The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

http://bit.ly/2Bc6yFm

The effect of baclofen combined with a proton pump inhibitor in patients with refractory laryngopharyngeal reflux: a prospective, open‐label study in thirty‐two patients

Abstract

Thirty‐two patients with refractory LPR confirmed by 24‐h MII‐pH were given a 3‐month course of baclofen 10 mg three times a day combined with PPI 15 mg twice a day.

Changes in RSI and reflux‐related quality of life from baseline to after treatment were evaluated.

MII‐pH monitoring of refractory LPR patients showed that the number of non‐acid reflux was much higher than acid reflux in laryngopharyngeal reflux and full‐column reflux.

After 3 months of PPI + baclofen medication, most RSI items and quality of life score showed a significant improvement compared to the baseline score, and the percentage of responders at 3 months was 53.1%.

In our experience, when a PPI therapy is unresponsive to LPR patients, baclofen can be considered as a second treatment option.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Sh6uOc

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

Abstract

Although modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric biphasic pulses for 14 CI ears. Overall, there was no effect of polarity on either ECAP SOE patterns, pitch ranking performance, or the relation between the two. This result is likely due the use of symmetric biphasic pulses, which may have reduced the size of the effect previously observed for pseudomonophasic pulses. Further research is needed to determine if a pseudomonophasic stimulus might further improve the relation between physiology and pitch perception.

http://bit.ly/2TpFoBN

Survival and Long-Term Biochemical Cure in Medullary Thyroid Carcinoma in Denmark 1997–2014: A Nationwide Study

Thyroid, Ahead of Print.


http://bit.ly/2DLIeeV

A Career in Global Surgery

This Viewpoint suggests that academic surgical departments are well positioned to lead global surgery efforts given their focus on teaching, innovation, and service.

http://bit.ly/2Bdfs5r

Toward a Broader, More Global Perspective for US Otolaryngology Residents

This essay discusses the benefits of the medical education system offering US otolaryngology residents the opportunity to gain a broader, more global perspective on the practice of otolaryngology.

http://bit.ly/2ToqTy5

Papillary Thyroid Microcarcinoma

A patient who was referred to our clinic for a second opinion on management of a small localized papillary thyroid cancer (PTC) asked, "Why should I have surgery to remove my thyroid if it's such a good cancer?" At the time of diagnosis, her health care practitioner told her she had a good cancer and recommended thyroidectomy. This question directly relates to the work by Davies et al in this issue of JAMA Otolaryngology–Head & Neck Surgery. However, it is important to first clarify some misconceptions about the experiences of patients with thyroid cancer.

http://bit.ly/2BaO5Ja

Patient Experience of Thyroid Cancer Active Surveillance in Japan

This study evaluates the concerns about cancer, treatment decisions, and overall experience of Japanese patients under active surveillance for thyroid cancer.

http://bit.ly/2TokPpr

Phosphaturic Mesenchymal Tumor of the Cerebellopontine Angle

This case report describes an otherwise healthy woman in her 30s who presented with left-ear hearing loss, tinnitus, distorted hearing, and occasional otalgia of a few months' duration.

http://bit.ly/2BdQCSV

Utilization of Nasal Endoscopy in the Medicare Population, 2000-2016

This study analyzes Medicare beneficiary and provider data from 2000 through 2016 to investigate trends in the number of nasal endoscopies performed among the Medicare population, reimbursement, and regional differences.

http://bit.ly/2TsOf5W

Variation in Care Delivery and Diagnostic Modality Among the Medicare Population

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Hur et al suggest that during the past decade, the use of diagnostic nasal endoscopy in the Medicare population has increased substantially and this increase has not been paralleled by a similar increase in surgical ethmoidectomy. The overall increase in the number of endoscopies was also accompanied by marked variability in endoscopy utilization across different states, with some states showing a large increase and others showing smaller increases.

http://bit.ly/2BdJrdz

A Large Tonsillar Mass in a Healthy Teenager

A previously healthy 18-year-old woman presented with a growth in the right oropharynx of 4 months' duration as well as voice changes, recent weight loss, and decreased appetite. What is your diagnosis?

http://bit.ly/2Tnan1q

Doctoring and Hearing Loss

In treating hearing loss, I've found there's a particular tendency–especially in men losing their hearing in late middle age–for patients...

http://bit.ly/2RsViK3

Tonsillectomy: Tonsilliths, Pandas, and other great band names

I can't tell you how many times people at parties find out that I'm an ENT and have me look...

http://bit.ly/2Wut05q

Eustachian Tubes: Pop It Like It’s Hawt

This topic is a bit related to the ear tubes topic, and I think it's worth covering because I get...

http://bit.ly/2G0VQ8I

Correlation between plan quality improvements and reduced acute dysphagia and xerostomia in the definitive treatment of oropharyngeal squamous cell carcinoma

Abstract

Background

To evaluate plan quality using volumetric‐modulated arc therapy (VMAT) and step‐and‐shoot intensity‐modulated radiation therapy (SS‐IMRT) techniques and for patients treated for oropharyngeal squamous cell carcinoma (OPSCC).

Methods

Treatment plans for patients treated definitively for stages I‐IVb, OPSCC between December 2009 and August 2015 were retrospectively reviewed. Dosimetric endpoints of involved organs‐at‐risk (OARs) were retrieved from clinical plans. Common Terminology Criteria for Adverse Events scores of acute toxicities were compared.

Results

Two‐hundred twenty‐two patients were identified with 134 and 88 receiving SS‐IMRT and VMAT with median follow‐up time of 23.0 and 7.9 months, respectively. The dosimetric endpoints of the OARs were significantly improved in VMAT cohort, which translated into significantly lower rates of grade 2 or higher acute dysphagia and xerostomia.

Conclusion

Improvements in stages I‐IVb, oropharyngeal cancer plan quality are associated with reduced grade ≥ 2 acute dysphagia and xerostomia.

http://bit.ly/2Wy7ZXq

Issue Information

http://bit.ly/2RsQAfg

Cover Image

The cover image, by Yifan Meng MD et al., is based on the Original Article Origin site‐based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery, DOI: 10.1002/hed.25435.

http://bit.ly/2Wy7Rao

Prof. Heinz Stammberger, MD (Hon. FRCS (Ed.), Hon. FRCS (Engl.), Hon. FACS) December 1st 1946–December 9th 2018

http://bit.ly/2DJ2pdq

Unique considerations in pediatric skull base surgery

Publication date: Available online 30 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Irit Duek, Dan M. Fliss

Pediatric skull base and craniofacial surgery presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Skull base reconstruction using locoregional flaps or free flaps may be safely performed in pediatrics. Although the general principles of skull base reconstruction are applicable to nearly all patients, the unique demands of skull base surgery in pediatrics merit special attention. Multidisciplinary care in experienced centers is of utmost importance.

http://bit.ly/2sVIqlP

Engineering of scaffold‐free tri‐layered auricular tissues for external ear reconstruction

Objectives

Current strategies for external ear reconstruction can lead to donor site morbidity and/or surgical complications. Tissue‐engineered auricular tissues may provide readily available reconstructive materials that resemble native auricular tissue, which is composed of a cartilaginous region sandwiched between two perichondrial layers. We previously developed scaffold‐free bi‐layered auricular tissues, consisting of a perichondrial layer and a cartilaginous layer, by cultivating chondrocytes and perichondrial cells in a continuous flow bioreactor. Here, we aimed to improve construct properties and develop strategies to engineer tri‐layered auricular constructs that better mimic native auricular tissue.

Study Design

Experimental study.

Methods

Different concentrations of insulin‐like growth factor (IGF)‐1 and insulin were supplemented during bioreactor culture to determine conditions for engineering bi‐layered constructs. We also investigated two methods of engineering tri‐layered constructs. Method 1 used Ficoll separation to isolate perichondrial cells, followed by the seeding of isolated perichondrial cells onto the opposing side of the bi‐layered constructs. Method 2 involved the growth of the bi‐layered constructs in osteogenic culture medium.

Results

The combination of 10 nM IGF‐1 and 100 nM insulin led to increased collagen content in the engineered bi‐layered constructs. For developing tri‐layered constructs, method 2 yielded thicker constructs with better mechanical and biochemical properties compared to method 1. In addition, the presence of the perichondrial layers protected the engineered constructs from tissue calcification.

Conclusion

Auricular tissues with a biomimetic microstructure can be created by growing chondrocytes and perichondrial cells in a continuous flow bioreactor, followed by cultivation in osteogenic medium.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2MIgKK1

Impact of treating facilities’ type and volume in patients with major salivary gland cancer

Objectives/Hypothesis

Investigate the relationship between facility volume and type on overall survival (OS) in patients with major salivary gland cancer undergoing surgical treatment.

Study Design

Retrospective review of the National Cancer Database (NCDB) 2004–2015.

Methods

The NCDB was queried for patients with surgically treated major salivary gland cancer. The mean number of cases treated at each institution was calculated. High‐volume facilities (HVFs) were defined as the top 10% of centers. Univariate and multivariate propensity score‐matched analyses were performed to evaluate the impact of facility volume and type on OS.

Results

A total of 8,658 patients were analyzed. Distribution among facilities was highly skewed, with a median value of 1.38 cases/year (range, 0.11–23.25). On univariate analysis, treatment at HVFs was not associated with improved OS. However, there were significantly more patients with adverse clinical features treated at HVFs. Treatment at HVFs was associated with increased rates of concomitant neck dissections and lower rates of positive margins. In propensity‐score matched cohorts, OS was not significantly improved in patients treated at HVFs (hazard ratio [HR]: 0.979; 95% confidence interval [CI]: 0.879‐1.091) or academic/research institutions (HR: 0.914; 95% CI: 0.821‐1.018).

Conclusions

Regionalization of care is occurring in patients with major salivary gland malignancies. Patients treated at HVFs had greater rates of adverse clinical features and more commonly underwent neck dissections, although adjuvant radiotherapy rates were similar between facility types. There was no apparent survival benefit to patients treated at HVFs or academic/research institutions, although there were lower rates of positive margins at HVF.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2sXc2PF

The benefit of trans‐attic endoscopic control of ossicular prosthesis after cholesteatoma surgery

Objective

To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma.

TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis.

Methods

A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall‐up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure‐tone average air–bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups.

Results

Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP).

Conclusion

Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2MHKpDh

Feasibility and tolerability of measuring translaryngeal pressure during exercise

Objectives/Hypothesis

To determine if simultaneous tracheal and supraglottic pressure measurement performed during a continuous laryngoscopy exercise (CLE) test is possible, tolerable, and feasible, and if so, whether measurements can be used to determined airflow resistance over the larynx, thus providing an objective outcome measure for the CLE test, the gold standard for diagnosing exercise‐induced laryngeal obstruction.

Study Design

Explorative descriptive clinical study.

Methods

A CLE test was performed with the addition of two pressure sensors (Mikro‐Cath 825‐0101; Millar, Houston, TX) placed at the epiglottic tip and at the fifth tracheal ring. To place sensors, laryngeal anesthesia and a channel scope were required. Tolerability and feasibility was determined by a Likert score and subjective indication from subjects and operators. Adjustments to the technique were made to increase tolerability. The pressure data were continuously collected and analyzed for artifacts, drifts, frequency response, and used with flow data to calculate translaryngeal resistance.

Results

All subjects (n = 7) completed all procedures. Two main areas of concern were identified regarding tolerability: application of topical anesthesia to the larynx and nasal discomfort due to the added diameter of the laryngoscope. Protocol adjustments improved both. Pressure data were obtained from all procedures in all subjects, were consistent, and followed physiological trends.

Conclusions

Continuous measurement of the translaryngeal pressure gradient during a CLE test is possible, feasible, and tolerable. A CLE test with direct measurement of the translaryngeal pressure gradient might become a valuable tool in the objective assessment of respiratory function, and normal values should be established in health and disease.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2sWEy3P

Neuroprotective factors and incident hearing impairment in the epidemiology of hearing loss study

Objective

Hearing impairment (HI) is common in aging adults. Aldosterone, insulin‐like growth factor (IGF1), and brain‐derived neurotrophic factor (BDNF) have been identified as potentially protective of hearing. The present study aims to investigate these relationships.

Methods

The Epidemiology of Hearing Loss Study is a longitudinal population‐based study of aging in Beaver Dam, Wisconsin, that began in 1993. Baseline for the present investigation is the 1998 to 2000 phase. Follow‐up exams occurred approximately every 5 years, with the most recent occurring from 2013 to 2016. Hearing was measured by pure‐tone audiometry. HI was defined as a pure tone average (PTA) > 25 decibels hearing level in either ear. Change in PTA was the difference between follow‐up examinations and baseline. Baseline serum samples were used to measure biomarkers in 2017. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to assess the effect of biomarker levels in the lowest quintile (Q1) versus the highest (Q5) on incident HI and PTA change.

Results

There were 1,088 participants (69.3% women) at risk of HI included in analyses. The mean baseline age was 63.8 years (standard deviation = 7.0). The 16‐year incidence of HI was 54.9% and was higher in men (61.1%) than women (52.1%). In age‐ and sex‐adjusted models, aldosterone (HR = 1.06, 95% CI = 0.82–1.37), IGF1 (HR = 0.92, 95% CI = 0.71–1.19), and BDNF (HR = 0.86, 95% CI = 0.66–1.12) levels were not associated with risk of HI. PTA change was similarly not affected by biomarker levels.

Conclusion

Aldosterone, IGF1, and BDNF were not associated with decreased risk of age‐related hearing loss in this study.

Level of Evidence

2b. Laryngoscope, 2019

http://bit.ly/2MFQFeA

Clinical applications of three‐dimensional printing in otolaryngology–head and neck surgery: A systematic review

Objectives

Medical three‐dimensional (3D) printing, the fabrication of handheld models from medical images, has the potential to become an integral part of otolaryngology–head and neck surgery (Oto‐HNS) with broad impact across its subspecialties. We review the basic principles of this technology and provide a comprehensive summary of reported clinical applications in the field.

Methods

Standard bibliographic databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and The Cochrane Central Registry for Randomized Trials) were searched from their inception to May 2018 for the terms: "3D printing," "three‐dimensional printing," "rapid prototyping," "additive manufacturing," "computer‐aided design," "bioprinting," and "biofabrication" in various combinations with the terms: "ptolaryngology," "head and neck surgery," and "otology." Additional articles were identified from the references of retrieved articles. Only studies describing clinical applications of 3D printing were included.

Results

Of 5,532 records identified through database searching, 87 articles were included for qualitative synthesis. Widespread implementation of 3D printing in Oto‐HNS is still at its infancy. Nonetheless, it is increasingly being utilized across all subspecialties from preoperative planning to design and fabrication of patient‐specific implants and surgical guides. An emerging application considered highly valuable is its use as a teaching tool for medical education and surgical training.

Conclusions

As technology and training standards evolve and as healthcare moves toward personalized medicine, 3D printing is emerging as a key technology in patient care in Oto‐HNS. Treating physicians and surgeons who wish to stay abreast of these developments will benefit from a fundamental understanding of the principles and applications of this technology. Laryngoscope, 2019

http://bit.ly/2sZQdyZ

Oxidative stress in prelingual sensorineural hearing loss and the effects of cochlear implant application on serum oxidative stress levels

Publication date: Available online 31 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Mustafa Celik, İsmail Koyuncu

Abstract

Objectives

The aim of this study is to investigate oxidative stress conditions in patients with prelingual profound sensorineural hearing loss (SNHL) and the effects of cochlear implant application on oxidative stress. In addition, we also aimed to evaluate the correlation between pre- and post-surgery oxidative stress markers and Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), Meaningful Use of Speech Scale (MUSS) and Free-Field Audiometry (FFA).

Methods

This is a prospective controlled study of the Ear-Nose-Throat Department of the Harran University Faculty of Medicine between April 2017 and January 2018. The study included 25 patients with prelingual profound SNHL diagnosis and cochlear implant surgery and 25 healthy control groups. Total thiol, native thiol, disulphide levels and LOOH levels were studied in serum samples taken from the patient group 2 weeks before and 6 months after the cochlear implant surgery and the healthy control group. In addition, IT-MAIS, MUSS and FFA tests, which were used to evaluate the personal development of patients with cochlear implants, were performed at preoperative and postoperative 6th month.

Results

In our study, we found that the levels of native thiol (p<0.01) and total thiol (p <0.01) were significantly lower and LOOH (p<0.04) values were significantly higher in preoperative SNHL patients than control group. We found that native thiol, total thiol values increased and LOOH values decreased in the postoperative with respect to preoperative values. However, the difference between preoperative and post operative values was not statistically significant. The correlation between pre- and post-surgery biochemical data and IT-MAIS, MUSS and FFA tests were found not to be significant.

Conclusions

Our study suggests that patients with prelingual profound SNHL are under oxidative stress and post-CI surgery data show that there is no significant relief in patients. This study can shed light on the biologic mechanisms between prelingual profound SNHL and oxidative stress.

http://bit.ly/2SlLYMe

Stridor as initial presentation of Rolandic Epilepsy

Publication date: Available online 30 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): José Ferreira Penêda, Sandra Alves, Francisco Monteiro, Inês Sousa Ribeiro, Nuno Barros Lima, Artur Condé

Abstract

The authors present the case of a 5-year-old girl referred to our institution due to several episodes of nocturnal stridor with ocular retroversion and parental notion of apnea. She has been previously submitted to adenotonsillectomy. Due to symptoms worsening she was referred to our hospital. Here, a nasal fiberoptic endoscopy evaluation was conducted and a diagnosis of laryngomalacia was done. The was submitted to CO2 laser ariepiglotoplasty with symptom improvement after surgery. During a follow-up appointment, parents reported self-limited clonic facial movements at sleep onset. The electroencephalogram (EEG) was compatible with benign childhood epileptiform discharges.

http://bit.ly/2HGnB7X

Pediatric Acute Unilateral Suppurative Lymphadenitis: The Role of Antibiotic Susceptibilities at a Large Tertiary Pediatric Care Center

Publication date: Available online 30 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Nathan R. Lindquist, Ankita Patro, Sarah A. Gitomer, Karina T. Cañadas

http://bit.ly/2SiQtav

Thanks to reviewers

Publication date: February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 1

Author(s):

http://bit.ly/2sVIkdE

Contents

Publication date: February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 1

Author(s):

http://bit.ly/2MFMu2F

Serum-based metabolomics characterization of patients with reticular oral lichen planus

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Xu-zhao Li, Shuai-nan Zhang, Xu-yan Yang

Abstract

Objective

Oral lichen planus (OLP) is a chronic inflammatory mucosal lesion and systemic disease. In OLP, reticular type is the most common presentation of the disease. However, little is known about it. The aim of this study was to analyze the pathogenesis of reticular OLP and its possible associations with the pathological changes in other organ systems through serum-based metabolomics.

Methods

Blood samples were obtained from 16 reticular OLP patients and 24 control subjects. Liquid chromatography (LC)-mass spectrometry (MS) system was used to identify differentially expressed metabolites. The pathways analysis was performed by MetaboAnalyst. Pathological network was constructed by Cytoscape software.

Results

Totally, 31 modulated metabolites were identified, whose dysregulations affected 25 metabolic pathways and 7 pathological processes in the disease. Through an impact-value screen (impact-value＞0.1), 6 pathways were selected as the significantly dysregulated pathways. Pathological network showed that these metabolites participated in 7 pathological processes, that is, apoptosis process, DNA damage and repair disorder, oxidative stress injury, carbohydrate metabolism disorder, mood dysfunction, inflammatory lesion, and other pathological process.

Conclusion

The study demonstrated that reticular OLP could cause the dysregulations of the metabolites in serum, which might be also further linked to other organ and systemic diseases through the blood system, such as diabetes, sleep disorders, and depression, etc.

http://bit.ly/2sSVVCK

Influence of low-level laser therapy on orthodontically-induced inflammatory root resorption. A systematic review

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Dimitrios Michelogiannakis, Deema Al-Shammery, Zohaib Akram, P. Emile Rossouw, Fawad Javed, Georgios E. Romanos

Abstract

Objective

The aim was to assess the influence of low-level laser therapy (LLLT) on orthodontically-induced inflammatory root resorption (OIIRR).

Methods

A systematic search was conducted in indexed databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligibility criteria were as follows: (a) original clinical and animal/experimental studies; (b) prospective studies; (c) intervention: effect of LLLT on OIIRR; (d) control group (OIIRR without LLLT); (e) statistical analysis; and (f) tomographic or histologic assessment of OIIRR. Quality assessment of the experimental and clinical studies was performed following the Animal Research Reporting In-vivo Experiments (ARRIVE) and Consolidated Standards of Reporting Trials (CONSORT) guidelines, respectively. The risk of bias of the included studies was also determined.

Results

Nine (7 experimental and 2 clinical) of the initially identified 39 studies were included. One clinical and 2 experimental studies showed that LLLT during orthodontic tooth movement (OTM) significantly reduces OIIRR. One experimental study reported that LLLT during OTM in sockets treated with alloplastic materials significantly reduces OIIRR. One experimental study found that LLLT after OTM significantly repairs OIIRR, whereas one clinical study did not report a significant reparative affect. Three experimental studies showed that LLLT increases OIIRR during OTM, corticotomized-OTM, and OTM into grafted defects, respectively. The minimum, median and highest ARRIVE scores (out of 20) of the included experimental studies were 15, 17 and 19, respectively. The mean CONSORT score of the included clinical studies was 23 (out of 25).

Conclusions

In conclusion, the influence of LLLT on OIIRR remains debatable.

http://bit.ly/2MFNXFW

HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies

Abstract

Background

Interventional radiotherapy (brachytherapy; IRT) reemerged in the last decades as a potentially useful tool in head and neck oncology after a set of clear technical improvements were developed.

Methods

Sixty‐one high dose ratio (HDR) IRT treatments were recommended and performed on 58 patients. We classified the cases into four relatively homogeneous groups based on the clinical needs that led to the recommended IRT. Also, we separately evaluated primary and recurrent cases.

Results

Disease‐specific survival was significantly different among the four treatment groups. The group with the best prognosis was the cohort treated locally by exclusive interstitial IRT for resectable midface malignancies (2‐year relapse‐free survival = 82%, disease‐specific survival = 89%).

Conclusion

HDR IRT is a valuable tool in well‐defined clinical situations and, in particular, in recurrences. In midface malignancies, it could become the preferred primary treatment.

http://bit.ly/2WxFFo4

Assessing functional outcomes in head and neck surgical oncology

Abstract

Background

A reliable method of measuring functional outcomes is essential to inform treatment decisions in head and neck cancer.

Methods

Members of the American Head and Neck Society were surveyed regarding their use of functional outcome assessment tools. Qualitative statistical analysis was performed to identify major tools used and to clarify obstacles to functional outcome assessment. A comprehensive literature review was performed to identify available tools.

Results

A total of 142 surgeons were surveyed. 44.12% of respondents use at least 1 tool to assess functional outcomes. The most frequently used tools were modified barium swallow, MD Anderson Dysphagia Inventory, and functional endoscopic evaluation of swallow (FEES). 72.65% of respondents reported barriers to assessment, most frequently a lack of support to administer the tests or to collect, apply or analyze the results. Review of the literature revealed 173 available tools.

Conclusions

Although a wide variety of validated tools are available in the literature to assess functional outcomes after head and neck surgery, major obstacles to their use persist. The lack of a standard measure that is practical and transferable continues to impair research progression in this field.

http://bit.ly/2RtuIAf

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

http://bit.ly/2FZue3A

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

http://bit.ly/2FZue3A

Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public

1. THYROID HORMONE THERAPY Taking levothyroxine with breakfast may be fine for many patients
Volume 6 Issue 11
Heather Hofflich, DO
90,612 views

2. THYROID NODULES Risk of thyroid cancer based on thyroid ultrasound findings
Volume 7 Issue 1
Jamshid Farahiti, MD
86,024 views

3. HYPOTHYROIDISM Desiccated thyroid extract vs Levothyroxine in the treatment of hypothyroidism
Volume 6 Issue 8
Angela M. Leung, MD, MSc
53,659 views

4. THYROID CANCER High risk of thyroid cancer in patients with multinodular goiter
Volume 6 Issue 11
Jamshid Farahiti, MD
46,359 views

5. HYPOTHYROIDISM When is the best time to take thyroid hormone?
Volume 4 Issue 5
Whitney Woodmansee, MD
46,413 views

6. THYROID AND PREGNANCY First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss
Volume 3 Issue 8
Whitney Woodmansee, MD
34,091 views

7. THYROID HORMONE TESTS Determination of optimal TSH ranges for reflex Free T4 testing
Volume 11 Issue 2
Whitney W. Woodmansee MD
22,787 views

8. HYPERTHYROIDISM Thyroid tests on newborns within the first five days will detect neonatal hyperthyroidism
Volume 7 Issue 7
Heather Hofflich, DO
21,568 views

9. THYROID AND PREGNANCY Low TSH levels early on in pregnancy may be normal
Volume 9 Issue 10
Alan P. Farwell, MD, FACE
21,047 views

10. THYROID AND PREGNANCY Increasing levothyroxine doses early in pregnancy is associated with a lower risk for pregnancy loss in hypothyroid women
Volume 9 Issue 10
Shirin Haddady, MD
20,502 views

 

The post Check out the ten Top-viewed articles in 2018 – Clinical Thyroidology for the Public appeared first on American Thyroid Association.

http://bit.ly/2RsRY1w

Syndromes that predispose to epistaxis

Abstract

Purpose

Our aim was to evaluate if epistaxis is directly associated with the etiology or pathophysiological mechanism which results in the syndrome itself or arises as a secondary effect.

Methods

We performed an extensive literature review of the web-based PubMed database from the National Library of Medicine to ascertain syndromes related to this condition. Etiology, pathophysiological mechanisms, occurrence, clinical features and management were noted for each of these syndromes.

Results

Epistaxis is commonly seen in syndromes that are usually directly related to vascular abnormalities or coagulation defects. However, in some cases, it is not.

Discussion and conclusion

Since a number of these syndromes are rare and elaborate tests are not carried out in the absence of a positive family history or until other specific clinical features appear, a risk of underdiagnosis and the dilemma of whether epistaxis is specifically related to the syndrome or a secondary effect still remains.

http://bit.ly/2UorUGo

Dietary behaviors and survival in people with head and neck cancer: Results from Head and Neck 5000

Abstract

Background

The association between diet and head and neck cancer (HNC) survival is unclear.

Methods

Cox proportional hazard models measured the association between fruit, vegetable, and deep‐fried food intake and HNC overall survival adjusting for clinical, social and lifestyle variables including smoking, alcohol, and HPV status.

Results

Fruit and vegetable intake and improved survival were associated in minimally adjusted analyses. Following adjustment for smoking and alcohol consumption (fully adjusted analyses), the association with survival disappeared for fruit (HR 0.91, 95% CI 0.67, 1.23; P for trend = .55) and attenuated for vegetables (HR 0.79, 95% CI 0.61, 1.03; P for trend = .04). We observed no association between survival and deep‐fried food intake in minimally adjusted or fully adjusted analyses (HR 0.88 95% CI 0.72, 1.07; P for trend = .13).

Conclusions

Vegetable intake and HNC survival are modestly associated. There is some confounding by tobacco and alcohol consumption.

http://bit.ly/2WuQ1oP

Patient‐defined duration of benefit from juvederm (hyaluronic acid) used in injection laryngoplasty

Objectives/Hypothesis

Injection laryngoplasty has become valuable in treating laryngologic disorders including vocal cord atrophy, paralysis, and paresis. Although materials such as carboxymethylcellulose and calcium hydroxylapatite are Food and Drug Administration (FDA) approved, they are not without limitations. Juvederm (hyaluronic acid) is an alternative treatment that is not FDA approved. Although studies have examined Juvederm's longevity in cutaneous injections, there are limited data examining durability of Juvederm used in laryngoplasty. We aimed to determine the longevity and effectiveness of Juvederm used in injection laryngoplasty.

Study Design

Retrospective cohort study.

Methods

Subjects who underwent injection laryngoplasty using Juvederm were reviewed. Longevity was defined as the time between injection and the date that a patient first noted subjective deterioration of their voice. All subjects were subsequently followed using videostroboscopy to evaluate for Juvederm resorption. Longevity was analyzed using a Kaplan‐Meier survival model, and effectiveness of laryngoplasty was determined using the Voice‐Related Quality of Life index scores and analyzed using a Wilcoxon signed ranks test.

Results

Fifty‐nine subjects met inclusion criteria and underwent Juvederm injection laryngoplasty. Kaplan‐Meier survival analysis revealed a mean longevity of 10.6 months (95% confidence interval: 9.1‐12.0 months). Wilcoxon signed ranks analysis of the pre‐ and postinjection Voice Related Quality of Life (VRQOL) scores revealed improvement, with a mean preinjection VRQOL of 49.2 (standard deviation [SD] = 25.8) and mean postinjection VRQOL of 68.2 (SD = 27.5) (P < .001).

Conclusions

Injection laryngoplasty using Juvederm is an effective treatment for vocal cord atrophy, paralysis, and paresis. Knowledge of the patient‐defined duration of benefit following laryngoplasty using Juvederm plays an important role in counseling patients as well as in the planning of future interventions.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FYZShN

Clinicopathological significance of tumor cyclin D1 expression in oral cancer

Publication date: Available online 30 January 2019

Source: Archives of Oral Biology

Author(s): Pablo Ramos-García, Miguel Ángel González-Moles, Lucía González-Ruiz, Ángela Ayén, Isabel Ruiz-Ávila, Manuel Bravo, José Antonio Gil-Montoya

Abstract

Objective

To evaluate the association of cyclin D1 overexpression with clinicopathological parameters classically considered of prognostic value in OSCC (T, N, M, clinical stage, degree of differentiation, invasive morphology and, cellular proliferation index).

Design

A retrospective immunohistochemical study was conducted of cyclin D1 and ki-67 expression in 68 OSCCs from 54 patients. Cases were scanned using a digital pathology system. The tumor expression of markers was assessed in four randomly selected fields (40x), and a semi-automatized count was conducted of cyclin D1-positive and -negative cells.

Results

Cyclin D1 overexpression was found in 28.7% of the cases of OSCC. It was significantly and positively associated with the following clinicopathological parameters: low tumor differentiation degree (p = 0.030), invasive morphology (p = 0.045), and proliferative phenotype according to tumor cell ki-67 expression(p = 0.018).

Conclusions

Cyclin D1 overexpression is an event of oral carcinogenesis associated with clinicopathological parameters classically associated with a poor prognosis in patients with OSCC.

http://bit.ly/2UsJSrg

Deletion of cas3 gene in Streptococcus mutans affects biofilm formation and increases fluoride sensitivity

Publication date: Available online 29 January 2019

Source: Archives of Oral Biology

Author(s): Boyu Tang, Tao Gong, Xuedong Zhou, Miao Lu, Jumei Zeng, Xian Peng, Shida Wang, Yuqing Li

Abstract

Objective

The goal of this study was to analyze the impact of cas3 gene on the biofilm formation and virulence gene expression in S. mutans, since our previous studies have found a connection between CRISPR/Cas systems and biofilm formation in S. mutans.

Methods

The cas3 gene in-frame deletion strains of S. mutans UA159 was constructed by a two-step transformation procedure and the cas3 mutant strain was complemented in trans. The biofilm biomass was measured by crystal violet staining, and the synthesis of exopolysaccharides (EPS) was measured by the anthrone-sulfuric method. Biofilm analysis and structural imaging was using confocal laser scanning microscope (CLSM) and scanning electron microscope (SEM) assays. The fluorescence in situ hybridization (FISH) was used to analyze the spatiotemporal interactions between S. mutans and Streptococcus sanguinis. Fluoride sensitivity was determined using fluoride tolerance assays. The expression of biofilm formation related genes was evaluated by qRT-PCR.

Results

Our results showed that S. mutans cas3 deletion strain formed less biofilm and became less competitive when it was co-cultured with S. sanguinis under fluoride treatment. The expression levels of virulence genes including vicR, gtfC, smu0630 and comDE were significantly downregulated.

Conclusions

The cas3 gene in S. mutans could regulate biofilm formation and fluoride resistance, consequently affecting S. mutans competitiveness in a dual-species biofilm model under fluoride treatment. These results also provide a potential strategy for enhancing fluoride specificity, with cas3 gene as a potential genetic target in the modulation of oral microecology and the treatment of dental caries.

http://bit.ly/2DJ1NEA

Bismuth supplements as the first‐line regimen for Helicobacter pylori eradication therapy: Systemic review and meta‐analysis

Abstract

Background and Aims

An increase in the use of antibiotics leads to increased antibiotic resistance of Helicobacter pylori (H pylori). Consequently, it has been considered that the first‐line standard regimen should be changed. The main purpose of this study was to evaluate the efficacy of nonantibiotic (bismuth) supplements as a first‐line regimen for H pylori eradication.

Methods

We searched PubMed, EMBASE, CINAHL, and the Cochrane Library databases for randomized controlled trials (RCTs) reported in English and undertaken up until August 2018. A meta‐analysis of all randomized controlled trials comparing bismuth supplements with non‐bismuth‐containing regimens in H pylori eradication was performed. RCTs of classic bismuth‐containing quadruple therapy as a first‐line regimen were excluded.

Results

We identified twenty‐five randomized trials (3990 patients), and the total H pylori eradication rate, according to per protocol analyzed, was 85.8%. The odds ratio was 1.83 (95% confidence interval (CI). 1.57‐2.13). Among these RCTs, there were 7 RCTs for bismuth add‐on therapy, and the odds ratio was 2.81 (95% CI. 2.03‐3.89). When the studies were performed in a high clarithromycin resistance area (≥15%) or included patients with clarithromycin resistance, bismuth‐containing regimens were superior to non‐bismuth regimens. Moreover, the incidence of total side effects was insignificant.

Conclusions

Bismuth supplements as a first‐line regimen could be effective, with bismuth add‐on regimens being the most effective. Particularly, bismuth supplements showed the potential efficacy for clarithromycin‐resistant strains and would be the most viable alternative in clinical practice.

http://bit.ly/2TlKkrt

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

Publication date: Available online 29 January 2019

Source: Auris Nasus Larynx

Author(s): Toshinori Kubota, Tsukasa Ito, Yasuhiro Abe, Hiroyuki Chiba, Yutaka Suzuki, Seiji Kakehata, Masaru Aoyagi

Abstract

Objectives

The ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.

Subjects and methods

We examined 2 groups of subjects: 10 subjects with unilateral hearing impairment in whom the recruitment phenomenon was detected by the alternate binaural loudness balance test and 12 normal subjects. We compared the relationships between the ASSR response and the stimulus sound pressure level in the 2 groups using the 80-Hz ASSR.

Results

The amplitude of ASSR was significantly higher in the impaired ear in hearing-impaired subjects compared to a normal ear in normal subjects. The latency of ASSR was significantly shorter in the impaired ear in hearing-impaired subjects than in the normal ear in the normal subjects.

Conclusion

This study showed that the recruitment phenomenon caused the higher amplitude and the shorter latency observed in hearing-impaired subjects in the 80-Hz auditory steady-state response (ASSR) in comparison with normal subjects.

http://bit.ly/2HG9tM6

Outcomes following radiation for cutaneous squamous cell carcinoma of the head and neck: Associations between immune suppression and recurrence

Abstract

Background

Data evaluating outcomes and patterns of recurrence following radiation therapy (RT) for cutaneous squamous cell carcinoma (cSCC) of the head and neck are limited.

Methods

We performed a retrospective analysis of 111 head and neck cSCC patients treated with RT at 4 affiliated institutions.

Results

With median follow‐up of 7 months, there were 29 (26%) recurrences, 73% of which were nodal (n = 21). Immunosuppression (IS) was the only factor associated with recurrence (47% in IS, 22% in non‐IS, P = .04), and also with time to recurrence in multivariate analysis (HR 5.5; P = .03). No factors were associated with recurrence among patients who received definitive RT. The majority of patients who recurred were salvaged with surgery (n = 20, 69%).

Conclusion

In a cohort of cSCC treated with radiotherapy, there was an association between IS and increased failure risk. The majority of failures were salvaged surgically.

http://bit.ly/2HN5Jsm

Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives

Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G7H0fM

Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice

Purpose of review Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach. Recent findings Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment. Summary The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance. Correspondence to Petr Szturz, MD, PhD, Medical Oncology, Department of Oncology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 079 556 76 67; e-mail: szturz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2FWXiZI

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice

Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GeWbUe

Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives

Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G7H0fM

Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice

Purpose of review Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach. Recent findings Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment. Summary The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance. Correspondence to Petr Szturz, MD, PhD, Medical Oncology, Department of Oncology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 079 556 76 67; e-mail: szturz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2FWXiZI

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice

Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GeWbUe

Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib

Facial plast Surg
DOI: 10.1055/s-0039-1677718

In functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.
[...]

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Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2sSFUN1

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

The ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.

http://bit.ly/2CQO2lV

Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study

Abstract

Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.

http://bit.ly/2RpyzhM

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

Abstract

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

http://bit.ly/2WpEszg

Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study

Abstract

Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.

http://bit.ly/2RpyzhM

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

Abstract

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

http://bit.ly/2WpEszg

Pediatric simulation training: Tips to make it effective for medics

Educators need to provide realistic simulation training to ensure pediatric patient clinical competence

http://bit.ly/2BaRxDD

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

Abstract

Background

The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors.

Methods

All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system.

Results

A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time.

Conclusion

Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.

http://bit.ly/2WuUvf1

Prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma treated by intra‐arterial infusion chemotherapy concurrent with radiotherapy

Abstract

Background

The aim of this study was to evaluate the prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma (SCC) treated with intra‐arterial infusion chemotherapy concurrent with radiotherapy.

Methods

A total of 46 patients were reviewed retrospectively in this study. The treatment schedule comprised intra‐arterial chemotherapy (total, 60 mg/m² docetaxel and 150 mg/m² cisplatin) and three‐dimensional computed tomography based, daily conventional radiotherapy (total, 60 Gy/30 fr) for 6 weeks.

Results

The median follow‐up period was 40 months (range, 3‐110 months). The 3‐year overall survival and locoregional control rates for all patients were 64.3% and 84.3%, respectively. The OS rate of the patients with N0‐1 was significantly higher than that of the patients with N ≥ 2 (P < .05). No grade 5 toxicities were observed.

Conclusions

Intra‐arterial infusion chemotherapy concurrent with radiotherapy was effective for advanced maxillary gingival SCC.

http://bit.ly/2Rr6y9w

Performance of a 31‐gene expression profile test in cutaneous melanomas of the head and neck

Abstract

Background

We report the performance of a gene expression profile test to classify the recurrence risk of cutaneous melanoma tumors of the head and neck as low‐risk Class 1 or high‐risk Class 2.

Methods

Of note, 157 primary head and neck cutaneous melanoma tumors were identified. Survival analyses were performed using Kaplan‐Meier and Cox methods.

Results

Gene expression profile class and node status stratified tumors into significantly different 5‐year survival groups by Kaplan‐Meier method (P < .0001 for all end points), and both were independent predictors of recurrence in multivariate analysis. Overall, 74% of distant metastases and 88% of melanoma‐specific deaths had Class 2 risk.

Conclusion

The gene expression profile test identifies cases at increased risk for metastasis and death independent of a clinically or pathologically negative nodal status, suggesting that incorporation of this molecular tool could improve clinical management of patients with head and neck cutaneous melanoma, especially in those with a negative sentinel lymph node biopsy.

http://bit.ly/2WsW4KL

Consequences of hearing aid acclimatization on ALLRs and its relationship with perceived benefit and speech perception abilities

Abstract

Objective

The study aimed to track long latency responses over a period of hearing aid use in naïve hearing aid users, and study its relationship with change in speech perception abilities and perceived benefit.

Methods

Thirty adults in the age range of 23–60 years with moderate sensorineural hearing loss participated in the study. Auditory late latency responses (ALLRs), signal-to-noise ratio − 50 (SNR-50), and scores of speech spatial and qualities questionnaire (SSQ) were measured three times over a period of 2 months of hearing aid use.

Results

ALLRs showed a significant decrease in the P1 and N1 latency across the three measurements. Significant increase in the scores of SSQ and significant decrease in the SNR-50 were also found. The change in ALLRs did not correlate with change in scores of either SSQ or SNR-50.

Conclusions

The study provides evidence for improvements in neural processing of auditory cortical areas with hearing aid acclimatization. The improvements seen in perceived benefit and speech perception are not related to the improvements in ALLRs. This is the first study in the domain with a younger group compared to the previous studies and the results show evidence for neural plasticity influencing hearing aid acclimatization benefits.

http://bit.ly/2RUPhdT

Tinnitus: psychosomatische Aspekte

Zusammenfassung

Tinnitus ist ein häufiges Symptom unklarer Genese, das multifaktoriell bedingt und aufrechterhalten sein kann. Es ist oftmals, aber nicht zwingend, mit Hörverlust assoziiert. Emotionale Belastung oder maladaptive Copingstrategien, die sich in Reaktion auf Tinnitus entwickeln oder durch ihn verstärkt werden können, stellen Schlüsselfaktoren für psychosoziale Interventionen dar. Hierzu eignen sich – nach Abklärung somatischer Einflussfaktoren – entkatastrophisierende Informationsvermittlung und ggf. psychotherapeutische Interventionen. Maßnahmen zur Verbesserung der Hörwahrnehmung (z. B. Hörgeräte oder Cochleaimplantate) können über direkte (Verbesserung der Hörwahrnehmung) oder indirekte Effekte (Verbesserung des emotionalen Befindens oder der Lebensqualität) ebenfalls zur Tinnitushabituation beitragen.

http://bit.ly/2HEIy35

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

http://bit.ly/2UonIqk

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

http://bit.ly/2UonIqk

Reliability of clinical diagnosis of masses of the cerebellopontine angle: A retrospective multi-institutional study

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

Author(s): Alexander L. Luryi, Elias M. Michaelides, Seilesh Babu, Dennis I. Bojrab, John F. Kveton, Robert S. Hong, John Zappia, Eric W. Sargent, Christopher A. Schutt

Abstract

Objectives

To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology.

Design

Retrospective chart review.

Participants

Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017.

Main outcome measures

Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses.

Results

Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05).

Conclusions

Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.

http://bit.ly/2DEEpYT

The factors associated with the early diagnosis of nasal NK/T-cell lymphoma with prominent ocular symptoms and general nasal NKTL

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

Author(s): Zhenzhen Hu, Ying Wang

Abstract

Aim

This study explored the clinical features of nasal natural killer/T-cell lymphoma (NKTL) in patients with prominent ocular symptoms and those with general nasal NKTL to improve the early diagnosis of nasal NKTL.

Method

A retrospective cohort study was performed with 278 patients with nasal NKTL admitted to the First Affiliated Hospital of Zhengzhou University between January 2011 and December 2017. Of these cases, 56 presented with nasal NKTL and prominent ocular symptoms, and 222 presented with general nasal NKTL.

Results

No significant differences in gender and age distribution were found between patients with general nasal NKTL and those with nasal NKTL and prominent ocular symptoms (p > 0.05). Cases of nasal NKTL and prominent ocular symptoms were usually complicated with B symptoms(48.2% vs 32.9%, p < 0.05). Patients with nasal NKTL and prominent ocular symptoms were more likely to progress to stage III disease (p < 0.01). The median time from first onset to diagnosis was 2.5 months. Most patients with general nasal NKTL had a longer history (69.6% vs 45.0%, p < 0.01). The misdiagnosis rate of the first visit of patients with general nasal NKTL was 29.3%, and that of patients with prominent ocular symptoms was 51.8%; this difference was significant (p < 0.01). Patients with nasal NKTL and prominent ocular symptoms showed a higher positive rate of EBV DNA (p < 0.01), which was significantly associated with staging (p < 0.01).

Conclusions

Compared with patients with general nasal NKTL, the early diagnosis of patients with prominent ocular symptoms is difficult and easy to misdiagnose. Patients with nasal NKTL and prominent ocular symptoms mostly present with advanced disease stages, and most patients have B symptoms and a high positive rate of EBV DNA.

http://bit.ly/2Ur3TyF

Pain perception and functional/occlusal parameters in sleep bruxism subjects following a therapeutic intervention

Abstract

Background

This study was conducted to assess the individual pain perception in sleep bruxism (SB) subjects. Moreover, the effects of a cognitive behavioural therapy (CBT) compared to an occlusal appliance (OA) on pain perception and a possible continuative impact on several functional parameters were investigated.

Methods

A total of 57 SB subjects participated in this investigation. The diagnosis of SB was based on the clinical criteria of the American Academy of Sleep Medicine (AASM). Twenty-eight SB subjects were randomly allocated to the CBT group and 29 to the OA group. The therapeutic intervention took place over a period of 12 weeks, whereby both groups were examined at baseline, immediately after termination of the intervention, and at a 6-month follow-up for pain perception and functional parameters. At each of the three measurement periods, participants completed the pain perception scale and ten functional/occlusal parameters were recorded.

Results

Of the 12 parameters recorded, statistically significant main effects were found for the affective pain perception (p < 0.05) and for the three functional variables. Interestingly, the values obtained for the affective pain perception were considerably below that of a reference group. Apart from the determined statistically significant results, the values recorded for all functional/occlusal variables as well as those obtained for the sensory pain perception were clearly located within normative ranges.

Conclusions

Within the limitations of this study, it might be concluded that the significantly reduced affective pain perception in SB subjects is the expression of an adaptation mechanism.

http://bit.ly/2BbFWUP

Surgical planning in pediatric skull base surgery

Publication date: Available online 28 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Randall A. Bly, Angelique M. Berens, Jonathan A. Perkins, Craig Miller, Manuel Ferreira, Jason S. Hauptman, Kris S. Moe

Treatment of pediatric skull base disorders is complex and requires individual planning. Compared to adult patients, the pathologies are more congenital and benign. Advanced surgical planning has been shown to improve outcomes and involves a variety of different software platforms to enable sophisticated review of image data sets, including virtual endoscopy and the details of surgical approach options. There are greater than 50 open and endoscopic surgical approaches described. Endoscopic approaches in patients under age 4 are extremely challenging due to the underdeveloped sinuses and overall smaller size of the craniofacial skeleton and nasal cavity. A multidisciplinary surgical team should develop and review surgical plan options with the patient and family.

http://bit.ly/2TliQlF

Pediatric Lateral Graft Tympanoplasty A Review of 78 Cases

Publication date: Available online 28 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kevin Y. Zhan, Kasey W. Rawlins, Jameson K. Mattingly, Prashant S. Malhotra, Oliver F. Adunka

Abstract

Objectives

The optimal timing and technique for repairing chronic tympanic membrane (TM) perforations in pediatric patients remains controversial. The objectives are to determine the surgical and hearing outcomes of pediatric lateral graft tympanoplasty at a tertiary teaching hospital.

Methods

A retrospective review was conducted for pediatric lateral graft tympanoplasties performed for chronic TM perforations by a single surgeon over a four-year period. Primary and secondary outcomes were graft failure rate and hearing outcomes, respectively.

Results

78 cases were analyzed. The mean age at time of surgery was 10.3 years (range 5-18 years). Mean follow-up was 11.0 months; 27 patients had follow-up >1 yr. Most patients were non-syndromic (85.9%), had a history of bilateral Eustachian tube dysfunction (ETD) (59%) and presented with marked myringosclerosis (73.1%). Thirty-three percent of cases were revision tympanoplasties. A learner surgeon (resident or fellow) was present in 89.7% of cases. Successful closure of the TM was achieved in 97.4% (76/78) of cases and 92.6% (25/27) of cases with >1-year follow-up. No obvious difference in graft failure was noted with regards to age at time of surgery, perforation size, history of bilateral ETD, presence of a learner surgeon, myringosclerosis, presence of syndromic features, or history of prior tympanoplasty. Ninety-one percent of patients either improved hearing or preserved their conductive hearing deficit. Poorer hearing outcomes were only associated with post-operative blunting.

Conclusions

Pediatric lateral graft tympanoplasty is effective in repairing chronic perforations with excellent hearing outcomes. Common quoted predictors of surgical outcome such as age at the time of surgery, syndromic features, history of previous myringoplasty, perforation size, and ETD dysfunction were not associated with graft failure in our series.

http://bit.ly/2Uni9IB

Severe cryopyrin-associated periodic syndrome first characterized by early childhood-onset sensorineural hearing loss – case report and literature review

Publication date: Available online 28 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Amaris Hui, Liane B. Johnson, Rony Greemberg, Lynette Penney, Suzanne Ramsey

Abstract

Infant-onset bilateral sensorineural hearing loss is a key presenting symptom of the autoinflammatory cryopyrin-associated periodic syndrome. Other symptoms include periodic fever, cold-induced urticaria-like rash, chronic aseptic meningitis, polyarticular arthralgias, and renal AA amyloidosis. Early recognition and treatment with interleukin-1 blockade are critical for preventing disabling or fatal complications. We describe a patient with severe cryopyrin-associated periodic syndrome who presented at age 18 months with macrocephaly and moderate sensorineural hearing loss, later developing systemic sequelae. The pathogenic nature of the de novo NLRP3 gene variant identified was supported by a markedly elevated serum amyloid A level and sustained clinical response to anti-IL-1 therapy.

http://bit.ly/2DFcQim

Qualitative and quantitative scintigraphy in sialorrhea before and after botulinum toxin injection

Objectives/Hypothesis

Sialorrhea is excessive saliva production and its usual escape of from the oral cavity. The use of botulinum toxin has been preconized, but its effectiveness until now has been unreliably measured. Our objective was to qualitatively and quantitatively determine the effectiveness of botulinum toxin injection in the reduction of saliva production by the parotid gland.

Study Design

Outcomes research.

Methods

Patients with moderate‐to‐critical sialorrhea had one of the parotid glands injected with 50 U of botulinum toxin, leaving the other as the control. Fifteen days after the toxin injection, they underwent scintigraphic analyses with intravenous injection of 10 mCi (37 MBq) of Tc‐99 m (sodium pertechnetate). After this, the noninjected gland was treated for therapeutic complementation.

Results

The glands injected with botulinum toxin showed uptake reduction in 100% of patients. The uptake reduction in counts per second varied from 8% to 36%. The Wilcoxon paired test comparing the control glands with those injected showed a significant difference for the action of botulinum toxin (P = .0039).

Conclusions

The scintigraphic study of parotid glands shows that botulinum toxin is effective in reducing sodium pertechnetate uptake.

Level of Evidence

2c Laryngoscope, 2019

http://bit.ly/2G6oVyB

Eye movement desensitization and reprocessing as a treatment for tinnitus

Objectives/Hypothesis

To determine the effectiveness of eye movement desensitization and reprocessing (EMDR) as a treatment for tinnitus.

Study Design

Single‐site prospective interventional clinical trial at a university hospital in the United Kingdom.

Methods

Participants were provided with tEMDR. This is a bespoke EMDR protocol that was developed specifically to treat individuals with tinnitus. Participants received a maximum of 10 sessions of tEMDR. Outcome measures including tinnitus questionnaires and mood questionnaires were recorded at baseline, discharge, and at 6 months postdischarge.

Results

Tinnitus Handicap Inventory and Beck Depression Inventory scores demonstrated a statistically significant improvement at discharge after EMDR intervention (P = .0005 and P = .0098, respectively); this improvement was maintained at 6 months postdischarge. There was also a moderate but not significant (P = .0625) improvement in Beck Anxiety Inventory scores.

Conclusions

This study has demonstrated that the provision of tEMDR has resulted in a clinically and statistically significant improvement in tinnitus symptoms in the majority of those participants who took part. Furthermore, the treatment effect was maintained at 6 months after treatment ceased. This study is of particular interest, as the study protocol was designed to be purposefully inclusive of a diverse range of tinnitus patients. However, as a small uncontrolled study, these results do not consider the significant effects of placebo and therapist interaction. Larger high‐quality studies are essential for the verification of these preliminary results.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FVL8jF

Comparison of balance outcomes according to treatment modality of vestibular schwannoma

Objectives

We sought to compare balance outcomes according to treatment modality of vestibular schwannoma (VS) via a meta‐analysis that divided measuring tools of balance outcomes into three categories based on type.

Methods

A comprehensive review of the literature from January 1966 to September 2017 was performed, looking for studies about long‐term balance outcomes after microsurgery (MS), radiotherapy (RT), or observation for VS. A comprehensive meta‐analysis was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and Egger's regression.

Results

Among 633 references, 34 were included in the meta‐analysis. Perceived dizziness improvement rate was significantly higher in the MS group than in the RT group (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.08 to 2.40; P < .05, I ² = 4.18], but no significant difference was observed between the two groups with regard to validated dizziness questionnaire score (standardized mean difference: 0.04; 95% CI: −0.36 to 0.44; P = .84, I ² = 69.61) or dizziness or disequilibrium‐related symptom incidence rate (OR: 0.91; 95% CI: 0.50 to 1.68; P = .77, I ² = 0). In a subanalysis conducted within the groups after intervention, the MS group demonstrated a lower vertigo incidence rate (P < .001), and the RT group experienced a significant reduction in validated dizziness questionnaire score (P < .05).

Conclusions

Our results indicate that MS should be considered at least equal to RT in regard to resolving long‐term dizziness and improving balance outcomes. Furthermore, well‐designed studies are necessary to predict balance outcomes after VS treatment and to choose from among possible treatment options.

Level of Evidence

2a Laryngoscope, 2019

http://bit.ly/2G6oODb

Positive airway pressure ventilation and complications in pediatric tracheocutaneous fistula repair

Objectives

Surgical repair of persistent tracheocutaneous fistula in children may be complicated by tracheal air leak with resultant subcutaneous emphysema, pneumomediastinum, and/or pneumothorax. We first sought to identify clinical risk factors for postoperative complications after primary repair of persistent tracheocutaneous fistula in children. Second, the type and frequency of complications in patients administered positive airway pressure ventilation (e.g., bag‐valve mask ventilation, continuous positive airway pressure [CPAP], or bilevel positive airway pressure [BiPAP]) postoperatively was determined and compared to a control population.

Methods

This was a retrospective investigation of all pediatric patients (n = 108) undergoing surgical repair of persistent tracheocutaneous fistula from January 2000 and April 2016 at a tertiary, academic referral center. Type and frequency of postoperative complications were compared among patients who were administered positive airway pressure ventilation postoperatively versus those who were not.

Results

Of 108 pediatric patients, complications after tracheocutaneous fistula repair occurred in 22 (20.4%) patients. These included symptoms of respiratory distress requiring intervention (e.g., supplemental O₂, racemic epinephrine, intubation), subcutaneous emphysema, pneumomediastinum and/or pneumothorax, bleeding, wound infection, and readmission. Frequency of all postoperative complications was significantly higher in patients administered positive airway pressure ventilation versus those who were not (50.0% vs. 16.7%, P = 0.015), as were rates of subcutaneous emphysema, pneumomediastinum, and/or pneumothorax (33.3% vs. 4.2%, P = 0.005).

Conclusion

Positive airway pressure ventilation after primary repair of persistent tracheocutaneous fistula in children may increase risk of serious respiratory complications. In practice, we advocate for avoidance of bag‐valve mask ventilation and caution when utilizing CPAP or BiPAP postoperatively in these patients.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2FUEytF