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1.
Otolaryngol Clin North Am ; 57(4): 589-597, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38575486

ABSTRACT

This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis.


Subject(s)
Amyotrophic Lateral Sclerosis , Deglutition Disorders , Humans , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Deglutition Disorders/diagnosis , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/therapy , Multiple Sclerosis/complications , Parkinson Disease/complications , Stroke/complications
2.
Am J Otolaryngol ; 44(2): 103789, 2023.
Article in English | MEDLINE | ID: mdl-36708683

ABSTRACT

OBJECTIVES/HYPOTHESIS: Attendance is essential to voice therapy's effectiveness in the treatment of voice and laryngeal disorders. With such high rates of drop-out and non-attendance, it is important to understand the factors that influence this behavior. This study sought to identify potential predictors of attendance to voice therapy at an interdisciplinary voice clinic. STUDY DESIGN: Single-institution retrospective cohort study. METHODS: In this retrospective cohort study, patients evaluated at an interdisciplinary voice clinic who received a referral for voice therapy were identified. Age, gender, voice-related diagnoses, Voice Handicap Index-10 scores, Reflux Symptom Index scores, and measures of patient perceptions (self-rated severity, importance of voice in one's life, and "feelings about voice therapy") were recorded to evaluate associations with attendance to at least one therapy session. Standard statistical analysis and logistic regressions were performed. RESULTS: Of 168 subjects included, 111 (66.1 %) attended at least one session of voice therapy. Patients diagnosed with primary hyperfunctional voice disorders had a significantly higher attendance rate than other groups. Attenders had higher self-ratings of severity and more positive "feelings about voice therapy" compared to non-attenders. Regression models found three significant predictors of therapy attendance: primary diagnosis of hyperfunctional voice disorder, self-rated severity, and "feelings about voice therapy." CONCLUSION: In this cohort, patients with more positive feelings about voice therapy, higher self-rated severity, and a diagnosis of primary hyperfunctional voice disorder were more likely to attend voice therapy.


Subject(s)
Dysphonia , Gastroesophageal Reflux , Voice Disorders , Humans , Dysphonia/diagnosis , Retrospective Studies , Voice Disorders/diagnosis , Voice Disorders/therapy , Patient Compliance , Voice Training
3.
Immunohorizons ; 6(1): 47-63, 2022 01 18.
Article in English | MEDLINE | ID: mdl-35042773

ABSTRACT

The Fc receptor for IgM, FcMR, is unusual in that it is preferentially expressed by cells of the adaptive immune system. It is, moreover, the only constitutively expressed Fc receptor on human T cells. Efforts to decipher the normal functions of FcMR have been complicated by species-specific expression patterns in lymphocytes from mice (B cells) versus humans (B, NK, and T cells). In human cells, FcMR cell-surface expression has been reported to be low at baseline ex vivo, with one suggested contribution being ligand-induced internalization by serum IgM. Indeed, preincubation overnight in IgM-free culture medium is recommended for studies of FcMR because surface display is increased under these conditions. We investigated FcMR display on human lymphocytes in PBMCs and found that, surprisingly, cell-surface FcMR was unaffected by IgM abundance and was instead downregulated in high-cell density cultures by a yet undefined mechanism. We further found that ex vivo processing of whole blood decreased surface FcMR, supporting the idea that FcMR expression is likely to be greater on circulating lymphocytes than previously appreciated. Collectively, these findings prompt new predictions of where and when FcMR might be available for functional interactions in vivo.


Subject(s)
B-Lymphocytes/cytology , Immunoglobulin M/immunology , Receptors, Fc/immunology , T-Lymphocytes/cytology , B-Lymphocytes/immunology , Cell Count , Humans , Leukocytes, Mononuclear/metabolism , Lymphopoiesis/immunology , Membrane Proteins/immunology , Receptors, Fc/biosynthesis , T-Lymphocytes/immunology
4.
Int J Pediatr Otorhinolaryngol ; 118: 42-46, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30578995

ABSTRACT

OBJECTIVE: To determine whether anesthesiologists need to rely on polysomnography (PSG) when predicting need for airway intervention during induction in patients with sleep-disordered breathing (SDB). METHODS: Prospective case-control observational study at a tertiary care pediatric hospital. Children between the ages of 2-17 undergoing tonsillectomy were divided into three groups: those presenting with OSA observed by history and/or physical examination alone (SDB; n = 33), those with OSA determined by preoperative PSG (OSA; n = 32), and a control group (n = 35) undergoing tonsillectomy for recurrent tonsillitis. An anesthesiologist ranked each case on the level of intervention required to maintain ventilation. RESULTS: Age, height and BMI were associated with greater induction difficulty (r's > .225, p's < .025). Compared to controls, induction difficulty was significantly greater for the SDB group (mean difference = -0.751, 95% confidence interval [CI] = -1.241, -0.261, p = .003), but not for the OSA group (p = .061). No significant difference in induction difficulty was observed between SDB and OSA groups. In a subgroup analysis of the OSA group, an apnea-hypopnea index (AHI) > 10 correlated with increased level of intervention during induction (r = .228, p = .022). Race was also associated with AHI >10 (odds ratio = 3.859, 95% CI = 1.485, 10.03, p = .006). CONCLUSION: Children with OSA undergoing tonsillectomy require more airway intervention during induction than children with recurrent tonsillitis. Age and BMI were correlated with greater induction difficulty, suggesting that PSG data should be considered in light of these clinical characteristics to ensure an optimal postoperative course for children undergoing tonsillectomy.


Subject(s)
Anesthesia, General , Sleep Apnea, Obstructive/complications , Tonsillectomy , Age Factors , Body Mass Index , Case-Control Studies , Child , Child, Preschool , Female , Humans , Male , Polysomnography , Postoperative Period , Prospective Studies , Severity of Illness Index , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/physiopathology , Sleep Apnea, Obstructive/physiopathology , Tonsillitis/surgery
5.
J Pediatric Infect Dis Soc ; 5(3): 259-68, 2016 Sep.
Article in English | MEDLINE | ID: mdl-26407249

ABSTRACT

INTRODUCTION: The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level in the United States. METHODS: Pediatric discharges for PPA and RPA were evaluated by using the Kids' Inpatient Database from 2003, 2006, 2009, and 2012. Cases were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes 478.22 and 478.24 for PPA and RPA, respectively. Nationally representative incidence data were calculated by using weighted case estimates and US census data. Demographic and cost analyses were conducted by using unweighted analyses. RESULTS: There were 2685 hospital discharges for PPA and 6233 hospital discharges for RPA during the 4 study years combined. The incidence of RPA increased from 2.98 per 100 000 population among children <20 years old in 2003 to 4.10 per 100 000 in 2012. The incidence of PPA peaked at 1.49 per 100 000 in 2006. Incidences were highest among children <5 years old and boys in all age groups for PPA and RPA. Winter-to-spring seasonality also was evident for both. PPA was managed surgically in 58.1% of the cases, and RPA was managed surgically in 46.7%. Surgery was performed most often on the day of admission or the following day, was more frequent at teaching hospitals, and was associated with higher hospital charges. The mean hospital length of stay was longer for children who had surgery versus those who did not (4.4 vs 3.1 days [for PPA] and 4.8 vs 3.2 days [for RPA], respectively; both P < .001). The median charges for RPA and PPA were similar. The proportions of children with RPA or PPA covered by Medicaid increased during the study period. CONCLUSION: PPA and RPA represent relatively common male-predominant childhood infections with similar epidemiologies. The incidence of hospital discharges with a diagnosis of RPA increased during the study period. Substantial proportions of children with PPA or RPA are now managed without surgery. Surgical drainage was associated with higher hospital charges and longer lengths of stay.


Subject(s)
Pharyngeal Diseases/epidemiology , Retropharyngeal Abscess/epidemiology , Adolescent , Child , Child, Preschool , Female , Hospital Charges , Hospitalization , Humans , Incidence , Infant , Length of Stay , Male , Retropharyngeal Abscess/therapy , Retrospective Studies , United States/epidemiology
6.
Am J Rhinol Allergy ; 27 Suppl 1: S16-9, 2013.
Article in English | MEDLINE | ID: mdl-23711033

ABSTRACT

Rhinosinusitis is common in the pediatric population; however, diagnostic and management techniques often differ when compared with adult rhinosinusitis. Multidisciplinary guidelines have outlined the diagnostic criteria for pediatric rhinosinusitis. Although acute rhinosinusitis is a more infectious phenomenon, chronic sinusitis involves a more multifactorial etiology. This article outlines some of the definitions of rhinosinusitis, diagnosis and management of pediatric sinusitis, and the complications of rhinosinusitis seen in the pediatric population.


Subject(s)
Bacterial Infections/diagnosis , Rhinitis/diagnosis , Sinusitis/diagnosis , Virus Diseases/diagnosis , Acute Disease , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/complications , Bacterial Infections/therapy , Child , Chronic Disease , Disease Progression , Humans , Interdisciplinary Communication , Population Groups , Practice Guidelines as Topic , Rhinitis/complications , Rhinitis/therapy , Sinusitis/complications , Sinusitis/therapy , Virus Diseases/complications , Virus Diseases/therapy
7.
Am J Rhinol Allergy ; 27(3): 16-19, 2013 May 01.
Article in English | MEDLINE | ID: mdl-29021031

ABSTRACT

Rhinosinusitis is common in the pediatric population; however, diagnostic and management techniques often differ when compared with adult rhinosinusitis. Multidisciplinary guidelines have outlined the diagnostic criteria for pediatric rhinosinusitis. Although acute rhinosinusitis is a more infectious phenomenon, chronic sinusitis involves a more multifactorial etiology. This article outlines some of the definitions of rhinosinusitis, diagnosis and management of pediatric sinusitis, and the complications of rhinosinusitis seen in the pediatric population.

11.
Ear Nose Throat J ; 88(8): 1067-73, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19688717

ABSTRACT

Since the Sept. 11, 2001, attack on the World Trade Center (WTC), the health status of survivors, rescue and cleanup workers, and residents of Lower Manhattan has been monitored. Exposure to dust and particulate matter resulted in numerous complaints of both upper and lower aerodigestive tract irritation. The symptoms, diagnoses, and management of affected persons have previously been described in the literature. However, evidence establishing causation is scarce, especially with regard to the purported long-term effects of such exposure. Many persons who were exposed to the Ground Zero site have otolaryngologic conditions that are common in persons who were not so exposed. Therefore, otolaryngologists involved in the care of such patients should be cautious about assigning a diagnosis of "WTC syndrome" without a comprehensive examination to look for other possible etiologies. A diagnosis of a treatable, potentially serious health problem should not be missed simply because a patient who was exposed to WTC irritants was presumed to have WTC syndrome. In this review, we discuss the reported otolaryngologic manifestations of exposure to the WTC site, and we describe the specific cases of 2 workers there who continue to have otolaryngologic complaints. Considerable research is needed to establish the existence and nature of any long-term sequelae of exposure to WTC fallout.


Subject(s)
Air Pollutants/adverse effects , Dust , Environmental Exposure , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/etiology , September 11 Terrorist Attacks , Adult , Humans , Male , Middle Aged , Occupational Exposure , Syndrome
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