Abstract
Mycobacterium bovis Bacille Calmett–Guerin (BCG) has been shown to possess potent antitumor activity particularly in various animal models, while, the cellular and molecular mechanisms underlying its activity are not well understood. We found that lipomannan (BCG-LM), a lipophilic component of the mycobacterial cell envelope, specifically inhibits tumor growth and induces the infiltration of eosinophils at local tumor-invasion sites. In contrast, neither lipoarabinomannan (BCG-LAM) nor the cell wall of Mycobacterium bovis BCG (BCG-CW) exerted anti-tumor immunity. BCG-LM enhances cytotoxic activity of eosinophils via the increased production of superoxide. Global transcriptomic analyses of BCG-LM-pulsed DCs identified C-C motif ligand (CCL)5 as a crucial chemokine for the anti-tumor immunity induced by BCG-LM, indicating that CCL5 plays an important role for the accumulation of eosinophils in the tumor microenvironment. Furthermore, BCG-LM and memory Th2 cells exerted a synergetic effect on tumor progression by cooperatively enhancing the eosinophil function. Thus, this study revealed un-identified BCG-LM-mediated anti-tumor mechanism via superoxide produced by infiltrated eosinophils in the tumor microenvironment. Since BCG-LM activates this unique pathway, it may have potent therapeutic potential as immune-cell therapy for cancer patients.Πέμπτη 5 Οκτωβρίου 2017
Advances in Otolaryngology
Function
Abstract: Preeclampsia is one of the most common complications of pregnancy in the world. In Indonesia, the incidence of preeclampsia lies within 3–10% of all pregnancies every year. Preeclampsia is a multisystem disorder that causes endothelial dysfunction and vasospasm that may lead to ischemia and organ damage especially to the end organs. Cochlea serves as an end organ and is therefore vulnerable to damage under ischemic conditions. This research aimed to understand the role of preeclampsia on the destruction of cochlear outer hair cells function. Subjects were pregnant women who were hospitalized in the Obstetrics and Gynecology Ward of Sardjito Hospital. Diagnosis of preeclampsia was obtained by defining level of high blood pressure measurement and quantitative 24 hours of proteinuria. Meanwhile, cochlear outer hair cell function was measured by the distortion product otoacoustic emission (DPOAE). The DPOAE results showed that REFER presented in 6 (10%) patients with preeclampsia and none in those without preeclampsia groups. This result demonstrated preeclampsia as one of the risk factors for impaired function of cochlear outer hair cells.
PubDate: Thu, 12 May 2016 08:18:26 +000
Implant Recipients
Abstract: The aim of this study was to compare the effectiveness of a music appreciation training program (MATP) to that of focused music listening (FML) for improving music and/or speech in noise perception for postlingually deafened cochlear implant (CI) recipients. It was hypothesized that the MATP would show greater improvements than FML. Ten CI recipients were randomly divided into two groups: one undertaking the MATP and the other undertaking FML. Participants completed four 30-minute sessions per week for 8 weeks, with tests of music and speech-in-noise perception being administered four times per participant: before and after a control period, immediately after the intervention, and 4–8 weeks after intervention. There was a significant pre- to posttraining difference for the MATP group on the instrument identification test, as well as for half of the quality rating assessments. Although no statistically significant improvements were obtained for the FML group, there was a trend of higher scores postintervention for the instrument and ensemble identification tests, and compliance was substantially better than for the MATP group. While the results showed that only the music training significantly improved music perception, the potential of FML to benefit some CI recipients for some tasks was also observed.
PubDate: Tue, 26 Jan 2016 12:17:24 +000
Abstract: There is variability in the literature regarding the presence of positional nystagmus in healthy participants with reportedly normal vestibular and central nervous system function. This ranges from 7.5% to 88% and raises an important clinical question. If 88% of healthy participants have positional nystagmus then how is the clinician to interpret the presence of positional nystagmus in a patient presenting with dizziness and/or disequilibrium' The primary purpose of this investigation was to examine the prevalence and characteristics of positional nystagmus in patients evaluated specifically for dizziness and imbalance. Data was collected using retrospective chart review. 200 charts were randomly selected from all patients seen for evaluation of dizziness and imbalance over a period of eight months. Clinicians independently reviewed the data from positional testing for each chart. Nystagmus was present if there was a clear slow and fast phase component and there were three beats in a 10 s time window. Nystagmus direction and intensity data were collected. Results indicate positional nystagmus is present in 10.5% to 21% of patients evaluated for dizziness and imbalance. Use of liberal criteria for determining presence of positional nystagmus (i.e., 3 beats in 20 sec) may account for higher prevalence rates across other studies.
PubDate: Sun, 24 Jan 2016 09:21:12 +000
Systematic Review and Meta-Analysis
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo of peripheral origin. The lateral semicircular canal (LSCC) follows the posterior semicircular canal (PSCC) as the site of pathology in the majority of patients. Therapy, aiming at relocating particles causing aberrant LSCC stimulation has been applied by forced prolonged positioning, barbecue, and particle repositioning maneuvers. Results of the different techniques are variable. This systematic review/meta-analysis aimed to find out which therapy technique yields higher cure rates. MedLine database provided at National Library of Medicine was searched for randomized controlled trials comparing results of different therapeutic techniques for patients with LSCC BPPV. For studies included in qualitative analysis/synthesis, the following were collected independently by the author: number of participants, count of patients with geotropic and apogeotropic LSCC in each treatment group, and resolution of vertigo/nystagmus assessed by symptomatic improvement and negative supine roll test 1–24 hours following intervention considering the type of LSCC BPPV (geotropic/apogeotropic). Level Ia evidence (systematic review of RCTs) shows superiority of Gufoni maneuver over sham for both geotropic and apogeotropic LSCC BPPV. Comparisons between different therapeutic maneuvers for LSCC BPPV based on results of published RCTs could not be set.
PubDate: Thu, 10 Dec 2015 12:34:50 +000
Cancer
Abstract: Objective. To elucidate the incidence of cisplatin induced ototoxicity in adult patients, with a focus on an adult population. Study Design. IRB approved retrospective study. Methods. The charts of patients who underwent cisplatin therapy from 1995 to present were reviewed. Inclusion criteria were (1) cisplatin as the primary chemotherapeutic agent and (2) hearing evaluation performed prior to and after treatment. Audiometric thresholds were measured by presenting pure-tone stimuli at 0.25 to 10.0 kHz. Criteria for hearing loss were based on the Chang criteria. Cochlear radiation doses were also calculated in patients with primary tumors in their head and neck or brain. Results. There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014, which 30 met inclusion criteria. Eight were patients treated for head and neck or brain cancer. Evaluation with ANOVA testing identified statistically significant decline in audiometric scores for WRS and pure tone frequencies 500, 2000, 4000, 6000, and 8000 Hz in the right ear. Overall, hearing loss was noted with 63% incidence and in patients who received radiation to their cochlea and cisplatin. Conclusion. The incidence of cisplatin induced ototoxicity was significant and even more prevalent in those patients receiving both cisplatin and radiation to their cochlea.
PubDate: Thu, 12 Nov 2015 11:31:30 +000
Reinke Edema Using Voice Handicap Index
Abstract: Voice disorders exert a dramatic influence on patients’ quality of life (QOL). The physical, functional, and emotional impact can be accurately assessed using the conventional questionnaire of “voice handicap index” (VHI) or its shorter version, the VHI-10. We evaluated the VHI scores of patients suffering from obstructive Reinke’s edema, a benign laryngeal disorder, before and after endoscopic treatment. Comparison of pre- and postoperative VHI scores showed the treatment efficacy. The scores achieved were similar to asymptomatic individuals (control group), thus improving their quality of life. Furthermore, both VHI and VHI-10 tests yielded similar scores. We suggest routine systematic incorporation of the VHI-10 test for pre- and postoperative routine evaluation of patients with Reinke’s edema. The results are faster and reliable.
PubDate: Mon, 19 Oct 2015 13:44:14 +000
Using a Combined Electric-Acoustic System
Abstract: People with residual hearing in the low frequencies and profound hearing loss in the high frequencies often do not benefit from acoustic amplification. Focus on this group of patients led to the development of the combined electric-acoustic stimulation (EAS) systems which can provide users with greater speech perception than can cochlear implant (CI) alone or acoustic hearing alone. EAS users wear a combined speech processor that incorporates a behind-the-ear audio processor that sits with an ear hook on the user’s pinna and a hearing aid, which sits in the ear canal. However, with the introduction of single-unit processors, which combine the audio processor, coil, control unit, and battery pack into a single device that sits on the implant site, therefore off the ear, simultaneous electric (CI) and acoustic (hearing aid) stimulation is not currently possible with a combined processor. To achieve EAS with a single-unit processor, a CI user must also wear a hearing aid. This study seeks to determine if experienced users of combined EAS speech processors could also benefit from using a combination of a single-unit speech processor that sits off the ear and an in-the-ear hearing aid.
PubDate: Mon, 28 Sep 2015 08:18:57 +000
Cervical Vestibular Evoked Myogenic Potential in Identification of
Meniere’s Disease
Abstract: Cervical vestibular evoked myogenic potential (cVEMP) and cochlear hydrops analysis masking procedure (CHAMP) have both shown sensitivity in identifying Meniere’s disease. However none of the previous reports have compared the two tests for their relative efficacy in identifying Meniere’s disease. Hence the present study aimed to compare the efficiency of cVEMP and CHAMP in evaluating Meniere’s disease. The study included 58 individuals with unilateral definite Meniere’s disease and an equal number of age and gender matched healthy individuals. cVEMP corresponding to 500 Hz tone burst was recorded from ipsilateral sternocleidomastoid muscle and CHAMP was acquired from the conventional electrode sites for single channel auditory brainstem response recording using a default protocol of the Biologic Navigator Pro evoked potential system. Both cVEMP and CHAMP showed statistically significant differences between the groups (). The receiver operating curves revealed 100% sensitivity and specificity for CHAMP as against 70.7% sensitivity and 100% specificity for cVEMP in identifying Meniere’s disease. Therefore, CHAMP appears to be the test of choice provided the degree of hearing loss does not exceed a moderate degree. cVEMP could be used for all degrees of hearing losses, but with slight constraint on the sensitivity.
PubDate: Sun, 22 Feb 2015 13:28:06 +000
Abstract: Follow-up program in squamous cell carcinoma of head and neck district is crucial to detect locoregional recurrence and second primary tumors and to manage treatment toxicities. The choice of the appropriate frequency of visits and imaging modality can be troublesome. Details of timing surveillance and type of diagnostic procedure are still not well defined. This review highlights the problem from a clinician’s point of view.
PubDate: Wed, 14 Jan 2015 07:58:37 +000
Abstract: Neck abscesses are difficult to diagnose and treat. Currently, contrast-enhanced computed tomography (CECT) is the imaging modality of choice. The study aims to determine the predictive value of CECT findings in diagnosing neck abscess, causes of neck abscess and the most common neck space involved in the local population. 84 consecutive patients clinically suspected to have neck abscess who underwent CECT and surgical confirmation of pus were included. Demographic and clinical data were recorded. 75 patients were diagnosed as having neck abscess on CECT; out of those 71 patients were found to have pus. Overall CECT findings were found to have a high sensitivity (98.6%) and positive predictive value (PPV) (94.7%) but lower specificity (67.2%) in diagnosing neck abscess. The CECT diagnostic criterion with the highest PPV is the presence of rim irregularity (96%). The most common deep neck space involved is the submandibular compartment, which correlates with the finding that odontogenic cause was the most common identifiable cause of abscess in the study population. Thus, in a patient clinically suspected of having neck abscess, CECT findings of a hypodense mass with rim irregularity are helpful in confirming the diagnosis and guiding clinical management.
PubDate: Tue, 18 Nov 2014 00:00:00 +000
Results
Abstract: The aim of this work is to present a modified transcanal technique for cochlear implantation. It was a prospective study on 125 cochlear implant patients presenting to two tertiary referral hospitals between January 2010 and January 2013 and followed up for 6–30 months. Their age range was 2–56 (mean 3.4 years) and the male: female ratio was of 2.1 : 1. A modified transcanal technique was adopted through a small postauricular incision. A tympanomeatal flap is elevated, the middle ear is exposed, and the round window membrane is exposed by drilling the overhanging niche. The electrode is channeled in an open trough along the posterosuperior meatal wall, which is reconstructed by autologous cartilage. The round window was used for insertion in 110 patients and a cochleostomy in 15. The main outcome measures were technical steps, operative time, and ease and completeness of electrode insertion. The actual surgical time (excluding device testing) ranged between 25 and 40 minutes (mean 30.1 min). There were 115 complete insertions and 10 partials. There were 6 chorda tympani injuries, 2 electrode exposures with 1 requiring revision, and 2 cases with a tympanic membrane perforation which were grafted uneventfully. One case had severe infection with extrusion of the device 1 year after successful implantation.
PubDate: Thu, 13 Nov 2014 00:00:00 +000
Abstract: Objectives. To assess the effects of early oral feeding in laryngectomy patients versus delayed oral feeding. The outcomes used are mortality, pharyngocutaneous fistula rate, quality of life, hospital length of stay, and complications. Method. We performed searches within five major databases until June 2013. We considered randomised control trials (RCTs) and included nonrandomised studies for the assessment of harms. Results. We included four RCTs for assessment of benefits and three nonrandomised studies for assessment of harms (393 participants). There was no statistically significant difference detected in mortality at six months, pharyngocutaneous fistulae, or complications. The length of hospital stay was shorter in the early feeding group, MD −2.72 days [95% CI −5.34 to −0.09]. Conclusion. Early oral feeding appears to have similar incidence of complications and has the potential to shorten the length of hospital stay. Further well-designed RCTs are necessary because of weakness in the available evidence.
PubDate: Sun, 28 Sep 2014 10:00:53 +000
Insight for a Clinical Approach
Abstract: Cisplatin, one of the most effective and potent anticancer drugs, is used in the treatment of a wide variety of both pediatric and adult malignancies. However, the chemotherapeutic use of cisplatin is limited by its serious side effects, such as nephrotoxicity and ototoxicity. Ototoxicity produced by cisplatin is usually persistent, depending on the age of the patient, the cumulative number of doses, the number of chemotherapy cycles, the history of noise exposure, and deteriorating renal function. The mechanism of the ototoxicity caused by cisplatin is based on the generation of reactive oxygen species, which interfere with the antioxidant protection of the organ of Corti. Thus, protecting the cochlea with antioxidants ameliorates ototoxicity from cisplatin. In this context, melatonin appears as a therapeutic option for preventing the ototoxic effects of cisplatin, since the research in the last decade has proven its ability to be both a direct free radical scavenger and indirect antioxidant. In this sense, some of the evidence suggesting that melatonin is efficient for combating cisplatin-induced ototoxicity is summarized and discussed in this paper.
PubDate: Mon, 18 Aug 2014 07:46:12 +000
Minimally Invasive Preclinical Model
Abstract: Objectives. (1) Evaluate safety of autogenous engineered septal neocartilage grafts and (2) compare properties of implanted grafts versus controls. Study Design. Prospective, basic science. Setting. Research laboratory. Methods. Constructs were fabricated from septal cartilage and then cultured in vitro or implanted on the nasal dorsum as autogenous grafts for 30 or 60 days. Rabbits were monitored for local and systemic complications. Histological, biochemical, and biomechanical properties of constructs were evaluated. Results. No serious complications were observed. Implanted constructs contained more DNA () and less sGAG perDNA () when compared with in vitro controls. Confined compressive aggregate moduli were also higher in implanted constructs () and increased with longer in vivo incubation time (). Implanted constructs displayed resorption rates of 20–45 percent. Calcium deposition in implanted constructs was observe. Conclusion. Autogenous engineered septal cartilage grafts were well tolerated. As seen in experiments with athymic mice, implanted constructs accumulated more DNA and less sGAG when compared with in vitro controls. Confined compressive aggregate moduli were higher in implanted constructs. Implanted constructs displayed resorption rates similar to previously published studies using autogenous implants of native cartilage.
PubDate: Wed, 23 Jul 2014 11:01:49 +000
Abstract: Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50% of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition.
PubDate: Thu, 17 Jul 2014 06:29:58 +000
Abstract: Purpose. This paper reviews analyses for tracheostomy within our patient population over the last 6 years. Methods. We conducted a retrospective chart review of consecutive patients undergoing tracheostomy at the tertiary Dicle University Medical hospital, Turkey, from January 2006 to December 2012. Patient age, sex, emergency, planned tracheostomy, indications, complications, and decannulation time were all assessed. Results. Fifty-six (34 male, 22 female) adult Pediatric patients undergoing tracheostomy between 2006 and 2013 were investigated. The most common indication for tracheostomy was upper airway obstruction (66.7%), followed by prolonged intubation (33.3%). Mean decannulation times after tracheostomy ranged between 1 and 131 days, the difference being statistically significant (). There was no significant difference in terms of mean age (; ). There was also no statistical difference between emergency and planned tracheotomies (). Conclusion. In our patient population, there was a significant decline in the number of tracheotomies performed for prolonged intubation and an increasing number of patient tracheostomy for upper airway obstruction. According to the literature, permanent decannulation rates were slightly higher with an increase in genetic diseases such as neuromuscular disease.
PubDate: Thu, 26 Jun 2014 00:00:00 +000
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