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Continuous Intraoperative Recurrent Laryngeal Nerve Monitoring: Techniques, Applications, and Controversies
AbstractPurpose of ReviewPurpose of the present review is to illustrate the current state of the art concerning continuous intraoperative recurrent laryngeal nerve monitoring (cIONM) for thyroid surgery.Recent FindingscIONM potentially leads to an improved postoperative vocal cord palsy rate, compared to the intermittent technique. There are currently two main approaches for cIONM: either conventional cIONM based on vagal nerve stimulation or experimental methods, which do not require the positioning of a vagal nerve electrode. One of these methods is the recently described technique “LAR-cIONM,” which utilizes the lar...
Source: Current Otorhinolaryngology Reports - June 7, 2021 Category: ENT & OMF Source Type: research

Patient-Centered Care in Vocal Fold Paralysis: What Really Matters?
AbstractPurpose of ReviewLiterature review of patient-reported outcome (PRO) measures after surgical intervention for unilateral vocal fold paralysis (UVFP).Recent FindingsThe majority of studies focus on resolution of dysphonia, dyspnea, and dysphagia, while few studies focus on psychosocial dimensions. Overall, voice-related PRO measures improve after all interventions; however, they do not normalize to pre-UVFP levels, as issues remain with singing, loud speech, and high-vocal-demand activities. All voice-related PRO measures have comparable improvement across all interventions. Dyspnea symptoms are common after UVFP; h...
Source: Current Otorhinolaryngology Reports - June 7, 2021 Category: ENT & OMF Source Type: research

Upper Airway Resistance Syndrome: a Combined ENT and Dental Approach
AbstractPurpose of ReviewIt is well accepted that obstructive sleep apnea (OSA) is not merely a simplistic anatomical imbalance of a small box (jaw) versus the over-crowding of tissue contents (namely the tonsils, tongue, palate, and lateral pharyngeal walls) within this container. Most sleep specialists agree that there is a strong complex neuro-physiological interconnected web of neurological and proprioceptor mechanism ongoing in this sleep disorder, perhaps simplified phenotypically as the PALM scale (Pcrit, arousal threshold, loop gain, and muscle responsiveness). What determines which patient would sleep through a pr...
Source: Current Otorhinolaryngology Reports - June 7, 2021 Category: ENT & OMF Source Type: research

Advanced Palate Surgery: What Works?
AbstractPurpose of ReviewTo describe the current knowledge about palate surgery in obstructive sleep apnea (OSA). Basic and advanced surgical techniques developed during the last years will be illustrated.Recent FindingsPalate surgery has evolved from ablative and aggressive surgeries to more selective and conservative surgery. Minimally invasive surgery has a role in palate surgery, including radiofrequency of the soft palate that can be performed in the office. Nevertheless, invasive techniques may be more effective in the long term. From tonsillectomy to modern lateral wall addressing pharyngoplasties have shown some go...
Source: Current Otorhinolaryngology Reports - June 2, 2021 Category: ENT & OMF Source Type: research

Sialadenitis of Unknown Etiology
AbstractPurpose of ReviewMost sialadenitis is attributed to infection, obstruction, or underlying autoimmunity; however, there are several rare processes affecting the salivary glands without clear etiology. We review the available literature, specifically addressing presentation, evaluation, and treatment.Recent findingsJuvenile recurrent parotitis is a typically self-limiting entity occurring in school-age children and may be benefitted by sialendoscopy. Sclerosing polycystic adenosis is a rare cystic disorder of major salivary glands, diagnosed, and treated through surgery. Inflammatory pseudotumor is thought to be an a...
Source: Current Otorhinolaryngology Reports - May 28, 2021 Category: ENT & OMF Source Type: research

Hypoglossal Nerve Monitoring During Sleep Surgery: Methodology, Utility Optimization
This article describes the methodology for applying nerve monitoring during HGNS surgery and reviews evidence supporting its utility in optimizing therapeutic outcomes.Recent FindingsIntraoperative nerve stimulation and monitoring can successfully and reliably isolate hypoglossal nerve fibers that innervate muscles that produce tongue protrusion (to be included within the implanted electrode cuff) from those that innervate muscles that produce retraction (to be excluded from the cuff). This minimizes post-implantation mixed activation (both tongue protrusion and retraction), which can inhibit therapeutic responses to HGNS....
Source: Current Otorhinolaryngology Reports - May 25, 2021 Category: ENT & OMF Source Type: research

Neuroanatomy and Monitoring of the External Branch of the Superior Laryngeal Nerve
This article reviews the anatomy and identification of the EBSLN, its role in voice physiology, and the updated literature describing the role for intraoperative neuromonitoring (IONM).Recent FindingsWith the widespread acceptance of IONM, particularly in the identification of recurrent laryngeal nerve damage, recent studies have demonstrated a role for this technology in the surgical identification of the EBSLN. However, the ability of IONM to improve clinical outcomes with regard to the EBSLN has not been fully elucidated in the current literature.SummaryThe intraoperative identification and preservation of the EBSLN req...
Source: Current Otorhinolaryngology Reports - May 24, 2021 Category: ENT & OMF Source Type: research

Adult Bilateral Vocal Fold Paralysis
We describe etiologies and treatment options for BVFP in the adult population.Recent FindingsMultiple management strategies for BVFP have been described and are evolving. Tracheotomy is often employed initially while return of vocal fold mobility is awaited. Other short-term temporizing treatments, such as suture lateralization and laryngeal botulinum toxin injection, have been developed and can potentially allow patients to avoid tracheotomy. When mobility does not return after an appropriate observation period, permanent treatment options such as cordotomy and medial arytenoidectomy may be considered. These procedures im...
Source: Current Otorhinolaryngology Reports - May 21, 2021 Category: ENT & OMF Source Type: research

Intraoperative Nerve Monitoring Setup and Data Interpretation: How Do I Augment My IONM Experience?
This article emphasizes the published International Neural Monitoring Study Group guidelines on intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery. These guidelines have informed the algorithms by which intermittent and continuous nerve monitoring (IIONM and CIONM, respectively) is used. There have been multiple follow-up studies on rates of use, prognostication, and clinical outcomes using the technology.SummaryEstablished algorithms for intraoperative nerve monitoring allow the endocrine surgeon to easily gather and analyze data that are valuable in ultimately improving post-operative voice ou...
Source: Current Otorhinolaryngology Reports - May 17, 2021 Category: ENT & OMF Source Type: research

A Phenotypic Approach for Personalised Management of Obstructive Sleep Apnoea
AbstractPurpose of ReviewObstructive sleep apnoea (OSA) is a common sleep disorder associated with various symptoms and health consequences. In recent years, it has been increasingly recognised that there are different OSA phenotypes relating to risk factors and pathophysiology as well as clinical expression (symptoms and comorbidity). This review provides a narrative of currently investigated OSA phenotypes relating to disease and treatment which could help move the field towards the future vision of personalised management for OSA.Recent FindingsThere is emerging evidenceOSA phenotypes relating to pathophysiology and cli...
Source: Current Otorhinolaryngology Reports - May 15, 2021 Category: ENT & OMF Source Type: research

Intermittent and Continuous Monitoring of the Facial Nerve: From the Ear to the Neck
This article defines two major types of facial nerve monitoring (intermittent and continuous), delves into the current literature that supports the use of intraoperative facial nerve monitoring in procedures from the ear to the neck, and provides specific tips for monitoring during these procedures.Recent FindingsIntermittent facial nerve monitoring, otherwise known as mapping, has two subtypes including intraoperative facial nerve mapping and preoperative facial nerve mapping. Continuous facial nerve monitoring also has two subtypes including passive continuous facial nerve monitoring (free-run EMG) and active continuous ...
Source: Current Otorhinolaryngology Reports - May 14, 2021 Category: ENT & OMF Source Type: research

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation
AbstractPurpose of ReviewTracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care.Recent FindingsPediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with ...
Source: Current Otorhinolaryngology Reports - April 15, 2021 Category: ENT & OMF Source Type: research

Correction to: Management of Neurofibromatosis Type 2 Associated Vestibular Schwannomas
A Correction to this paper has been published:https://doi.org/10.1007/s40136-021-00345-7 (Source: Current Otorhinolaryngology Reports)
Source: Current Otorhinolaryngology Reports - April 14, 2021 Category: ENT & OMF Source Type: research

Multimodality Treatment of Large Vestibular Schwannomas
AbstractPurpose of ReviewVestibular schwannomas are WHO grade I tumors of the eighth cranial nerve that lead to hearing loss, tinnitus, vestibular dysfunction, and facial nerve compromise. The management of vestibular schwannomas consists of observation, radiosurgery, or microsurgical resection. In this review, we discuss the various treatment modalities specifically targeting large vestibular schwannomas in addition to their treatment risk profiles.Recent FindingsAlthough there has been a trend towards treatment with radiosurgery for smaller lesions, consensus reports still advocate for surgical debulking in patients with...
Source: Current Otorhinolaryngology Reports - April 13, 2021 Category: ENT & OMF Source Type: research

Treatment of Small Vestibular Schwannomas
AbstractPurpose of ReviewVestibular schwannomas (VS) are benign neoplasms that arise from the Schwann cells enveloping the vestibular division of the eighth cranial nerve. These tumors typically exhibit indolent growth and commonly cause audiovestibular dysfunction. If allowed to grow large enough, VS can cause brainstem compression and become fatal. Treatment options include observation with serial imaging, radiotherapy, and microsurgical resection. This review will summarize the literature regarding treatment outcomes for patients with small VS.Recent FindingsAdvances in diagnostic imaging have allowed for earlier and mo...
Source: Current Otorhinolaryngology Reports - April 10, 2021 Category: ENT & OMF Source Type: research