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Literature Review: A Roundup of Important Recent Studies
From: ENT Today, May 2012
by Sue Pondrom
- Passive Smoke Affects Ultrastructure of Nasal Mucosa in Children
- Increased Eustachian Tube Dysfunction in Children with Obstructive Sleep Apnea
- Risk Factors for Spasmodic Dysphonia
- Predictors of Complications of Free Flap Reconstruction
Passive Smoke Affects Ultrastructure of Nasal Mucosa in Children
What is the effect of passive exposure to smoke on nasal respiratory mucosa in children?
Background: Most studies concerning the effects of passive, or secondhand, smoking have examined its carcinogenic effect on the lower respiratory tract, while the effects on nasal respiratory mucosa have not been widely studied.
Study design: Study of 20 children exposed and 10 not exposed to passive smoke.
Setting: Department of Otolaryngology-Head and Neck Surgery and Department of Pathology, Alexandria Medical School, Alexandria, Egypt.
Synopsis: Twenty children ages five to 11 years with a history of prolonged exposure to passive smoke and 10 children with a negative household smoking history had biopsies taken during tonsillectomy from the lower border of the inferior turbinate. Examination of the nasal mucosa showed several ultrastructural changes in those exposed to passive smoke, including patchy loss of cilia, generalized loss of cilia, squamous metaplasia, hyperplasia of goblet cells and seromucinous acini and vascular congestion. The authors said the changes in the respiratory nasal mucosa appeared to be directly proportionate to the duration of passive exposure to smoke. Additionally, they noted that their findings are contrary to those reported in patients with allergic rhinitis, and that, at the same time, they explain the absence of pericapillary and subepithelial edema, which are commonly described in allergic cases.
Bottom line: Children exposed to passive cigarette smoke may develop several structural changes in their respiratory nasal mucosa, with subsequent negative effects on ciliary activity and mucociliary function. As a result, defense mechanisms of the nose may be ruined or lost.
Reference: Elwany S, Ibrahim AA, Mandour Z, et al. Effect of passive smoking on the ultrastrucrure of the nasal mucosa in children. Laryngoscope. 2012;122(5):965-969.
—Reviewed by Sue Pondrom
Increased Eustachian Tube Dysfunction in Children with Obstructive Sleep Apnea
How common is Eustachian tube dysfunction (ETD) in children with obstructive sleep apnea (OSA), and what interventions are available?
Background: The prevalence of OSA in the general pediatric population is approximately 4 to 7 percent. However, no clear relationship between the severity of OSA and the presence of ETD has been established.
Study design: Retrospective medical record review.
Setting: Department of Otolaryngology, University of Pittsburgh; Department of Pediatric Otolaryngology and Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Penn.
Synopsis: The prevalence of ETD was investigated in 295 babies aged three to 24 months who were diagnosed with OSA. Of these, 31.9 percent met the criteria for ETD, with a breakdown of 66 percent males and 34 percent females. An analysis of OSA severity in patients with ETD showed 41.5 percent mild, 39.4 percent moderate and 19.1 percent severe, with a similar distribution in general OSA. A total of 30 patients (31.9 percent) required two or more myringotomy and ventilation tube placement (MT) procedures, with 135 MT procedures overall. The authors noted that additional MT procedures following nonsurgical interventions occurred more frequently (54.5 percent) than after surgical interventions (34.8 percent). The nonsurgical interventions occurred at an earlier average age (15.5 months) than the surgical interventions (20.3 months).
Bottom line: The prevalence of ETD in patients with OSA (31.9 percent) is significantly higher than in the general pediatric population (4 to 7 percent); however, the efficacy of surgical treatment is not clear from this study.
Reference: Robison JG, Wilson C, Otteson TD, et al. Increased Eustachian tube dysfunction in infants with obstructive sleep apnea. Laryngoscope. 2012;122(5):1170-1177.
—Reviewed by Sue Pondrom
Risk Factors for Spasmodic Dysphonia
Which risk factors are uniquely associated with spasmodic dysphonia, compared with other voice disorders?
Background: Symptoms for spasmodic dysphonia, believed to be a focal dystonia of the larynx, typically begin in the fifth decade of life and remain chronic thereafter. There are approximately 50,000 individuals with spasmodic dysphonia in the U.S. No cure exists, and treatment options are limited to botox chemodenervation, laryngeal nerve avulsion or denervation-reinnervation surgical procedures.
Study design: Case-control epidemiology study.
Setting: Department of Communication Sciences and Disorders, Division of Otolaryngology-Head and Neck Surgery, University of Utah; University of Utah Voice Disorders Clinic and Surgical Center, Salt Lake City; Department of Health Science, Brigham Young University, Provo, Utah; Department of Speech-Language Pathology, University of New Mexico Hospitals, Albuquerque.
Synopsis: A questionnaire was administered to 150 patients with spasmodic dysphonia and 136 patients with other structural, neurological and functional voice disorders. Several factors were uniquely associated with spasmodic dysphonia: 1) a personal history of cervical dystonia, sinus and throat illnesses, mumps, rubella, dust exposure and frequent volunteer voice use; 2) a family history of voice disorders; 3) an immediate family history of vocal tremor and meningitis and 4) an extended family history of head and neck tremor, ocular disease and meningitis. Vocal tremor coexisted with spasmodic dysphonia in 29 percent of cases. The authors found no association between spasmodic dysphonia and psychogenic or behavioral issues. The diverse control group and lack of conventional epidemiologic sampling procures and statistical analyses made it difficult to establish risk factors.
Bottom line: Spasmodic dysphonia is likely multifactorial and associated with several endogenous and exogenous factors.
—Reviewed by Sue Pondrom
Predictors of Complications of Free Flap Reconstruction
What are the predictors of complications following free flap reconstruction in the head and neck?
Background: Each year, more than 400,000 head and neck squamous cell cancers are diagnosed worldwide. Surgical resection is frequently required, necessitating reconstruction for appropriate wound closure, restoration of function and aesthetics. The significance of predictors of complication is a matter of debate.
Study design: Retrospective analysis.
Setting: Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Canada.
Synopsis: The authors analyzed 304 consecutive free flap reconstructions performed over a seven-year period. Patient and procedure characteristics included age, sex, peripheral vascular disease (PVD), diabetes mellitus, pre-operative cerebrovascular accident, pre-operative myocardial infarction, alcohol history, smoking history, pre-operative chemoradiation, indication for reconstruction, T stage, N stage, defect classification, node dissection and flap type. Of the comorbid conditions assessed with univariate ordinal regression, only PVD was associated with statistically significantly different complication grades. With multivariate ordinal regression, however, PVD was not found to have a statistically significant relationship with complication grades.
Bottom line: Overall, the incidence of serious complications according to the Clavien-Dindo classification system was found to be low. The only statistically significant predictors of complication grades were increased tumor stage and pharyngoesophageal reconstruction.
Reference: le Nobel GJ, Higgins KM, Enepekides DJ. Predictors of complications of free flap reconstruction in head and neck surgery: analysis of 304 free flap reconstruction procedures. Laryngoscope. 2012;122(5):1014-1019.
—Reviewed by Sue Pondrom