Factors Associated with Xerostomia in Non-Radiated Patients

Objective: To identify factors significantly associated with xerostomia in non-radiated patients. Methods: Patients who attended the outpatient otolaryngology clinic at Siriraj Hospital (Bangkok, Thailand) with complaints of dry mouth were invited to join this study. Collected data included age, gender, body mass index, smoking status, alcohol use, underlying disease, and previous medication and/or therapy. Irradiated patients were excluded. Participants were classified into either the diseased or xerostomia group by abnormal oral cavity examination and symptoms, or the no xerostomia group, which was defined as dry mouth symptoms with no presence of abnormal physical findings. Results: Two hundred and two participants with a history of dry mouth were consecutively enrolled. There were 86 patients with physical findings compatible with xerostomia, and 116 symptomatic patients without xerostomia. Multivariate analysis revealed age over 50 years (adjusted odds ratio [aOR]: 3.1, 95% confidence interval [CI]: 1.3-7.9; p=0.012), analgesic and muscle relaxant intake (aOR: 3.6, 95% CI: 1.3-9.7; p=0.012), psychotherapeutic medication (aOR: 7.8, 95% CI: 2.6-23.7; p<0.001), and radioactive iodine therapy (aOR: 3.7, 95% CI: 1.2-11.8; p=0.015) to be independent predictors of xerostomia. Conclusion: Xerostomia is a condition that can adversely affect quality of life. The results of this study revealed older age (≥50 years), analgesics and muscle relaxants, psychotherapeutic medications, and radioactive iodine therapy to be significantly associated with xerostomia. A thorough understanding of the symptoms, diagnosis, relevant risk factors, and effective management is essential for improving outcomes among patients with xerostomia.   

Simulated Surgical Model Design for Myringotomy and Tympanostomy Tube Insertion in Children using Medical Image Processing and 3D-Printing Technologies

Objective: Researchers aimed to design surgical simulation models using medical image processing and 3D-printing technologies to train otolaryngologie residents with correct surgical techniques and study their skills improvement. Materials and Methods: The models were produced for three age ranges (group A: 8-12 years old, group B: 3-7 years old, and group C: 10 months - 2 years old). Eleven residents were practiced from older to younger child models. Overall surgical time and results were evaluated to determine improvement. Both residents and specialists assessed satisfaction surveys after training. Results: The median operational time was significantly reduced by 64.57% in model A and 50.24% in model B (p < 0.05). Operating time and surgical skills improved in order from models A, B, and C. Model C showed the most improvement with correct operational techniques in myringotomy incision (66.7%, p = 0.003) and tympanostomy tube insertion (48.5%, p = 0.011). Residents’ and specialists’ satisfaction assessments exhibited prominent satisfaction results with surgical simulation model training. Conclusion: Surgical simulation models training enhanced residencies’ confidence and improved correct surgical techniques. Residencies can gradually practice skills from fundamental to more complicated techniques in younger child model where symptom occurs

Improving International Standards in Surgical and Procedural Training through Comparative Operative Log Growth Charts

Objective: To use these growth charts to critically assess sufficiency of cases and parity of cases between residents, and to compare these growth charts to available international standards for minimum case numbers. Methods: Operative Log Growth Charts were developed for key indicator procedures for graduating otolaryngology residents in 2012-2014 at a large teaching hospital in the capital city of a newly industrialized country. Comparisons were made between years of training and required minimum case numbers published by the ACGME RRC for Otolaryngology. Results: Data was available to create 7 key indicator operative log growth charts to include all available data from 2012-2014 residents. These growth charts were used to assess growth in operative procedures for residents in the program compared to historical norms in the program. Graduating residents surpassed ACGME minimum case numbers in Bronchoscopy only and were below the minimum numbers for the other key indicators tested. Conclusion: There is significant heterogeneity in the standards for otolaryngology training between countries. It is possible to develop program-specific and country-specific operative log growth charts

Association of cleft palate and craniofacial syndromic anomalies with the outcome of tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion

This research was aimed to study the association of cleft palate and craniofacial syndromic anomalies with the outcome of the tympanic membrane after tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion. A retrospective cohort study was done in 85 children with cleft palate and 102 non-cleft children who had tympanostomy tube insertion for otitis media with effusion. The desired outcome was the recovery of recurrent otitis media with effusion with intact tympanic membrane. Craniofacial syndromic anomalies were found in 11.8% of the children in both groups. Intact tympanic membrane was found most commonly in noncleft children without craniofacial anomalies (63.7%). Cleft palate was the most significant risk for the non-intact tympanic membrane after adjusting for syndromic anomalies and the number of tympanostomy tube insertion (p = 0.047). Time to recovery from recurrent otitis media with effusion was shortest in the non-cleft children without craniofacial anomalies (4.9 years) with the highest probability of cure (hazard ratio and 95% CI 3.46 (1.62, 7.39)). Children with cleft palate had higher probability of cure than the children with cleft palate and craniofacial syndromic anomalies (hazard ratio and 95% CI 2.59 (1.16, 5.80)). Children with cleft palate and craniofacial syndromic anomalies had highest incidence of otorrhea (59.1%) and repeated tympanostomy tube insertion (86.4%). Craniofacial syndromic anomalies with cleft palate contributed to a longer time to recovery and higher incidence of complications from tympanostomy tube

Long-term Outcome of the Management of Otitis Media with Effusion in Children with and Without Cleft Palate Using the House-brand Polyethylene Ventilation Tube Insertion

Objective: To study the long-term outcome of otitis media with effusion in children with and without cleft palate treated with the same protocol of ventilation tube insertion. Materials and Methods: A retrospective cohort study was conducted in eighty-five children with cleft palate and 80 children without cleft palate who had otitis media with effusion and had follow-up between 2001 and 2019. Both groups were treated with ventilation tube insertion for longstanding middle ear effusion more than 90 days. The main outcome was the cumulative incidence of surgical management, time of the indwelling ventilation tubes, conditions of the tympanic membrane, and the hearing outcome. Results: At 24 months old, 63.5% of children with cleft palate and 11.3% of children without cleft palate had their first ventilation tube insertion. Repeated surgery was done in 81.2% of children with cleft palate and 50% of children without cleft palate (p < 0.001). The median duration of the indwelling tube was 11.3 months in the children with cleft palate and 12.4 months in the non-cleft children (p = 0.82). At the end of the study, 63.7% of children without cleft palate and 43.5% of children with cleft palate had normal tympanic membrane (p = 0.009). The hearing outcomes of children with and without cleft palate were 20.7 dB and 19.3 dB, respectively. Conclusion: Children with and without cleft palate were managed under the same guideline and the hearing outcome was favorable in both groups