Using Augmented Reality to Reduce Fear and Promote Cooperation During Pediatric Otolaryngologic Procedures.

This case series examines interactive AR during minor otolaryngologic procedures. Although VR has been successfully used for pediatric vascular access, removing children from comforting people in the real world has resulted in patient anxiety. AR offers a potential advantage, utilizing distracting holographic images when patients maintain eye contact with parents. The primary objective was to determine the effect of AR on fear during pediatric otolaryngologic procedures. Secondary objectives included evaluating pain; procedure compliance; and patient, parent and physician attitudes toward AR, as well as assessing the feasibility of adding AR to a busy outpatient otolaryngologic clinic. Laryngoscope, 131:E1342-E1344, 2021.

Flexible versus rigid laryngoscopy: A randomized crossover study comparing patient experience.

OBJECTIVES: To compare flexible distal-chip laryngoscopy (FDL) versus rigid telescopic laryngoscopy (RTL) in regard to examinees' pain level, comfort, satisfaction, and preference, and to evaluate the clinician's assessment of the examinees' experience with both exam types. STUDY DESIGN: Randomized crossover study. METHODS: Twenty-three normal adult subjects were recruited to undergo both FDL and RTL; the initial exam type was randomized. Subjects and clinicians completed corresponding questionnaires after each exam. Differences in participant characteristics and questionnaire scores between the two exam types were assessed via Pearson χ2 and paired t tests, respectively. RESULTS: Overall, participants reported that FDL was more uncomfortable than RTL (4.22 vs. 2.91, P = .003) and scored higher on the pain scale for FDL compared to RTL (2.91 vs. 1.70, P = .006). However, there was no significant difference in number of participants who preferred FDL versus RTL (10 [43%] vs. 13 [57%]). Poor correlation was seen between clinicians' assessment of participants' discomfort and actual reported discomfort for FDL (2.70 vs. 4.22, P = .001). CONCLUSIONS: Subjects undergoing FDL experience greater discomfort and pain compared to RTL, but do not demonstrate a differential preference of exam. Overall, clinicians underestimate the discomfort of patients undergoing FDL, but participants maintain high satisfaction with both exams nonetheless. LEVEL OF EVIDENCE: 1 Laryngoscope, 130:2663-2666, 2020.

The use of visual distraction to improve the tolerability of flexible laryngoscopy.

BACKGROUND: Flexible laryngoscopy is a commonly performed procedure in otolaryngology. Although this procedure is not considered painful, many patients describe it as uncomfortable. This study investigated the role of visual distraction as a form of pain relief during flexible laryngoscopy. METHODS: The study included patients undergoing flexible laryngoscopy at the University Hospital Southampton. Patients were self-allocated to one of four groups: with or without co-phenylcaine anaesthetic spray; and with and without visual distraction. Visual distraction involved the patient watching the procedure concurrently with the clinician, via a video monitor. Pre- and post-procedural discomfort was assessed using a visual analogue scale. RESULTS: The use of topical anaesthetic spray was not associated with significantly reduced discomfort scores (p > 0.05). Discomfort scores were significantly reduced in the visual distraction groups (p = 0.04), irrespective of the use of topical anaesthetic spray. CONCLUSION: This small study showed that visual distraction should be considered as a simple and cost-effective alternative to local anaesthetic for flexible laryngoscopy.

Endoscopic investigation and evaluation of anxiety for the management of globus sensation.

OBJECTIVE: To verify whether the severity of globus sensation would be affected by the results of investigations on possible underlying serious pathology in the head, neck and esophagus. METHODS: Thirty-six patients with globus sensation were enrolled in this study. All the patients suffered relatively persistent globus sensation which remained after conventional laryngoscopy at their family doctors. These patients were investigated for possible underlying oropharyngeal and esophageal lesions using fiberoptic endoscopy. The severity of globus was evaluated by the visual analog scales (VAS), and the degree of anxiety was evaluated by the state section of State Trait Anxiety Inventory (STAI-s). The questionnaires were administered at their first visits, and 9.6±3.2 months after endoscopy. The follow-up data obtained from 22 patients were incorporated in the further evaluations. Multiple regression analysis was used to evaluate the relationship between the improvement of VAS scores and that of STAI-s scores. Afterwards, Pearson product-moment correlation coefficient was measured. The recorded images of fiberoptic endoscopy were retrospectively verified by an expert of upper gastrointestinal endoscopy. RESULTS: No malignancies were observed in the endoscopic examination. Despite no treatment administered during the follow-up period, significant improvement of VAS scores was observed from the initial scores (40±21) to follow-up scores (27±27, p=0.014) in the patients examined in this study. The multiple linear regression analysis proved that the improvement of STAI-s scores was the only factor significantly affected the improvement of VAS scores (p=0.029) among the dependent valuables. The retrospective evaluation of the recorded images revealed comorbid esophagitis in 10 out of the 22 patients. When patients were stratified with the presence of comorbid esophagitis, significant improvement of VAS scores was observed only in the group without comorbid esophagitis at their follow up (17±20, p=0.026) compared with their initial scores (36±17). The multiple linear regression analysis proved that the improvement of VAS scores was significantly affected by the improvement of STAI-s scores (p=0.047) in this group. Moreover, significant positive relationship between the improvement of VAS scores and that of STAI-s scores was observed only in the group without comorbid esophagitis (r=0.61, p=0.047). CONCLUSION: Proper investigation to prove no underlying serious pathology may lead to the improvement of globus sensation in the patients without comorbid esophagitis through the reduction of their anxiety even when their symptoms are relatively persistent. Our results also indicated that some treatments against esophagitis may be helpful for the improvement of globus sensation in the patients with this comorbid disease.

Morbidity and patient perception of flexible laryngoscopy.

OBJECTIVES: The recently published Clinical Practice Guideline: Hoarseness (Dysphonia) revealed major deficits in the literature regarding relatively routine clinical decision-making. One of the more controversial points in the Guideline regarded the utility and timing of laryngeal visualization via flexible laryngoscopy, potentially because of sparse literature regarding the risks and potential morbidity. We sought to prospectively address this issue in order to optimize evaluation protocols. METHODS: Two-hundred fifty consecutive patients with a variety of complaints completed a survey after undergoing flexible laryngoscopy. The survey queried 1) demographics; 2) discomfort of pretreatment anesthesia and scope placement in the nose and pharynx; 3) fear of future examinations; and 4) patient perception and past experience. Concurrently, the laryngoscopist reported the complications and anatomic variations encountered. RESULTS: The discomfort and pain ratings from both the anesthetic spray and the scope placement were low. No statistically significant differences were observed with regard to sex; however, women reported greater fear associated with examinations (p = 0.0001). Anatomic abnormalities were observed in 14.4% of patients, and these patients reported greater discomfort, pain, and fear regarding the examination. No adverse events were observed. CONCLUSIONS: Flexible laryngoscopy was well tolerated, with little to no risk. The presence of nasal anatomic abnormalities predicted increased discomfort.

Disfunción de cuerdas vocales secundaria a reflujo gastroesofágico / Gastroesophageal reflux as a cause of vocal cord dysfunction

La disfunción de cuerdas vocales se caracteriza por la aducción paradójica de las mismas durante la inspiración, y ocurre con mayor frecuencia en mujeres jóvenes. Es un síndrome caracterizado por crisis habitualmente autolimitadas de tos, sibilancias, disnea y estridor inspiratorio, presentados en forma brusca. Su incidencia e historia natural son desconocidas. Puede coexistir o asemejar a un asma refractario. Originalmente los trastornos psicológicos eran la única causa conocida, aunque luego se describieron múltiples factores desencadenantes orgánicos como el reflujo gastroesofágico, ejercicio, sinusitis, distonía, tiroidectomía, irritantes respiratorios e infecciones de vías aéreas superiores. Para el diagnóstico se requiere una alta sospecha, y la realización de una laringoscopia directa objetivando la aducción de las cuerdas vocales durante la inspiración en el paciente sintomático. La terapia fonoudiológica y la psicoterapia han sido extensamente utilizadas, sin una evaluación prospectiva. Uno de los ejes centrales del manejo, es el tratamiento de la causa subyacente si esta se identifica. Reportamos dos casos de disfunción de las cuerdas vocales secundaria a reflujo gastroesofágico que evolucionaron en forma favorable con tratamiento específico

Vocal cord dysfunction (VCD), is characterized by a paradoxical adduction of the vocal cords during inspiration, and occurs predominantly in young women. Common symptoms are cough, wheezing, episodic dyspnea, and inspiratory stridor. The true incidence and course of the disease are unknown, and it is usually self limited. It can coexist with, or mimic refractory asthma. Psychological disorders were thought to be the principal cause, subsequently multiple organic diseases have also been reported, like gastroesophageal reflux disease (GERD). Diagnosisis made by clinical suspicion and direct observation. The Gold standard for diagnosis is laryngoscopy with visualization of the paradoxical motion of the vocal cords when the patient is symptomatic. Speech therapy and psychotherapy have been used extensively without any prospective study. We report two cases of VCD associated with GERD, both with excellent respond to treatment

User satisfaction and forces generated during laryngoscopy using disposable Miller blades: a manikin study.

Increasing awareness of prion-related diseases has led to an increase in the number of disposable laryngoscope blades available. We compared 11 disposable and standard re-usable Miller size 1 blades. In this manikin-based study, we studied user satisfaction for field of view at laryngoscopy, build quality and users' willingness to use the blade in an emergency situation. These were found to be better with metal disposable blades (p

Transnasal flexible laryngo-oesophagoscopy: an evaluation of the patient's experience.

The aim of this study was to evaluate the patient's experience of transnasal flexible laryngo-oesophagoscopy under local anaesthetic in an out-patient setting. This was a clinical observational study using a patient questionnaire and visual analogue score. Subjects were 50 patients seen in the hospital's ENT outpatient clinic between March and August 2004 in whom transnasal flexible laryngo-oesophagoscopy was performed and who completed pain discomfort questionnaires. Any patient undergoing transnasal flexible laryngo-oesophagoscopy, for either diagnostic or therapeutic purposes, was included in the study. Patients in whom transnasal flexible laryngo-oesophagoscopy was not necessary as part of their investigation or treatment were excluded. Patients completed a questionnaire, providing a simple visual analogue score for discomfort during the procedure. Any operative complications were noted by the surgeon. All patients completed transnasal flexible laryngo-oesophagoscopy, and the upper aerodigestive tract was clearly visualized. The procedure is well tolerated, with mean score of <1 out of 10 for all forms of discomfort. There was a complication rate of 2 per cent (one patient with epistaxis); no other complications occurred. Transnasal flexible laryngo-oesophagoscopy is a new diagnostic and therapeutic technique which is well tolerated by patients. It compares favourably with other flexible endoscopic techniques. This report documents for the first time a detailed description of patients' experience of this technique.

Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions.

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions, 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorqus vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.

[The significance of psychological factors in the early diagnosis of laryngeal and hypopharyngeal tumors]. / Die Bedeutung psychologischer Faktoren für die Frühdiagnose der Larynx- und Hypopharynx Geschwülste.

The clinical course of malignant disease is influenced by the patient's personality and his attitude to disease and to treatment. The authors interviewed 150 patients scheduled to undergo microlaryngoscopy, indicated to identify pathologic aberrations of the larynx and pharynx. - Analysis of the data showed that fear of cancer was less common in patients found to have a carcinoma than in those with benign aberrations. Patients with cancer were more inclined to postpone medical examination and showed a significantly greater degree of denial of their symptoms. A positive family history of malignant disease was significantly more frequent in patients who had marked fear of cancer than in those who did not have such fears. Female patients fearing cancer had a significantly greater frequency of neurotic symptoms, compared to females who had no fear. For nearly a half of smokers (45%) the proposed microlaryngoscopy provided a motive to give up smoking.