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Keywords: case series; laser arytenoidectomy; swallow EN case series laser arytenoidectomy swallow 347 350 4 02/17/22 20220301 NES 220301 Key Points Endoscopic CO2 laser medial arytenoidectomy is performed for glottic stenosis; however, post-operative aspiration remains a risk. In terms of detailed post-operative swallow assessment, 14 patients underwent repeat post-operative FEES, typically performed day 1 post-operatively, and two patients underwent Videofluoroscopic Swallow Study (VFSS). Twenty-six patients had recorded corresponding post-operative FOIS scores, as shown in Figure 2a along with the distribution of pre-operative scores, with "N/A" depicting the missing scores from six patients. If baseline swallow is impaired, this should not preclude the patient from arytenoidectomy; baseline FEES is essential to aid surgical planning and inform patient consent. [Extracted from the article]

Objectives: Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle‐aged, female and Black populations. Diagnosis usually requires evidence of non‐caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. Design: We performed a PubMed literature review to determine the evidence base supporting this. Results: ENT manifestations are present in 5%‐15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by speech and language therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. Conclusions: The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life‐threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area. [ABSTRACT FROM AUTHOR]

Objectives: In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post‐procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates. Design: Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8‐month period between November 2019 and July 2020. Patients were assessed preoperatively for pre‐existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery. Setting: Tertiary adult airway service for predominantly benign pathology. Results: Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r =.22, p =.008) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r = −.20, p =.014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r = −.19, p =.023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r =.45, p = 1.611 × 10−8). Conclusion: In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms. [ABSTRACT FROM AUTHOR]

One patient was too unwell to proceed with biopsy or treatment, whilst the other had a significant past history of systemic sarcoidosis. Follow-up duration since diagnosis of laryngeal sarcoidosis averaged 5.8 years, the longest being 29 years whereby the diagnosis of laryngeal sarcoidosis predated our airway service. Laryngeal sarcoidosis is rare and typically affects middle-aged females Presenting symptoms typically relate to airway and voice, less so, dysphagia Systemic manifestations are common Medical management is often required with intermittent surgical intervention Multidisciplinary management is crucial, including physician, surgeon and speech therapist INTRODUCTION Sarcoidosis is a multi-system, non-caseating granulomatous condition of unknown aetiology, typically affecting the lung. Of the 30 patients who underwent surgical treatment, the average age at diagnosis was 39.8 years old, which is consistent with other studies.2 Given the relatively early age of onset and prominent symptoms, patients inevitably require medical and/or surgical intervention. [Extracted from the article]

In this study we aimed to explore the effects of epidural analgesia achieved by a combination of low-dose bupivacaine and fentanyl infused through an epidural catheter on mother, foetus and labour process in nulliparous at-term pregnant women during vaginal delivery. This study was designed in a prospective, randomised controlled manner. Epidural analgesia was achieved in 50 nulliparous women. Fifty nulliparous women did not undergo epidural analgesia procedure. The duration of the first stage of labour was significantly shortened, while the second stage was significantly lengthened in pregnant women who underwent epidural analgesia (p < 0.05). In conclusion, starting epidural analgesia application during the active phase of the first stage of labour may shorten the duration of the first stage compared with the group of nulliparous women not undergoing epidural analgesia. The factor that has an impact on this may be the addition of fentanyl to bupivacaine used for epidural analgesia. [ABSTRACT FROM AUTHOR]

Purpose: The use of nasal decongestant and nasal anaesthesia is currently not recommended during drug-induced sleep endoscopy (DISE) according to the European position paper. The evaluation of the effects of nasal decongestant/anaesthesia on DISE has not been performed before and our aim is to perform a pilot study to determine whether nasal decongestants/anaesthesia affects DISE outcomes. Methods: 27 patients undergoing DISE for OSA or for simple snoring were included. On each patient, DISE was performed twice, before and approximately 10 min after the administration of two puffs of co-phenylcaine nasal spray (lidocaine hydrochloride 5%, phenylephrine 0.5%, and benzalkonium chloride 0.01%) into each nostril. A nasal peak inspiratory flow was used for the objective assessment of nasal airway obstruction. During the first and the second DISE the loudness of the snoring was also recorded. Results: Change in DISE total grading after nasal spray administration was not statistically significant. For the same grading, changes in percentage of contribution to collapse were not statistically significant. Sex, AHI, BMI, tonsils grade, presence of rhinitis, turbinate hypertrophy, nasal septal deviation, or nasal peak inspiratory flow limitation had no influence on the effect of nasal spray. Co-phenylcaine did not significantly influence the loudness of snoring. Conclusions: Our pilot study supports the use of co-phenylcaine nasal spray during DISE and the positive effects of the nasal spray do not influence the grading outcome. Importantly, the decongestant enhances the nasal assessment during DISE and potentially aids in the diagnosis of nasal obstruction while the nasal anaesthetic component may be beneficial by reducing nasal discomfort during DISE and thereby helping to reduce the total dose of intravenous anaesthetic administered. However, further studies on a larger population are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Voltage-gated K+ channels composed of Kv7.2 and Kv7.3 are the predominant contributors to the M-current, which plays a key role in controlling neuronal activity. Various lines of evidence have indicated that Kv7.2 and Kv7.3 form a heteromeric channel. However, the subunit stoichiometry and arrangement within this putative heteromer are so far unknown. Here, we have addressed this question using atomic force microscopy imaging of complexes between isolated Kv7.2/Kv7.3 channels and antibodies to epitope tags on the two subunits, Myc on Kv7.2 and HA on Kv7.3. Initially, tsA 201 cells were transiently transfected with equal amounts of cDNA for the two subunits. The heteromer was isolated through binding of either tag to immunoaffinity beads and then decorated with antibodies to the other tag. In both cases, the distribution of angles between pairs of bound antibodies had two peaks, at around 90° and around 180°, and in both cases the 90° peak was about double the size of the 180° peak. These results indicate that the Kv7.2/Kv7.3 heteromer generated by cells expressing approximately equal amounts of the two subunits assembles as a tetramer with a predominantly 2:2 subunit stoichiometry and with a random subunit arrangement.WhentheDNAratio for the two subunits was varied, copurification experiments indicated that the subunit stoichiometry was variable and not fixed at 2:2. Hence, there are no constraints on either the subunit stoichiometry or the subunit arrangement. [ABSTRACT FROM AUTHOR]