The Laryngoscope
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Comparative Study
Cystic fibrosis transmembrane conductance regulator modulation by the tobacco smoke toxin acrolein.
Evidence indicates that decreased mucociliary clearance (MCC) is a major contributing feature to chronic rhinosinusitis. Tobacco-smoke exposure is thought to inhibit transepithelial Cl(-) secretion, a major determinant of airway surface liquid hydration and MCC. The objective of the current study was to evaluate the effects of acrolein exposure (a prominent tobacco smoke toxin) on vectorial Cl(-) transport through the major apical anion channel cystic fibrosis transmembrane conductance regulator (CFTR) in sinonasal epithelium. ⋯ The present study demonstrates that acrolein has complex but pronounced interaction with the major apical Cl(-) transport mechanism that uses CFTR. Further investigations are required to determine acrolein's impact as a tobacco smoke constituent on mucociliary transport.
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Diagnostic transnasal flexible endoscopy (TNFE) is a commonly used office procedure in otolaryngology. Currently there is a paucity of data on the impact of TNFE on physiologic parameters. This is relevant with the advent of office-based endoscopic procedures. The goal of this study is to measure the impact of topical decongestion, anesthesia, and diagnostic TNFE on vital signs: systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and oxygenation (O(2) sat). ⋯ Diagnostic TNFE and topical lidocaine can have an impact on physiologic parameters; however, these changes are unlikely to be clinically significant.
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Public reporting and transparency of patient experience is an emerging national healthcare priority. The objectives of this report are to describe patient satisfaction scores in ambulatory otolaryngology and examine the association of teaching status across multiple service domains. ⋯ Otolaryngology patients evaluated in the teaching setting report lower patient satisfaction overall, primarily related to access to care and visit-specific processes; however, they are more likely to display loyalty and recommend their practice and care provider. The teaching setting does not influence care provider satisfaction scores. Because practice loyalty is most closely correlated to provider-specific behaviors, otolaryngologists may consider enhancement of provider-patient communication to improve patient satisfaction regardless of the practice setting. Academic otolaryngology practices should consider focusing on access systems and process improvement to enhance the overall patient experience.
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Review Meta Analysis
Dexamethasone and postoperative bleeding after tonsillectomy and adenotonsillectomy in children: A meta-analysis of prospective studies.
Tonsillectomy and adenotonsillectomy are common pediatric surgical procedures. Although perioperative administration of dexamethasone is common, recent data indicate a possible association between dexamethasone and increased risk of postoperative hemorrhage. ⋯ There was no overall association between dexamethasone administration and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy. However, this study cannot exclude the possibility of an association between specific dexamethasone doses and increased odds of bleeding. The results underscore the need for more dedicated prospective studies of this very common intervention.
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The purpose of this study was to share our clinical experience in the use and accuracy of a newly designed, low-profile titanium mesh (Modus OPS 1.5; Medartis, Basel, Switzerland) for primary internal orbital reconstruction. ⋯ The newly designed, thin titanium mesh is a reliable and safe implant for the repair of orbital defects. Owing to insufficient intraoperative control, two plates showed buckling at the posterior border, which made a repair necessary. Awareness of this problem may avoid such complications in the future. However, it would seem reasonable to improve the stability of the mesh by increasing the profile height, to minimize potential complications.