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Objective Stapes surgery is technically challenging, yet its methodology is not standardized. We aim to elucidate preferences in stapes surgery among American Otological Society (AOS) otologists and determine if any common practice patterns exist. Study design Cross-sectional study via emailed questionnaire. Setting Surgery centers. Subjects and methods Members of the AOS were an emailed a survey to quantify variables including surgical volume, anesthetic preference, laser use, type of procedure, footplate sealing technique, antibiotic use, and trainee participation. Results Most otologists (71%) performed 2 to 5 stapes surgeries per month under general anesthesia (69%) with stapedotomy (71%) as the preferred procedure. Most (56%) used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration. Either the handheld potassium titanyl phosphate (KTP) laser (40%) or handheld carbon dioxide (CO2) laser (33%) was used. The heat-activated memory hook (51%) was the preferred prosthesis. Footplate sealing method was variable, as was antibiotic use among respondents. Trainee participation was limited, as 42% of otologists allowed residents to place the prosthesis, and fewer allowed residents to crimp the prosthesis, and laser or drill the footplate. Surgeons with higher surgical volume (≥ 6 surgeries per month) demonstrated the following statistically significant correlations: footplate fenestration with laser in a rosette pattern and pick for debris removal (rs = −0.365, P = 0.014) and trainee participation with fellows only (rs = 0.341, P = 0.022). Conclusions Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

OBJECTIVE To define and quantify common points and relationships within the anterior nasal septum and recognize the anatomic curvature of the dorsal and caudal septum as arcs with certain rises. STUDY DESIGN Case series study. METHODS Forty cadaveric quadrangular cartilages were dissected. Points along the septum were defined and relationships measured. Angles that composed the anterior septum using values that did account for the curvature of the anterior nasal septum, or classical L-strut values, were compared to C-strut values, which included rises away from the L-strut. RESULTS The mean arc of the nasal septum dorsum was significantly longer than the caudal arc (25.9 ± 5.14 mm vs. 23.96 ± 4.07 mm, P = 0.048); the mean rise of the dorsal arc was significantly shorter than the rise of the caudal arc (3.04 ± 1.25 mm vs. 3.88 ± 1.42 mm, P = 0.006). The mean point of furthest rise of the dorsal arc was slightly anterior to the midpoint of the dorsal strut (13.43 ± 5.07 mm); the mean caudal equivalent was slightly posterior to the midpoint of the caudal strut (8.55 ± 4.33 mm). Septal angles measured using L-strut versus C-strut values were significantly different. CONCLUSION The L-strut leading edge is not congruent with the anatomic septum and can be better described as a C-strut with arcs and rises away from classically interpreted straight L-strut lines, all of which may guide surgeons in the creation of a more natural, supportive cartilage framework while encouraging quantifiable septorhinoplasty teaching. LEVEL OF EVIDENCE NA. Laryngoscope, 1806-1810, 2018.

Burning mouth syndrome (BMS) is a chronic oral pain syndrome that primarily affects peri- and postmenopausal women. It is characterized by oral mucosal burning and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. The etiology of the disease process is unknown, but is thought to be neuropathic in origin. The goal of this systematic review was to assess the efficacy of the various treatments for BMS. Literature searches were conducted through PubMed, Web of Science, and Cochrane Library databases, which identified 22 randomized controlled trials. Eight studies examined alpha-lipoic acid (ALA), three clonazepam, three psychotherapy, and two capsaicin, which all showed modest evidence of potentially decreasing pain/burning. Gabapentin was seen in one study to work alone and synergistically with ALA. Other treatments included vitamins, benzydamine hydrochloride, bupivacaine, Catuama, olive oil, trazodone, urea, and Hypericum perforatum. Of these other treatments, Catuama and bupivacaine were the only ones with significant positive results in symptom improvement. ALA, topical clonazepam, gabapentin, and psychotherapy may provide modest relief of pain in BMS. Gabapentin may also boost the effect of ALA. Capsaicin is limited by its side effects. Catuama showed potential for benefit. Future studies with standardized methodology and outcomes containing more patients are needed.

To examine aspects of litigation involving iatrogenic dysphonia and injury to the recurrent laryngeal nerve in the adult population.Legal database review.Medicolegal judicial system.Jury verdicts and settlement reports listing voice impairment or recurrent laryngeal nerve dysfunction as a primary injury in adult patients were identified in the Westlaw Database. Reports were examined for plaintiff demographics, defendant specialty, procedure performed, rates of settlements and verdicts, monetary awards, primary plaintiff symptoms, and common allegations.A total of 123 jury verdict and settlement reports were identified. General surgeons (24%), otolaryngologists (20%), and anesthesiologists (18%) were involved in the majority of cases. The procedure causing the alleged injury was primarily thyroidectomy (34%), followed by intubation (18%) and spinal instrumentation (10%). The majority of cases (70%) were decided in favor of the defendant. Where monetary awards were recorded, settlements and jury verdicts in favor of the plaintiff ranged between $4250 and $3,000,000, with a mean of $788,713. In addition to voice disturbances, complaints of dyspnea and dysphagia were commonly listed alleged injuries. The only factors associated with plaintiff verdicts were general surgery specialty (odds ratio, 6.3; 95% confidence interval, 1.7-23.2) and claims of loss of consortium (odds ratio, 8.5; 95% confidence interval, 1.2-60.7).Dysphonia is a common complication in a number of procedures across multiple specialties. Although the majority of cases are decided in favor or the defendant, payments awarded can be considerable. Awareness of factors involved in these medical malpractice cases can help limit physician liability.

Objectives/Hypothesis To evaluate the postoperative course of children who underwent coblation T&A versus those who underwent coblation partial intracapsular tonsillectomy and adenoidectomy (PITA). Study Design Retrospective cohort study. Methods Records of children undergoing consecutive tonsillectomies from July 2009 to October 2012 were analyzed. All surgeries used a coblation device. Outcomes including intraoperative and postoperative bleeding, pain, and return to preoperative diet were analyzed comparing the coblation T&A and coblation PITA patients. Results Of 415 patients evaluated, 258 (62.2%) underwent coblation T&A and 157 (37.8%) underwent coblation PITA. Seventeen (4.1%) patients experienced postoperative hemorrhage, 15 (88.2%) of whom underwent T&A and two (11.8%) of whom underwent PITA (P = 0.024). Multivariate analysis demonstrated that coblation T&A was a significant contributor to postoperative hemorrhage, with an odds ratio of 4.8 (95% confidence interval [CI]: 1.08–21.21) compared to coblation PITA. Patients who underwent T&A resumed normal diets significantly later (8 days, SD 4.6) than those who underwent PITA (5.4 days, standard deviation [SD]: 3.4) (P = 0.022). In terms of pain severity, more T&A patients reported “severe” pain and more PITA patients reported “moderate” pain (P = 0.047). More T&A patients experienced a “post-op dip,” defined as increased pain during postoperative days 5–9, than did PITA patients (P

To analyze the dental health of patients with head and neck cancer who received comprehensive dental care after intensity-modulated radiation therapy (IMRT) compared with radiation therapy (RT).Historical cohort study.Veteran Affairs (VA) hospital.In total, 158 patients at a single VA hospital who were treated with RT or IMRT between 2003 and 2011 were identified. A complete dental evaluation was performed prior to radiation treatment, including periodontal probing, tooth profile, cavity check, and mobility. The dental treatment plan was formulated to eliminate current and potential dental disease. The rates of dental extractions, infections, caries, mucositis, xerostomia, and osteoradionecrosis (ORN) were analyzed, and a comparison was made between patients treated with IMRT and those treated with RT.Of the 158 patients, 99 were treated with RT and 59 were treated with IMRT. Compared with those treated with IMRT, significantly more patients treated with RT exhibited xerostomia (46.5% vs 16.9%; P.001; odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11-0.52), mucositis (46.5% vs 16.9%; P.001; OR, 0.24; 95% CI, 0.11-0.52), and ORN (10.1% vs 0%; P = .014; OR, 0.07; 95% CI, 0.00-1.21). However, significantly more patients treated with IMRT were edentulous by the conclusion of radiation treatment (32.2% vs 11.1%; P = .002; OR, 3.8; 95% CI, 1.65-8.73).Patients who were treated with IMRT had fewer instances of dental disease, more salivary flow, and fewer requisite posttreatment extractions compared with those treated with RT. The number of posttreatment extractions has been reduced with the advent of IMRT and more so with a complete dental evaluation prior to treatment.

ObjectiveTo evaluate a swallow preservation protocol (SPP) in which patients received swallow therapy before, during, and after radiation treatment and its efficacy in maintaining swallowing function in head and neck cancer patients.DesignCase series with chart review.SettingTertiary care academic medical center.Subjects and methodsEighty-five patients who received radiation (RT) or chemoradiation (CRT) participated in the SPP from 2007 to 2012. Subjects were divided into 2 groups: compliant and noncompliant with SPP. At each SPP visit, the diet of each patient was recorded as regular (chewable), puree, liquid, or gastrostomy tube (G-tube) dependent, along with their compliance with the swallow exercises. Patients were stratified by age, gender, tumor stage, type of treatment, radiation dose, diet change, dysguesia, odynophagia, pain, and stenosis. Statistical analysis was performed comparing the 2 compliance groups in regards to swallowing-related outcomes at 1 month after completion of therapy.ResultsFifty-seven patients were compliant and 28 were noncompliant with SPP during treatment. The compliant group had a higher percentage of patients tolerating a regular diet (54.4% vs 21.4%, P = .008), a lower G-tube dependence (22.8% vs 53.6%, P = .008), and a higher rate of maintaining or improving their diet (54.4% vs 25.0%, P = .025) compared to noncompliant patients.ConclusionA swallow preservation protocol appears to help maintain or improve swallow function in head and neck cancer patients undergoing RT or CRT. Patients who are able to comply with swallow exercises are less likely to worsen their diet, receive a G-tube, or develop stenosis.

Passive approaches for vibration-free handling of deformable beams are investigated in this article. Dynamic equations of a flexible beam handled by robot end-effectors are formulated and analyzed first. From the analysis, it is revealed that the inertia forces caused by the beam motion may affect the vibration of the beam in certain motion patterns. Motion trajectories of the end-effector that lead to a small or no vibration of the beam in these motion patterns are then specified. Because vibrations cannot be totally eliminated even if the vibration-free motion trajectory is employed, another passive approach is further suggested. The approach employs a rubber pad in parallel with a spring installed on the fingers of the end-effector. To understand the effectiveness of this passive approach, damped vibration and optimal damping are investigated. Experiments and simulations are conducted to verify the above two methods. The experiments display the vibration-free motion of the beam using the proposed motion planning strategy. The simulation results demonstrate the effects of the vibration-free trajectory and the passive damping. © 1995 John Wiley & Sons, Inc.

Using vision sensors to study object deformation is introduced in this article. The vision sensor is used to identify the deformation characteristic and estimate the deformation behavior of flexible beams. First, a nonlinear equation describing the deformation of the beam is given. Then, cubic spline functions are used to approximate the contour of the deformed beam after the beam is detected by the vision sensor. Using the cubic spline approximation and Maclaurin's series expansion, a procedure to determine the deformation characteristic is formulated. To estimate the deformation behavior, numerical differential method to solve the nonlinear equation is used. The error of this numerical method can be controlled with the aid of the vision sensor. Finally, experimental results are given to verify that the proposed methods are effective.