Study to assess proper timing of laryngoscopy in post-thyroid surgery patients to detect recurrent laryngeal nerve injury

Background: Thyroid surgeries are commonly done nowadays for benign and malignant conditions. Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. The purpose of the study was to determine the impact of rigid endoscopy (Hopkins rod-lens telescope) performed at different time intervals on the diagnosis of RLNP in post-thyroid surgery patients. Aims and Objectives: To assess Proper Timing of Laryngoscopy in Post-thyroid Surgery patients to Detect RLN Injury. Materials and Methods: Rigid endoscopy was performed postoperatively at day 0 (T0), at 2nd day post-op (T1), and day 14 (T2). For patients with RLNP, repeated examinations were performed at 2 months (T3), 6 months (T4), and 12 months (T5). Results: The study included 50 patients of thyroid swelling with different diagnoses. Overall, 35 patients appeared for postoperative laryngoscopic examination of the vocal folds at our center, providing 61 nerves at risk. RLNP rate was 8.1% at T0, 11.5% at T1, 9.8% at T2, 8.1% at T3, 4.9% at T4, and 3.3% at T5. T1 was significantly superior to all other time intervals in terms of diagnosis of RLNP but statistically not significant. Conclusion: Rigid endoscopy is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord morbidity with great and significant variability of results. Second day post-op inspection of the larynx (T1) is suggested.

Challenges in treating patients with foreign bodies in hypopharynx and esophagus: our experience in a tertiary care hospital

<p><strong>Background: </strong>Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngologic emergencies. Every new case poses a clinical challenge with need for optimal treatment strategy. The objective of our study is to highlight a few of the challenges faced while treating these patients.</p><p><strong>Methods:</strong> A prospective study was done on all patients who reported to the ENT casualty, Government Medical College Kozhikode with history or suspicion of foreign body throat from January 2020 to January 2021. A total of 160 patients reported of which 48 (30%) patients required further evaluation with rigid endoscopy and foreign body removal in the operative room. A few challenges like migration of foreign bodies, dilemma in diagnosis with FB mimicking ossified cartilages on X-ray, FB removal in mentally challenged patients and treatment of esophageal perforation post rigid endoscopy are discussed.</p><p><strong>Results: </strong>Only 48 (30%) patients of the total 160 patients required rigid endoscopy and foreign body removal in the operating room. The foreign body was obtained in 42 (87.5%) patients while 6 (12.5%) patients improved post rigid endoscopy though foreign body was not obtained. One patient with denture in the esophagus developed esophageal perforation requiring prolonged hospital stay.</p><p><strong>Conclusions:</strong> A high index of suspicion among patients presenting with dysphagia, neck pain and sudden decrease in food intake is warranted. Early diagnosis with appropriate imaging modalities is essential for confirmation of diagnosis. Dentures are among FBs that necessitate more caution. Esophageal perforation, a rare but life-threatening complication must be diagnosed timely with appropriate surgical intervention.</p>

749 Unexpected benefits of pandemic guidelines for the management of epistaxis

Aim The Royal Victoria Hospital adopted ENT UK’s pandemic guidelines for the management of epistaxis. We aimed to reduce ENT referrals, in-patient admissions and staff exposure to COVID-19 whilst maintaining patient safety. This involved collaboration with ED to promote the use of absorbable packs and pharmacological alternatives over rhinoscopy & rigid endoscopy with cautery +/- non-absorbable packs. Method Data was collected on patients presenting with epistaxis over a six-week period beginning March 2020 and the same period in 2019. Key factors recorded were number of presentations, ENT referrals, admissions, and their durations, along with management and outcomes. ENT provided training to ED staff and produced video resources for the "My ED" app. Feedback from ED and patient data was gathered to improve training and assess effectiveness. Results Pre-pandemic, 48% of ED epistaxis presentations were referred to ENT vs. 28% following the guidelines introduction. In 2019 49% of referrals were admitted vs. 42% in 2020. The average in-patient stay was reduced from four nights to one. Re-admission rate remained similar from 22% in 2019 to 20% in 2020. These results were achieved following repeated improvements to the training sessions. Conclusions The ENT UK guidelines, when supplemented with ED collaboration, are effective at reducing ENT referrals and admissions. In addition to reducing COVID-19 exposure, the guidelines offered an improved patient experience (less invasive intervention, reduced/removed in-patient stay) with no loss of efficacy. This, combined with a reduced treatment cost of ∼£2,000 per in-patient, suggests the guidelines have long-term value out-with a pandemic setting.

Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus

OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored–matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5–57.5 vs 62.5, IQR 50–70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.