tube (ET) dilation during swallowing observed on transnasal videoendoscopy and quantified by sonotubometry.

STUDY DESIGN

Descriptive observational study.

METHODS

Simultaneous transnasal videoendoscopic and sonotubometric recordings were done on 33 adults with no middle ear disease. Briefly, microphones were placed in the ear canals, a 45° telescope introduced through one side of the nose to visualize and record ipsilateral ET movements, and the probe from a sound generator placed in the opposite nostril. At a generated nasopharyngeal sound level, ET movements and ipsilateral microphone signals were continuously recorded while the subject performed a series of three swallows. For each swallow, relational movements among ET structures observed on video recordings and characteristics of the sonotubometry signal envelope at the ear canal were quantified at three times: swallow onset (T1), maximum soft-palate elevation (T2), and maximum ET luminal dilation (T3).

RESULTS

A total of 99 swallows were analyzed. The average medial rotation of the ET cartilage and lateral wall over the T1-T2 interval were -32.7 ± 14.9° and 7.2 ± 25.1°, and over the T2-T3 interval were 4.6 ± 7.7° and 6.2 ± 14.6°, respectively. The transtubal sound transmission during a swallow peaked at an amplitude of 30.5 ± 35.7 mV during the 572.5 ± 292.6 ms of elevated sound-pressure time. Correlational analysis documented significant linear associations between the relational measures of ET component movements from videoendoscopy and the signal envelope measures from sonotubometry.

CONCLUSIONS

There is a direct linear relationship between the degree of ET luminal dilation visualized on videoendoscopy and represented in the sonotubometry signal envelope.

LEVEL OF EVIDENCE

NA Laryngoscope, 126:2778-2784, 2016.

Videoendoscopic single-port axillary dissection

Videoendoscopy is newly used in breast and axillary surgery. Single-port surgery is one of the newest methods of minimally invasive surgery. This report describes the first case of videoendoscopic single-port axillary dissection. In histopathological evaluation, 24 lymph nodes were identified and one node was infiltrated by the cancer cells. Videoendoscopic single-port axillary dissection is a precise and improvable technique. Single-port videoendoscopic axillary dissection could be more feasible with individual tools that will be designed for minimally invasive breast surgery.

Current diagnostic trends in sleep disordered breathing

Over the past two decades, various methods of sophisticated diagnostics of the upper airway have been tested in patients with sleep disordered breathing (SDB). In this context, endoscopic techniques and pharyngeal pressure recordings are of special interest for the otorhinolaryngologist.Whereas the basic otorhinolaryngological examination is able to detect anatomical pathologies which need to and can be corrected, the Müller-Manoeuvre seems to help exclude patients from uvulopalatopharyngoplasty.To a large extent, videoendoscopy during natural sleep has been replaced by videoendoscopy under sedation. Despite good methodological preparation and impressive presentability of the obstructions, there is not sufficent evidence to demonstrate that videoendoscopy under sedation improves the success rate of surgery in SDB. However, in assessing the impact of the epiglottis on upper airway obstructions in the individual patient, videoendoscopy is the only existing option.Multi-channel pressure recordings permit analysing the entire sleep period and are well tolerated. They can be used to determine the Apnea-Hypopnea-Index as well as to quantify obstructive events in the upper and lower pharyngeal segment. On the other hand, obstructions of the tongue base cannot be distinguished from obstructions related to the epiglottis. According to the data available so far, the benefit of sophisticated diagnostics of the upper airway still has to be judged with caution. Therefore, the promising approaches of both videoendoscopy under sedation and multi-channel pressure recordings deserve further intensive research. According to the personal estimation of the author, they will nevertheless become valuable tools for otorhinolaryngologists in the near future, thus complementing the basic ENT-examination and improving the treatment of patients.