American journal of otolaryngology
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Pediatric tonsillectomy is a common procedure now being performed most often for patients with obstructive sleep apnea, which has been associated with increased sensitivity to the respiratory side effects of opioid medications. This study investigates a strategy to decrease the use of opiate medications in a particularly vulnerable population. ⋯ In this case-control study, use of dexmedetomidine and local anesthetic injected into the tonsillar fossa led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum pain score without an increase in adverse events. Meaning: Use of dexmedetomidine and local anesthetic as anesthetic adjuncts may help reduce need for intraoperative opiates and decrease the use of volatile anesthetic agents in pediatric tonsillectomy patients, which are undesirable medications in the pediatric population for their respective respiratory depression and potentially neurotoxic side effects.
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Myasthenia gravis (MG) is an autoimmune disease. Dysarthria, dysphagia, and difficulty swallowing as exclusive initial and primary complaints in MG (laryngeal MG) are rare and seldom reported. ⋯ Laryngeal MG is a rare and possibly under-diagnosed condition. The patients can present with dysarthria, dysphagia, or difficulty swallowing. Fluctuation in severity of disease by neostigmine/edrophonium test is a typical feature for MG patients. AChR antibody and RNS tests should be included to evaluate the pathologic changes in the neuromuscular junction.
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We evaluated the relationship between otitis media with effusion and thiol/disulfide homeostasis using a novel marker of oxidative stress. ⋯ Oxidative stress may be the major cause of the increase in oxidized thiols in patients with bilateral otitis media with effusion, however, this relationship requires further investigation.
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Randomized Controlled Trial
Ultrasound guided superior laryngeal nerve block as an adjuvant to generalanesthesia during endoscopic laryngeal surgery: A prospective, randomized, double-blind trial.
Blindly administered bilateral (B/L) superior laryngeal nerve (SLN) blocks, have been used to decrease the perioperative stress response of endoscopic laryngosurgeries. Use of ultrasound (USG) for giving these blocks is more likely to be successful, with fewer complications. We evaluated the efficacy of USG guided B/L SLN block in decreasing perioperative cough, sore-throat and hoarseness of voice. ⋯ USG guided SLN block as an adjuvant to GA resulted in better recovery profile of the patients with significant reduction in postoperative cough, sore throat and hoarseness of voice.
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Randomized Controlled Trial Comparative Study
Comparison of the medical costs and effects of large traumatic eardrum perforations treatment.
We investigated the medical costs and effects of ofloxacin drops (OFLX), gelatin sponge patches, spontaneous healing, and endoscopic myringoplasty on healing in large tympanic membrane perforations (TMPs). ⋯ Although the gelatin sponge and myringoplasty treatments significantly shortened the closure time compared with spontaneous healing, the gelatin sponge patch did not significantly improve the closure rate, and the medical cost of myringoplasty was significantly higher than that of the other treatments. In contrast, OFLX significantly shortened closure time and had a higher closure rate than spontaneous healing, and the medical costs were lower than those of the gelatin sponge and myringoplasty procedures.