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1.
Ear Nose Throat J ; 94(1): E30-3, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25606843

RESUMO

Myxomas of the vocal fold are rare benign tumors often presenting with chronic dysphonia and less frequently with airway obstruction. The current consensus is that all laryngeal myxomas should be totally excised with clear margins to prevent recurrences. The recommendation for complete excision, however, has to be balanced with consideration of preserving vocal fold phonatory and sphincteric function. We report a case of vocal fold myxoma recurring twice after subtotal excision via two surgical approaches. This case illustrates a benign lesion with potential for recurrence and the need for a balanced treatment approach.


Assuntos
Disfonia/etiologia , Neoplasias Laríngeas/complicações , Mixoma/complicações , Doença Crônica , Glote , Humanos , Neoplasias Laríngeas/diagnóstico , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico
2.
JAMA Otolaryngol Head Neck Surg ; 140(3): 243-9, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24457914

RESUMO

IMPORTANCE: Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. OBJECTIVE: To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. DESIGN, SETTING, AND PARTICIPANTS: This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. INTERVENTIONS: Surveys were sent to the 62 individuals' residency programs to evaluate those individuals on a 5-point Likert scale in various categories as well as to rank those individuals as being in the top 50% or bottom 50% of their graduating class. MAIN OUTCOMES AND MEASURES: All else being equal, we hypothesized that applicants who had the manual dexterity and visuospatial skills to accurately carve a bar of soap would more likely possess the skills necessary to become a good surgeon. RESULTS: There was no difference between individuals with the best soap carvings and those with the worst soap carvings in all categories: cognitive knowledge, visuospatial ability, manual dexterity, decision making, and overall score (P > .10 for all categories). There was a 95% response rate, with 35 of 37 residency programs responding and 59 of 62 surveys returned. CONCLUSIONS AND RELEVANCE: Manual dexterity aptitude testing in the form of soap carving does not appear to correlate with surgical skill at the time of graduation. Further studies need to be conducted to determine the role of manual dexterity and visuospatial aptitude testing in the otolaryngology application process.


Assuntos
Testes de Aptidão , Aptidão , Competência Clínica , Educação Médica Continuada/métodos , Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Sabões , Humanos , Inquéritos e Questionários
3.
Ear Nose Throat J ; 91(2): E22-4, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22359141

RESUMO

Pertussis is a rare condition in adults. This report describes a 65-year-old man presenting to the otolaryngology service with hoarseness secondary to pertussis. He had a history of worsening cough and hoarseness occurring over several weeks. Laryngoscopy showed significant erythema at the medial edges of the vocal folds. Stroboscopy demonstrated bilateral decreased amplitude and decreased mucosal wave of the vocal folds. Polymerase chain reaction testing of the sputum revealed Bordetella pertussis. The patient was started on azithromycin, and he reported gradual resolution of the chest and laryngeal symptoms over the next few months. Pertussis, or whooping cough, is not common in the United States because of childhood vaccination protocols. Nevertheless, otolaryngologists need to be aware of this condition as a possible cause of hoarseness.


Assuntos
Bordetella pertussis/isolamento & purificação , Rouquidão/etiologia , Coqueluche/complicações , Coqueluche/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Humanos , Masculino , Escarro/microbiologia , Coqueluche/tratamento farmacológico
4.
J Grad Med Educ ; 3(3): 414-6, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22942976

RESUMO

BACKGROUND: The objective of this study was to determine the extent of interest in international electives among prospective otolaryngology residents and to determine whether the availability of international electives affected students' interest in ranking a particular residency program. METHODS: A 3-part survey was given to all medical students enrolled in the 2008 otolaryngology match via the Electronic Residency Application Service. Part 1 elicited demographic information. Part 2 explored general interest in international rotations. Part 3 involved ranking several factors affecting students' choice of residency programs. This survey was developed at our institution, with no formal validation. Participation was anonymous and voluntary. RESULTS: A total of 307 students entered the otolaryngology match, and 55 surveys (18%) were completed. Twenty-five of 55 students (55%) had completed an international elective during or prior to medical school, and 51 of 55 respondents (93%) had a "strong" or "very strong" desire to participate in an international elective during residency; 48 of 55 students (87%) had a "strong" or "very strong" desire to participate in international surgical missions after residency. Future practice goals had no correlation with interest in international rotations, either during or after residency training. Respondents ranked 8 factors that had an impact on residency program selection in the following order of importance: operative experience, location, lifestyle, research opportunities, didactics, international electives, prestige of program, and salary. CONCLUSION: Interest in international medicine among prospective otolaryngologists was high in this subset of respondents but did not appear to affect residency program selection.

5.
Laryngoscope ; 115(5): 899-902, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15867662

RESUMO

OBJECTIVES: Floseal, a novel hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin, is applied as a high-viscosity gel for hemostasis. This study is a prospective, randomized, controlled clinical trial of Floseal compared with nasal packing in patients with acute anterior epistaxis. STUDY DESIGN: Institutional review board-approved, prospective, randomized, controlled, nonblinded, crossover clinical trial. METHODS: Seventy consecutive patients presenting with acute anterior epistaxis were randomized to receive Floseal or nasal packing for control. Patients were crossed over to the other technique after two unsuccessful attempts of the first technique. Patients were seen in the clinic within 7 days for follow-up. Ten-point visual analogue scales were used to rank effectiveness (1 = ineffective, 10 = effective), physician technical ease (1 = difficult, 10 = easy), physician satisfaction (1 = unsatisfied, 10 = satisfied), patient discomfort during hemostasis (0 = none, 9 = unbearable), patient discomfort at follow-up office visit, and patient satisfaction. Additional data included need for subspecialist consultation to control bleeding, rebleeding rates within 7 days, and rebleeding at follow-up visit. RESULTS: Floseal (n = 35) was judged by physicians to be more effective than nasal packing (n = 35) at initial control of anterior epistaxis (9.9 vs. 7.7, P < .001). Physicians found Floseal to be easier to use (9.4 vs. 3.2, P < .001) and were more satisfied with Floseal (9.6 vs. 3.5, P < .001). Patients experienced less discomfort with Floseal than with nasal packing both at initial control (1.4 vs. 8.9, P < .001) and at follow-up visit (0.0 vs. 8.5, P < .001), and Floseal patients were more satisfied overall (9.1 vs. 2.9, P < .001). Fewer in-person otolaryngology consultations were requested for Floseal patients (8.6% vs. 31.0%, P < .05). Floseal patients experienced fewer rebleeding rates within 7 days (14% vs. 40%, P < .05). Rebleeding rates at follow-up visit were higher in the nasal packing than the Floseal group at time of packing removal (63% vs. 0%, P < .001). Eight (23%) patients were crossed over from the nasal packing group to the Floseal group when nasal packing was ineffective. One Floseal patient (3%, P < .05) was crossed over into the nasal packing group. There were no complications in either group. CONCLUSIONS: Floseal hemostatic sealant is a better tolerated, more effective, safe, and easy alternative to nasal packing in patients presenting with acute anterior epistaxis. Future studies may wish to evaluate Floseal's use in posterior epistaxis.


Assuntos
Epistaxe/tratamento farmacológico , Esponja de Gelatina Absorvível/farmacologia , Esponja de Gelatina Absorvível/uso terapêutico , Técnicas Hemostáticas , Doença Aguda , Idoso , Estudos Cross-Over , Feminino , Seguimentos , Esponja de Gelatina Absorvível/administração & dosagem , Hemostasia , Humanos , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários
6.
Laryngoscope ; 115(2): 274-7, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15689749

RESUMO

OBJECTIVES/ HYPOTHESIS: The objective was to present the unique case of previously unreported asymptomatic cylindrical tracheal foreign body causing near-total airway obstruction. The asymptomatic nature of the case made diagnosis and management challenging. STUDY DESIGN: A retrospective case review at an urban health maintenance organization medical center. METHODS: A 3.5-year-old asymptomatic boy was incidentally discovered to have a metallic foreign body in his mid trachea on a screening scoliosis roentgenogram. He underwent rigid bronchoscopic retrieval the following day. RESULTS: The foreign body was found to be a corroded, 9 x 6-mm metallic cylinder with a narrowed luminal diameter of 2.0 mm. Intubation was maintained in the pediatric intensive care unit for 48 hours, and extubation was performed in the operating room under direct bronchoscopy. Mitomycin C was applied to a circumferential area of denuded tracheal mucosa. CONCLUSION: Tracheal foreign bodies are distinctly different clinical entities from bronchial foreign bodies. Asymptomatic bronchial foreign bodies are relatively common, but to the authors' knowledge, an asymptomatic tracheal foreign body had not been reported previously. Discussion focused on pathophysiology with reference to Poiseuille's law, diagnosis, and management of asymptomatic tracheal foreign bodies, including the possibility of elective bronchoscopic retrieval.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Corpos Estranhos/complicações , Traqueia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/cirurgia , Broncoscopia , Pré-Escolar , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Intubação Intratraqueal , Masculino , Radiografia , Traqueia/diagnóstico por imagem
7.
Otolaryngol Head Neck Surg ; 131(5): 601-5, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15523433

RESUMO

PROBLEM ADDRESSED: Floseal is a novel matrix hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin. It is applied as a high-viscosity gel for hemostasis and has been clinically proven to control bleeding. This study is a prospective, randomized, controlled clinical trial of Floseal sealant compared to traditional suction cautery hemostasis in children undergoing adenoidectomy. METHODS AND MEASURES: Seventy patients (mean age 7.0 yrs, 45.7% male) with obstructive sleep apnea underwent traditional cold steel adenoidectomy with an adenoid curette and were then randomized to receive the hemostatic sealant (Floseal) or cautery to obtain hemostasis. Patients were crossed over to the other hemostatic technique if hemostasis was not achieved after more than 100 mL of blood loss or 15 minutes elapsed time. Objective data collected included time to hemostasis and blood loss during hemostasis. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal (0 = none, 3 = brisk) and ease of operation (1 = extremely easy, 6 = extremely difficult). Parents recorded diet on a journal and were contacted by phone at postoperative day 7 and questioned with regard to return to regular diet and use of narcotics. RESULTS: Compared to patients in the cautery group (n = 35), Floseal patients (n = 35) had significantly shorter times to hemostasis (0.6 +/- 1.3 minutes vs 9.5 +/- 5.4 minutes [mean +/- SD], P < 0.001), less blood loss (2.5 +/- 9.2 mL vs 29.4 +/- 27.1 mL, P < 0.001), less subjective bleeding (0.0 +/- 0.6 vs 2.0 +/- 0.7, [median 4-point VAS +/- SD], P < 0.001), and subjectively easier operations (2.6 +/- 1.0 vs 5.2 +/- 1.0 [mean 6-point VAS +/- SD], P < 0.001). Furthermore, Floseal patients returned to regular diet earlier (2.7 +/- 0.7 vs 4.1 +/- 0.5 days [mean +/- SD], P < 0.001) and had less use of narcotics at 7 days postoperatively (40% vs 69%, P < 0.05). Lastly, three patients in the cautery group were crossed over to the Floseal group, but no Floseal subjects were crossed over to the cautery group. The retail cost of Floseal is US 85 dollars. Operating room costs are estimated at US 12 dollars/minute. Reducing the operative length by 8.9 minutes on average produces a cost savings of US 106.80 dollars per operation. There were no complications in either experimental group including postoperative hemorrhage, hospitalization, blood transfusion, or aspiration. CONCLUSIONS: Floseal matrix hemostatic sealant is a safe, efficacious, easy, and cost-effective technique for obtaining hemostasis in children undergoing adenoidectomy. Limitations of the study include the fact that it is nonblinded, which does allow for some bias in the subjective data recorded. However, utilizing 4 different operating surgeons, 3 of whom were not affiliated with the study, minimized this. CLINICAL SIGNIFICANCE OF STUDY: This study demonstrates the safety and efficacy of a novel hemostatic sealant in children undergoing adenoidectomy. Floseal matrix hemostatic sealant can be used as a first-line hemostatic agent, and it is a good tool in the armamentarium of otolaryngologists who encounter significant bleeding following adenoidectomy.


Assuntos
Adenoidectomia/métodos , Esponja de Gelatina Absorvível/uso terapêutico , Hemostasia Cirúrgica/instrumentação , Hemostáticos/uso terapêutico , Adenoidectomia/economia , Adolescente , Perda Sanguínea Cirúrgica/prevenção & controle , Criança , Pré-Escolar , Análise Custo-Benefício , Eletrocoagulação/economia , Eletrocoagulação/métodos , Feminino , Esponja de Gelatina Absorvível/economia , Hemostasia Cirúrgica/economia , Hemostáticos/economia , Humanos , Lactente , Masculino , Estudos Prospectivos , Apneia Obstrutiva do Sono/cirurgia , Fatores de Tempo , Resultado do Tratamento
8.
Laryngoscope ; 114(12): 2196-9, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15564844

RESUMO

OBJECTIVE: To present a case report and to propose an anatomic explanation for a rare complication of tonsillectomy, severe dysphagia caused by bilateral paralysis of the glossopharyngeal nerve. STUDY DESIGN: Retrospective case review and prospective cadaveric dissection. METHODS: The medical record and radiologic data were reviewed from a patient who had severe dysphagia after tonsillectomy. In addition, 10 formalin-preserved cadaver head and neck specimens were dissected to identify the anatomic course of 20 glossopharyngeal nerves. The distance between the nerve and tonsillar fossa was measured at two sites. RESULTS: The patient was diagnosed with bilateral paralysis of the glossopharyngeal nerve and required use of gastrotomy tube for years postoperatively. The mean distance from the posterosuperior tonsillar fossa and the main trunk of the glossopharyngeal nerve was 10.7 mm, and the mean distance from the posteroinferior tonsillar fossa and the closest lingual branch of the glossopharyngeal nerve was 6.5 mm. CONCLUSIONS: Direct nerve injury seems the most plausible explanation for this rare complication of tonsillectomy. The proximity of the glossopharyngeal nerve to the tonsillar fossa emphasizes the importance of maintaining the correct surgical plane during surgery.


Assuntos
Transtornos de Deglutição/etiologia , Nervo Glossofaríngeo , Paralisia/etiologia , Tonsilectomia/efeitos adversos , Adulto , Cadáver , Transtornos de Deglutição/diagnóstico , Dissecação , Feminino , Seguimentos , Doenças do Nervo Glossofaríngeo/diagnóstico por imagem , Doenças do Nervo Glossofaríngeo/etiologia , Doenças do Nervo Glossofaríngeo/fisiopatologia , Humanos , Laringoscopia , Imageamento por Ressonância Magnética , Paralisia/diagnóstico por imagem , Paralisia/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X , Tonsilectomia/métodos
9.
Ear Nose Throat J ; 83(3): 195-8, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15086016

RESUMO

The use of speech recognition systems as a replacement for other types of transcription systems is increasing rapidly, partly because many people are unable to use conventional keyboards as a result of upper-extremity repetitive strain injury (RSI). However, the frequent or continuous use of such systems can cause muscle tension dysphonia in some patients. The scientific literature suggests that there is an association between upper-extremity RSI and muscle tension dysphonia. We present a retrospective case series of five patients with workplace upper-extremity RSI who developed muscle tension dysphonia soon after they began using discrete computerized speech recognition software. The diagnosis of dysphonia was based on laryngovideostroboscopy, acoustic analyses, and voice load testing. All patients had normal voice when using everyday speech, but speaking into the computer resulted in the rapid onset of aperiodicity, strain, and a decrease in fundamental frequency. In three of the five patients, laryngovideostroboscopy showed posterior glottic overapproximation, but no other abnormalities. Treatment was centered on voice therapy and avoidance of long periods of using computerized speech recognition systems. The condition of three of the five patients improved with therapy. We conclude that computer speech recognition programs can lead to the onset of muscle tension dysphonia in some patients. These patients can be successfully treated with voice therapy.


Assuntos
Auxiliares de Comunicação para Pessoas com Deficiência/efeitos adversos , Contração Muscular , Distúrbios da Voz/etiologia , Adulto , Feminino , Humanos , Músculos Laríngeos/lesões , Laringoscopia , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Estudos Retrospectivos , Software , Fonoterapia , Gravação em Fita , Resultado do Tratamento , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/terapia
11.
Arch Otolaryngol Head Neck Surg ; 128(10): 1201-3, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12365895

RESUMO

New masses in the head and neck region of previously treated patients with cancer are considered suggestive of potential recurrence. Fine-needle aspiration is an excellent primary tool for evaluating these masses but may show atypical squamous cells that mislead clinicians to pursue aggressive treatment. We describe 3 patients in whom submandibular gland masses developed after radiation therapy for squamous cell carcinoma and for whom subsequent excisional biopsy findings showed benign squamous metaplasia. We review distinguishing clinical and histopathologic features that may allow these lesions to be identified. We also propose a treatment algorithm for this uncommon clinical scenario.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Metaplasia/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias da Glândula Submandibular/patologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Otolaryngol Head Neck Surg ; 126(5): 554-61, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12075231

RESUMO

OBJECTIVES: Diagnostic accuracy of the ThinPrep process (Cytyc, Boxborough, MA) was compared with that of conventional (smear) cytopreparation for fine-needle aspiration (FNA) of head and neck masses. METHODS: In a prospective, randomized, single-blinded study, 209 patients served as their own controls and underwent 236 FNAs using ThinPrep and conventional (smear) cytopreparatory techniques. RESULTS: ThinPrep produced less air-drying artifact and less mechanical distortion than the conventional method. The conventional technique was diagnostic in 63% of samples; the ThinPrep technique was diagnostic in 55% of samples. When all results were combined, pathologists subjectively preferred the conventional technique but accepted use of ThinPrep as the only cytopreparatory technique for most head and neck masses. CONCLUSIONS: For adequately experienced cytopathologists, ThinPrep is acceptable for FNA of salivary masses, neck cysts, metastatic lymph nodes, and thyroid lesions. Conventional smear technique should be used for FNA of nonmetastatic lymphoid lesions. Use of ThinPrep can complement use of the conventional (smear) cytopreparatory technique when aspirate is nondiagnostic or bloody, when the patient has a blood-borne infectious disease, when the clinician is inexperienced, or when aspirate has entered the syringe.


Assuntos
Biópsia por Agulha , Neoplasias de Cabeça e Pescoço/patologia , Técnicas de Preparação Histocitológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comportamento do Consumidor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
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