Faculty Bibliography

INTRODUCTION/BACKGROUND:This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis. METHODS:A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "facial," "synkinesis," "palsy," and various combinations of the terms. RESULTS:The resultant inability to control the full extent of one's facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms. DISCUSSION/CONCLUSIONS:A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.

PURPOSE OF REVIEW/OBJECTIVE:The larynx is a complex organ that houses some of the most intricate structures of the human body. Owing to its delicate nature, the larynx is affected by different medications to varying degrees. Many of these effects manifest in subjective complaints in one's voice or swallow. This review article invokes the present available literature to describe the effects different medical agents have on the functionality of the laryngeal structures. RECENT FINDINGS/RESULTS:Multiple available studies explore the effects of inhaled corticosteroids on the larynx. While laryngeal candidiasis is a well known complication of chronic steroid use, other rarer fungal infections have also demonstrated themselves as risks. Among anesthetics, the literature suggests that sevoflurane in standard and high doses does not appear to significantly reduce the risk of laryngospasm. The use of topical and intravenous lidocaine appear to have conflicting evidence regarding their use in laryngospasm prevention, whereas postoperative sore throat, hoarseness, and cough may be prevented with preinduction nebulization of ketamine and magnesium sulfate or budesonide. SUMMARY/CONCLUSIONS:Further study is warranted to explore the effects that these and other classes of agents, such as antibiotics, have on the structure and function of the larynx.

BACKGROUND:) and tarsal marginal show (TMS) may be more sensitive in identifying eyelid retraction and eversion. METHODS:This is a cohort study of consecutive patients undergoing lower blepharoplasty with skin pinch removal, laser resurfacing, or skin pinch removal with prophylactic lateral canthal resuspension. Mean follow-up was 22.1 weeks. RESULTS:in the skin pinch with canthoplasty group compared to that in the skin pinch only group (p < 0.05). TMS was significantly increased after both laser resurfacing (p < 0.001) and skin pinch only (p < 0.05), and both postoperative groups demonstrated significantly increased TMS compared to skin pinch with canthoplasty (p < 0.05). CONCLUSIONS:and TMS are more sensitive markers for lower eyelid retraction than MRD2. Subtle eyelid retraction and eversion occur after anterior lamellar work and can be prevented with prophylactic lateral canthal resuspension.

OBJECTIVE: Our objective was to determine the developmental status of young children with sleep-disordered breathing (SDB) as measured by the Ages and Stages Questionnaire (ASQ-3) and to evaluate improvement after treatment. METHODS: The ASQ-3 was completed at entry, 3 months and 6 months after adenotonsillectomy or adenoidectomy. The questionnaire consists of 30 items that assess five domains: communication, gross motor, fine motor, problem solving and personal-social. Domain scores were compared with normative values: abnormal >/=2 SDs and borderline >/=1 but <2 SDs below the mean. RESULTS: 80 children, mean (SD) age 3.0 (0.94) years, 62.5% male, 77.5% African American, were enrolled. Median (range) apnea-hypopnea index (AHI) was 12.6 (1.4-178.5). At entry, 22 (27.5%) children scored in the abnormal range in at least one developmental area and an additional 23 (28.8%) had at least one borderline score. A generalized linear model including gender, AHI, maternal education and prematurity showed that only prematurity was an independent predictor of at least one abnormal or borderline entry score (likelihood ratio test p < 0.001). Adjusting for covariates and excluding children with a history of prematurity, the prevalence of at least one abnormal or borderline score (based on 112 observations of 70 children) was estimated at 49% (95% CI [37, 62]) at baseline; 34% (95% CI [17, 56]) at 3 months; and 22% (95% CI [10, 41]) at 6 months. Post-hoc pairwise comparison of time points showed the baseline versus 6-month difference to be statistically significant (p = 0.015). CONCLUSIONS: The 27.5% baseline prevalence of abnormal ASQ scores in children with SDB indicates it is a risk factor for developmental delay. Significant improvements in score classifications were found 6 months after surgery.

OBJECTIVE:To analyze existing tinnitus treatment trials with regard to eligibility criteria, outcome measures, study quality, and external validity and to recognize the effect of patient demographics, symptom duration, severity, and otologic comorbidity on research findings to help practitioners apply them to patient encounters. DATA SOURCES/METHODS:Systematic literature search conducted by an information specialist for development of the American Academy of Otolaryngology-Head and Neck Surgery Foundation's tinnitus clinical practice guideline. REVIEW METHODS/METHODS:Articles were assessed for eligibility with the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and data extracted by 2 independent investigators. Studies were assessed for methodological quality, inclusion and exclusion criteria, patient demographics, and outcome measures. RESULTS:A total of 147 randomized trials met inclusion criteria. Nearly all studies took place in a specialist setting. More than 50% did not explicitly define tinnitus, and 44% used a subjective severity threshold, such as "severely disturbing." Fifty-four percent required symptom duration of at least 6 months for study eligibility, and up to 33% excluded patients with "organic" hearing loss or otologic conditions. Mean age was 52.2 years, and median follow-up was 3 months. Only 20% had a low risk of bias. CONCLUSION/CONCLUSIONS:Randomized trials of tinnitus interventions are most applicable to older adults with tinnitus lasting ≥ 6 months who are evaluated in specialty settings. High risk of bias, short follow-up, and outcome reporting raise concerns about the validity of findings and may influence how clinicians apply trial results to individual patients and establish treatment expectations, thus demonstrating the need for further quality research in this field.