The Laryngoscope
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Controlled Clinical Trial
Triological thesis: concurrent endoscopic sinus surgery and cosmetic rhinoplasty: rationale, risks, rewards, and reality.
To examine the effect of concurrent endoscopic sinus surgery (ESS) on the postoperative course of cosmetic rhinoplasty (CR), identify any specific contraindications, and to develop more useful treatment regimen in patients undergoing concurrent ESS and CR. ⋯ While our data supports concurrent ESS and CR as safe, our findings suggest that the presence and treatment of concurrent sinonasal disease prolongs the patients' recovery from CR. This may be due to the effects of sinus pathology and manipulation of sinonasal venous and lymphatic drainage patterns or could be due to subclinical infectious soiling of rhinoplasty tissue planes. We recommend a two-team approach to promote excellent surgical technique, avoid surgeon fatigue, and enhance patient care. We recommend adequate medical management of chronic sinusitis prior to surgery, pre, intra and postoperative antibiotic coverage, appropriate postoperative sinus toilet beginning 1 week after surgery and careful and close patient follow-up to optimize results. Most importantly, we advocate close coordination of sinonasal and rhinoplastic care in a two-team approach to maximize care.
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Laryngeal symptoms are increasingly recognized to occur in chronic persistent cough and may result from the sensory hyperresponsiveness that characterizes this condition. Apart from cough, the motor consequences of sensory activation have not been well described in chronic persistent cough. The efficacy of speech pathology treatment for chronic cough suggests that laryngeal dysfunction may be relevant in chronic persistent cough. This study investigated the relationship between cough reflex sensitivity and laryngeal dysfunction, which was assessed as paradoxical vocal cord movement (PVCM) and extrathoracic airway hyperresponsiveness, in patients with chronic cough. ⋯ Laryngeal dysfunction is common in chronic cough, where it is manifest as paradoxical vocal cord movement and extrathoracic airway hyperresponsiveness. Laryngeal dysfunction in chronic cough is associated with reduced quality of life. Laryngeal hypersensitivity may be a common mechanism that can be effectively treated by speech language therapy.
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Incidence of perioperative airway complications in patients with previous medialization thyroplasty.
Determine the incidence and characterize perioperative airway complications in patients who have undergone medialization thyroplasty (MT) and subsequently undergo procedures requiring anesthesia. ⋯ The incidence of perioperative airway complications in post-MT patients is non-neglible and may be serious. Surgical, anesthesia, and recovery room staff should be made aware of the significantly increased risk of airway complications in post-MT patients.
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Randomized Controlled Trial Comparative Study
Computer-assisted teaching of epistaxis management: a Randomized Controlled Trial.
To determine whether computer-assisted learning (CAL) is an effective tool for the instruction of technical skills. ⋯ CAL learners demonstrated significantly greater improvement across both subjective and objective outcome measures when compared to the text-based group. Additionally, students favored learning via the CAL modality, which further suggests that CAL is a valuable means of imparting procedural knowledge to novice medical trainees.
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Multicenter Study Comparative Study
Acute radiographic workup of blunt temporal bone trauma: maxillofacial versus temporal bone CT.
To evaluate the radiographic workup of blunt temporal bone trauma and determine the utility of maxillofacial computed tomography (CT) versus temporal bone CT in identifying carotid canal fractures. ⋯ A combination of helical computed tomography and physical exam findings can allow for judicious use of temporal bone CTs when no maxillofacial CT is indicated. Temporal bone CTs rarely change acute management. But when they do, it is in regard to the need for further workup of possible vascular injury. Lastly, maxillofacial CTs are adequate for identifying carotid canal fractures.