Andrea F. Lewis

Congenital bilateral vocal fold paralysis and Charcot-Marie-Tooth disease.

We present the case of a patient with Charcot-Marie-Tooth disease (CMT) type 1 with congenital bilateral vocal fold paralysis in order to emphasize the treatment options and long-term outcome. The case is reviewed with regard to presentation, differential diagnosis, and treatment. We also reviewed the literature to determine the frequency of congenital and childhood presentations of bilateral vocal fold paralysis associated with CMT, most specifically CMT type 1. We found only 14 children reported to have bilateral vocal fold paralysis associated with CMT, and only 1 of these cases was associated with CMT type 1. None of these patients had congenital vocal fold paralysis. Because of the degenerative nature of the disease, our patient underwent endoscopic cordotomy to avoid tracheotomy. We conclude that CMT should be included in the differential diagnosis in evaluating neonates with bilateral vocal fold paralysis. If CMT is definitively diagnosed, it could alter the course of treatment.

Diagnostic Evaluation of Inhalant Allergies: A Cost-effectiveness Analysis:

Background The purpose of this study was to compare the cost-effectiveness of modified quantitative testing (MQT), intradermal dilutional testing (IDT), and in vitro allergy testing as diagnostic methods used in the management of patients with suspected IgE-mediated inhalant allergies. Methods A systematic review was conducted to determine key statistics for analysis, such as prevalence of disease, and sensitivity and specificity of each diagnostic modality. Costs were calculated based on charges from distribution companies to providers. A deterministic cost-effectiveness analysis then was conducted using a decision tree model to evaluate the various diagnostic strategies. After identifying results at baseline, we performed a sensitivity and threshold analysis to assess the strength of recommendations. Results At an allergic rhinitis prevalence of 20%, MQT dominated IDT and in vitro testing, with 85 people correctly diagnosed at a baseline total cost of

A cost-effectiveness analysis of the up-front use of balloon catheter dilation in the treatment of pediatric chronic rhinosinusitis

6630 for the 100 patients tested. Although in vitro testing had the highest effectiveness, it had an incremental cost-effectiveness ratio of

Comparison of pullout strength of resorbable screws in human cadaveric laryngeal cartilage using different drill diameters

3185. The results were sensitive to changes in the prevalence, costs, and sensitivities and specificities of the different modalities. Conclusion The prevalence of allergic rhinitis is high and rising according to many studies, leading to a growing population of patients requiring allergy testing. Not only does todays medical community want effective health interventions, but also there is pressure to make health care cost efficient. This study looks at the cost-effectiveness of various diagnostic allergy tests. In our model, we found MQT to be the most cost-effective method of diagnosing allergic disease.

Postoperative carotid spasm in the setting of head and neck surgery

BACKGROUND The treatment of pediatric sinusitis continues to be a controversial topic. It has been recommended to treat pediatric chronic rhinosinusitis (CRS) with adenoidectomy before proceeding to more invasive techniques. There are concerns regarding side effects of endoscopic sinus surgery in pediatric patients. With the advent of balloon catheter dilation (BCD) as a minimally invasive technique, some authors are recommending up front adenoidectomy with BCD in order to maximize disease resolution while minimizing risk. PURPOSE Our study examines the cost effectiveness of adenoidectomy alone versus adenoidectomy and upfront BCD for the management of pediatric CRS. METHODS A decision tree analysis was created to determine the cost effectiveness of treating a pediatric patient who has failed medical management, using adenoidectomy versus adenoidectomy with up-front BCD. Three separate decision trees were made. The incremental cost effectiveness ratio (ICER) was calculated for each scenario and a sensitivity analysis was done to determine how different values impacted our results. RESULTS Adenoidectomy as the sole first procedure was found to be more cost effective in all three decision trees. For tree 1, the adenoidectomy plus BCD arm was 0.03% more effective in the end, but with an

The effect of continuous positive airway pressure therapy on nasal patency: Effect of CPAP therapy on nasal patency

81, 431 incremental cost. CONCLUSIONS Costs in addition to outcomes must be considered when comparing treatment modalities in our current health care environment. This study found that adenoidectomy as a first intervention before proceeding to more advanced techniques is nearly as effective and is a much more cost-effective algorithm for the treatment of pediatric CRS. However, the physician must advocate the best treatment for his or her own patients.

Iatrogenic pneumothorax during hypoglossal nerve stimulator implantation

In a previous study at our institution, it was determined that resorbable screws with untapped drill holes resulted in the highest resistance forces to linear load when compared with titanium screws. The 1.1‐mm drill diameter/2.0‐mm screw diameter and 1.5/2.0 drill/screw combinations were superior to the 1.1/1.5 combinations; however, there was no conclusion as to the best screw size to drill bit diameter. The aim of this prospective study was to compare the pullout strength of resorbable screws in fresh frozen cadaveric laryngeal cartilage. The importance of drill hole diameter will also be determined.

Frequency Tuning in the Tone Burst-Evoked Myogenic Potentials in Extraocular Muscles in Normal Human Subjects

Delayed arterial spasm is a clinical and angiographic condition frequently observed after subarachnoid hemorrhage. It has long been associated with a local myogenic reaction to prolonged arterial contact with fresh blood. Carotid spasm from direct manipulation of the petrous carotid during skull base procedures is also a rare but known response to longitudinal arterial traction. Uncomplicated cervical cases, although subject to similar conditions of arterial manipulation, have less commonly been associated with arterial spasm. Two cases of severe internal carotid spasm leading to stroke in patients undergoing removal of glomus tumors are presented to emphasize carotid spasm as a potential complication in head and neck surgery. The perioperative guidelines to prevent, recognize, and treat this complication are also reviewed as outlined in the literature.

Resident fatigue in otolaryngology residents: a Web based survey ☆ ☆☆

Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure (CPAP) users and are frequently cited as reasons for noncompliance. To our knowledge, no study has demonstrated a change in objective or subjective nasal patency in patients with obstructive sleep apnea (OSA) after a therapeutic trial of CPAP therapy.

Cummings otolaryngology: Head and neck surgery, fourth edition

Hypoglossal nerve stimulation is a promising new treatment for patients with obstructive sleep apnea. In the initial Stimulation Therapy for Apnea Reduction Trial, the overall rate of serious adverse events was <2% and no cases of pneumothorax were reported. We present the case of an iatrogenic pneumothorax during placement of the chest sensor lead between the intercostal muscles. Following clinical and radiological evaluation, surgery was continued and the patient was treated expectantly. In the following review, we discuss pathophysiology, diagnosis, and expected outcomes. Surgeons placing hypoglossal nerve stimulators should be aware of complications and prepared to manage a pneumothorax.