Prospective Pilot Study: Tolerability of Outpatient Penile Plication Under Nursing-Administered Conscious Sedation vs Anesthesiologist-Administered Deep Sedation.

INTRODUCTION: Penile plication is commonly performed for Peyronie's disease under general or spinal anesthesia. Conscious sedation (CS) offers decreased anesthetic risks, cost-effectiveness, and the ability to perform the procedure in outpatient settings with shorter wait times. We sought to compare tolerability of penile plication under deep intravenous sedation (DIS) administered by anesthesiologists and nursing-administered CS (NACS). METHODS: Tolerability for penile plication was prospectively evaluated, excluding revision surgeries and those with hourglass or hinge deformities. DIS included midazolam and ketamine with infusion of propofol and remifentanil. NACS consisted of midazolam and fentanyl. Baseline characteristics, procedural information, and patient- and surgeon-reported pain assessments were collected. Patients were administered a standardized tolerability questionnaire on follow-up. RESULTS: Forty patients were enrolled (23 DIS; 17 NACS) with similar baseline characteristics. Median curvature of the DIS cohort was 55° (interquartile range = 43.75-76.25) and 45° (interquartile range = 45-60) in NACS. There was a 100% success rate with no procedure abortion or conversion to general anesthetic. On follow-up, all patients had functional curvature (<20°), and 100% of patients in the DIS and NACS cohorts reported that they would recommend CS to others. Over 93% of patients in both cohorts would choose CS over general anesthetic in the future, with no differences in perioperative and postoperative pain between groups. CONCLUSIONS: Penile plication with CS, whether administered by an anesthesiologist or nursing, is well tolerated with no differences in pain or complications. This indicates that outpatient penile plication with trained nursing staff administering CS can safely reduce costs, risks, and wait times.

The Impact of COVID-19 Restrictions on Hospital Admissions of Common Head and Neck Infections.

INTRODUCTION: Following the emergence of COVID-19, multiple preventative measures were implemented to limit the spread of the disease. This study aims to elucidate the impact of COVID-19 restrictions on hospital admissions of otolaryngology-related infections. MATERIALS AND METHODS: A retrospective chart review was conducted to capture all admissions for otolaryngology-related infections in the 2 years pre- and post-COVID-19 at the Health Sciences Centre in Winnipeg, Manitoba. These infections included croup, tracheitis, neck abscess, peritonsillar abscess, otitis media, mastoiditis, sinus infection, orbital infection, pharyngotonsillitis, retro/parapharyngeal abscess, and acute epiglottitis. Demographic information and admission details were collected and analyzed to compare pre- and post-COVID-19 admissions. Further analysis was conducted to compare hospital admissions of patients from rural/remote regions. RESULTS: Between March 2018 and March 2022, 253 pediatric patients and 197 adults were admitted for otolaryngology-related infections. Total pediatric admissions decreased post-COVID-19 (154 pre-COVID-19, 99 post-COVID-19; p < 0.001) whereas adult admissions remained stable (107 pre-COVID-19, 90 post-COVID-19; p = 0.25). No significant difference in mean patient age, admission duration, surgical rates or in the proportion of admissions from patients from rural/remote regions was observed in the pediatric or adult cohort when comparing pre-COVID-19 data to post-COVID-19 data. Diagnosis-specific changes in admissions were observed in pediatric croup (40 pre-COVID-19, 15 post-COVID-19; p < 0.001) and in adult orbital infections (30 pre-COVID-19, six post-COVID-19; p < 0.001). CONCLUSION: Following the implementation of COVID-19 restrictions, there was a decrease in admissions due to pediatric croup and adult orbital infections with an overall decrease in pediatric Otolaryngology-infection related admissions. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

Anesthetic options for Rezum water vapor therapy Is minimal sedation tolerable for a minimally invasive procedure?

INTRODUCTION: There has been a rapid expansion of the armamentarium for managing benign prostatic hyperplasia (BPH). Due to the invasiveness and complication risks of traditional surgical management, minimally invasive procedures have emerged. Rezum water vapor therapy is a safe, effective alternative. Given the minimally invasive nature, there is interest in administering conscious sedation over general anesthesia to decrease procedural times and costs and increase accessibility by completing procedures in an office-based setting. We sought to assess and describe patient-reported tolerability for Rezum completed under oral and deep intravenous sedation. METHODS: Patients who underwent Rezum between April and November of 2022 under conscious sedation with oral sedation and local anesthesia (OSLA) or deep intravenous sedation (DIS) were enrolled. Baseline information was collected, and followup interviews were conducted where patient tolerability scores, future anesthetic preferences, and complication data was prospectively obtained. RESULTS: Fourteen patients were enrolled in each group. The OSLA and DIS cohorts had a median tolerability score of 8 (interquartile range [IQR] 3.5) and 9 (IQR 1.75), respectively, indicating highly tolerable experiences. There was no significant difference between groups (p=0.13). On followup, 85.7% of patients in the OSLA and 100% in DIS groups expressed their future preference for conscious sedation over general anesthetic, with no significant difference between the two groups (p=0.46). CONCLUSIONS: Our study demonstrates OSLA and DIS are both viable conscious sedation methods for Rezum, with patients reporting high tolerability to the procedure regardless of sedation choice. Almost all patients receiving conscious sedation would choose to undergo Rezum using conscious sedation again and had minimal complications.

Mental Health Outcomes of Mothers of Children With Congenital Gastrointestinal Anomalies Are Similar to Control Mothers: A Longitudinal Retrospective Cohort Study.

PURPOSE: Mothers of infants born with congenital gastrointestinal surgical anomalies experience a unique caregiving role. Whether these challenges result in more mental health diagnoses than the general population is unknown. This study assessed mental health diagnoses in mothers of children born with congenital surgical anomalies (CSA) compared to mothers of children without CSA. METHODS: A total of 780 mothers of children with CSA (case-mothers) and 6994 control-mothers were included. Mental health diagnoses were obtained using International Classification of Diseases 9 codes from an administrative database. Multivariate hazard ratios (HR) of mental health diagnoses were determined for mothers following childbirth, controlling for socioeconomic status, mental health diagnoses prior to childbirth, and age at childbirth. Subgroup analyses were completed for anxiety, depression, and post-traumatic stress disorder (PTSD). The association between a woman's mental health history and becoming a case-mother was analyzed using risk ratios (RR). RESULTS: Case-mothers were not at increased risk of mental health disorders compared to controls (HR = 1.00; CI95 = 0.92-1.09). In aggregate analysis, no increased risk of anxiety, depression, or PTSD was found. Subgroup analyses revealed that congenital diaphragmatic hernia case-mothers had an increased risk of depression (HR = 1.43; CI95 = 1.08-1.88). No other case-mothers were at increased risk of mental health diagnoses, anxiety, depression, or PTSD. Only omphalocele was associated with mental health diagnoses before childbirth (RR = 1.89; CI95 = 1.58-2.26). CONCLUSIONS: Collectively, mothers of children with CSAs did not have a greater risk of a mental health disorder, anxiety, depression, or PTSD compared to control-mothers. Only mothers of children with congenital diaphragmatic hernia had an increased risk of depression. LEVEL OF EVIDENCE: II.

Prevalence of Mental Health Disorders in Individuals With Gastrointestinal Congenital Surgical Anomalies: A Systematic Review and Meta-analysis.

PURPOSE: Studies examining functional outcomes and health-related quality of life for patients with congenital surgical anomalies (CSA) are increasingly common. However, the prevalence of mental health disorders in this population has not been determined. The purpose of this review is to summarize the reported prevalence of mental health disorders in children born with gastrointestinal CSA. METHODS: A systematic review of the literature was conducted on Medline (OVID), EMBASE (OVID), CINAHL (EbscoHost), and Scopus to identify studies reporting mental health diagnoses in children with a gastrointestinal CSA. A meta-analysis of the prevalence of anxiety disorders and depressive disorders was completed. RESULTS: Of 2546 manuscripts, seven met the inclusion criteria. All included manuscripts looked at patients with anorectal malformation (ARM) and/or Hirschsprung disease (HD). No studies assessed other gastrointestinal CSAs. A total of 183 psychiatric diagnoses were reported in 1167 patients. A pooled analysis of ARM patients revealed a 14.0% prevalence of anxiety disorders (N = 208; CI95 = 4.4-23.4%) and an 18.75% prevalence of depressive disorders (N = 48; CI95 = 7.7-29.8%). A pooled analysis of HD patients revealed a 15.8% prevalence of anxiety disorders (N = 19; CI95 = 0.6-32.2%) and a 4.75% prevalence of depressive disorders (N = 758; CI95 = 3.23-6.26%). CONCLUSIONS: There is a paucity of evidence on mental health outcomes of individuals born with gastrointestinal CSA. However, the available evidence suggested a high prevalence of mental health diagnoses in individuals born with ARM or HD with 1 in 7 having an anxiety disorder. Additionally, 1 in 5 ARM patients and 1 in 20 HD patients were diagnosed with a depressive disorder. TYPE OF STUDY: Systematic review and meta-analysis. LEVEL OF EVIDENCE: IV.

Validation of an integrated pressure level measured earmold wideband real-ear-to-coupler difference measurement.

OBJECTIVE: To validate measurement of predicted earmold wideband real-ear-to-coupler difference (wRECD) using an integrated pressure level (IPL) calibrated transducer and the incorporation of an acoustically measured tubing length correction. DESIGN: Unilateral earmold SPL wRECD using varied hearing aid tubing length and the proposed predicted earmold IPL wRECD measurement procedure were completed on all participants and compared. STUDY SAMPLE: 22 normal hearing adults with normal middle ear status were recruited. RESULTS: There were no clinically significant differences between probe-microphone and predicted earmold IPL wRECD measurements between 500 and 2500 Hz. Above 5000 Hz, the predicted earmold IPL wRECD exceeded earmold SPL wRECDs due to lack of standing wave interference. Test-retest reliability of IPL wRECD measurement exceeded the reliability of earmold SPL wRECD measurement across all assessed frequencies, with the greatest improvements in the high frequencies. The acoustically measured tubing length correction largely accounted for acoustic effects of the participant's earmold. CONCLUSIONS: IPL-based measurements provide a promising alternative to probe-microphone earmold wRECD procedures. Predicted earmold IPL wRECD is measured without probe-microphone placement, agrees well with earmold SPL wRECDs and is expected to extend the valid bandwidth of wRECD measurement.

Validity and reliability of integrated pressure level real-ear-to-coupler difference measurements.

OBJECTIVES: (1) To validate the measurement of foam-tip real-ear-to-coupler differences (wRECD) using an integrated pressure level (IPL) method and (2) to compare the reliability of this method to SPL-based measurement of the wRECD. DESIGN: SPL-based wRECD and the proposed IPL wRECD measurement were completed bilaterally. Test-retest reliability of IPL wRECD was determined with full re-insertion into the ear canal and compared to published SPL wRECD test-retest data. STUDY SAMPLE: 22 adults with normal hearing and middle ear status were recruited. RESULTS: Differences between SPL-based wRECD and IPL wRECD measurements were within 1.51 dB on average below 5000 Hz. At and above 5000 Hz, IPL wRECD exceeded SPL wRECDs by 6.11 dB on average. The average test-retest difference for IPL wRECD across all assessed frequencies was 0.75 dB with the greatest improvements in reliability found below 750 Hz and above 3000 Hz. CONCLUSIONS: IPL wRECD yielded improved estimates compared to SPL wRECD in high frequencies, where standing-wave interference is present. Independence from standing wave interference resulted in increased wRECD values above 4000 Hz using the IPL measurement paradigm. IPL wRECD is more reliable than SPL wRECD, does not require precise probe-microphone placement, and provides a wider valid wRECD bandwidth than SPL-based measurement.

A systematic review and meta-analysis of computed tomography in the diagnosis of pediatric foreign body aspiration.

INTRODUCTION: Rigid bronchoscopy remains the gold standard for the diagnosis of foreign body aspiration (FBA) despite high rates of negative bronchoscopies. The use of computed tomography (CT) imaging in the assessment of FBA has recently emerged and could help obviate unnecessary bronchoscopy in these patients. The aim of this study is to assess the diagnostic accuracy of CT in the diagnosis of pediatric FBA. METHODS: A systematic literature review was conducted to identify studies reporting the use of CT imaging in suspected pediatric FBA. The search included published articles in Ovid MEDLINE, Ovid EMBASE, PubMed MEDLINE and Web of Science. The search strategy included all articles from inception of the database to January 2021. Manuscripts were reviewed and graded for quality using the QUADAS-2 tool. Subgroup analyses based on the use of virtual bronchoscopy (VB) and sedation was conducted. A meta-analysis evaluating the use of VB in the diagnosis of FBA was also conducted. RESULTS: Sixteen manuscripts met all inclusion criteria. In total, 2056 pediatric patients ranging from 0.3 to 15 years underwent CT for suspected FBA. The sensitivity and specificity of CT were 98.8% and 96.6%, respectively. VB was used in 71.4% (1391/1948) of patients while sedation during CT was required in 70.2% (1263/1800) of patients. Radiation dosing ranged from 0.04 to 2 mSv, 0.99-59.1 mGy-cm and 0.03-16.99 mGy. CONCLUSION: CT can accurately diagnose pediatric FBA and can help decrease the rate of unnecessary bronchoscopies with an acceptable dose of radiation.

Performance of Statistical Indicators in the Objective Detection of Speech-Evoked Envelope Following Responses.

OBJECTIVES: To assess the sensitivity of statistical indicators used for the objective detection of speech-evoked envelope following responses (EFRs) in infants and adults. DESIGN: Twenty-three adults and 21 infants with normal hearing participated in this study. A modified/susa∫i/speech token was presented at 65 dB SPL monoaurally. Presentation level in infants was corrected using in-ear measurements. EFRs were recorded between high forehead and ipsilateral mastoid. Statistical post-processing was completed using F -test, Magnitude-Square Coherence, Rayleigh test, Rayleigh-Moore test, and Hotelling's T 2 test. Logistic regression models assessed the sensitivity of each statistical indicator in both infants and adults as a function of testing duration. RESULTS: The Rayleigh-Moore and Rayleigh tests were the most sensitive statistical indicators for speech-evoked EFR detection in infants. Comparatively, Magnitude-Square Coherence and Hotelling's T 2 also provide clinical benefit for infants in all conditions after ~30 minutes of testing, whereas the F -test failed to detect responses to EFRs elicited by vowels with accuracy greater than chance. In contrast, the F-test was the most sensitive for vowel-elicited response detection for adults in short tests (<10 minute) and performed comparatively with the Rayleigh-Moore and Rayleigh test during longer test durations. Decreased sensitivity was observed in infants relative to adults across all testing durations and statistical indicators, but the effects were largest in low frequency stimuli and seemed to be mostly, but not wholly, caused by differences in response amplitude. CONCLUSIONS: The choice of statistical indicator significantly impacts the sensitivity of speech-evoked EFR detection. In both groups and for all stimuli, the Rayleigh test and Rayleigh-Moore tests have high sensitivity. Differences in EFR detection are present between infants and adults regardless of statistical indicator; however, these effects are largest for low-frequency EFR stimuli and for amplitude-based statistical indicators.

Characteristics of Speech-Evoked Envelope Following Responses in Infancy.

Envelope following responses (EFRs) may be a useful tool for evaluating the audibility of speech sounds in infants. The present study aimed to evaluate the characteristics of speech-evoked EFRs in infants with normal hearing, relative to adults, and identify age-dependent changes in EFR characteristics during infancy. In 42 infants and 21 young adults, EFRs were elicited by the first (F1) and the second and higher formants (F2+) of the vowels /u/, /a/, and /i/, dominant in low and mid frequencies, respectively, and by amplitude-modulated fricatives /s/ and /∫/, dominant in high frequencies. In a subset of 20 infants, the in-ear stimulus level was adjusted to match that of an average adult ear (65 dB sound pressure level [SPL]). We found that (a) adult-infant differences in EFR amplitude, signal-to-noise ratio, and intertrial phase coherence were larger and spread across the frequency range when in-ear stimulus level was adjusted in infants, (b) adult-infant differences in EFR characteristics were the largest for low-frequency stimuli, (c) infants demonstrated adult-like phase coherence when they received a higher (i.e., unadjusted) stimulus level, and (d) EFR phase coherence and signal-to-noise ratio changed with age in the first year of life for a few F2+ vowel stimuli in a level-specific manner. Together, our findings reveal that development-related changes in EFRs during infancy likely vary by stimulus frequency, with low-frequency stimuli demonstrating the largest adult-infant differences. Consistent with previous research, our findings emphasize the significant role of stimulus level calibration methods while investigating developmental trends in EFRs.

Montage-related Variability in the Characteristics of Envelope Following Responses.

OBJECTIVES: The study aimed to compare two electrode montages commonly used for recording speech-evoked envelope following responses. DESIGN: Twenty-three normal-hearing adults participated in this study. EFRs were elicited by a naturally spoken, modified /susa∫i/ stimulus presented at 65 dB SPL monaurally. EFRs were recorded using two single-channel electrode montages: Cz-nape and Fz-ipsilateral mastoid, where the noninverting and inverting sites were the vertex and nape, and the high forehead and ipsilateral mastoid, respectively. Montage order was counterbalanced across participants. RESULTS: Envelope following responses amplitude and phase coherence were significantly higher overall in the Cz-nape montage with no significant differences in noise amplitude. Post hoc testing on montage effects in response amplitude and phase coherence was not significant for individual stimuli. The Cz-nape montage also resulted in a greater number of detections and analyzed using the Hotelling's T2. CONCLUSIONS: Electrode montage influences the estimated characteristics of speech-evoked EFRs.