In-office Laryngeal Procedures: a Modern Perspective for Vocal Fold Interventions

Introduction: The purpose of this article is to discuss in-office laryngeal procedures as an alternative to surgical intervention under general anesthesia. In-office procedures have become more common due to technological advancements. As a result, these approaches are less invasive and more patient-friendly, with increased pain tolerance and reduced procedure time and cost. Methods: We conducted a thematic analysis of published reports regarding the best known and performed in-office laryngeal interventions. Three questions guided our analysis: What laryngological procedures can be performed in the office setting? What are the advantages of in-office laryngology procedures compared to operating room surgical procedures? Why aren't more in-office procedures performed in some Latin American countries? Discussion: Despite being performed more frequently, there is still controversy whether in-office procedures should be performed as often due to the risk of complications. Furthermore, procedures that are done in the office setting are more popular in some countries than in others, even though their benefit has been well demonstrated. This article describes various in-office procedures, including biopsy, vocal fold injections, and laser surgery. We also discuss what factors might contribute to having office-procedures being performed more frequently in some countries than others. Conclusion: Awake interventions offer numerous benefits, including shorter procedure time, reduced costs, and lower patient morbidity. These advantages have significantly transformed the treatment of laryngeal diseases in modern laryngology practice in a global manner.

Introducción: El propósito de este artículo es discutir los procedimientos laríngeos en el consultorio como una alternativa a la intervención quirúrgica bajo anestesia general. Los procedimientos en consultorio se han vuelto más comunes debido a los avances tecnológicos. Como resultado, estos enfoques son menos invasivos y más amigables para el paciente, con mayor tolerancia al dolor y reducción del tiempo y costo del procedimiento. Métodos: Realizamos un análisis temático de los informes publicados sobre las intervenciones laríngeas más conocidas y realizadas. Tres preguntas guiaron nuestro análisis: ¿Qué procedimientos laringológicos se pueden realizar en el consultorio y cuales sin los más frecuentes?, ¿cuáles son las ventajas de los procedimientos laringológicos fuera del quirófano frente a los que se realizan bajo anestesia general?, ¿por qué no se realizan más procedimientos laringológicos en el consultorio en la mayoría de los países en Latinoamérica? Discusión: A pesar de que se realizan con mayor frecuencia, aún existe controversia sobre si los procedimientos en consultorio deben realizarse con tanta frecuencia debido al riesgo de complicaciones. Además, los procedimientos que se realizan en el consultorio son más populares en algunos países que en otros, aunque sus beneficios han sido bien demostrados. Este artículo describe varios procedimientos en el consultorio, incluida la biopsia, las inyecciones de cuerdas vocales y la cirugía con láser. También se discutieron los factores que podrían contribuir a que los procedimientos en el consultorio se realicen con más frecuencia en algunos países que en otros. Conclusión: Las intervenciones con pacientes despiertos ofrecen numerosos beneficios, incluido un tiempo de procedimiento más corto, costos reducidos y una menor morbilidad para el paciente. Estas ventajas han transformado significativamente el tratamiento de las enfermedades laríngeas en la práctica de la laringología moderna a nivel mundial.

Laringoscopia directa vs videolaringoscopia en la intubación del paciente con COVID-19 / Direct laryngoscopy versus videolaryngoscopy in COVID-19 patient intubation

Introducción: Muchos enfermos de COVID-19 requieren ser ventilados. La laringoscopia directa (LD) es el método tradicional empleado en el manejo de la vía aérea; sin embargo, la videolaringoscopia (VL) es una alternativa en estos pacientes. Objetivo: Comparar la laringoscopia directa y la videolaringoscopia en el manejo de la vía aérea en pacientes con COVID-19. Métodos: Se realizó un estudio observacional retrospectivo. El universo y la muestra estuvieron conformado por los pacientes intubados por médicos de la brigada Henry Reeve en hospitales de Cancún y Ciudad de México. Se conformaron dos grupos; el Grupo laringoscopia directa con 91 pacientes y el Grupo videolaringoscopia con 103. Las variables estudiadas fueron: edad, sexo, número de predictores de una vía respiratoria anatómicamente difícil (VRAD), visualización de la apertura glótica, intentos de intubación y las complicaciones de la intubación. El análisis estadístico de los datos se realizó con el paquete estadístico SPSS 23.0. Resultados: Los grupos fueron comparables en cuanto a edad, sexo y predictores de vía respiratoria anatómicamente difícil. La visualización glótica completa o parcial en el grupo videolaringoscopia fue de 97 por ciento, mientras que en el grupo laringoscopia directa fue de 86 por ciento. La intubación endotraqueal al primer intento superó el 70 por ciento en el grupo VL y el 50 por ciento en el grupo LD. Las principales complicaciones encontradas fueron la desaturación y la hipotensión arterial con una mayor frecuencia en el grupo LD (40,7 por ciento y 49,5 por ciento). Conclusiones: La videolaringoscopia mejoró la visualización glótica y la intubación endotraqueal al primer intento, con menos complicaciones en los pacientes estudiados(AU)

Introduction: Many COVID-19 patients require ventilation. Direct laryngoscopy is the traditional method used for airway management; however, videolaryngoscopy is an alternative in these patients. Objective: To compare direct laryngoscopy and videolaryngoscopy for airway management in COVID-19 patients. Methods: A retrospective observational study was carried out. The universe and the sample consisted of patients intubated by physicians from Henry Reeve brigade at hospitals in Cancun and Mexico City. Two groups were formed: the direct laryngoscopy group, with 91 patients, and the videolaryngoscopy group, with 103 patients. The variables studied were age, sex, number of predictors of an anatomically difficult airway, visualization of the glottic opening, intubation attempts, and intubation complications. Statistical analysis of the data was performed using the SPSS 23.0 statistical package. Results: The groups were comparable in terms of age, sex and predictors of an anatomically difficult airway. Complete or partial glottic visualization in the videolaryngoscopy group was 97 percent , while in the direct laryngoscopy group it was 86 percent . Endotracheal intubation at the first attempt exceeded 70 percent in the videolaryngoscopy group and 50 percent in the direct laryngoscopy group. The main complications observed were desaturation and arterial hypotension with a higher frequency in the direct laryngoscopy group (40.7 percent and 49.5 percent , respectively). Conclusions: Video laryngoscopy improved glottic visualization and endotracheal intubation at the first attempt, with fewer complications in the patients studied(AU)

Clinicopathological Evaluation of the Patients with Hoarseness of Voice.

Hoarseness is one of the commonest symptoms which brings the patient to physician. Any change in quality of voice must be evaluated thoroughly and promptly as it may underlie some infective or neoplastic lesion which can be managed better if diagnosed at an early stage.METHODSThe study was conducted in Pt. J.N.M. Medical College, Raipur, for period of 1.5 years in which 81 patients with hoarseness were selected. After complete general and ENT examination, required investigations were done. Data was collected, tabulated and compared. Out of the total of 81 patients, 58 were males and 23 were females. Carcinoma laryngo-pharynx was found to be the most common cause of hoarseness. Most of the cases were from middle age group i.e. 50 to 60 years. Associated tobacco addiction in any form was very common in all the patients.RESULTSHoarseness of voice can be an alarming symptom in adult patients, particularly when it is present in males with chronic history of addiction. One should be very cautious during investigations as it leads to malignancy most of the time. Early diagnosis and treatment give good prognosis and better outcome to the patient.CONCLUSIONSHoarseness of voice is just a symptom with a very diverse aetiology. Proper diagnosis through detailed history and prompt examination leads to early diagnosis and management as well.

Severe thermal injury of larynx in a child following accidental ingestion of hot tea

Thermal injury to the upper respiratory tract caused by aspiration of hot liquids resulting in laryngeal edema and subsequent obstruction of the airway is commonly not seen in the pediatric population. Unlike adults, children are more prone for subglottic injury, swelling and resulting obstruction of the airway due to the smaller size of the trachea and relatively large epiglottis. Examination of the airway with laryngoscopy hence should be recommended in all patients with inhalational and aspiration burn injury as it will help in guiding airway management and preventing development of complications. Authors report a case of a 3-year-old male child with accidental ingestion of just made hot tea. Upon presentation there was severe stridor and signs of respiratory distress requiring emergency intubation. Direct laryngoscopy revealed glottic edema and ulcer. Upper GI endoscopy showed erythematous arytenoids, esophagus and stomach showing few erythematous flat lesions. Chest radiographic examination showed bilateral para cardiac and perihilar inhomogeneous opacities suggestive of aspiration pneumonitis. The child was gradually weaned and extubated on day three of admission. Ingestion of hot liquids can cause airway and esophageal thermal burns. Rapid diagnosis and treatment are essential in management of inhalational and aspiration burn injury to reduce the morbidity, mortality and long-term sequelae in these patients. Children are more prone for burn accidents due to their curious and exploratory behavior and their inability to perceive the hazards. Since most of the pediatric burn accidents happen at home, parents should be offered education about prevention of burn and advised on how to manage and treat minor burn injuries and to watch for any warning signs in which case to rush to the nearest hospital.

Comparison of King Vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial / Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado

Abstract Background and objectives We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. Methods A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. Results and conclusions First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p > 0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4 s, p < 0.001), and time to intubation (95% CI 3-4.6 s, p < 0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4 s, p < 0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p < 0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Resumo Justificativa e objetivos Comparamos a eficiência do videolaringoscópio King Vision e do laringoscópio Macintosh, quando usados por anestesiologistas experientes em pacientes adultos com diferentes condições de intubação, em um estudo clínico prospectivo randomizado e controlado. Métodos Foram selecionados 388 pacientes com estado físico ASA I ou II (de acordo com a classificação da American Society of Anesthesiologists - ASA), programados para anestesia geral com intubação traqueal. Cada paciente foi intubado com ambos os laringoscópios sucessivamente, em uma ordem aleatória. A taxa de sucesso da intubação, o tempo até a melhor visibilização da glote, o tempo de intubação, o tempo de ventilação, a classificação de Cormack-Lehane (graus) e as complicações relacionadas à laringoscopia e intubação foram analisados. Resultados e conclusões As taxas de sucesso na intubação na primeira tentativa foram similares para o King Vision e o Macintosh (96,6% vs. 94,3%, respectivamente, p > 0,05). As médias dos tempos até a melhor visibilização da glote (IC 95% 0,5-1,4 s, p < 0,001) e de intubação (IC 95% 3-4,6 s, p < 0,001) foram maiores no King Vision. A diferença no tempo de intubação foi semelhante quando as tentativas malsucedidas de intubação foram excluídas (IC 95% 2,8-4,4 s, p < 0,001). Com base na classificação de Mallampati modificada na consulta pré-operatória, o King Vision melhorou significativamente a visibilização da glote em mais pacientes (220 pacientes, 56,7%) em comparação com o Macintosh (180 pacientes, 46,4%) (p < 0,001). Nenhum dos pacientes apresentou dessaturação periférica de oxigênio abaixo de 94%. Os anestesiologistas experientes podem obter taxas semelhantes de sucesso na primeira tentativa de intubação e de traumas das vias aéreas com ambos os laringoscópios. O King Vision requer tempos mais longos até a visibilização da glote e de intubação traqueal, mas não causa dessaturação adicional.

Double ectopic thyroid gland in a 10-year-old Filipino boy

Objective@#To present a case of a double ectopic thyroid gland in a 10-year old boy and discuss the pros and cons of the different management options that were available. @*Methods@# Design: Case Report. Setting: Tertiary Hospital in Metro Manila. Subject: One (1). @*Results@#A 10-year-old boy presented with hoarseness and easy fatigability for 6 years. Rigid endoscopy and CT scan showed an infraglottic mass originating from the anterior tracheal wall causing obstruction. Biopsy revealed thyroid tissue with atypia. Thyroid scintigraphy showed uptake in the submental and midline anterior neck. Thyroid hormone levels were consistent with hypothyroidism. Levothyroxine returned hormone levels to normal and resulted in complete regression of the mass with no symptoms of dyspnea, stridor or bleeding.@*Conclusion@#The management of ectopic thyroid presents a challenge as there are no guidelines for optimal treatment. Thyroid hormone insufficiency is a frequent occurrence, and emphasis must be given to its monitoring. Surgery in a critical airway lesion such as this may be reserved for cases where the patient experiences dyspnea and stridor or lack of response to thyroid hormone treatment.

Video versus direct laryngoscopy on successful first-pass endotracheal intubation in ICU patients / 世界急诊医学杂志（英文）

BACKGROUND: Airway management in intensive care unit (ICU) patients is chalenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy (DL) and that by using the video laryngoscopy (VL). METHODS: A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success. RESULTS: A total of 163 ICU patients underwent intubation during the study period (81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group (67.9％ vs. 69.5％,P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications (all P>0.05). CONCLUSION: Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

Comparison of effect of video tracheal intubation and direct laryngoscopy on tracheal intubation in patients with missing teeth / 中国基层医药

Objective To compare the effect of the application of tracheal intubation with SEESHEEN video intubation endoscope (ENF-20) and direct laryngoscopy in patients with missing teeth.Methods 50 patients with missing teeth were selected,and they were randomly divided into two groups, respectively after induction of general anesthesia in tracheal intubation using ENF-20 (group E) and direct laryngoscopy (SHUCMAN laryngoscopy) (group S) intubation.The time of intubation, the times of intubation and the complication of intubation were recorded.Results The success rate of intubation in group E was 92%, which was significantly higher than 64% in group S (x2=5.711,P=0.017).The intubation time of group E was (27±12)s, which was significantly shorter than (36±13)s in group S (t=-2.620,P=0.012).The total intubation complications of group E was 12%, which was significantly lower than 48% of the group S (x2=6.095,P=0.014).Conclusion The successful rate of tracheal intubation in patients with missing teeth by using video tracheal intubation (ENF-20) is higher and with less complication.

Comparison of video laryngoscope, direct laryngoscopy and fibreoptic bronchoscope nasal intubation on hemodynamics, inflammatory and stress response / 中国内镜杂志

Objective To analyze the differences of video laryngoscope, direct laryngoscopy and fibreoptic bron﹣choscope nasal intubation on hemodynamics, inflammatory and stress response. Methods 117 patients underwent surgery from November 2013 to March 2015 were chose as research subjects and randomly divided into video laryn﹣goscope group, direct laryngoscopy group, fiberoptic bronchoscope group based on different cannula enrolled way. Then compared the hemodynamics, inflammation, stress level after intubation among the three groups. Results Com﹣pared with the T0, the three groups patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), C-reactive protein (CRP), interleukin -6 (IL-6), tumor necrosis factor (TNF-α), norepinephrine (NE), plasma cortisol (Cor), angiotensinⅡ(ATⅡ) differences had no significant difference (P>0.05);compared with direct laryn﹣goscopy group, video laryngoscope group, fiberoptic bronchoscope group patients' T1, T2, T3 SBP, DBP, HR, CRP, TNF-α, IL-6, NE, Cor, ATⅡ levels were lower; compared with the video laryngoscope group, optical fiber bron﹣choscopy group patients SBP, DBP, HR, CRP, TNF-α, IL-6, NE, Cor, ATⅡ low levels at T1, T2, T3 were lower (P<0.05). Conclusions Fibreoptic bronchoscope nasal intubation has less influence on patients, will not cause severe stress and inflammatory response, it is one of the ideal instrument anesthesia induction intubation.

Efficacy of intubation performed by trainees on patients in the lateral position

<p><b>INTRODUCTION</b>Anaesthetists may be called upon to emergently secure the airway of a laterally positioned patient. Intubating a patient's trachea in the lateral position may be difficult due to unfamiliarity. This exploratory study aimed to investigate the success rate of lateral intubation performed by novices in a controlled setting.</p><p><b>METHODS</b>In this observational study, all patients who presented for elective surgery requiring the lateral position with planned lateral intubation at Singapore General Hospital were included. The trainee assigned to each patient had no prior indication of the proposed lateral intubation until the start of the case. Verbal instructions were given before the start of and during the procedure. The consultant anaesthetist in attendance could intervene at any point to prevent patient harm or if the trainee requested assistance. Time to intubation, adjuncts used and complications encountered were recorded.</p><p><b>RESULTS</b>A total of 44 consecutive patients were included in this study. The trainees completed 42 of the 44 lateral intubations, with 41 being successfully performed on the first attempt. All patients were intubated successfully in a lateral position within two attempts. The mean duration of intubation was 57.3 ± 36.4 seconds. There was no difference between left and right lateral intubation. Other than one episode of transient desaturation on pulse oximetry, there were no complications.</p><p><b>CONCLUSION</b>Lateral intubation by trainees had a high success rate when supervised by an experienced operator. Intubation of patients in unconventional positions using routine airway equipment should be included in airway training for trainees.</p>

Correspondencia entre test predictivos de vía aérea difícil y la laringoscopia directa / Correspondence between predictive test of difficult airway and directlaryngoscopy

Fundamento: Una de las responsabilidades del anestesiólogo es establecer y mantener la vía aérea (V.A.) permeable en cualquier situación clínica que conlleve un compromiso de la misma (anestesia, urgencias, reanimación, etc). El fundamento básico para conseguirlo es la valoración sistemática de la VA y el reconocimiento de las posibles dificultades. Objetivo: Establecer la correspondencia entre los test predictivos de vía aérea difícil y la laringoscopia rígida directa. Método: Se realizó un estudio analítico transversal en pacientes que fueron sometidos a algún tipo de cirugía que requirió anestesia general endotraqueal, en el período comprendido de Enero del 2007, a Septiembre del 2007, en el Hospital Provincial Clínico-Quirúrgico Docente Manuel Ascunce Doménech. De un universo de trescientos noventa y ocho pacientes, la muestra quedó constituida por ciento ochenta que fueron intervenidos de manera electiva y urgente, con administración de dicha anestesia. Resultados: La mayoría no presentó entidad clínica asociada a la vía aérea, y en los que existió se encontraron con mayor frecuencia la obesidad y la Diabetes Mellitus. Conclusiones: El test predictivo de mayor sensibilidad fue la apertura bucal. Los test predictivos de más especificidad fueron la extensión Atlanto-occipital, la apertura bucal y Mallampati. El mejor predictor de una laringoscopia difícil se correspondió con la apertura bucal. Los mejores predictores para la identificación de una laringoscopia fácil, fueron la apertura bucal, Mallampati, distancia tiromentoniana y extensión Atlanto-occipital.

Background: One of the anesthesiologist's responsibilities is to establish and to keep permeable the airway in any clinical situation that involves a commitment (anesthesia, urgencies, resuscitation, etc). The basic principle to attain it is the systematic valuation of the airway and the recognition of the possible difficulties. Objective: To establish the correspondence among the predictive test of difficult airway and the direct rigid laryngoscopy. Method: An analytic cross-sectional study was carried out in patients that were subjected to a kind of surgery that required endotracheal general anesthesia, from January 2007 to September 2007, at the Clinical-Surgical Educational Provincial Hospital Manuel Ascunce Domenech. Of an universe of three hundred ninety eight patients, the sample was constituted by one-hundred eighty that were intervened in an elective and urgent way, with administration of this anesthesia. Results: Most didn't present clinical entity associated to the airway, and in those that it existed, obesity and Diabetes Mellitus with more frequency were found. Conclusions: The predictive test of more sensibility was the oral opening. The ones of more specificity was the atlanto-occipital extension, the oral opening and Mallampati. The best predictor in a difficult laryngoscopy belonged to the oral opening. The best predictors for the identification of an easy laryngoscopy, were the oral opening, Mallampati, thyromental distance and atlanto-occipital extension.

Clinical Observation of the Application of Nicardipine in Direct Laryngoscopy / 中国药房

OBJECTIVE:To assess the preventing effect of nicardipine on stress reaction induced by direct laryngoscopy.ME_THODS:30 patients undergoing elective direct laryngoscopy were randomly divided into two groups:the routine group(group C)and nicardipine group(group N),15 patients for each group.In group C,anesthesia was performed with routine anesthetics,in group N,addition to routine anesthetics,nicardipine was administered by a bolus of 10?g/kg,there after 1～2?g/(kg?min)continuously intravenous administration.Blood pressure(BP),heart rate (HR) and blood sugar(Glu)were recorded perioperatively.RESULTS:The BP and HR increased in both groups from intubation to extubation,but when compared to the base value,the increase in group C had statistical significance (P0.05);There were significant differences between two groups at the same time points(P