Current opinion in otolaryngology & head and neck surgery
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Curr Opin Otolaryngol Head Neck Surg · Jun 2015
ReviewEvidence-based treatment of voice and speech disorders in Parkinson disease.
Voice and speech impairments are present in nearly 90% of people with Parkinson disease and negatively impact communication and quality of life. This review addresses the efficacy of Lee Silverman Voice Treatment (LSVT) LOUD to improve vocal loudness (as measured by vocal sound pressure level vocSPL) and functional communication in people with Parkinson disease. The underlying physiologic mechanisms of Parkinson disease associated with voice and speech changes and the strength of the current treatment evidence are discussed with recommendations for best clinical practice. ⋯ Data support the efficacy of LSVT LOUD to increase vocal loudness and functional communication in people with Parkinson disease. Timely intervention is essential for maximizing quality of life for people with Parkinson disease.
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Curr Opin Otolaryngol Head Neck Surg · Apr 2015
ReviewGastrostomy in head and neck cancer: current literature, controversies and research.
This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. ⋯ There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
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Curr Opin Otolaryngol Head Neck Surg · Feb 2015
ReviewPedicled flaps in endoscopic skull base reconstruction: review of current techniques.
To discuss the current applications and indications for the use of pedicled flaps in the reconstruction of endoscopic skull base defects. ⋯ Adoption of vascularized pedicled flaps over the last decade, particularly the recently popularized NSF, has greatly reduced complications associated with endoscopic skull base surgery. The need for vascularized flap reconstruction is governed primarily by defect size and location, and by the presence of a high-flow CSF leak. Additional vascularized flaps can be used in conjunction with the NSF, or as an alternative when the NSF is unfavorable or unavailable.
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Curr Opin Otolaryngol Head Neck Surg · Feb 2015
ReviewThe utility of lumbar drains in modern endoscopic skull base surgery.
Lumbar drains were once routinely used for cerebrospinal fluid (CSF) diversion in endoscopic skull base reconstruction. The vascularized pedicled nasoseptal flap has now become the reconstructive workhorse in the setting of high-flow leaks. High-flow CSF leaks occur when there is violation of a cistern or ventricle. As lumbar drains have the potential for significant complications and the rate of postoperative CSF leak has decreased with the use of vascularized flaps, lumbar drain use has been challenged. ⋯ Lumbar drains are not necessary in the settings of low-flow CSF leaks or even in all high-flow leaks. We consider the use of a lumbar drain in settings wherein a high-flow leak is encountered or anticipated and the patient has other risk factors that may make the risk of postoperative CSF leak higher or closure of the leak more difficult.
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Curr Opin Otolaryngol Head Neck Surg · Feb 2015
ReviewThe role of nasal treatments in snoring and obstructive sleep apnoea.
This review highlights recent advances and views on the role of the nose in snoring and obstructive sleep apnoea. ⋯ Snoring and obstructive sleep apnoea are upper airway disorders in which the role of the nose has been well researched. Studies support that nasal surgery improves quality of life in snoring, but it may not lead to resolution of snoring. Likewise, nasal treatments for obstructive sleep apnoea increase the quality of life and treatment compliance in some patients. Further stratification of patients who may benefit from nasal intervention may clarify the role of nasal surgery.