Background: The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports. Objectives: The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic. Methods: Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity. Results: Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia ( P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported. Conclusions: Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.
Osteomas are benign lesions that arise in the temporal bone commonly in the external canal. However middle ear osteomas are extremely rare. They are usually asymptomatic and discovered incidentally or may present with conductive hearing loss. This article reports a case of middle ear promontory osteoma with review of literature.
Background: Obstructive sleep apnea (OSA) has been associated with increased risk of respiratory complications after adenotonsillectomy in children. Not all such children require overnight admission, and same-day surgery is appropriate for some patients. Selection of those that are suitable for same day discharge relies on accurate identification of OSA severity. Guidelines about 'Day Care Adenotonsillectomy in presence of Sleep Apnea'' provided by Nottingham Children's Hospital, the UK, published in 2014, and applies to those children who had a sleep study performed pre-operatively. A typical cost-effective practical sleep study entails at-home overnight pulse oximetry. Aim: The aim of audit study was to see if suspected OSA is appropriately managed at Trafford General Hospital (TGH), the UK, according to the standards provided by Nottingham Children's Hospital, in addition to taking one standard from the Royal College of Pediatrics and Child Health report, on Standards for Services for Children with Disorders of Sleep Physiology, published in 2009. Study Design: This is a retrospective local audit study focused on children who were referred to ENT at TGH for suspected OSA or who were suspected of OSA during ENT follow-up for another non-OSA reason.
Conclusion:There is good practice in excluding insufficiently analyzed oximetry. Non-compliance was mostly due to mild OSA being ruled in on an inconclusive study. The listing and referral for adenotonsillectomy is appropriate despite conflicting local practice to refer all children with suspected OSA to a specialized centre.
Background: The improvement of clinical outcomes for patients with hypopharyngeal squamous cell carcinoma (SCC) has been particularly challenging for head and neck surgeons and oncologists. Chemoradiotherapy (CRT) has been used for patients with advanced hypopharyngeal cancer with the aim of preserving the larynx. The reasons for the un-favorable prognosis of hypopharyngeal cancers are the strong tendency for extensive sub-mucosal spread, the early occurrence of regional lymphatic involvement, and the relatively high rate of distant spread. Aim: This study was conducted to collect the recent data about the different modalities of management of advanced stage hypopharyngeal carcinoma (stage III and IV), and systematically review the outcomes of each modality either alone or in combination and compare their efficacy. Methods: Search of published medical articles from 2001 till 2018, on management of advanced hypopharyngeal carcinoma either by radio- chemotherapy versus surgery alone or in combination with postoperative radiotherapy in Medline, Embase, Elsvier. Twenty-one articles fulfilled the inclusion criteria and were included in our study. Results: Overall survival, regarding surgery group was reported in 8 studies with total 1657 patients achieved overall survival (46.23%); While in CRT group, it was reported in 18 studies with total 2995 patients achieved overall survival (43%). Comparative study between the 2 groups revealed decrease in overall survival rate; in CRT group; compared to surgery group; with significant statistical difference (p=0.019). Conclusion: The treatment approach had a significant impact on overall survival and recurrence rate, as described in other series. Given the equivalence between these two strategies suggested in several series, definitive CRT seems to be an advantageous option as it improves organ preservation and, consequently, the functional outcome. Recent developments in chemo-radiation treatment techniques could hopefully increase tumor management and survival rates.
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