Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Ye Ming, Yun Hu, Yuyue Li, Jinfeng Yu, Haojue He, Leilei Zheng
ObjectivesThe purpose of this study was to assess, through a systematic review and meta-analysis, the efficacy of maxillary protraction appliances (MPAs) on improving pharyngeal airway dimensions in growing class III patients with maxillary retrognathism.MethodsAn electronic search in PubMed, Cochrane Library, Web of Science, and EMBASE was until September 2nd, 2017. The assessments of methodological quality of the selected articles were performed using the Newcastle-Ottawa Scale. Review Manager 5.3 (provided by the Cochrane Collaboration) was used to synthesize the effects of MPAs on pharyngeal airway dimensions.ResultsFollowing full-text articles evaluation for eligibility, 6 studies (168 treated subjects and 140 untreated controls) were included in final quantitative synthesis and they were all high-quality. Compared to untreated control groups, the treatment groups had increased significantly nasopharyngeal airway dimensions with the following measurements: PNS-AD1 (fixed: mean difference, 1.33 mm, 95% CI, 0.48mm-2.19 mm, P = .002), PNS-AD2 (random: mean difference, 1.91 mm, 95% CI, 0.02mm-3.81 mm, P = .05), aerial nasopharyngeal area (fixed: mean difference, 121.91 mm2, 95% CI, 88.70 mm2-155.11 mm2, P < .00001) and total nasopharyngeal area (fixed: mean difference, 142.73 mm2, 95% CI, 107.90 mm2-177.56 mm2, P < .00001). Meanwhile, McNamara's upper pharynx dimension (fixed: mean difference, 0.96 mm, 95% CI, 0.29mm-1.63 mm, P = .005), which was highly related to post-palatal airway dimension, was also improved significantly. However, no statistically significant differences in adenoidal nasopharyngeal area (P > .05) and McNamara's lower pharynx dimension (P > .05) existed.ConclusionsMPAs can increase post-palatal and nasopharyngeal airway dimensions in growing skeletal class III subjects with maxillary retrusion. It may be suggested that MPAs have the potential to reduce the risk of obstructive sleep apnea syndrome in children with maxillary retrusion by enlarging airway space.
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Σάββατο 23 Δεκεμβρίου 2017
Effects of maxillary protraction appliances on airway dimensions in growing class III maxillary retrognathic patients: A systematic review and meta-analysis
Cochlear implant symmetry via template
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): A.J. Hallwachs, J.E. Weinstein, B.K. Reilly
Current trends in bilateral cochlear implantation (CI) favor a minimally invasive subperiosteal pocket technique. Symmetric receiver-stimulator (R/S) placement is an important goal for bilateral CI, especially with regard to patient satisfaction. In this article, we describe a method easily adopted to achieve optimal symmetry. Upon reviewing the Senior Author's 11 bilateral CI cases using the direct subperiosteal pocket technique with the proposed "mirror template," we found improved symmetry, which translated into high patient and family satisfaction regarding the aesthetics of the symmetric R/S placement.
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Mature and immature pediatric head and neck teratomas: A 15-year review at a large tertiary center
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Harish Dharmarajan, Noémie Rouillard-Bazinet, Binoy M. Chandy
IntroductionPediatric head and neck teratomas account for less than 4% of congenital teratomas. The distinct presentations and outcomes of mature and immature head and neck teratomas have not been well established.ObjectivesTo review the management and outcomes of pediatric head and neck teratomas. To distinguish differences between mature and immature tumors with respect to the age at presentation and surgery, tumor size and location, alpha fetoprotein (AFP) levels, airway management, and recurrence.MethodsA 15-year retrospective chart review of patients treated for head and neck teratomas at Texas Children's Hospital was performed. A total of 20 patients were included. Wilcoxon rank and Fisher's exact tests were used for statistical analysis.ResultsImmature teratomas were associated with both higher AFP levels (80800 ng/ml, p = 0.02) and maximum tumor dimensions (14.4 cm, p = 0.0034) than mature teratomas (24400 ng/ml and 6.44 cm). Patients with immature tumors were younger at the time of surgical resection (19.8 days, p = 0.025) compared to those with mature tumors (348 days). 89% of immature teratomas involved anterior neck localization compared to 27% for mature teratomas (p = 0.0098); 88% of the immature teratomas required an EXIT (Ex Utero Intrapartum Treatment) procedure compared with 40% of the mature teratomas (p = 0.0656). Recurrence was noted in only two cases: an immature teratoma 51 months after incomplete resection and a mature teratoma 33 months after complete resection. Long-term consequences of surgical resection included cleft palate (38.9%), dysphagia (33.3%), facial nerve paresis/paralysis (16.7%) and tracheotomy (16.7%).ConclusionImmature teratomas had higher AFP levels, tumor dimensions, frequency of anterior neck localization, and requirement of EXIT than mature teratomas. Given that there was no significant difference between the recurrence rates of immature and mature teratomas, follow-up vigilance should be maintained equally regardless of tumor maturity.
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Lingual tonsillectomy in children with Down syndrome: Is it safe?
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Jonathan R. Skirko, Emily L. Jensen, Norman R. Friedman
ObjectiveEvaluate peri-operative course and morbidity in children with Down syndrome (DS) who underwent a lingual tonsillectomy (LT) for residual obstructive sleep apnea (rOSA).MethodsRetrospective case series for children with DS who underwent LT for rOSA from April 2011 to July 2016. Our primary outcomes were length of stay, readmission and complications. Surgical effectiveness was evaluated by change in the obstructive apnea-hypopnea-index(OAHI) and oxygen saturation nadir.ResultsThirty-nine patients underwent LT. The mean length of stay was 1.3 days with n = 21(72%) staying one night. One subject (2.6%) had a post-operative bleed that did not require operative intervention. No other major complications occurred. In terms of effectiveness of surgery, twenty–nine children had sufficient data for inclusion. Median OAHI did not appreciably change (p = 0.07) from before surgery. Five subjects (17%) were cured of OSA (OAHI < 2/hour) and a mix of improvement and worsening was identified. The lowest oxygen saturation improved from 78% (SD = 7) before surgery to 82% (SD = 6) after surgery (p = 0.003).ConclusionLT has a favorable post-operative course but its effectiveness at curing rOSA in the DS population has not been established/proven. Further research is indicated to determine optimal surgical management for DS children with LTH.Level of evidence4.
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How does a bilingual environment affect the results in children with cochlear implants compared to monolingual-matched children? An Italian follow-up study
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Francesca Forli, Giada Giuntini, Annalisa Ciabotti, Luca Bruschini, Ulrika Löfkvist, Stefano Berrettini
ObjectivesTo compare the results after cochlear implantation achieved by monolingual and bilingual deaf children implanted at our Institution, with the aim of understanding if there are any differences between the two groups and if there is a correlation between the outcomes and some patients' variables.MethodsThe study group was composed by 14 bilingual deaf children and the control group by the same number of monolingual children implanted at our Institution. The control group was obtained by matching to each bilingual child a monolingual one with a similar clinical history regarding age at hearing loss diagnosis, age at first hearing-aids fitting and age at CI procedure. Children received a speech perception and linguistic development evaluation through specific structured tests. The linguistic competence of the patients both in mainstream and native language was determined by the Student Oral Language Observation Matrix (SOLOM).ResultsWe did not find any statistically significant differences between bilingual and monolingual children in speech perception outcomes. Nevertheless, we obtained different results concerning language skills: bilingual implanted children scored lower at structured language tests, even if the difference was not statistically relevant. Bilingual children scored significantly lower than monolingual ones at the SOLOM scale for linguistic competence.ConclusionThe results reported in the present study show better language skills after cochlear implant in Italian monolingual cases than in bilingual ones. This seems to be related to the condition of bilingualism in Italy, mainly related to immigration, and frequently associated with low socio-economic levels, poor competence in the mainstream language and poor social integration, with a suboptimal exposure to the mainstream language and difficulties in following the rehabilitative program.
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Are validated patient-reported outcomes used on children in pediatric otolaryngology? A systematic review
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Kevin Wong, Jacquelyn Piraquive, Chelsea A. Troiano, Anita Sulibhavi, Kenneth M. Grundfast, Jessica R. Levi
ObjectivesReview the pediatric otolaryngology literature to 1) identify studies in which children completed patient-reported outcome (PRO) measures and 2) appraise the psychometric quality and validity of these PROs as they apply to pediatrics.MethodsIn October 2016, a systematic review was performed by two reviewers on PubMed/MEDLINE and EMBASE for all otolaryngology-related studies that utilized PROs in children. Inclusion criteria included articles that required children (age<18) to complete PROs. Exclusion criteria included validation studies, reviews, and abstracts. Interreviewer agreement was determined using Cohen's kappa. Quality and rigor of validation testing for included PROs was determined using the COnsensus-based Standards for selection of health status Measurement Instruments.ResultsInterrater agreement was very good (κ = 0.91; 95% CI, 0.85–0.98). Out of 316 articles retrieved, 11 met inclusion criteria. Eight PROs were identified. Six PROs were tested for validity and three of these PROs were tested for validity specifically within children. The most frequently utilized PRO was the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire. Two studies (18.2%) utilized PROs within the scope of their validation. Seven studies (63.6%) used PROs outside the scope of their validation. Two studies (18.2%) used non-validated PROs.ConclusionsPatient-reported outcomes have become an integral part of research and quality improvement. There is a relative paucity of PROs directed towards children in pediatric otolaryngology and some studies utilized PROs that were not validated or not validated for use in this age group. Future efforts to design and validate more instruments may be warranted.
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EXIT (ex utero intrapartum treatment) in a growth restricted fetus with tracheal atresia
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): S. Kyle Gonzales, Steven Goudy, Kara Prickett, Jane Ellis
Congenital high airway obstruction syndrome (CHAOS) encompasses a heterogeneous group of pathologies leading to poor lung development and difficulty oxygenating the newborn after delivery. While previously uniformly fatal, the ex utero intrapartum therapy (EXIT) procedure has provided a method to treat these patients and provide an airway to potentiate survival. We present a patient diagnosed prenatally with CHAOS secondary to tracheal atresia complicated by severe intra-uterine growth restriction (IUGR) who was successfully delivered via an EXIT procedure at 33-weeks. Multidisciplinary care and planning is paramount.
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Profilactic role of simvastatin and mitomycin C in tracheal stenosis after tracheal damage: Study in rats
Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Adnan Ekinci, Sema Koc, Ahmet Serhat Erdoğan, Hakan Kesici
ObjectivesWe aimed to investigate the prophylactic effect simvastatin of and mitomycin C (MMC) on laryngeal and tracheal stenosis in tracheotomised rats by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind.Material and methodStandard vertical tracheotomy was performed on 24 rats. Then the animals were randomly divided into three groups as A, B and C. In group A 0.4 mg/day once daily mitomycin C was injected to the paratracheal region for 14 days. In group B daily 30 mg/kg/day simvastatin was given via gavage to rats for 14 days. In group C 2 cc/day intraperitoneal saline given to rats and the created control group by 14 days follow up. After 10 days, tracheal cannulas were removed. Three weeks later, all animals were euthanized and trachea specimens were harvested. The present study investigates the effects of MMC and Simvastatin on fibrosis, inflammation, stenosis index and tracheal wall thickness in a tracheal injury model.ResultsThe difference between the groups in terms of degree of inflammation scores was statistically insignificant (P = 0,187). Differences between the groups were found to be insignificant in terms of the preventionof fibrosis (P = 0,993). There was no significant difference between groups in terms of stenosis index (P = 0.645). In terms of wall thickness, control, simvastatin and mitomycin C groups were statistically different (p = 0.038). The difference between post-hoc test results was between Mitomycin C and control groups (p = 0.036).Maximum wall thickness in the MMC group (0,299 mm) was significantly lower compared to the control group (0,382 mm)(P < 0,0001). Maximum wall thickness was statistically lower in the simvastatin (0.324 mm) group compared with the control group (0.382 mm) (P < 0.0001). There was no statistically significant difference between the simvastatin group (0,198 mm) and control group (0,200 mm) with respect to minimum wall thickness (P = 0.982). Minimum wall thickness was significantly lower in the mitomycin-C group (0,160 mm) comparison to the control group (0,200 mm) (P < 0.0001).ConclusionIt was detected that the simvastatin and MMC is not effective in preventing the tracheal stenosis, inflammation and fibrosis formation.
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Iatrogenic Cushing's syndrome and adrenal insufficiency in infants on intranasal dexamethasone drops for nasal obstruction – Case series and literature review
Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Rohan R. Joshi, Alison Maresh
The use of intranasal steroid drops for nasal obstruction in infants is common practice and can prevent more invasive surgical procedures; however, it is not without complication. We describe 2 cases of iatrogenic Cushing's secondary to nasal steroids in infants with nasal obstruction, discuss the etiology of this unusual complication, and review previous literature reports. While reporting in the literature is sparse, these cases highlight the risk of development of adrenal insufficiency with usage of nasal steroid drops in infants as well as the need for close monitoring of administration and tapering of the drops. Additionally, we suggest an approach to the infant with symptomatic nasal obstruction that addresses the usage of intranasal steroid drops and emphasizes the need for quick tapering and possible endocrine consultation when appropriate.
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Impact of age on the anatomy of the pediatric pterygopalatine fossa and its relationship to the suprazygomatic maxillary nerve block
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Alexander P. Marston, Glenn Merritt, Jonathan M. Morris, Shelagh A. Cofer
ObjectivesThe suprazygomatic maxillary nerve block is associated with improved post-operative pain management after select craniofacial surgical procedures. This study's objective is to better define the impact of pediatric facial skeletal growth on techniques for accessing the pterygopalatine fossa (PPF).MethodsPediatric patients with prior thin-slice maxillofacial computed tomography imaging were identified in an institutional radiology database. Aquarius image-processing software (Ver. 4.4.11, TeraRecon, Inc., Foster City, CA) was used to measure from the suprazygomatic skin to the greater wing of the sphenoid where the needle is then re-oriented in an anterior and inferior trajectory allowing it to advance into the PPF.ResultsA total of 90 patients ranging from 0 to ≤18 years of age were included in the study. The mean distance from the suprazygomatic skin to the foramen rotundum in patients 0 to ≤12 months of age and >13 to ≤18 years of age was 38.6 (SD ± 4.7) and 47.1 (SD ± 3.2) mm, respectively (p < .0001). The statistical analysis demonstrated a positive correlation between age in years and all of the measured distances (p = .0001). With respect to the plane of the needle entry site, the anterior and inferior angles required for passage into the PPF in the 0 to ≤12 months age group were 11 (SD ± 2.1) and 9.0 (SD ± 2.5) degrees, respectively, compared to those in the >13 to ≤18 years of age group at 12.4 (SD ± 1.9) and 12.1 (SD ± 3.2) degrees, respectively. These data reveal that patients in the oldest compared to the youngest pediatric age groups require significantly greater needle insertion, yet the angles of needle re-orientation are clinically similar between these two pediatric age groups varying by up to only 3°.ConclusionAs expected, the distance from the skin to the foramen rotundum increases significantly with age; however, the angles of re-orientation with respect to the original needle entry site demonstrated up to only 3° of variability between the youngest and oldest age groups evaluated in this pediatric cohort.
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A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Giulia Lorenzoni, Sekib Umihanić, Danila Azzolina, Emiliano Manza, Fuad Brkić, Dario Gregori
ObjectivesThe present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from European countries.MethodsThe analysis is based on FB injury cases included in the Susy Safe registry. Cases from the Ear-Nose-Throat (ENT) Clinic, University Clinical Center of Tuzla (B&H) were compared with cases from European countries participating in the Susy Safe project. Multiple Correspondence Analysis (MCA) was performed to elucidate differences within a large data set regarding mechanisms and objects causing injuries.ResultsThe results of the MCA showed that the first three dimensions explained 43% of the variability. The first dimension was identified by children hospitalized for FB ingestion, the second one by children hospitalized for FB aspiration (lower airways), and the third one by children with an FB in the ear or in the upper airways. The analysis of the median of coordinates of factors contributing to each dimension showed that the greatest difference between B&H and European countries regarded the third one. Looking at the profile of these patients, it might be suggested that the proportion of males and females and the type of activity in which they were involved at time of injury occurrence are different among the countries consideredConclusionsThis study proposes a simple tool for assessing differences among countries in the distribution of FB injuries. This case study shows that B&H has different patterns of FB injuries in the upper respiratory tract.
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Validity of automated threshold audiometry in school aged children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): S.M. Govender, M. Mars
BackgroundAutomated hearing tests have the potential to reduce the burden of disease amongst learners by introducing such services within the school context.MethodsThe aim of the study was to conduct a validation study on normal and hearing impaired learners, comparing air and bone conduction automated test results to conventional test results in 50 school aged learners (n = 100 ears) within a noise controlled school environment using a cross sectional comparative study design. The KuduWave 5000 (Emoyo.net) was used in this study.Data analysisThe spearman's correlation coefficient was calculated to determine test-retest reliability. The mean and standard deviation (SD) was measured for each frequency. The absolute mean difference (AMD) and SD was calculated for both air and bone conduction testing at each frequency for automated testing. A paired sampled t-test and a one way ANOVA was used to identify any significant differences. Alpha was set as 0.05.ResultsThere was significant correlation between thresholds obtained for automated test one and test two for normal hearing and hearing impaired group. The spearmans correlation coefficient was high (close to +1) for majority of the results for both groups across the frequency range. Both air and bone conduction testing across the frequency range of 250 Hz–2000 Hz and at 8000 Hz were not statistically signfiicant (p < .005) for both groups, however at 4000 Hz for bone conduction testing in the hearing impaired group, there was a statisticially signficant difference (p = .003). This was attirubted to the variaibilty in bone conduction test results often due to force and placement of the bone vibrator.ConclusionThe findings indicate that automated audiometry can yield relaible results that are comparable to conventional test results. Key clinical considerations include extending the response time, regular rest periods, improving instructions and comfort levels.
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Plasticity after pediatric cochlear implantation: Implication from changes in peripheral plasma level of BDNF and auditory nerve responses
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Razieh Alemi, Masoud Motassadi Zarandy, Mohammad Taghi Joghataei, Ali Eftekharian, Mohammad Reza Zarrindast, Nasim Vousooghi
IntroductionSensory neural hearing loss could lead to some structural and physiological changes in the auditory pathways, such as alteration in the expression of neurotrophins. These factors, especially Brain-Derived Neurotrophic Factor (BDNF), play an important role in synaptic functions and experience-related plasticity. Restoring cochlear function after hearing loss is possible through cochlear implantation (CI). Evaluation of the blood concentration changes of neurotrophins as prerequisites of plasticity could help scientists to determine the prognosis of CI as in the candidacy procedure or enhancing prosthesis function by adding the exact needed amount of BDNF to the electrode array.MethodsHere we have studied the plasma BDNF concentration before CI surgery and 6 months after using CI device in 15 pediatric CI recipients and compared this level with changes of BDNF concentration in 10 children who were using hearing aid (H.A). In addition, we searched for a possible correlation between post-surgery plasma BDNF concentration and electrical compound action potential (ECAP) and comfort-level (C-level) thresholds.ResultsPlasma BDNF concentration in children with CI increased significantly after CI surgery, while this difference in H.A group was not significant. Analysis of repeated measures of ECAP and C-level thresholds in CI group showed that there were some kinds of steadiness during follow- up sessions for ECAP thresholds in basal and E16 of middle electrodes, whereas C-level thresholds for all selected electrodes increased significantly up to six months follow-up. Interestingly, we did not find any significant correlation between post-surgery plasma BDNF concentration and ECAP or C-level threshold changes.ConclusionIt is concluded that changes in C-level threshold and steady state of ECAP thresholds and significant changes in BDNF concentration could be regarded as an indicator of experienced-related plasticity after CI stimulation.
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Reliability and validity of the Chinese pediatric voice handicap index
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Kena Liu, Shaofeng Liu, Zhou Zhou, Qinyi Ren, Jie Zhong, Renzhong Luo, Huabiao Qin, Siyi Zhang, Pingjiang Ge
ObjectivesTo evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI).Material and methodsThe original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient.ResultsThe internal consistency of total score and three subscales scores of Chinese pVHI were 0.788–0.944. The test-retest reliability was 0.631–0.887(P < .001). The pVHI scores of control group significantly were lower than the pathological group (P = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694–0.807, P = .000). The pVHI scores positively correlated with GRB assessment (P < .01).ConclusionsThe Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia.
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A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Neha A. Patel, Randall A. Bly, Seth Adams, Kristen Carlin, Sanjay R. Parikh, John P. Dahl, Scott Manning
ObjectivesPostoperative calcium management is challenging following pediatric thyroidectomy given potential limitations in self-reporting symptoms and compliance with phlebotomy. A protocol was created at our tertiary children's institution utilizing intraoperative parathyroid hormone (PTH) levels to guide electrolyte management during hospitalization.The objective of this study was to determine the effect of a new thyroidectomy postoperative management protocol on two primary outcomes: (1) the number of postoperative calcium blood draws and (2) the length of hospital stay.Study designInstitutional review board approved retrospective study (2010–2016).MethodsConsecutive pediatric total thyroidectomy and completion thyroidectomy ± neck dissection cases from 1/1/2010 through 8/5/2016 at a single tertiary children's institution were retrospectively reviewed before and after initiation of a new management protocol. All cases after 2/1/2014 comprised the experimental group (post-protocol implementation). The pre-protocol control group consisted of cases prior to 2/1/2014. Multivariable linear and Poisson regression models were used to compare the control and experimental groups for outcome measure of number of calcium lab draws and hospital length of stay.Results53 patients were included (n = 23, control group; n = 30 experimental group). The median age was 15 years. 41 patients (77.4%) were female. Postoperative calcium draws decreased from a mean of 5.2 to 3.6 per day post-protocol implementation (Rate Ratio = 0.70, p < .001), adjusting for covariates. The mean number of total inpatient calcium draws before protocol initiation was 13.3 (±13.20) compared to 7.2 (±4.25) in the post-protocol implementation group. Length of stay was 2.1 days in the control group and 1.8 days post-protocol implementation (p = .29). Patients who underwent concurrent neck dissection had a longer mean length of stay of 2.32 days compared to 1.66 days in those patients who did not undergo a neck dissection (p = .02). Hypocalcemia was also associated with a longer mean length of stay of 2.41 days compared to 1.60 days in patients who did not develop hypocalcemia (p < .01).ConclusionsThe number of calcium blood draws was significantly reduced after introduction of a standardized protocol based on intraoperative PTH levels. The hospital length of stay did not change. Adoption of a standardized postoperative protocol based on intraoperative PTH levels may reduce the number of blood draws in children undergoing thyroidectomy.
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Central xanthoma of the mandible associated with hyperlipidemia: A rare presentation
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): John K. Brooks, Behzad Mostoufi, Ahmed S. Sultan, Zaid H. Khoury, Jeffery B. Price, John C. Papadimitriou, John R. Basile, Cinthia B. Drachenberg, Rania H. Younis
Xanthoma is a common, self-limiting cutaneous lesion of non-Langerhans cell, lipid-laden foamy histiocytes that is often concomitant with hyperlipidemia. The intraosseous counterpart is rarely encountered and typically presents as a painless, expansile osteolytic process in the context of hyperlipidemia or normolipidemia. Only a scant number of gnathic xanthomas have been reported in the otolaryngologic literature. We report the clinical, laboratory, radiographic, histopathologic, immunohistochemical, and ultrastructural studies of a mandibular lesion discovered in an asymptomatic 16-year-old male, and associated with 2 previously unreported comorbidities, namely hyperlipidemia and vitamin D deficiency.
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Proportion of CD4 and CD8 tumor infiltrating lymphocytes predicts survival in persistent/recurrent laryngeal squamous cell carcinoma
Source:Oral Oncology, Volume 77
Author(s): Rebecca Hoesli, Andrew C. Birkeland, Andrew J. Rosko, Mohamad Issa, Kelsey L. Chow, Nicole L. Michmerhuizen, Jacqueline E. Mann, Steven B. Chinn, Andrew G. Shuman, Mark E. Prince, Gregory T. Wolf, Carol R. Bradford, Jonathan B. McHugh, J. Chad Brenner, Matthew E. Spector
Tumor infiltrating lymphocytes (TILs) have been shown to be an important prognostic factor in patients with previously untreated head and neck cancer. After organ preservation therapy for laryngeal cancer and subsequent persistence/recurrence, the prognostic value of TILs is unknown. Our goal was to determine if TILs have value as a prognostic biomarker in patients with surgically salvageable persistent/recurrent laryngeal squamous cell carcinoma.Levels of TILs were quantified on tissue microarrays from 183 patients undergoing salvage total laryngectomy for persistent/recurrent laryngeal cancer after radiation or chemoradiation between 1997 and 2014. Demographic and clinical data were abstracted. Immunohistology evaluation included CD4, CD8, PDL-1, p16, CD31, Vimentin, EGFR, and p53.Elevated levels of either CD8 or CD4 positive TILs were associated with improved disease specific survival (CD8: HR 0.46, 95% CI 0.24–0.88, CD4: HR 0.43; 95% CI 0.21–0.89) and disease free survival (CD8: HR 0.53, 95% CI 0.29–0.94, CD4: HR 0.52; 95% CI 0.27–0.99). Levels of CD8 (HR 0.74; 95% CI 0.47–1.17) or CD4 (HR 0.66; 95% CI 0.40–1.08) TILs were not significantly associated with overall survival. In bivariate analysis, patients with elevated CD4 and/or CD8 TILs had significantly improved disease specific survival (HR 0.42; 95% CI 0.21–0.83) and disease free survival (HR 0.45; 95% CI 0.24–0.84) compared to patients with low levels of CD4 and CD8. PDL-1, p16, CD31, Vimentin, EGFR, and p53 were not significant prognostic factors. On multivariate analysis, elevated CD8 TILs were associated with improved disease specific survival (HR 0.35; 95% CI 0.14–0.88, p = .02) and disease free survival (HR 0.41; 95% CI 0.17–0.96, p = .04).CD8, and possibly CD4, positive TILs are associated with favorable disease free and disease specific survival for recurrent/persistent laryngeal cancer.
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Substernal thyroidectomy: the trans-cervical approach
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Christine M. Dahlhausen, Nathaniel J. Walsh, David J. Terris
Substernal thyroid goiters that require surgery may pose unique challenges to thyroid surgeons based on the size and inferior extent of the disease. Consequently, there are multiple variations to the approach and additional considerations in operative planning and technique that are often required. While there is some debate on the precise definition of substernal thyroid, for the purposes of this manuscript it is considered to be thyroid tissue below the sternal notch or clavicle. This article aims to provide thyroid surgeons who encounter the challenges of substernal thyroid a straightforward algorithm for planning and operative techniques that have proven successful in the safe and effective management of this condition.
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Revision central neck dissection
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Gian-Marco Busato, Jeremy Freeman
Recurrent well differentiated thyroid cancer is an important problem and incidence is on the rise. Recurrence preferentially involves lymph nodes of the central and lateral neck. Detection and surveillance of such disease is commonly performed via serum thyroglobulin and high frequency neck ultrasonography. Management options include: active surveillance, local ablative techniques, RAI, external beam radiotherapy, and surgery. The gold standard of care is surgical removal in the form of comprehensive neck dissection. While revision surgery in the neck does carry increased risk, the use of well-established techniques can decrease this risk and allow surgeons to safely and effectively treat patients with recurrent neck disease.
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Preface
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Phillip Pellitteri
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Techniques for thyroid cancer involving extreme superior thyroid pole
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Daniel Kwon, Alfred Simental
Standard operative techniques for thyroidectomy have become well refined and widely disseminated. However, special circumstances, such as superior pole thyroid cancers, can present unique difficulties for the unprepared surgeon. Appropriate workup and appreciation of the unique anatomic relationships in the superior-most extent of the thyroid gland is vital in surgical planning. The ability to anticipate and manage a variety of contingencies such as superior laryngeal nerve sacrifice, vascular isolation / repair, laryngectomy, and repair of pharyngeal defects are essential for safe surgery for cancers of the extreme superior thyroid pole.
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Operative Techniques in Otolaryngology-Head and Neck Surgery
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Joseph Scharpf
The worldwide incidence of thyroid cancer has increased and generated great debate and study concerning the proper evidence-based management strategies. Despite this increase, there has been no significant increase in advanced, invasive thyroid cancers, which continue to represent the primary cause of thyroid cancer specific death. This section provides an evidence-based management review for thyroid cancer invading the aero-digestive tract and addresses critical issues of diagnosis, preoperative evaluation, surgical management, and adjuvant treatment germane to this important subset of patients. Illustrative examples of complex patients will be presented in the context of evidence-based literature to help guide the practitioner in an area less frequently encountered by many surgeons.
http://ift.tt/2zop75u
Surgery for fibro adherent inflammatory thyroid disease
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): David Goldenberg, Warren Swegal, Mitchell Dunklebarger, Phillip K. Pellitteri
Inflammatory thyroid diseases include those which are mediated through autoimmune disorders such as Hashimoto′s thyroiditis and Grave′s disease, as well as inflammatory goiter and sub-acute thyroiditis. In patients with such disorders, the thyroid gland often becomes markedly enlarged with an associated fibro-vascular connective tissue reaction involving the thyroid capsule and surrounding soft tissues. This results in dense, adherent connective tissue which may compress and obscure critical central neck compartment structures and make capsular dissection challenging. Thyroid surgery in patients with fibro-adherent inflammatory thyroid disease are technically challenging and post-operative complication rates are higher for these procedures. Due to these increased risks for complications, operative procedures in these circumstances should be designed with careful consideration of the anatomic changes associated with the underlying inflammatory pathology. Elements important to successful surgical resection include appropriate patient preparation and surgical planning, together with execution of the operative procedure with adaptation to many of the changes induced by inflammation on both the thyroid gland and the surrounding central neck structures.
http://ift.tt/2BGShCB
Prediction of agenesis of the mandibular second premolar using the developmental stages of the mandibular canine, first premolar, and second molar
Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Ji-Soo Song, Teo Jeon Shin, Young-Jae Kim, Jung-Wook Kim, Ki-Taeg Jang, Sang-Hoon Lee, Hong-Keun Hyun
ObjectiveThe aim in this study was to suggest a standard for early diagnosis of agenesis of the mandibular second premolars (L5) by estimating the developmental stages of the mandibular canines (L3), first premolars (L4), and second molars (L7).DesignAmong all 5136 pediatric patients aged 5–11 years who received panoramic radiographs between June 2008 and December 2009 at Seoul National University Dental Hospital, 215 control patients and 74 agenesis patients who met inclusion criteria were analyzed. The developmental stages of all L3, L4, L5, and L7 of control and agenesis patients were estimated using the method proposed by Demirjian. To identify the tooth (L3, L4, L7) with the developmental pattern most similar to that of L5, Kendall rank correlation coefficients and Bootstrap method were used. To verify that patients with agenesis of L5 show delayed development, Wilcoxon rank sum test was used. To identify the stages in which to diagnose agenesis of L5, we performed survival analysis.ResultsThere was a significant correlation between the developmental stages of L3, L4, L7 and L5. The developmental stages of those three teeth in the agenesis group were delayed compared with those in the control group at certain ages. If the developmental stages of at least two of those three teeth reach Demirjian stage D without the calcification of L5, agenesis of L5 can be confirmed.ConclusionsAgenesis of L5 can be confirmed when two of the three teeth (L3, L4, L7) reach Demirjian stage D.
http://ift.tt/2C4hp5J
Prediction of agenesis of the mandibular second premolar using the developmental stages of the mandibular canine, first premolar, and second molar
Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Ji-Soo Song, Teo Jeon Shin, Young-Jae Kim, Jung-Wook Kim, Ki-Taeg Jang, Sang-Hoon Lee, Hong-Keun Hyun
ObjectiveThe aim in this study was to suggest a standard for early diagnosis of agenesis of the mandibular second premolars (L5) by estimating the developmental stages of the mandibular canines (L3), first premolars (L4), and second molars (L7).DesignAmong all 5136 pediatric patients aged 5–11 years who received panoramic radiographs between June 2008 and December 2009 at Seoul National University Dental Hospital, 215 control patients and 74 agenesis patients who met inclusion criteria were analyzed. The developmental stages of all L3, L4, L5, and L7 of control and agenesis patients were estimated using the method proposed by Demirjian. To identify the tooth (L3, L4, L7) with the developmental pattern most similar to that of L5, Kendall rank correlation coefficients and Bootstrap method were used. To verify that patients with agenesis of L5 show delayed development, Wilcoxon rank sum test was used. To identify the stages in which to diagnose agenesis of L5, we performed survival analysis.ResultsThere was a significant correlation between the developmental stages of L3, L4, L7 and L5. The developmental stages of those three teeth in the agenesis group were delayed compared with those in the control group at certain ages. If the developmental stages of at least two of those three teeth reach Demirjian stage D without the calcification of L5, agenesis of L5 can be confirmed.ConclusionsAgenesis of L5 can be confirmed when two of the three teeth (L3, L4, L7) reach Demirjian stage D.
http://ift.tt/2C4hp5J
Patients should now be informed of the benefits of the use of a piezoelectric saw before orthognathic bilateral sagittal split osteotomy
Since the Montgomery ruling1, surgeons have had to widen the scope of consent to include any information that could be of material interest to patients before a procedure. Orthognathic patients who have had bilateral sagittal split osteotomy have traditionally been warned about high rates of permanent change of sensation to the lower lip or chin, and recent multicentre data from the UK has identified a self-reported rate of change of sensation of 56%.2
http://ift.tt/2BpX2fL
Free flap surgery in Europe: an interdisciplinary survey
Publication date: Available online 21 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C. Rendenbach, N. Hölterhoff, S. Hischke, K. Kreutzer, R. Smeets, A.T. Assaf, M. Heiland, J. Wikner
Free flap surgery is essential for the aesthetic and functional reconstruction of various parts of the body. The aim of this study was to compare current concepts of perioperative flap management between ENT, craniomaxillofacial, and plastic surgeons. A European survey was conducted among 570 surgical departments, covering all aspects of free flap surgery. Focus was placed on antibiotic and antithrombotic drug use, aspects of osseous reconstruction, and flap monitoring strategies. One hundred and seventy-two medical units participated. A broad spectrum of anticoagulant regimens and a trend towards prolonged antibiotic prophylaxis were found. Fixation with (CAD/CAM) reconstruction plates was more popular than monocortical locking with miniplates in the mandible. Visual assessment and Doppler systems were reported to be the most common monitoring modalities. The flap loss rate was stated to be higher after osseous reconstruction. Only a few differences in perioperative flap management were identified between the different surgical fields, and osseous reconstruction appears to be the most challenging.
http://ift.tt/2BYLUKr
Pulmonary tumor thrombotic microangiopathy successfully treated with corticosteroids: a case report
Pulmonary tumor thrombotic microangiopathy is a special type of tumor thromboembolism. We report the case of a patient who developed pulmonary tumor thrombotic microangiopathy with alveolar hemorrhage. Almost ...
http://ift.tt/2zlOF2N
Phosphorylation of intracellular signaling molecules in peripheral blood cells from psoriasis patients on originator or biosimilar infliximab
Abstract
Background
Psoriasis vulgaris is a chronic, inflammatory skin disease characterized by a dysregulated immune response and it is associated with substantial systemic comorbidities. Biological drugs like tumor necrosis factor (TNF) inhibitors can ameliorate the disease but are expensive. Biosimilar drugs have the same amino acid sequence as the originator, but differences in manufacturing can affect biological activity, efficacy and tolerability.
Objectives
We aimed to explore potential differences in intracellular phosphorylation of signaling molecules in peripheral blood cells from TNF inhibitor infliximab treated psoriasis patients compared to healthy controls, and to investigate if the phosphorylation pattern was influenced by switching from originator infliximab to biosimilar CT-P13.
Methods
By flow cytometry, we measured phosphorylation of NF-κB, ERK1/2, p38 MAPK and STAT3 before and after TNF stimulation in monocytes and T, B, natural killer and CD3+CD56+ cells from 25 psoriasis patients treated with infliximab and 19 healthy controls.
Results
At inclusion, phosphorylation levels of peripheral blood mononuclear cells were increased in psoriasis patients compared to healthy controls, even though clinical remission had already been achieved. Phosphorylation levels declined in both patients on originator and biosimilar infliximab during continued treatment. No significant differences were detected between the two medications after 12 months.
Conclusions
Psoriasis patients on infliximab have higher activation levels of PBMC than healthy controls, possibly reflecting systemic inflammation. Switching from originator infliximab to biosimilar CT-P13 did not affect phosphorylation levels or clinical parameters, suggesting that CT-P13 is a non-inferior treatment alternative to originator infliximab.
This article is protected by copyright. All rights reserved.
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The role of adult attachment orientation and coping in psychological adjustment to living with skin conditions
Abstract
Background
Skin conditions can be associated with significant psychological distress. Investigation of attachment orientation and associated use of coping strategies is a promising perspective from which to investigate psychological adjustment to skin conditions.
Objectives
To examine the role of adult attachment orientation, conceptualised as two dimensions: attachment avoidance and attachment anxiety, in psychological adjustment (appearance related distress and skin related quality of life) and the mediating role of two coping strategies: defeatism and activity.
Methods
Attachment avoidance and attachment anxiety (ECR), use of coping strategies (COPE), appearance related distress (DAS 24) and skin related quality of life (Skindex-16) were assessed through a cross-sectional online survey in 207 adults with skin conditions. Multiple mediation analyses were performed using PROCESS path analysis.
Results
Overall, higher attachment avoidance and higher attachment anxiety were associated with higher appearance related distress and greater impact on emotions and functioning aspects of quality of life. For attachment anxiety, the relationship was fully explained by more frequent use of defeatism coping. For attachment avoidance, the relationship was partially explained by more frequent use of defeatism coping (and in the case of appearance related distress also more frequent use of activity coping), and higher attachment avoidance was also associated with poorer psychological adjustment in a way that could not be explained by use of assessed coping strategies.
Conclusions
Insecure attachment orientation (high attachment avoidance or high attachment anxiety) is linked to poorer adjustment. People with insecure attachment might benefit from psychological interventions that target underlying attachment orientation.
This article is protected by copyright. All rights reserved.
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Lymphoedema in Lentigo Maligna patients treated with imiquimod, a long term adverse effect
Abstract
Lentigo Maligna (LM) is a potential precursor lesion of Lentigo Maligna Melanoma (LMM). It is treated to prevent progression to LMM. A recent epidemiological study reports a progression rate of 2.0-2.6% over a course of 25 years1. The gold standard of treatment is surgical excision with 5 mm margin2. Topical application of imiquimod cream is an off-label alternative.
This article is protected by copyright. All rights reserved.
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Efficacy of anti-PD-1 on skin carcinomas and melanoma metastases in an Xeroderma Pigmentosum patient
Abstract
Xeroderma pigmentosum is an orphan disease of poor prognosis. We report one case of parallel efficacy with anti-PD-1 antibody on both melanoma and skin carcinoma in a xeroderma pigmentosum patient.
A 17-year old patient presented with metastatic melanoma and multiple non melanoma skin cancers. He was treated with pembrolizumab, a monoclonal anti-PD-1 antibody, at the dose of 2mg/Kg 3 weeks apart. Parallel therapeutic efficacy of anti-PD1 was observed in metastatic melanoma and skin carcinomas, and maintained at week 24.
This observation suggests anti-PD1 may be considered in patients with XP and metastatic melanoma as well as advanced non melanoma skin cancer.
This article is protected by copyright. All rights reserved.
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Novel POFUT1 mutation associated with hidradenitis suppurativa-Dowling Degos Disease firm up a role for Notch signalling in the pathogenesis of this disorder
Abstract
We read with great interest the article by Pavlovsky et al;1 describing PSENEN mutations associated with hidradenitis suppurativa-Dowling Degos Disease (HS-DDD) and suggesting a role for Notch signalling in the pathogenesis of this disorder. The literature also describes mutations in the POFUT1 gene as causative genetic defects in Dowling Degos Disease.2 Decreased Notch activity is associated with mutations in POFUT1.
This article is protected by copyright. All rights reserved.
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Platelet-to-lymphocyte ratio predicts long-term survival in laryngeal cancer
Abstract
Objectives
Although the survival rate of laryngeal cancer is relatively high, some patients with laryngeal squamous cell carcinoma (LSCC) show the least benefit from laryngectomy, owing to few determining diagnostic tools. We aimed to identify high-risk patients according to a preoperatively determined signature of the platelet-to-lymphocyte ratio (PLR) of > 193.55, as an indicator of poor treatment outcome in LSCC patients.
Methods
We retrospectively evaluated 899 patients who underwent laryngectomy for LSCC. The patients were stratified by PLR into three subgroups: low (≤ 119.55), moderate (> 119.55 and ≤ 193.55), and high (> 193.55). Kaplan–Meier curves were plotted to compare the intergroup cancer-specific survival (CSS).
Results
Patients with high PLR had significantly worse survival outcomes (5-year CSS, low vs. moderate vs. high: 75.3 vs. 68.4 vs. 53.9%; 10-year CSS, low vs. moderate vs. high: 65.0 vs. 56.0 vs. 38.6%, P < 0.001). Patients with PLR > 193.55 represented malnutrition and more advanced cancer stage..
Conclusion
Patients with PLR > 193.55 experience poor outcomes and represent malnutrition, more advanced cancer stage.
http://ift.tt/2DAgqrL
Correction to: Cerebrovascular CO 2 reactivity during isoflurane-nitrous oxide anesthesia in patients with chronic renal failure
Abstract
In the original publication of the article, the first sentence was published incorrectly under the section "Patients and preoperative assessment". The correct sentence should read as, "The Yamaguchi University Graduate School of Medicine Ethics Committee for Human Study approved the study protocol (18th August 2004: H16-71)".
http://ift.tt/2D2KtYj
Assessing miRNAs profile expression as a risk stratification biomarker in oral potentially malignant disorders: A systematic review
Source:Oral Oncology, Volume 77
Author(s): Haytham El-Sakka, Omar Kujan, Camile S. Farah
ObjectivesThis paper aims to systematically review current findings on altered expression of miRNAs in OPMDs and whether they can be used as risk stratification biomarkers.MethodsStudies were collated after searching three different electronic databases: PubMed, Embase, Medline. Additional searches were carried out through cross checking the bibliographies of selected articles. After a thorough selection process made by two of the authors, 40 articles met the inclusion criteria and were included in the review. Studies were assessed and analysed in terms of how the candidate miRNA biomarkers were differentially expressed and validated.ResultsThe included studies examined the expression of miRNAs from human specimens (blood serum/plasma, saliva, tissue) as diagnostic or prognostic biomarkers in patients with OPMDs, some of which have been utilised as risk stratification biomarkers for malignant transformation and have showed promising findings.ConclusionThe current evidence to support or refute the prognostic utility of miRNAs in predicting cancer progression in OPMDs is equivocal. Further longitudinal prospective studies with solid study design are warranted.
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Sensitivity and specificity of oral HPV detection for HPV-positive head and neck cancer
Source:Oral Oncology, Volume 77
Author(s): Brooke J. Gipson, Hilary A. Robbins, Carole Fakhry, Gypsyamber D'Souza
BackgroundThe incidence of HPV-related head and neck squamous cell carcinoma (HPV-HNSCC) is increasing. Oral samples are easy and non-invasive to collect, but the diagnostic accuracy of oral HPV detection methods for classifying HPV-positive HNSCC tumors has not been well explored.MethodsIn a systematic review, we identified eight studies of HNSCC patients meeting our eligibility criteria of having: (1) HPV detection in oral rinse or oral swab samples, (2) tumor HPV or p16 testing, (3) a publication date within the last 10 years (January 2007–May 2017, as laboratory methods change), and (4) at least 15 HNSCC cases. Data were abstracted from each study and a meta-analysis performed to calculate sensitivity and specificity.ResultsEight articles meeting inclusion criteria were identified. Among people diagnosed with HNSCC, oral HPV detection has good specificity (92%, 95% CI = 82–97%) and moderate sensitivity (72%, 95% CI = 45–89%) for HPV-positive HNSCC tumor. Results were similar when restricted to studies with only oropharyngeal cancer cases, with oral rinse samples, or testing for HPV16 DNA (instead of any oncogenic HPV) in the oral samples.DiscussionAmong those who already have HNSCC, oral HPV detection has few false-positives but may miss one-half to one-quarter of HPV-related cases (false-negatives). Given these findings in cancer patients, the utility of oral rinses and swabs as screening tests for HPV-HNSCC among healthy populations is probably limited.
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Bioinformatics for dermatology – why we should learn about code
Abstract
The era of high throughput sequencing (HTS; otherwise known as next-generation sequencing) has revolutionised dermatological research. New publications describing successful translational research based on interpretation of omics data from dermatological sources appear each month. Bioinformatics refers to the tools used to collect, classify and analyse such datasets.
This article is protected by copyright. All rights reserved.
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Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis
Abstract
Purpose
Oropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy.
Methods
PubMed/MEDLINE and three other databases were searched through November 25, 2017. Two authors independently searched the literature. Eligibility (1) patients: children or adults with snoring, (2) intervention: oropharyngeal and/or tongue exercises, (3) comparison: pre and post-treatment data for snoring, (4) outcomes: snoring frequency and snoring intensity, (5) study design: publications of all study designs.
Results
A total of 483 articles were screened, 56 were downloaded in their full text form, and nine studies reported outcomes related to snoring. There were a total of 211 patients (all adults) in these studies. The snoring intensity was reduced by 51% in 80 patients from pre-therapy to post-therapy visual analog scale values of 8.2 ± 2.1 (95% CI 7.7, 8.7) to 4.0 ± 3.7 (95% CI 3.2, 4.8). Berlin questionnaire snoring intensity reduced by 36% in 34 patients from 2.5 ± 1.0 (95% CI 2.2, 2.8) to 1.6 ± 0.8 (95% CI 1.3, 1.9). Finally, time spent snoring during sleep was reduced by 31% in 60 patients from 26.3 ± 18.7% (95% CI 21.6, 31.0) to 18.1 ± 20.5% (95% CI 12.9, 23.3) of total sleep time.
Conclusions
This systematic review demonstrated that myofunctional therapy has reduced snoring in adults based on both subjective questionnaires and objective sleep studies.
http://ift.tt/2D2xjdU