While our sample was statistically underpowered, AB produced clinical improvements in constipation severity and QOL.
Both men and women reported improvements in general and IBD-specific quality of life after surgery, but only men demonstrated several areas of improved sexual function. Women reported improved sexual desire but no other sexual function improvement. The postsurgical gender difference in sexual function, despite similar improvements in quality of life, may be accounted for by unexamined aspects of female sexual function.
Objective The videofluoroscopic swallow study (VFSS) is the gold standard diagnostic tool to evaluate oropharyngeal dysphagia. Although objective measurements on VFSS have been described, there is no universal method of analysis, and the majority of clinicians use subjective interpretation alone. The purpose of this investigation was to evaluate the accuracy of subjective VFSS analysis. Study Design Double-blinded experiment. Setting Tertiary care laryngology center. Subjects and Methods Seventy-six de-identified videos from VFSS evaluations of patients with dysphagia were presented to blinded, experienced speech-language pathologists and laryngologists individually. Evaluators rated each video as normal or abnormal for hyoid elevation (HE), pharyngeal area (PA), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo). A blinded investigator assessed evaluators' inter- and intrarater agreement and compared their responses to objectively measured results for these parameters to examine accuracy. Results Evaluators correctly classified only 61.5% of VFSS videos as normal or abnormal, with moderate interrater agreement (κ = 0.48, P < .0001). Intrarater agreement was highly variable (κ = 0.43-0.83). Accuracy was greatest for PCR (71.6%), with poorer performance for HE (61.3%), PESo (59.2%), and PA (45.3%). Interrater agreement was moderate for all parameters, with greater concordance for PCR (κ = 0.59) and PESo (κ = 0.54) and less for HE (κ = 0.40) and PA (κ = 0.44). Evaluators unanimously agreed on a correct interpretation of a VFSS only 28% of the time. Conclusion Subjective assessment of VFSS parameters is inconsistently accurate when compared with objective measurements, with accuracy ratings ranging from 45.3% to 71.6% for specific parameters. Inter- and intrarater reliability for subjective assessment was moderate and highly variable.
ediatric vocal fold paralysis (VFP) is a disorder with varied presentation and congenital, iatrogenic, neurological, and traumatic causes. [1][2][3] Although the true incidence is unknown because some cases are not immediately recognized, 2 it is not an unusual entity, especially among the neonatal intensive care unit population. Unilateral VFP (UVFP) usually presents with voice problems, such as a weak cry, and may involve feeding difficulty and/or aspiration with feeding or stridor. 3,4 Bilateral VFP (BVFP) constitutes approximately 60% of pediatric VFP cases 1,3,5 and usually involves considerable airway obstruction and respiratory distress in addition to the problems associated with UVFP.Although management of UVFP focuses on facilitating closure of the glottis, management of BVFP generally centers on improving the airway. Tracheostomy was traditionally performed, although this procedure is becoming less common with recognition of the possibility of spontaneous resolution and the increased use of static glottic opening procedures, such as arytenoidectomy, arytenoidopexy, and cricoid split with balloon expansion, in the pediatric population. [6][7][8][9][10][11] Although nonselective laryngeal reinnervation has gained traction as a durable treatment with good outcomes in children with UVFP, [12][13][14][15][16][17][18][19][20] bilateral selective laryngeal reinnervation (SLR) for adults with BVFP is still in development.IMPORTANCE Bilateral vocal fold paralysis (BVFP) in pediatric patients is a challenging entity with multiple causes. Traditional approaches to managing BVFP include tracheostomy, arytenoidectomy, suture lateralization, cordotomy, and posterior cricoid enlargement. These interventions are used to create a stable airway but risk compromising voice quality.OBJECTIVES To assess the use of bilateral selective laryngeal reinnervation (SLR) surgery to manage BVFP and restore dynamic function to the larynx in pediatric patients. DESIGN, SETTING, AND PARTICIPANTSIn this case series performed at 2 tertiary care academic institutions, 8 pediatric patients underwent bilateral SLR to treat BVFP (5 patients with iatrogenic BVFP and 3 with congenital BVFP) from November 2004 to August 2018 with follow-up for at least 1.5 years. INTERVENTIONS Bilateral selective laryngeal reinnervation surgery.MAIN OUTCOMES AND MEASURES Flexible laryngoscopy findings, subjective and objective measures of voice quality, subjective swallowing function, and decannulation in patients who were previously dependent on a tracheostomy tube. RESULTSParticipants included 6 boys and 2 girls with a median age of 9.3 (range, 2.2 to 18.0) years at the time of surgery. All 8 patients were decannulated; 6 patients had preoperative tracheostomies and 2 had perioperative tracheostomies. Voice quality, as measured using the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, improved in 6 of 8 patients after reinnervation, and swallowing was not impaired in any patients. In 2 patients, GRBAS scale scores remained the same before and a...
Our findings support the reliability and validity of the Constipation-Related Quality of Life measure. Future validation of the Constipation-Related Quality of Life measure for assessing changes in quality of life in response to treatments for constipation is needed.
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