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.
Introduction. Parapharyngeal abscesses are invariably a diagnostic and therapeutic challenge for pediatric otolaryngologists. The lack of consistency in the Polish nomenclature in relation to the English terms additionally complicates the problem. The wide spectrum of signs and symptoms, as well as an extremely heterogenous clinical presentation of the disease, also delay the implementation of appropriate treatment. Aim. The aim of the study was to analyze selected epidemiological and clinical characteristics of the parapharyngeal abscesses in children, such as the seasonality in the incidence, diagnostic difficulties, and available treatment methods. Material and Methods. A retrospective analysis was conducted on data obtained from medical histories of patients treated for deep neck space infections in the years 2013–2018 in the Department of Pediatric Otolaryngology of the Medical University of Warsaw. The study analyzed the age and sex of the children, as well as diagnostic methods and bacterial culture tests of the abscess. Particular attention was drawn to the seasonality in the incidence of the parapharyngeal abscesses in children. A statistical analysis was performed and seasonality index for the data was calculated, and a simulation of the prognosis of the occurrence of the factor for a moving average with a reference period of 2 months was performed. Next, the thesis on the discrete uniform data distribution was adopted, and Monte Carlo method was used for testing of the hypothesis. The significance level was α = 1%. The probability of 9 cases in one month was calculated based on the binomial distribution. Results. In the years 2013–2018, 23 children with parapharyngeal and retropharyngeal abscesses were admitted to the Department, 9 of which were admitted in December. In the analyzed group, a slight advantage in the number of boys was observed, with the male to female ratio being M:F = 1.3:1. Mean age of the patients was 3 years and 5 months. All the children had undergone an upper respiratory tract infection before being diagnosed with a deep neck space infection. All the patients had enlarged neck lymph nodes. The seasonality index for December was over 3 times higher than for March and accounted 4.696. The hypothesis on the discrete uniform data distribution was adopted (H0). The significance level was α = 1%. Based on monomial distribution, the probability of the occurrence of 9 cases in one month was calculated and amounted P(9) = 0.000141. Hence, the rejection of H0 occurs with an error of 0.17% < 1%. Conclusions. In Poland, the admission of a child diagnosed with a retropharyngeal or parapharyngeal abscess is most likely in late autumn – in November and December. Purulent deep neck space infections in children are a complication of upper respiratory tract infections. Deep neck space infections are difficult to diagnose due to the lack of pathognomonic signs and symptoms. The conservative treatment is an alternative to the surgical drainage in stable patients with small-size abscesses under the conditions of normalization of inflammatory marker levels and improvement of the general condition of the patient.
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