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Méndez Gutiérrez JC, García-Covarrubias L, Reding-Bernal A, Velázquez Chong HA, Fernández Ángel DF, García Covarrubias A, Hernández-Rivera JC. Utility of a clinical risk scale to predict the requirement of advanced airway management in patients with a diagnosis of deep neck abscess. Braz J Otorhinolaryngol 2024; 90:101360. [PMID: 38035470 PMCID: PMC10698535 DOI: 10.1016/j.bjorl.2023.101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES To analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. METHODS Observational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p<0.05 was considered significant. RESULTS A sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p=0.001) as well as the multiple spaces involvement, (p=0.001) the presence of air corpuscles, (p=0.001) compromise of the retropharyngeal space (p=0.001) and age greater than 55 years (p=0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p=0.001, 95% CI 0.856-0.984). CONCLUSIONS The clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Juan Carlos Méndez Gutiérrez
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Head and Neck Department, Mexico City, Mexico
| | - Luis García-Covarrubias
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, CMN XXI, Instituto Mexicano del Seguro Social, Gastro-Surgery Department, Mexico City, Mexico; Hospital General de México "Dr. Eduardo Liceaga", Surgery Department, Mexico City, Mexico.
| | - Arturo Reding-Bernal
- Hospital General De México "Dr. Eduardo Licega", Research Department, Mexico City, Mexico
| | - Héctor A Velázquez Chong
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Head and Neck Department, Mexico City, Mexico
| | | | | | - Juan Carlos Hernández-Rivera
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Medical Research Unit on Nephrological Diseases, Mexico City, Mexico
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Sheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol 2023. [PMID: 37147934 DOI: 10.1111/coa.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs. DESIGN This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. SETTING Secondary or tertiary care centres that undertook management of DNSIs. PARTICIPANTS All adult patients with a DNSI. MAIN OUTCOME MEASURES The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. RESULTS Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI. CONCLUSIONS There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.
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Affiliation(s)
- Zain Sheikh
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
- Department of Academic Clinical Training, University of Sheffield, Sheffield, UK
| | - Beverley Yu
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Emily Heywood
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Natasha Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Shahed Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
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Principles of Treatment and Clinical-Evolutionary Peculiarities of Deep Cervical Spaces Suppurations-Clinical Study. Life (Basel) 2023; 13:life13020535. [PMID: 36836892 PMCID: PMC9965330 DOI: 10.3390/life13020535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
As medical-surgical emergencies, regardless of the causal agent, deep cervical space suppurations are not only a diagnostic challenge, but also a therapeutic one. In some cases, in spite of proper therapeutic measures, extremely severe complications can develop. A 5-year retrospective study (2016-2020) was conducted on a group of 107 patients suffering from cervical suppurations, being hospitalized and treated in the ENT Clinic of the "Sf. Apostol Andrei" Emergency County Hospital of Galați. This research is a clinical-statistical study based on the experience of this ENT clinic and was carried out based on the analysis of the patients' medical records. Descriptive analysis' statistical methods of the data series collected from the clinical observation sheets were used, with the patients' informed consent for the processing of the aforementioned data, with the agreement of the Ethics Commission of the Emergency Clinical Hospital "Sf. Apostol Andrei" Galați and the College of Physicians Galați, România. The patients' clinical and multidisciplinary treatment features included in the study group are presented. The results highlight the clinical particularities of deep cervical space suppurations treatment, including under COVID-19 impact, or with other comorbidities, having consequences on the case mix index increase or directly on the costs, admittance duration and the clinical status of the patient at discharge. The conclusions of the clinical study are based on the fulfillment of the research objectives in terms of treatment and symptomatology of deep cervical space suppurations and under the impact of comorbidities (global health crisis and pandemic, triggering of comorbidities due to health care access difficulty in the context of anti-COVID-19 government-implemented measures and the infection-rate that overburdened the medical system in the early period of the pandemic). Individualized treatment of deep cervical space suppurations is recommended to be approached multidisciplinary. Of particular importance is early diagnosis combined with prompt and correctly instituted multidisciplinary treatment. In this context, an appropriate medical measure that we recommend is patient health education, as it was observed in the clinical study: most times, patients address medical services with advanced disease, hence the generally unfavorable prognosis and outcome (about 25% of patients develop unfavorable prognosis and 4% die).
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Tao X, Hua H, Liu Y. A novel model for predicting mortality in the management of deep neck infections. EAR, NOSE & THROAT JOURNAL 2022:1455613221133245. [PMID: 36318220 DOI: 10.1177/01455613221133245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Deep neck infections (DNIs) are a common and intractable disease encountered in ENT clinics that impose a significant medical and financial burden on affected individuals and their families. However, insufficient data are currently available for predicting outcomes in cases of DNI. The present study thus sought to develop a novel model capable of predicting treatment outcomes of DNI patients just using indicators at the visit. METHODS Patients with DNIs treated from 2010 to 2022 were included in the present study. Patient data were retrospectively collected from medical records. Risk factors associated with mortality were identified using logistic regression models. A predictive model was constructed based on odds ratios for factors calculated using a multivariate regression model. RESULTS In total, 153 patients were enrolled in the present study. Risk factors associated with mortality included age >50 years, residence in a rural area, dyspnea at visit, the involvement of multiple infected sites, serum albumin<34 g/L, renal insufficiency, mediastinitis, pulmonary infection, and septic shock. A multivariate regression model revealed that mediastinitis (OR: 7.308, P < 0.001), serum creatinine>95 μmol/L (OR: 23.363, P < 0.05), and serum albumin<34 g/L (OR: 13.837, P < 0.05) were independent predictors of mortality in deep neck infection patients, with serum creatinine>95 μmol/L being particularly critical to the outcomes. Diabetes was not the predictor of mortality but was associated with long-term hospitalization (P < 0.001). CONCLUSIONS In summary, the model constructed in the present study was capable of estimating the potential for poor outcomes in DNI patients before the initiation of treatment. These findings may help improve doctor-patient communication, especially for those struggling financially.
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Affiliation(s)
- Xiaoyao Tao
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongting Hua
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Debta P, Swain SK, Sahu MC, Abuderman AA, Alzahrani KJ, Banjer HJ, Qureshi AA, Bakri MMH, Sarode GS, Patro S, Siddhartha S, Patil S. Evaluation of Candidiasis in Upper-Aerodigestive Squamous Cell Carcinoma Patients—A Clinico-Mycological Aspect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148510. [PMID: 35886361 PMCID: PMC9318475 DOI: 10.3390/ijerph19148510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 12/04/2022]
Abstract
Candida is a commensal yeast. It can be infective when the host’s defense mechanism is weakened, as in the case of squamous cell carcinoma patients. We aimed to evaluate the prevalence and clinical mycological manifestation of candidiasis in 150 cancer cases comprised of preoperative and post-operative (with or without radiotherapy) upper aerodigestive squamous cell carcinoma. A total of 150 patients suffering from squamous cell carcinoma of the Upper Aero-Digestive Tract (UADT) were divided into preoperative (n = 48), post-operative without radiotherapy (n = 29) and post-operative with radiotherapy (n = 73). Samples were collected using cotton swabs and cultured. Candida species were identified according to color pigmentation on Candida Differential Agar (CDA) plate. The clinico-mycological association of patients was evaluated by the chi-square test, and 98 out of 150 patients showed the presence of various Candida species. The major species isolated was Candida albicans (53%), followed by Candida tropicalis (16%). There was a significant statistical difference between patients who showed mycological associations and patients who did not have any such association (p = 0.0008). The prevalence of oral candidiasis was found to be 65.33% among total cases of upper aero-digestive squamous cell carcinoma. Chronic erythematous cases of candidiasis were mainly seen in preoperative squamous cell carcinoma cases, whereas the acute erythematous type of candidiasis was mainly seen in post-operative cases who received radiotherapy. The clinicomycological assessment can help to correlate the signs and symptoms with the presence of candidiasis in upper aerodigestive squamous cell carcinoma patients. Meticulous testing and examination can help in the early detection of candidiasis. Future studies are needed to develop advance scientific preventive strategies for high-risk cases.
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Affiliation(s)
- Priyanka Debta
- Department of Oral Pathology & Microbiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan Deemed to Be University, K8, Kalinga Nagar, Bhubaneswar 751003, Odisha, India; or
| | - Santosh Kumar Swain
- Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to Be University, K8, Kalinga Nagar, Bhubaneswar 751003, Odisha, India;
| | | | - Abdulwahab A. Abuderman
- Department of Basic Medical Sciences, College of Medicine, Price Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia;
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; (K.J.A.); (H.J.B.)
| | - Hamsa Jameel Banjer
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; (K.J.A.); (H.J.B.)
| | - Ahtesham Ahmad Qureshi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; (A.A.Q.); (M.M.H.B.)
| | - Mohammed Mousa H. Bakri
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; (A.A.Q.); (M.M.H.B.)
| | - Gargi S. Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India; or
| | - Sangram Patro
- Department of Oral and Maxillofacial Surgery, Hi-Tech Dental College and Hospital, Bhubaneswar 751007, Odisha, India;
| | - Saswati Siddhartha
- Department of Oral Pathology & Microbiology, Hi-Tech Dental College and Hospital, Bhubaneswar 751007, Odisha, India;
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia
- Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
- Correspondence:
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Perina V, Szaraz D, Harazim H, Urik M, Klabusayova E. Paediatric Deep Neck Infection—The Risk of Needing Intensive Care. CHILDREN 2022; 9:children9070979. [PMID: 35883963 PMCID: PMC9315740 DOI: 10.3390/children9070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Deep neck infections are potentially dangerous complications of upper respiratory tract or odontogenic infections. The pathophysiology, clinical presentation, and potential spreading depend on the complex anatomy of the neck fascia. These infections can lead to severe pathological conditions, such as mediastinitis, sepsis, and especially airway impairment with difficult management. Because of the risk of life-threatening emergency situations and the possible impacts on the overall health status of affected children, their early recognition is of utmost importance. Torticollis, drooling, and stridor are the most common signs of advancing disease. Children presenting with these symptoms should be admitted to the paediatric intensive care unit for vital function monitoring, where the airway could be readily secured if function is compromised.
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Affiliation(s)
- Vojtech Perina
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, 625 00 Brno, Czech Republic; (V.P.); (D.S.)
| | - David Szaraz
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, 625 00 Brno, Czech Republic; (V.P.); (D.S.)
| | - Hana Harazim
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Urik
- Department of Paediatric Otorhinolaryngology, University Hospital Brno, Faculty of Medicine, Masaryk University, Cernopolni 9, 662 63 Brno, Czech Republic;
| | - Eva Klabusayova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Correspondence: ; Tel.: +420-532-234-693
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Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience. Antibiotics (Basel) 2022; 11:antibiotics11050664. [PMID: 35625308 PMCID: PMC9137525 DOI: 10.3390/antibiotics11050664] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/03/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.
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Kamiński B, Błochowiak K, Kołomański K, Sikora M, Karwan S, Chlubek D. Oral and Maxillofacial Infections—A Bacterial and Clinical Cross-Section. J Clin Med 2022; 11:jcm11102731. [PMID: 35628858 PMCID: PMC9145374 DOI: 10.3390/jcm11102731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
The treatment of oral and maxillofacial infections is based on a recognized algorithm that may require modification under the influence of various local and systemic factors. The aim of this study was to present a comprehensive and microbiological profile of oral and maxillofacial infections, and explore possible correlations between the course of an infection and selected systemic factors based on the medical records of 329 patients affected by the disease. We identified most common clinical, demographic, bacterial, and laboratory parameters specific for these infections. There were statistically significant differences in Erythrocyte Sedimentation Rate, number of accompanying diseases, otalgia, dyspnea, and speech difficulties occurrence and neck space involvement between diabetic and non-diabetic patients. The duration of hospitalization and accompanying diseases correlated positively with the patient age and white blood cell count, and C-reactive protein value negatively correlated with age. The primary cause of infections, age, and comorbid diseases can modify the infection course and increase the risk of developing serious complications. It confirms the need for effective and targeted bacterial treatment in the early stages of infections. Age and general diseases are the most important systemic factors determining the infection symptoms and laboratory parameters assessing the severity of the inflammatory process.
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Affiliation(s)
- Bartłomiej Kamiński
- Department of Otolaryngology, Maria Skłodowska-Curie District Hospital, 26-110 Skarżysko-Kamienna, Poland;
| | - Katarzyna Błochowiak
- Department of Oral Surgery and Periodontology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Konrad Kołomański
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, 25-375 Kielce, Poland; (K.K.); (M.S.)
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, 25-375 Kielce, Poland; (K.K.); (M.S.)
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sławomir Karwan
- Department of Maxillofacial Surgery, Regional Specialized Children’s Hospital, 10-561 Olsztyn, Poland;
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
- Correspondence:
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High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136775. [PMID: 34202480 PMCID: PMC8297125 DOI: 10.3390/ijerph18136775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023]
Abstract
Background: Peritonsillar abscess (PTA) is an infectious emergency in the head and neck, and patients with end-stage renal disease (ESRD) have an immunocompromised status. However, no relevant research has focused on the ESRD–PTA relationship. This study explored PTA in ESRD patients and their prognosis. Methods: We identified 157,026 patients diagnosed as having ESRD over January 1997 to December 2013 from Taiwan’s National Health Insurance Research Database (NHIRD). Each patient with ESRD (hereafter, patients) was matched with one control without chronic kidney disease (CKD; hereafter, controls) by sex, age, urbanization level, and income. Next, PTA incidence until death or the end of 2013 was compared between the two groups, and the relative risk of PTA was analyzed using a multiple logistic regression model. Results: The patients had a significantly higher PTA incidence than did the controls (incidence rate ratio: 2.02, 95% confidence interval [CI]: 1.40–2.91, p < 0.001). The Kaplan–Meier analysis revealed that the patients had a higher cumulative incidence of PTA than did the controls (p < 0.001). In Cox regression analysis, the patients had nearly twofold higher PTA risk (adjusted hazard ratio [HR]: 1.98, 95% CI: 1.37–2.86, p < 0.001). The between-group differences in the PTA-related hospital stay length (8.1 ± 10.3 days in patients and 5.7 ± 4.6 days in controls, p = 0.09), consequent deep-neck infection complication (4.2% in patients and 6.3% in controls, p = 0.682), and mortality (0.0% in both groups) were nonsignificant. Conclusions: Although ESRD does not predict a poor prognosis of PTA, it is an independent PTA risk factor.
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Lin Y, Gao W, Yue H, Chen W, Liu T, Ye J, Cai Q, Ye F, He L, Xie X, Xiong G, Wang B, Pang F, Li P, Wu J, Wang B, Huang J, Wen W, Lei W. A novel risk score for the prediction of airway management in patients with deep neck space abscess: a multicenter retrospective cohort study. J Intensive Care 2021; 9:41. [PMID: 34016187 PMCID: PMC8139013 DOI: 10.1186/s40560-021-00554-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Airway management, including noninvasive endotracheal intubation or invasive tracheostomy, is an essential treatment strategy for patients with deep neck space abscess (DNSA) to reverse acute hypoxia, which aids in avoiding acute cerebral hypoxia and cardiac arrest. This study aimed to develop and validate a novel risk score to predict the need for airway management in patients with DNSA. METHODS Patients with DNSA admitted to 9 hospitals in Guangdong Province between January 1, 2015, and December 31, 2020, were included. The cohort was divided into the training and validation cohorts. The risk score was developed using the least absolute shrinkage and selection operator (LASSO) and logistic regression models in the training cohort. The external validity and diagnostic ability were assessed in the validation cohort. RESULTS A total of 440 DNSA patients were included, of which 363 (60 required airway management) entered into the training cohort and 77 (13 required airway management) entered into the validation cohort. The risk score included 7 independent predictors (p < 0.05): multispace involvement (odd ratio [OR] 6.42, 95% confidence interval [CI] 1.79-23.07, p < 0.001), gas formation (OR 4.95, 95% CI 2.04-12.00, p < 0.001), dyspnea (OR 10.35, 95% CI 3.47-30.89, p < 0.001), primary region of infection, neutrophil percentage (OR 1.10, 95% CI 1.02-1.18, p = 0.015), platelet count to lymphocyte count ratio (OR 1.01, 95% CI 1.00-1.01, p = 0.010), and albumin level (OR 0.86, 95% CI 0.80-0.92, p < 0.001). Internal validation showed good discrimination, with an area under the curve (AUC) of 0.951 (95% CI 0.924-0.971), and good calibration (Hosmer-Lemeshow [HL] test, p = 0.821). Application of the clinical risk score in the validation cohort also revealed good discrimination (AUC 0.947, 95% CI 0.871-0.985) and calibration (HL test, p = 0.618). Decision curve analyses in both cohorts demonstrated that patients could benefit from this risk score. The score has been transformed into an online calculator that is freely available to the public. CONCLUSIONS The risk score may help predict a patient's risk of requiring airway management, thus advancing patient safety and supporting appropriate treatment.
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Affiliation(s)
- Yu Lin
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Wenxiang Gao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Huijun Yue
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Weixiong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Tianrun Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jin Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qian Cai
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Fei Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Long He
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Xingqiang Xie
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, People's Republic of China
| | - Guoping Xiong
- Department of Otorhinolaryngology-Head and Neck Surgery, Jiangmen Central Hospital Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, People's Republic of China
| | - Bin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Feng Pang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Pei Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jianhui Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Bin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Junru Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Jiangmen Central Hospital Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, People's Republic of China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Wenbin Lei
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China.
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Krarup JF, Nielsen HL, Danstrup CS. Severe deep neck space infection caused by Eggerthia catenaformis. BMJ Case Rep 2021; 14:14/4/e241384. [PMID: 33811097 PMCID: PMC8023740 DOI: 10.1136/bcr-2020-241384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 64-year-old woman was acutely referred to the Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital due to rapidly progressing neck swelling, fever and dysphagia. Clinical examination revealed submental swelling, trismus and laryngeal inflammation. A contrast-enhanced CT scan showed infection in the deep neck spaces with multiple abscesses. The patient underwent acute surgery and antimicrobial therapy was initiated and she was transferred to an intensive care unit. Three additional surgical procedures were needed before sufficient drainage was achieved. There was growth of different oral commensals from four separate pus aspirates, while Eggerthia catenaformis was cultured in all samples. Due to the extent of the infection, the patient stayed in the intensive care unit for 16 days, but recovered completely due to adequate surgery and antimicrobial therapy for 4 weeks. Here we present the third reported case of a severe deep neck space infection with multiple abscesses due to E. catenaformis.
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Affiliation(s)
- Jens Fabricius Krarup
- Otorhinolaryngology - Head and Neck Surgery, Aalborg Universitetshospital, Aalborg, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg Universitetshospital, Aalborg, Denmark .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Sander Danstrup
- Otorhinolaryngology - Head and Neck Surgery, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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12
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Wu JH, Li X, Chen GP, Fu MY, Ye F. Changing trends of deep neck infections in southern China: A review of 127 cases. Sci Prog 2021; 104:368504211028367. [PMID: 34191640 PMCID: PMC10358622 DOI: 10.1177/00368504211028367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aimed to review our experience with the clinical characteristics and management of deep neck infections (DNIs) and determine the changing trends of their characteristics over time in southern China. Patients diagnosed with a DNI between January 2009 and December 2018 were screened retrospectively for their demographic characteristics, etiology of infection, site of infection, microbiology, treatment, and complications. In total, 127 patients were included: 41 (32.3%) were treated between 2009 and 2013 (group A), and 86 (67.7%) were treated between 2014 and 2018 (group B). The most common site of infection in group A was the parapharyngeal space (15 patients, 36.6%), while that in group B involved multiple spaces (36 patients, 41.9%). The leucocyte count (×109 cells/L) was 13.23 ± 4.19 in group A and 16.04 ± 4.33 in group B (p < 0.001). Streptococcus viridans was the most common bacteria in both groups. The mean hospital stay was 21.46 ± 33.09 days in group A and 10.44 ± 6.19 days in group B. The rate of diabetes mellitus (DM) in group A was lower than that in group B (8/41 and 33/86, respectively; p = 0.034). Airway obstruction was the most common complication in both groups. DNIs are more likely to show multi-space involvement, affect more DM patients, and be associated with higher leucocyte counts over time. We infer that the duration from morbidity to admission and that from admission to operation play roles in the successful management of DNIs, possibly causing fewer complications, lower mortality rates, and shorter hospital stays. DM patients require increased attention.
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Affiliation(s)
- Jian-Hui Wu
- Min-Yi Fu, The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong 528400, P.R. China.
| | | | - Guo-Ping Chen
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| | - Min-Yi Fu
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| | - Fei Ye
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
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A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess-A 10-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031049. [PMID: 33504039 PMCID: PMC7908373 DOI: 10.3390/ijerph18031049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20–44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45–64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.
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Application of Disposable Multifunctional Drainage Tube-Assisted Irrigation in Patients With Severe Multi-Space Infections in Oral and Maxillofacial Head and Neck Regions. J Craniofac Surg 2020; 31:e202-e205. [PMID: 31977712 DOI: 10.1097/scs.0000000000006236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To compare the clinical efficacy of disposable multifunctional drainage tube (DMDT)-assisted irrigation with the traditional abscess incision rubber drainage technique in patients with severe multi-space infections in oral and maxillofacial head and neck regions. PATIENTS AND METHODS The data of 74 patients with severe multi-space infections in oral and maxillofacial head and neck regions, who were admitted to the Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Sichuan Province, China, between January 2015 and January 2019, were retrospectively studied. According to the treatment method, the patients were divided into 2 groups: the DMDT-assisted irrigation group and the abscess incision rubber drainage group. Cure rate, complications, length of hospitalization, days of antimicrobial use, cost of antimicrobial drugs, total hospitalization cost, number of dressing changes, and patient pain during dressing changes were compared between the 2 groups. RESULTS Of the 74 patients, 38 were treated with the DMDT-assisted irrigation, and 36 with the traditional abscess incision rubber drainage. Compared with the traditional treatment group, the total hospitalization cost of the DMDT-assisted irrigation group is not much different (P = 0.72), but the patients in the DMDT-assisted irrigation group have higher cure rate, fewer complications, less antibiotics cost, shorter hospitalization length and fewer dressing changes than the control group (P < 0.05). CONCLUSIONS The DMDT-assisted irrigation technique not only improves the cure rate, reduces complications, shortens hospitalization, reduces the use of antibiotics, and alleviates patient pain during dressing changes, but also improves clinical and therapeutic efficacy by reducing the number of dressing changes.
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Dai TG, Ran HB, Qiu YX, Xu B, Cheng JQ, Liu YK. Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report. World J Clin Cases 2019; 7:4150-4156. [PMID: 31832421 PMCID: PMC6906581 DOI: 10.12998/wjcc.v7.i23.4150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/24/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions. Clinically, if early odontogenic infections such as acute periapical periodontitis, alveolar abscess, and pericoronitis of wisdom teeth are not treated timely, effectively and correctly, the infected tissue may spread up to the skull and brain, down to the thoracic cavity, abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck. Severe multi-space infections are formed and can eventually lead to life-threatening complications (LTCs), such as intracranial infection, pleural effusion, empyema, sepsis and even death.
CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions. One week before admission, due to pain in the right lower posterior teeth, the patient placed a cigarette butt dipped in the pesticide "Miehailin" into the "dental cavity" to relieve the pain. Within a week, the infection gradually spread bilaterally to the floor of the mouth, submandibular space, neck, chest, waist, back, temporal and other areas. The patient had difficulty breathing, swallowing and eating, and was transferred to our hospital as an emergency admission. Following admission, oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology, thoracic surgery, general surgery, hematology, anesthesia and the intensive care unit to assist with treatment. The patient was treated with the highest level of antibiotics (vancomycin) and extensive abscess incision and drainage in the oral, maxillofacial, head and neck, chest and back regions. Unfortunately, the patient died of septic shock and multiple organ failure on the third day after admission.
CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions, which can result in multiple LTCs. The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.
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Affiliation(s)
- Tian-Guo Dai
- Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Panzhihua 617067, Sichuan Province, China
| | - Hong-Bing Ran
- Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Panzhihua 617067, Sichuan Province, China
| | - Yin-Xiu Qiu
- Department of Otolaryngology Head and Neck Surgery, Central Hospital of Panzhihua City, Panzhihua 617067, Sichuan Province, China
| | - Bo Xu
- Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Panzhihua 617067, Sichuan Province, China
| | - Jin-Qiang Cheng
- Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Panzhihua 617067, Sichuan Province, China
| | - Ying-Kai Liu
- Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Panzhihua 617067, Sichuan Province, China
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Marioni G, Fasanaro E, Favaretto N, Trento G, Giacomelli L, Stramare R, Ottaviano G, de Filippis C. Are panels of clinical, laboratory, radiological, and microbiological variables of prognostic value in deep neck infections? An analysis of 301 consecutive cases. Acta Otolaryngol 2019; 139:214-218. [PMID: 30887898 DOI: 10.1080/00016489.2018.1532606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Deep neck infections (DNIs) are often clinically challenging, and may be life-threatening. OBJECTIVE The present retrospective study aimed to identify panels of clinical, laboratory, radiological, and microbiological parameters that could identify patients with DNIs at higher risk of complications or long-term hospitalization. MATERIALS AND METHODS The investigation concerned 301 consecutive patients with DNIs treated at our institution between 2000 and 2014. RESULTS The discriminatory power of a combination of two variables (unknown origin of the infection and the need for surgical treatment) in terms of deep neck infection complications occurrence featured an AUC (ROC) of 0.6701. The power of a panel of four variables (age, leukocyte count, need for surgical treatment, days elapsing from hospitalization to surgical procedure) to identify DNIs necessitating long-term hospitalization featured an AUC (ROC) of 0.7929. CONCLUSION Using the scale proposed by Hosmer and Lemeshow, the four-variable panel showed an amply acceptable, nearly excellent discriminatory power for long-term hospitalization. SIGNIFICANCE Although this panel achieved promising results for prognostic purposes, other parameters potentially capable of predicting the outcome of DNIs and orienting treatment decisions need to be investigated.
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Affiliation(s)
- Gino Marioni
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Elena Fasanaro
- Radiotherapy Department, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Niccolò Favaretto
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Giacomo Trento
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | | | | | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, Audiology Unit, University of Padova, Treviso, Italy
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Adenoids in paediatric chronic rhinosinusitis, deep neck space infections and optimising otowicks in otitis externa. The Journal of Laryngology & Otology 2017; 131:751. [DOI: 10.1017/s0022215117001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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