Facial fillers: Relevant anatomy, injection techniques, and complications.

Objective: The aim of this review article is to discuss the currently available facial fillers, their differences and indications, relevant anatomy, injection techniques, and avoidance and management of complications. Data Sources: Clinical experience and scientific papers. Conclusions: Reversal of facial aging via filler injection has been around since the late 1800s with the initial use of detrimental products. Today, many safe and effective products exist and can be tailored to the individual patient's desired effect. With the evolution of both products and injection techniques, the rate of complications with facial filler use is low. Nonetheless, providers offering facial filler injections should have detailed knowledge of facial anatomy, including facial planes and soft tissue compartments. Multiple injection techniques exist. Different techniques should be used, depending on the anatomic target. Providers should also know how to avoid and manage complications.

An analysis of the inclusion of ear and hearing care in national health policies, strategies and plans.

Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms 'human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)', 'tuberculosis' and 'malaria' were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.

The evolution of facial reanimation techniques.

This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.

Hispanic Ethnicity as a Predictor of Voice Therapy Adherence.

BACKGROUND: Voice therapy is a well-studied, evidence-based treatment in the management of voice disorders, yet it is known that adherence rates are generally decreased due to a variety of identified factors. In light of this fact, a high rate of nonadherence to voice therapy has been anecdotally observed in the Hispanic community comprising a sizable portion of the patient population in South Florida. OBJECTIVE: We sought to analyze the rates of voice therapy attendance for patients who underwent treatment for benign vocal fold nodules at a single tertiary-care academic medical center. Based on our anecdotal observations, we hypothesized that Hispanic patients would have a significantly lower rate of voice therapy attendance compared to non-Hispanic patients. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective chart review was performed for Hispanic and non-Hispanic patients aged 18 years and older who were diagnosed in a single hospital-based otolaryngology department with benign vocal fold nodules between 2013 and 2018. Patients with other glottic pathology or those who were not recommended voice therapy as initial treatment were excluded. Demographic data, including ethnicity, home address, and preferred language by self-report (English vs. Spanish), were obtained and analyzed. Median income levels for patients were determined by postal codes. "Adherent" status was given to patients who attended at least one voice therapy session. Statistical comparisons of continuous quantitative variables were made using Student's t test, ordinal quantitative variables using Mann-Whitney U test, and categorical variables using Fischer's exact test. Statistical significance was determined as P < 0.05. RESULTS: One hundred eleven patients met inclusion criteria. The population was 85% female, with an average age of 41 years. Overall voice therapy adherence rate was 68%. Forty-eight percent of patients self-identified as Hispanic, and of this cohort, 42% spoke Spanish as a preferred language. Differences in annual income levels were noted between non-Hispanic and Hispanic patients ($61,799 vs. $51,697, P = 0.017), as well between English-preferring and Spanish-preferring patients ($60,276 vs. $43,504, P = 0.0014). Thirty of 53 (57%) of Hispanic patients were adherent to voice therapy, compared to 45 of 58 (78%) non-Hispanic patients (P = 0.025). No significant differences were found in age, Voice Handicap Index-10 score, or number of sessions attended between the therapy-adherent patients in the Hispanic and non-Hispanic groups. Further differences in adherence rates were noted when the Hispanic group was subclassified into English and Spanish language preferences. Fifteen of 31 (48%) English-preferring Hispanic patients attended voice therapy compared to 45 of 58 (78%) non-Hispanic patients (P = 0.0085), while Spanish-preferring Hispanic patients had a 68% therapy adherence rate (15 of 22, P = 0.4). English-preferring Hispanic patients had higher average Voice Handicap Index-10 (22.0 vs. 14.9, P = 0.018) and lower total attended sessions (2 vs. 3.6, P = 0.024) than their non-Hispanic counterparts. CONCLUSION: We believe this is the first study demonstrating a significantly lower rate of voice therapy adherence in Hispanic versus non-Hispanic patients. Decreased utilization of a proven treatment strategy for vocal fold nodules puts these patients at increased risk of treatment failure and decreased voice-related quality of life. Clinicians must be aware of ethnicity-based healthcare disparities and encourage proven treatment adherence to ensure highest quality of life.

Outcomes of Intubation-induced Vocal Fold Motion Impairment.

OBJECTIVE: Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-intubation. STUDY DESIGN: Retrospective chart review. METHODS: Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features. RESULTS: With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077). CONCLUSIONS: Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology.

Office-based corticosteroid injections as adjuvant therapy for subglottic stenosis.

OBJECTIVE: Subglottic stenosis (SGS) is a serious, potentially life-threatening disorder that is difficult to treat due to significant recurrence rates. While conventional treatment of SGS relies heavily on serial endoscopic dilation procedures, this study aims to characterize the efficacy of incorporating subglottic corticosteroid injections in increasing surgery-free intervals (SFIs) for a cohort of patients at a university-based medical system. STUDY DESIGN: Retrospective chart review. METHODS: All SGS patients who underwent endoscopic dilation and at least one adjuvant office-based serial intralesional steroid injection (SILSI) were reviewed. Patients were excluded if they had synchronous airway lesions or stenosis outside of the subglottis. Charts were reviewed for demographic and treatment-specific data. The SFI was calculated for patients both prior to the initiation of SILSI and after. Groups were compared via Mann-Whitney U test, with P < .05 as the threshold for significance. RESULTS: Thirteen patients met criteria, with mean age 50.1 ± 14.1 years and 7:6 female to male ratio. Eight of the thirteen (61.5%) had intubation-related stenosis, while 4/13 were idiopathic and 1/13 was due to Wegener's granulomatosis. Mean follow-up was 20.4 months. Patients underwent an average of 4.2 ± 2.2 postoperative injections, beginning 45.9 ± 19.0 days after surgery. The mean SFI prior to initiating SILSI was 288.6 ± 362.0 days; while after receiving SILSI, the mean interval was significantly longer (545.5 ± 152.7 days, P = .0041). CONCLUSIONS: We demonstrate that office-based corticosteroid injection for SGS was associated with a statistically significant improvement in the SFI and is a promising adjuvant approach. Future prospective studies should evaluate if the efficacy is reproducible on a large scale and if SILSI can and/or should be incorporated into the standard management paradigm for SGS treatment. LEVEL OF EVIDENCE: 4.

Presbyphonia and Minimal Glottic Insufficiency.

Presbyphonia is defined as aging of the voice, and its growing attention as a medical concern parallels the continuing increase of the geriatric population worldwide. It results from physiologic changes to several laryngeal structures, including the musculature, surrounding cartilage, and lamina propria of the vocal folds. Characterized by glottic insufficiency, dysphonia in the elderly typically presents as a deterioration of voice quality, altered pitch and fundamental frequency, vocal fatigue, and strain. Fortunately, there are multiple treatment options that have proven successful in improving quality of life and restoring vocal stability for these patients.

The incidence and recovery rate of idiopathic vocal fold paralysis: a population-based study.

PURPOSE: To determine the incidence and spontaneous recovery rate of idiopathic vocal fold paralysis (IVFP) and paresis (IVFp), and the impact of steroid treatment on rates of recovery. METHODS: This retrospective cohort study included all patients with IVFP or IVFp within a large integrated health-care system between January 1, 2008 and December 31, 2014. Patient demographics and clinical characteristics, including time to diagnosis, spontaneous recovery status, time to recovery, and treatment, were examined. RESULTS: A total of 264 patients were identified, 183 (69.3%) with IVFP and 81 (30.7%) with IVFp. Nearly all cases (96.6%) were unilateral and 89.8% of patients were over the age of 45. The combined (IVFP and IVFp) 7-year mean incidence was 1.04 cases per 100,000 persons each year with the highest 7-year mean annual incidence in white patients (1.60 per 100,000). The total rate of spontaneous recovery was 29.5%, where 21.2% had endoscopic evidence of resolution and 8.3% had clinical improvement in their voice without endoscopic confirmation. The median time to symptom resolution was 4.0 months. Use of steroids was not linked with spontaneous recovery in multivariable analyses. CONCLUSION: The annual incidence of VFP (IVFP and IVFp) was 1.04 cases per 100,000 persons, with spontaneous recovery occurring in nearly a third of patients, regardless of steroid use.

Genetic basis of hearing loss in Spanish, Hispanic and Latino populations.

Hearing loss (HL) is the most common neurosensory disorder affecting humans. The screening, prevention and treatment of HL require a better understanding of the underlying molecular mechanisms. Genetic predisposition is one of the most common factors that leads to HL. Most HL studies include few Spanish, Hispanic and Latino participants, leaving a critical gap in our understanding about the prevalence, impact, unmet health care needs, and genetic factors associated with hearing impairment among Spanish, Hispanic and Latino populations. The few studies which have been performed show that the gene variants commonly associated with HL in non-Spanish and non-Hispanic populations are infrequently responsible for hearing impairment in Spanish as well as Hispanic and Latino populations (hereafter referred to as Hispanic). To design effective screening tools to detect HL in Spanish and Hispanic populations, studies must be conducted to determine the gene variants that are most commonly associated with hearing impairment in this racial/ethnic group. In this review article, we summarize gene variants and loci associated with HL in Spanish and Hispanic populations. Identifying new genetic variants associated with HL in Spanish and Hispanic populations will pave the way to develop effective screening tools and therapeutic strategies for HL.

Recent advancements in nanoparticle based drug delivery for gastrointestinal disorders.

INTRODUCTION: The emergent field of nanoparticles has presented a wealth of opportunities for improving the treatment of human diseases. Recent advances have allowed for promising developments in drug delivery, diagnostics, and therapeutics. Modified delivery systems allow improved drug delivery over traditional pH, microbe, or receptor dependent models, while antibody association allows for more advanced imaging modalities. Nanoparticles have potential clinical application in the field of gastroenterology as they offer several advantages compared to the conventional treatment systems including target drug delivery, enhanced treatment efficacy, and reduced side effects. AREAS COVERED: The aim of this review article is to summarize the recent advancements in developing nanoparticle technologies to treat gastrointestinal diseases. We have covered the application of nanoparticles in various gastrointestinal disorders including inflammatory bowel disease and colorectal cancer. We also have discussed how the gut microbiota affects the nanoparticle based drug delivery in the gastrointestinal tract. EXPERT OPINION: Nanoparticles based drug delivery offers a great platform for targeted drug delivery for gastrointestinal disorders. However, it is influenced by the presence of microbiota, drug interaction with nanoparticles, and cytotoxicity of nanoparticles. With the advancements in nanoparticle technology, it may be possible to overcome these barriers leading to efficient drug delivery for gastrointestinal disorders based on nanoparticle platform.

Local drug delivery in the urinary tract: current challenges and opportunities.

Drug delivery is an important consideration in disease treatment. There are many opportunities for novel methods and technologies to hold promising roles in overcoming traditional obstacles. Delivery systems functionalised to boast synergistic antimicrobial effects, specific targeting, and enhanced bioavailability allow for improved therapeutic potential and better patient outcomes. Many of these delivery modalities find clinical practicality in the field of urology, specifically in the treatment of urinary tract infections (UTIs) and offer advantages over conventional methods. The aim of this review article is to discuss the current modalities of treatment for UTIs and the recent technological advancements for optimising drug delivery. We focus on challenges that persist in drug delivery during UTIs including barriers to antimicrobial penetration, drug resistance, biofilm formation and specific targeting limitations. With a discussion on how emerging methods combat these concerns, we present an overview of potential therapies with special emphasis on nanoparticle-based applications.