LitAlert #46
LitAlert #46
Animated videos after head and neck surgery
In surgical recovery patient education and engagement is essential and many otolaryngology patients have reported feeling under-prepared for the surgery and the recovery process. The purpose of this randomized clinical trial was to assess if a multimedia patient education platform for patients who are undergoing head and neck surgical procedures would improve patient education and increase satisfaction. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire was used to evaluate patient satisfaction. The study demonstrated that the use of multimedia patient education platform increased the satisfaction of the patients and that traditional clinical methods could be improved regarding patients’ treatment, mental health, family life, supplementary services and recovery process at home. A limitation to this study is raised by the authors, as seen in similar studies internet access can be a hindrance. However, further research is needed to evaluate if this platform leads to decreased hospital stay, shorter complication rates, and long-term effects.
Enhanced olfaction by nasal airflow inducing manoeuvre in laryngectomy patients
Total laryngectomy (TL) is an effective treatment for advanced laryngeal and hypopharyngeal cancer. Lack of airflow through the nasal cavity between the trachea and the nasal cavity and the loss of olfaction after a TL is a common side-effect. Olfaction is an important sense that gives patients a better quality of life (QoL) and the ability to appreciate flavor of food. In this study the effectiveness of the nasal airflow inducing manoeuvre (NAIM) or ‘polite yawn’ technique in laryngectomized patients was evaluated as well as improvement in olfaction and QoL. The NAIM technique is when the patient yawns with lips closed at the same time as they lower the floor of mouth, base of tongue and soft palate. This will induce negative pressure in the oral cavity and oropharynx, and this creates a flow of air that makes the odorant reach the olfactory receptors. Manoeuvres like NAIM in improving olfaction have not been extensively studied before. The results indicated that introducing NAIM as a rehabilitation technique enhanced the patient’s olfaction and QoL two weeks after surgery.
Proposed management protocol for Provox Vega XtraSeal
Tracheoesophageal speech with voice prosthesis (VP) is regarded as the most effective method for communication after a total laryngectomy. Improvements in VP development regarding VP are continuously made, yet they may still fail after a period of 2-3 months. The second most common cause for failure is periprosthetic leakage. Provox Vega XtraSeal has been shown to be effective at preventing periprosthetic leakage and prolonging the mean-duration of the VP. However, PVX use is limited and therefore the purpose of this systemic review was to propose a management protocol for PVX. The systemic review was based on four articles with 315 voice prosthesis in 55 patients, and showed that PVX could be effective in preventing periprosthetic leakage. The protocol suggested by the authors is The Tower of Hercules protocol. It is divided into three steps: (1) Measurement of the tracheoesophageal fistula using Provox Measure, (2) Minimization of the PVX slack by avoiding the complete visualization of the VP’s blue ring, (3) Nasofibroscopic examination of the oesophageal wall trying to appreciate both flanges in correct position.
Patient experience after total laryngectomy during the COVID-19 era
Total laryngectomy (TL) is a treatment for people with laryngeal cancer, however it leads to loss of voice, and changes to eating, drinking and breathing. This requires the patients to learn complex new skills in order to adapt, which they usually learn during the acute post-surgical stage. Enhanced recovery after surgery (ERAS) protocol in TL has recently been investigated more thoroughly, but the results are of varying quality and implementation difficult. During the COVID-19 era acute services have been of utmost importance and therefore it is possible that the changes during this time are aligned with the ERAS protocol. The focus of this study was to investigate the acute patient experience of having TL before and during COVID-19. The data was collected through semi-structured interviews from 10 people who had undergone a TL within the last two years. In conclusion, there were no major changes according to the patients experience regarding their acute post-surgical stage due to the changes in care because of COVID-19. The authors conclude that there is a need for more extensive studies on the ERAS model.
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