The nasal bones are the most commonly fractured bones in the body. Accurate diagnosis and appropriate surgical intervention are key in the management of nasal fractures. While these injuries are not life-threatening, mismanagement of nasal fractures can lead to both aesthetic and functional deformities. A thorough history and careful physical examination are adequate for the diagnosis of nasal fractures. Literature in the field does not support the use of x-ray films to aid in the diagnosis. The majority of injuries are seen after significant edema becomes present and cannot be accurately reduced at that time. Therefore, with the exception of grossly displaced fractures, open fractures, and septal hematomas, most nasal fractures should be definitively treated after 3 to 10 days once swelling has resolved. This article will review pertinent nasal anatomic structure, pathophysiological characteristics of nasal fractures, diagnostic techniques, treatment modalities, and common controversies associated with nasal fractures.

Objectives Formal evaluation of health states related to dysphonia have not been rigorously evaluated in affected patients. The objective of this project was to evaluate the health states of mild, moderate, and severe dysphonia using formal health state preference evaluation, and to compare these outcomes with the degree of voice handicap. Design Prospective health state preference assessment. Methods A convenience sample of patients presenting with voice complaints were enrolled from an academic voice center. Demographic and voice handicap index (VHI‐10) data were obtained, and an assessment of preference for five health states (monocular blindness, binocular blindness, mild dysphonia, moderate dysphonia, and severe dysphonia) was performed. Utility scores were calculated on a scale from 0 (death) to 1 (perfect health). Analysis was performed with ANOVA testing with post‐hoc comparisons and correlation statistics. Results Of 209 assessments, 149 (75.6%) met quality criteria. Relative to monocular blindness (score 0.61 [CI 0.57–0.64]), moderate dysphonia (0.58 [0.54–0.62]) was rated equivalently, with severe dysphonia (0.33 [0.29–0.37]) ranking significantly worse and mild dysphonia (0.96 [0.95–0.98]) significantly better. Binocular blindness (0.18 [0.15–0.21]) was the worst‐ranked health state. There was a weak inverse correlation of VHI‐10 with dysphonia‐related preference scores; with worsening reported voice handicap, scores decreased. Conclusion This study demonstrated that dysphonia had a significant impact of quality of life, with moderate dysphonia ranking equivalently with monocular blindness. These numerical estimates may be used for ongoing research into the value and cost‐effectiveness of medical, therapeutic, and surgical interventions for voice disorders. Level of Evidence 2c (outcomes research) Laryngoscope, 130:E177–E182, 2020

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Objectives We have previously demonstrated that biventricular pacing increased cardiac output within 1 hour of weaning from cardiopulmonary bypass in selected patients. To assess the possible sustained benefit, we reviewed in the present study the effects of biventricular pacing on the mean arterial pressure after chest closure. Methods A total of 30 patients (mean ejection fraction 35%± 15%, mean QRS 119 ± 24 ms) underwent coronary bypass and/or valve surgery. The mean arterial pressure was maximized during biventricular pacing using atrioventricular delays of 90 to 270 ms and interventricular delays of+80 to−80 ms during 20-second intervals in random sequence. Optimized biventricular pacing was finally compared with atrial pacing at a matched heart rate and to a sinus rhythm during 30-second intervals. Vasoactive medication and fluid infusion rates were held constant. The arterial pressure was digitized, recorded, and integrated. Statistical significance was assessed using linear mixed effects models and Bonferroni’s correction. Results Optimized atrioventricular delay, ranging from 90 to 270 ms, increased the mean arterial pressure 4% versus nominal and 7% versus the worst (P<.001). Optimized interventricular delay increased pressure 3% versus nominal and 7% versus the worst. Optimized biventricular pacing increased the mean arterial pressure 4% versus sinus rhythm (78.5 ± 2.4 vs 75.1 ± 2.4 mm Hg; P = .002) and 3% versus atrial pacing (76.4 ± 2.7 mm Hg; P = .017). Conclusions Temporary biventricular pacing improves the hemodynamics after chest closure, with effects similar to those within 1 hour of bypass. Individualized optimization of atrioventricular delay is warranted, because the optimal delay was longer in 80% of our patients than the current recommendations for temporary postoperative pacing.

Objectives Although patient‐reported outcome measures (PROMs) can be useful for assessing quality of life, they can be complex and cognitively burdensome. In this study, we prospectively evaluated a simple patient‐reported voice assessment measure on a visual analog scale (VAS voice) and compared it with the Voice Handicap Index (VHI‐10). Study design Prospective survey. Methods An abbreviated voice measure was designed by a team of otolaryngologists, speech pathologists, and patients that consisted of four VAS questions related to (a) a global question of voice disturbance, (b) physical function of voice, (c) functional issues, and (d) emotional handicap. All English‐speaking patients presenting to an academic laryngology clinic for a voice complaint were included. Internal consistency and validity were assessed with comparison to the VHI‐10. Results A total of 209 patients were enrolled. Ninety‐two percent of patients reported understanding the survey. The four‐item VAS survey was highly correlated with VHI‐10 score (Pearson correlation .81, P < .0001), and the Cronbach's alpha between all four VAS questions was .94. Age, gender, and diagnosis were not associated with either the global VAS or VHI‐10 tool. Conclusion Reducing the complexity of instruments assessing voice‐related quality of life is feasible, and the VAS voice correlated with existing measures. Simplified assessments may offer advantages compared to more cumbersome PROMs. Level of Evidence 2c