Pain perception of children undergoing nasendoscopy for investigation of voice and resonance disorders

Pain in Tourette Syndrome-Children’s and Parents’ Perspectives

Tourette Syndrome (TS) is a neurodevelopmental condition characterized by the presence of tics and associated behavioral problems. Yale Global Tic Severity Scale (YGTSS), The PedsQL Pediatric Pain Questionnaire, and Pediatric Pain Coping Inventory were used to assess the severity of tics, the severity of the pain, the location of the pain and pain coping strategies both from children’s and parents’ perspectives. Sixty percent of children demonstrated pain (past or present); the pain was reported by 72% of parents raising children with TS. The pain most commonly was cervical, throat, shoulder, ocular, and joint pain; most children declared pain located in more than one part of the body. Consistency between the declarations of children and their parents in coping with pain was observed. Pain should be recognized as a common comorbid aspect of tic disorders in childhood and therapeutic treatment must include the reduction of pain caused by tics.

Virtual Reality as Distraction Analgesia and Anxiolysis for Pediatric Otolaryngology Procedures

OBJECTIVES/HYPOTHESIS

While virtual reality (VR) has been used as analgesia and anxiolysis for invasive procedures, no literature exists on the use of VR in the pediatric otolaryngology setting. The purpose of this study was to determine the efficacy of VR in reducing pain and anxiety for pediatric otolaryngology patients.

STUDY DESIGN

Randomized controlled trial.

METHODS

A total of 53 patients aged 7-17 undergoing in-office nasal endoscopies were included. Patients were randomized to receive VR or standard of care. Procedural pain, anxiety, and satisfaction scores were recorded from patients and caregivers. The physician filled out a childhood emotional manifestation scale (CEMS).

RESULTS

Patients in VR group reported a significant decrease in pain (0.80 ± 1.06 vs. 2.26 ± 2.38, P = .018) and anxiety (9.50 ± 12.48 vs. 38.48 ± 29.83, P = .0002) and increase in procedural satisfaction (6.40 ± 0.77 vs. 4.74 ± 1.74, P = .0002) compared to patients in control group. CEMS scores were significantly reduced in VR group (5.15 ± 0.46 vs. 9.64 ± 5.66, P = .0001) and caregiver anxiety levels were significantly reduced in VR group (11.50 ± 17.67 vs. 27.39 ± 30.48, P = .041) compared to control group. There were no reported side effects. Procedural time did not significantly differ between groups.

CONCLUSIONS

For pediatric otolaryngology patients undergoing in-office nasal endoscopies, VR is a safe and effective form of distraction analgesia and anxiolysis, significantly reducing pain and increasing procedural satisfaction for patients. In addition, VR significantly reduces anxiety for both patients and caregivers without disrupting procedural efficiency and workflow.

LEVEL OF EVIDENCE

2. Laryngoscope, 131:E1714-E1721, 2021.

Patient-related and ENT-related predictive factors based on the pain experienced during flexible nasendoscopy

OBJECTIVES/HYPOTHESIS

The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures.

STUDY DESIGN

Monocentric, randomized, individual prospective study.

METHODS

A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded.

RESULTS

Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience.

CONCLUSION

This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain.

LEVEL OF EVIDENCE

1b.

Acoustic features for identifying constitutions in traditional Chinese medicine

OBJECTIVES

Constitutions are Traditional Chinese Medicine syndromes that are used to classify symptoms. The present study sought to identify objective acoustic features for eight commonly occurring abnormal constitutions.

METHODS

Speech signals were obtained from 281 subjects through a 1-second vowel sound, /a/, uttered by the subjects. For each constitution, differences in acoustic parameters between the low-score and high-score groups were compared.

RESULTS

Subjects in the high-score groups for Yin-deficiency, Qi-deficiency, Phlegm-wet, Blood-stasis, and Qi-depression showed lower acoustic intensities than subjects in the corresponding low-score groups (all p<0.05). Subjects in the high-score groups of Qi-deficiency and Blood-stasis exhibited higher maximum pitches and higher minimum pitches than subjects in the low-score groups (all p<0.01). The average number of zero-crossings was lower in the high-score groups of Qi-deficiency and Blood-stasis than in the low-score groups for both constitutions (p<0.05). Subjects in the high-score group of special diathesis demonstrated higher low-spectral-energy ratios than subjects in the low-score group (p<0.05), and subjects in the high-score group of Blood-stasis had higher middle spectral energy ratios than subjects in the low-score group (p<0.05). In contrast, the middle spectral energy ratio in the high-score group of special diathesis was lower than in its corresponding low-score group (p<0.05). The high spectral energy ratios were lower in the high-score groups for Yin-deficiency and Blood-stasis (both p<0.05) than in the low-score groups.

CONCLUSIONS

The present study identified acoustic features for constitutions and established objective methods for constitutional diagnosis. These acoustic features can potentially be applied in the expert system of Traditional Chinese Medicine for the diagnosis of constitutions in the general population.

A systematic review of faces scales for the self-report of pain intensity in children

CONTEXT

Numerous faces scales have been developed for the measurement of pain intensity in children. It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity, reliability, feasibility, and preference.

OBJECTIVES

To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility.

METHODS

Five major electronic databases were systematically searched for studies that used a faces scale for the self-report measurement of pain intensity in children. Fourteen faces pain scales were identified, of which 4 have undergone extensive psychometric testing: Faces Pain Scale (FPS) (scored 0-6); Faces Pain Scale-Revised (FPS-R) (0-10); Oucher pain scale (0-10); and Wong-Baker Faces Pain Rating Scale (WBFPRS) (0-10). These 4 scales were included in the review. Studies were classified by using psychometric criteria, including construct validity, reliability, and responsiveness, that were established a priori.

RESULTS

From a total of 276 articles retrieved, 182 were screened for psychometric evaluation, and 127 were included. All 4 faces pain scales were found to be adequately supported by psychometric data. When given a choice between faces scales, children preferred the WBFPRS. Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS.

CONCLUSIONS

For clinical use, we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use. For research use, the FPS-R has been recommended on the basis of utility and psychometric features. Data are sparse for children below the age of 5 years, and future research should focus on simplified measures, instructions, and anchors for these younger children.