Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing

<p>Abstract</p> <p>Background</p> <p>Sensory input is crucial to the initiation and modulation of swallowing. From a clinical point of view, oropharyngeal sensory deficits have been shown to be an important cause of dysphagia and aspiration in stroke patients. In the present study we therefore investigated effects of functional oropharyngeal disruption on the cortical control of swallowing. We employed whole-head MEG to study cortical activity during self-paced volitional swallowing with and without topical oropharyngeal anesthesia in ten healthy subjects. A simple swallowing screening-test confirmed that anesthesia caused swallowing difficulties with decreased swallowing speed and reduced volume per swallow in all subjects investigated. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of the individual SAM data was performed using a permutation test.</p> <p>Results</p> <p>The analysis of normal swallowing revealed bilateral activation of the mid-lateral primary sensorimotor cortex. Oropharyngeal anesthesia led to a pronounced decrease of both sensory and motor activation.</p> <p>Conclusion</p> <p>Our results suggest that a short-term decrease in oropharyngeal sensory input impedes the cortical control of swallowing. Apart from diminished sensory activity, a reduced activation of the primary motor cortex was found. These findings facilitate our understanding of the pathophysiology of dysphagia.</p

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Adult Burkitt lymphoma originating in the sphenoid sinus: case report and review of the literature.

Burkitt lymphoma is a high-grade B-cell non-Hodgkin lymphoma. The endemic form of this malignancy occurs primarily in children aged 5 to 7 years, and it presents with jaw and facial bone involvement. The sporadic form affects older children (mean age: 12.2 yr) and often manifests as an abdominal mass; it rarely involves the head and neck. The presence of any type of lymphoma in the paranasal sinuses is rare. We report a case of Burkitt lymphoma that originated in the sphenoid sinus in a 66-year-old white woman. The patient presented with hypoesthesia in the left V1 and V2 distributions and frequent left-sided headaches. Imaging revealed that the destructive lesion had spread into the cavernous sinus and infratemporal fossa. Repeat imaging showed progression of the lesion in just 1 month. An endoscopic sphenoidotomy was performed to obtain a tissue specimen, and a diagnosis of sporadic Burkitt lymphoma was established on the basis of its clinical, morphologic, and immunohistochemical characteristics. The patient underwent chemotherapy and radiation. Short-term follow-up imaging showed that the lesion had disappeared, and the patient remained disease-free at 3 years of follow-up. This case is one of the few reported cases of true adult Burkitt lymphoma originating in the sphenoid sinus. We discuss the rapid progression of the disease and the considerable amount of invasion that can occur with minimal symptoms

Conclusion: Perspectives on the Politics of Abortion

Perspectives on the Politics of Abortion examines the abortion issue from ethical, empirical, and legal angles and offers some rather unconventional analyses and surprising conclusions with regard to this familiar issue. One chapter argues that the emphasis on rights has made illegal and occasionally violent activity on the part of pro-life activists increasingly likely. Another chapter suggests that abortion is an instance of the more general right to self-defense. A chapter considers the problem of abortion from the standpoint of participants in the political process. And chapters examine the political tactics of the Roman Catholic Church and abortion rights in terms of constitutional due process. This important volume adds new voices and perspectives to the abortion debate

Lasers and Losers in the Eyes of the Law Liability for Head and Neck Procedures

IMPORTANCE Although some have noted that malpractice litigation may be plateauing, defensive medical practices are pervasive and make up a considerable proportion of the indirect costs medicolegal issues contribute toward our health care system. Accordingly, these trends have spurred considerable interest in characterizing factors that play a role in alleged medical negligence, along with outcomes and awards. OBJECTIVES To conduct a focused examination of malpractice litigation regarding laser procedures in the head and neck and to determine the reasons for initiating litigation as well as outcomes and awards. DESIGN AND SETTING Retrospective analysis of the WestlawNext legal database, encompassing publicly available federal and state court records, to identify malpractice cases involving laser procedures in the head and neck. MAIN OUTCOMES AND MEASURES Outcomes, awards, defendant specialty, and other allegations. RESULTS Most cases (28 [82%]) included in this analysis involved female plaintiffs. Of 34 cases, 19 (56%) were resolved with a defendant verdict. The median indemnity was $150 000, and dermatologists, otolaryngologists, and plastic surgeons were the most commonly named defendants. The most common procedures were performed for age-related changes, acne scarring, hair removal, and vascular lesions, although there were also several rhinologic and airway cases. Of all cases, 25 (74$600 000 vs $103 000), although this comparison did not reach statistical significance (P = .09). CONCLUSIONS AND RELEVANCE Procedures using lasers represent a potential target for malpractice litigation should an adverse event occur. Although cutaneous/cosmetic procedures were noted among cases included in this analysis, as well as other head and neck interventions, otolaryngologists were more likely to be named as defendants in the latter category. Although cases had modest indemnities compared with prior analyses, the potential for significant amounts was present. Inclusion into the informed consent process of specific factors detailed in this analysis may potentially decrease liability. In addition, physicians and patients should undergo comprehensive discussion regarding expectations as well as contingencies should adverse events occur

Voicing an impact: who does the National Institutes of Health support for voice disorder research?

PURPOSE: Interest in a variety of neoplastic, functional, neurological, and age-related laryngeal disorders has contributed to the development of laryngology as an established subspecialty. Funding support plays a critical role in facilitating scholarship within the field. Our objectives were to evaluate who is receiving funding from the NIH for topics relevant to voice disorders, and further describe temporal trends in grants awarded. METHODS: The NIH RePORTER database was searched for grants relevant to voice disorders. Data were further organized by PI specialty, academic department, and funding totals. Furthermore, PI scholarly impact, as measured by the h-index, was calculated. RESULTS: A total of 830 funded fiscal years (for 232 unique projects) totaling $203 million have supported projects examining voice disorders. A plurality of projects (32.8%) was awarded to PIs in otolaryngology departments, followed by 17.2% to speech pathology/communication sciences departments. Although year-to-year variation was noted, otolaryngology departments received approximately 15% of funding annually. Funded otolaryngologists had similar scholarly impact values to individuals in other specialties. CONCLUSIONS: The study of voice disorders involves an interdisciplinary approach, as PIs in numerous specialties receive NIH funding support. As they receive a considerable proportion of this funding and had similar h-indices compared to other specialties involved, otolaryngologists have just as much scholarly impact despite being a smaller specialty. As speech and language pathologists also comprised a significant proportion of individuals in this analysis, enhanced cooperation and encouragement of interdisciplinary scholarly initiatives may be beneficial