Role of Prolonged Intubation in Vocal Fold Motion Impairment in Critically Ill Patients.

OBJECTIVE: COVID-19 upsurge in orotracheal intubation (OTI) has opened a new opportunity for studying associated complications. Vocal fold motion impairment (VFMI) is a known complication of OTI. The present study sought to determine the impact of OTI and prolonged OTI on the risk of developing VFMI; to identify both risk and protective factors associated with it. STUDY DESIGN: Retrospective cohort study. SETTING: Multicenter. METHODS: Medical charts were reviewed for all patients that received invasive mechanical ventilation with a subsequent flexible laryngoscopic assessment between March 2020 and March 2022. The main outcomes were the presence of VFMI, including immobility (VFI) and hypomobility (VFH). RESULTS: A total of 155 patients were included, 119 (76.8%) COVID-19 and 36 (23.2%) non-COVID-19 patients; overall 82 (52.9%) were diagnosed with VFMI. Eighty (52.3%) patients underwent a tracheostomy. The median (IQR) intubation duration was 18 (11-24.25) days, while the median (IQR) time to tracheostomy was 22 (16-29). In the adjusted model, we observed there was a 68% increased risk for VFMI from day 21 of intubation (RR: 1.68; 95% CI 1.07-2.65; P = 0.025). CONCLUSIONS: VFMI is a frequent complication in severely ill patients that undergo intubation. A prolonged OTI was associated with an increased risk of VFMI, highlighting the importance of timely tracheostomy. Further research is needed to confirm these findings in other subsets of critically ill patients.

Observed Frequency and Characteristics of Hearing Loss in Osteogenesis Imperfecta

ABSTRACT Background: Osteogenesis imperfecta (OI) is a rare group of genetic disorders affecting connective tissue, with consequent bone fragility, frequent fractures and skeletal deformity. Depending on the type, patients can have blue sclera, dentinogenesis imperfecta, and hearing loss. Aim: To determine the frequency, type and audiometric characteristics of hearing loss in a group of patients with OI. Material and Methods: A prospective cohort study was completed. A clinical and diagnostic hearing evaluation with tympanometry, acoustic stapedial reflex, pure-tone and speech audiometry were performed. Results: Thirty patients completed the study; mean age of 22 years (range 6-63 years). Sixty seven percent had a type I OI. Overall, nine (30%) patients had hearing loss (15/60 ears). Of these, six had bilateral hearing loss. Of the 15 affected ears, six showed conductive hearing loss, five sensorineural hearing loss, and four mixed hearing loss. Patients with hearing loss were older than patients with normal hearing. Only one pediatric patient developed hearing loss. Of the ears without hearing loss, 13% did not have an acoustic stapedial reflex. Conclusions: In this group of patients with OI, 30% had hearing loss and among those ears with normal hearing, 13% did not have an acoustic stapedial reflex. Patients with OI should be monitored for hearing loss.

Antecedentes: La osteogénesis imperfecta (OI) es un grupo raro de trastornos genéticos que afectan al tejido conectivo, con la consiguiente fragilidad ósea, fracturas frecuentes y deformidad esquelética. Según el tipo, los pacientes pueden presentar escleras azules, dentinogénesis imperfecta e hipoacusia. Objetivos: Determinar la frecuencia, tipo y características audiométricas de la hipoacusia en un grupo de pacientes con OI. Material y Métodos: Se completó un estudio de cohorte prospectivo. Se realizó una evaluación clínica, y de la audición con timpanometría, reflejo estapedial, audiometría tonal y logoaudiometría. Resultados: Treinta pacientes completaron el estudio; edad media de 22 años (rango 6-63 años). El 67% tenía una OI tipo I. Nueve pacientes (30%) tuvieron hipoacusia (15/60 oídos). De estos, seis tenían hipoacusia bilateral. De los 15 oídos afectados, seis tenían hipoacusia de conducción, cinco hipoacusia neurosensorial y cuatro hipoacusia mixta. Los pacientes con hipoacusia eran mayores que los pacientes con audición conservada. Sólo un paciente pediátrico desarrolló hipoacusia. De los oídos sin hipoacusia, el 13% tenía un reflejo estapedial ausente. Conclusiones: En este grupo de pacientes con OI, el 30% tenía hipoacusia. Además, el 13% de los oídos con audición normal no tenía reflejo acústico estapedial. Los pacientes con OI deben ser monitoreados para detectar hipoacusia.

Observed Frequency and Characteristics of Hearing Loss in Osteogenesis Imperfecta.

BACKGROUND: Osteogenesis imperfecta (OI) is a rare group of genetic disorders affecting connective tissue, with consequent bone fragility, frequent fractures and skeletal deformity. Depending on the type, patients can have blue sclera, dentinogenesis imperfecta, and hearing loss. AIM: To determine the frequency, type and audiometric characteristics of hearing loss in a group of patients with OI. MATERIAL AND METHODS: A prospective cohort study was completed. A clinical and diagnostic hearing evaluation with tympanometry, acoustic stapedial reflex, pure-tone and speech audiometry were performed. RESULTS: Thirty patients completed the study; mean age of 22 years (range 6-63 years). Sixty seven percent had a type I OI. Overall, nine (30%) patients had hearing loss (15/60 ears). Of these, six had bilateral hearing loss. Of the 15 affected ears, six showed conductive hearing loss, five sensorineural hearing loss, and four mixed hearing loss. Patients with hearing loss were older than patients with normal hearing. Only one pediatric patient developed hearing loss. Of the ears without hearing loss, 13% did not have an acoustic stapedial reflex. CONCLUSIONS: In this group of patients with OI, 30% had hearing loss and among those ears with normal hearing, 13% did not have an acoustic stapedial reflex. Patients with OI should be monitored for hearing loss.