Simulation study: the development of a respiratory barrier enclosure with negative pressure and the analysis of its protective effect during intubation

Objective@#Within the last 2 years, coronavirus disease 2019 has spread rapidly across several continents, with 100 million confirmed infected patients. Physical barrier enclosure, also called “aerosol-box,” is a solution for the shortage of protective devices and spaces. In this study, we examined the safety of the novel barrier enclosure. @*Methods@#We simulated droplets by nebulizing 1% glycerol+99% ethanol solution. Two experienced physicians performed intubation under two conditions, such as the isolator condition (applying isolator without negative condition) and the negative pressure condition (applying isolator with the negative condition). We compared two conditions with two control groups, including negative control (room air) and positive control (synthetizing droplet air). During the procedure, particles were counted for 30 seconds, and this was repeated 10 times. At each condition, depending on the result of the normality test (Shapiro-Wilk test), an independent t-test was used when normality was satisfied, and a Mann-Whitney U-test was used when normality was not satisfied. @*Results@#The total number of particles in the positive control was 308,788 (175,936-461,124). The total number of particles for both conditions was significantly less than the positive control. Total number of particles in the isolator condition was 30,952 (27,592-33,244, P=0.001) and that in the negative pressure condition was 27,890 (27,165-29,786, P=0.001). @*Conclusion@#The novel barrier significantly reduces synthetizing droplets exposure during intubation. Application of negative pressure through the isolator results in an additional decrease in particle exposure. Studies involving a larger population of operators and prolonged procedures are required.

Effect of Intradiscal Monopolar Pulsed Radiofrequency on Chronic Discogenic Back Pain Diagnosed by Pressure-Controlled Provocative Discography: A One Year Prospective Study

OBJECTIVE: To investigate the efficacy and safety of percutaneous intradiscal monopolar pulsed radiofrequency (PRF) in patients with chronic disabling discogenic back pain. METHOD: Twenty-six subjects (7 males; mean age 43.2 years) with chronic back pain refractory to active rehabilitative management were recruited. All subjects underwent MRI for evaluation of Modic changes, and monopolar PRF (20 min at 60 V) at the center of target lumbar intervertebral disc confirmed by pressure-controlled provocative discography. Clinical outcomes were measured by the visual analogue scale (VAS), Oswestry disability index (ODI), and sitting tolerance time (ST) for 12 months after treatment. Successful clinical outcome was described as a minimum of 2 point reduction in VAS compared with the baseline at each follow-up period. RESULTS: The mean VAS for low back pain reduced significantly from 6.4+/-1.1 at pre-treatment to 4.4+/-1.9 at 12 months (p<0.05). The mean ODI score was 47.3+/-15.4 points at pre-treatment and 36.7+/-19.5 at 12 months (p<0.001). The ST was 27.8+/-20.4 minutes at pre-treatment and 71.5+/-42.2 at 12 months (p<0.001). However, successful clinical outcome was achieved at 58%, 50%, and 42%, measured at 3, 6, and 12 months post-treatment. There were no significant relationship between the clinical outcome and Modic changes; no adverse events were recorded. CONCLUSION: The results demonstrated that the application of intradiscal monopolar PRF might be relatively effective but limited; successful intervention for chronic refractory discogenic back pain is needed. To achieve the optimal outcome through intradiscal PRF, we suggested further studies about stimulation duration, mode, and intensity of PRF.

Effect of speech therapy on alveolar sound after lingual frenulotomy in tongue-tie patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many research papers showed that the most common articulation disorder in tongue-tie children was the error of alveolar sound. We performed speech therapy on alveolar sound after lingual frenulotomy to prove that the speech therapy after lingual frenulotomy improves the articulation of alveolar sound and that this effect is maintained. MATERIALS AND METHODS: We collected 28 children who never had speech therapy but could afford to have the speech therapy. The accuracy rate of consonant sound was calculated using a picture consonant test 2 weeks following the lingual frenulotomy. The speech therapy, called the phonetic placement and paired-stimulus technique, was performed 18 times for 3 months. This therapy decreased incidence rate of error. RESULTS: The incidence rate of alveolar sound error, which was calculated before speech therapy, was about 65%. And the incidence rate of alveolar sound error after speech therapy was 5-10%, which proved the effect of speech therapy. We divided alveolar sounds into target sounds and non-target sounds. And we performed speech therapy only on target sounds so the appearance rate of alveolar sound error decreased and the incidence rate of non-target sounds also decreased. We performed speech therapy after 2 weeks and the effect was maintained. CONCLUSION: The incidence rate of alveolar sound error decreased by using speech therapy and the effect was maintained. So the speech therapy must be performed after lingual frenulotomy.

A Case of CHARGE Syndrome / 대한이비인후과학회지

CHARGE syndroine, first described by Pagon, was named for its six dominant clinical features. They are coloboma of the eye, heart defects, atresia of the choanae, retarded growth and development including CNS anomalies, genital hypoplasia and/or urinary anomalies, and ear anormalies and/or hearing loss, We report a case of CHARGE syndrome with choanal atresia and ear anomalies in the otorhinolaryngologic field, with a review of the previously reported literature concerning CHARGE syndrome.