Patient Phenotyping in OSA

Abstract

Purpose of Review

OSA treatment paradigms are evolving from a "one treatment for all" philosophy to personalised therapeutic options based on anatomical and physiological phenotypes. Understanding these different phenotypes will become vital for clinicians as OSA testing and treatment become more targeted.

Recent Findings

Phenotyping of the pharynx and upper airway is vital to inform anatomical treatment options such as surgery and mandibular advancement splints. Manipulated CPAP testing allows determination of traits such as arousal threshold, muscular responsiveness and ventilatory control. Targeted therapies of each of these physiological traits have shown promise in selected patients in the research context.

Summary

Current treatment paradigms are based on anatomical therapies (CPAP, MAS, surgery); the limitations of which may be particularly evident in patients with physiological contributors to their OSA. Physiological phenotyping is an area of ongoing research into non-anatomical traits which contribute to airway obstruction.

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Is there enough evidence to refute the antiviral therapy in vestibular neuritis: A best evidence review

K Devaraja

Indian Journal of Otology 2018 24(3):135-138

Background: Recent research has provided extended support on the viral etiology of vestibular neuritis (VN); however, antiviral therapy is considered non-beneficial helpful in VN, contrary to its role in other similar viral-induced inflammatory conditions. The objective of this review is to segregate the available literature on antiviral therapy in VN and to evaluate and analyze the results of all those studies to know whether the antiviral therapy helps in VN patients or not. Materials and Methods: Electronic databases searched include PubMed, Scopus, Web of science, IndMED, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane library. Study Selection: Prospective randomized controlled trials (RCTs) comparing the outcomes of any form of antiviral therapy in VN, with that of placebo or any form of steroid or any other alternative therapy. Data Extraction and Data Synthesis: Among 581 screened articles, only one RCT was found on this topic, precluding the meaningful statistical analysis. However, this study did not consider the symptomatic improvement after antiviral therapy but only reported caloric response which is of less clinical relevance. No other controlled prospective study on antiviral therapy in VN has been published. Conclusions: The available evidence is not sufficient to disregard the beneficial effect of antiviral therapy in VN. Further randomized trials with better and clinically relevant study design are required to answer the question.

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Mastoid cavity obliteration using bone pate and ribbon-like temporalis muscle flap: Our experience

Chetan Bansal, VP Singh, Arvind Varma

Indian Journal of Otology 2018 24(3):194-198

Objective: The aim of this study was to elucidate a mix of bone pate with ribbon-like temporalis muscle flap for mastoid cavity obliteration after mastoid surgery to avoid mastoid cavity problems. Materials and Methods: In 54 patients of unsafe chronic suppurative otitis media, canal wall down mastoidectomy was done, size of the cavity assessed and ribbon-like temporalis muscle flap with bone pate used for mastoid cavity obliteration. Follow-up was done at 3 weeks, 3 months and then at 6 months. Results: Dry cavity with success rate of 83% is achieved with temporalis muscle flap technique of mastoid cavity obliteration. Conclusion: A mix of bone pate to obliterate the small spaces in the mastoid cavity along with a ribbon-like temporalis muscle flap is effective method of mastoid cavity obliteration as it gives a dry ear, is not bulky and most importantly maintains the canal.

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The relative contribution of visual cues and acoustic enhancement strategies in improving speech perception of individuals with auditory neuropathy spectrum disorders

Jithin Raj Balan, Sandeep Maruthy

Indian Journal of Otology 2018 24(3):139-147

Background and Objectives: The present study aimed to assess the relative benefits of visual cue supplementation and acoustic enhancement in improving speech perception of individuals with Auditory Neuropathy Spectrum Disorders (ANSD). Methods: The study utilized repeated measure research design. Based on the purposive sampling 40 participants with ANSD were selected. They were assessed for their speech identification of monosyllables in auditory only (A), visual only (V), and auditory-visual (AV) modalities. In the A and AV modalities, the perception of the primary, temporally enhanced, and spectrally enhanced syllables were assessed in quiet as well as 0 dB signal to noise ratio (SNR) conditions. The identification scores were compared across modalities, stimuli, and conditions to derive the relative benefits of visual cues and acoustic enhancement on speech perception of individuals with ANSD. Results: The group data showed a significant effect of modality with the mean identification score being the maximum in AV modality. This was true both in quiet and 0 dB SNR. The mean identification scores in quiet were significantly higher compared to that in 0 dB SNR. However, acoustic enhancement of speech did not significantly enhance speech perception. When acoustic enhancement and visual cues were simultaneously provided, speech perception was determined only by visual cues. The evidence from individual data showed that most of the individuals benefit from AV modality. Conclusions: The findings indicate that both auditory and visual modality needs to be facilitated in ANSD to enhance speech perception. The acoustic enhancements in the current form have negligible influence. However, the inference shall be restricted to the perception of stop consonants.

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A cross-sectional study on hearing loss using world health organization protocol in Delhi

Suneela Garg, Vipra Mangla, Charu Kohli, M Meghachandra Singh, Shelly Chadha, Neha Dahiya

Indian Journal of Otology 2018 24(3):184-189

Background: The World Health Organization (WHO) as per its recent estimates has predicted increasing prevalence of hearing loss globally. Data on magnitude of hearing loss in Delhi, India, are scarce, and the present study aims to highlight the extent of hearing loss problem in population using the standardized WHO protocol. Materials and Methods: A community-based cross-sectional study using the WHO protocol on "Survey for prevalence and causes of hearing loss" was conducted in selected rural and urban areas of Delhi from January to December 2017 among study participants aged 3 months and above. The sample size of 664 was taken from rural and urban areas of Delhi. Data collection instruments included the WHO structured questionnaire, hearing test, and ear examination using handheld otoacoustic emission (OAE) in children <5 years of age and pure-tone audiometry in persons >5 years. Ethical clearance was taken from the Institutional Ethical Committee. Written informed consent/assent was taken from study participants. Data were analyzed using SPSS (version 25). Qualitative data were expressed in percentage and quantitative data were shown as mean + standard deviation (SD). Results: The prevalence of hearing loss was 26.9%–15.6% in rural area (Barwala) and 84.4% in urban areas (0.62% in Balmiki Basti, 15.6% in Delhi Gate, 64.4% in Gokulpuri, and 3.8% in Vikram Nagar). Mean + SD age of study participants was 32.17 + 20.85 years. Mild hearing loss was seen in 66.7%, 54.5%, and 43.5% in 6–9, 10–19, and 20–39 years' age group of participants, respectively. Severe hearing loss was seen in 46.7% and 68.3% of study participants in 40–59 and >60 years' age group, respectively. Severe hearing loss was seen in 55.3% males and 42.8% females, respectively. In children <5 years, OAE was passed in 69.4% male and 30.6% female children. About 14.3% children with OAE referred were males and 85.7% were females. Conclusion: The prevalence of hearing loss using the WHO protocol was 26.9% in Delhi, and severity increased with increasing age and more among males than females.

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Evaluation of the hearing results after mastoidotympanoplasty operation with or without ossiculoplasty: A percentage change versus absolute change; a different methodology

Produl Hazarika, Seema Elina Punnoose, John Victor, Joyse Zachariah, Mrinmoy Hazarika

Indian Journal of Otology 2018 24(3):148-156

Purpose: Our article provides a comprehensive review of parameters of percentage change of the results regarding the documented hearing results (not based on any particular classification) in ear surgeries in chronic suppurative otitis media (CSOM) cases. Materials and Methods: Our series is a prospective cohort observational study in 230 cases of CSOM from 2009 to 2016 wherein we have evaluated the hearing improvement with a parameter of percentage change of hearing improvement between preoperative and postoperative period in various types of ear surgeries. Statistics and Results: A statistically significant difference was seen in 4 out of the 14 surgical groups, namely, in mastoidotympanoplasty, modified radical mastoidectomy (MRM), and MRM with tympanoplasty and in tympanoplasty. The rest of the 10 surgical groups had <10 cases, and therefore, the P significance could not be determined; however, these groups still showed hearing improvement. Conclusion: The superiority of the surgical techniques such as mastoidotympanoplasty, MRM, MRM with tympanoplasty and in tympanoplasty as demonstrated in our study aims to find an ideal surgical procedure in CSOM which gives the best chance to improve or preserve the hearing with complete eradication of the disease.

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Preauricular iatrogenic epidermoid cyst through middle-ear surgery

Hatice Celik, Ozlem Akkoca, Mustafa Ibas

Indian Journal of Otology 2018 24(3):204-206

Iatrogenic implantation of squamous epithelium during middle-ear surgery may cause epidermoid cyst (EC) development. These cysts may arise in different localizations of the head and neck following otological surgery. In this rare case, a giant EC with a size of 56 mm × 30 mm, which appeared in the preauricular area growing in the past 1 year in a 40-year-old male patient who underwent type 1 tympanomastoidectomy due to chronic otitis media without cholesteatoma 8 years ago, was discussed with the literature in terms of clinical findings and differential diagnosis.

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The role of parental hearing status in theory of mind after cochlear implant surgery

Kourosh Amraei, Mohammadparsa Azizi, Amirali Khoshkhabar, H Soori

Indian Journal of Otology 2018 24(3):157-161

Introduction: Theory of mind (ToM), or the understanding of others' thoughts and feelings and their behavioral consequences, has been extensively studied in hearing typically developing preschool children over several decades, including research demonstrating the influence of ToM on preschool children's social lives. Hearing impairment is common type of sensory loss in children. Literature indicates that children with hearing impairment deficit in social, cognitive, and communicate skills. Aim: This study performed to compare ToM of cochlear-implanted first- and second-generation deaf children. Methodology: This research is causal comparative. All 15 deaf children with deaf parent selected from Baqiyatallah Cochlear Implant (CI) Center. Hence, 15 cochlear-implanted children paired with them by purposive sampling. Results: Findings showed that t-test (t = −4.52, P < 0.01) was statistically significant. According to t-test, the second-generation children was significantly higher than the first-generation children in ToM. Conclusion: We can assume that the second-generation children were joined with their family in sign language, lead to the use of primary experience before of implant. So, it is recommended to use the sign language before cochlear implantation.

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A prospective study of outcome of boomerang-shaped chondroperichondrial graft in Type i tympanoplasty

Yogendra Kumar Pareek, Digvijay Singh Rawat, Yogesh Aseri, Manish Kumar Tailor, Praveen Chandra Verma, Bhuvenesh K Singh

Indian Journal of Otology 2018 24(3):179-183

Context: Cartilage has proven to be an excellent graft material inside the middle ear. The use of cartilage for tympanic membrane grafting may provide additional benefits in some difficult situations. Aims: The study was planned to evaluate the graft uptake and hearing after placement of "boomerang-shaped chondroperichondrial graft" in Type I tympanoplasty. Settings and Design: The prospective study was conducted on 40 patients having chronic suppurative otitis media with no active disease at least for last 6 weeks in a tertiary care center of North India. Patients having cholesteatoma and ossicular erosion/or necrosis were excluded from the study.Subjects and Methods: Those patients underwent tympanoplasty Type I by postaural approach and underlay grafting using "boomerang-shaped chondroperichondrial graft" from tragal cartilage and were followed up for 3 months. Hearing evaluation was performed preoperatively and postoperatively after 3 months. Statistical Analysis Used: The mean, range, and standard deviation of air conduction and air-bone gap were calculated and compared with preoperative findings. Results: The mean age of study group was 26.23 ± 12.46 years. Ear discharge (100%) and hearing impairment (87.5%) were the chief presenting complaints. The mean duration of ear discharge was 6.67 ± 6.75 years. Type I tympanoplasty was performed in all cases using "boomerang-shaped chondroperichondrial graft" harvested from tragal cartilage. Graft was taken up at the 3rd month in all patients. The preoperative mean air conduction was 43.21 ± 7.17 dB, which at the 3rd month improved to 36.49 ± 6.60 (P = 0.00004). Preoperative mean air-bone gap was 25.45 ± 8.44 dB which was improved to 19.31 ± 8.18 dB postoperatively at the 3rd month (P = 0.0014). Conclusions: Boomerang-shaped chondroperichondrial graft has excellent "take rate" in Type I tympanoplasty.

http://bit.ly/2Ch5ZcN

Subjective visual vertical in different peripheral vestibular disorders

Mostafa El Khosht Mahmoud, Maha Hassan Abou-Elew, Rasha Soliman, Aliaa Aly Moustafa El Brequi

Indian Journal of Otology 2018 24(3):162-167

Context: The subjective visual vertical (SVV) is considered to be a functional measure of otolith-mediated verticality perception. Aims: This study aims to detect the normative data of SVV and to analyze SVV changes in peripheral vestibular disorders. Settings and Design: This was a observational, cross-sectional study. Subjects and Methods: Forty-five adult patients with chronic peripheral vestibular disorders endolymphatic hydrops, vestibular neuritis, and benign paroxysmal positional vertigo and 20 normal individuals were included in this study. After full history taken, SVV deviations and caloric tests were completed. Statistical Analysis Used: Independent Student's t-test for independent sample when comparing 2 groups. ANOVAs test compared three or more means for statistical significance. Tukey's test compared the means of every treatment to the means of every other treatment. Chi-square test was performed. Normal cutoff value was calculated by mean +2 standard deviation (SD) as high limit and mean −2 SD as low limit. Results: The normative data of SVV ranged from −0.2° to 1.26° in clockwise direction and from −0.04° to 0.95° in the counterclockwise direction. SVV in counterclockwise direction were significantly deviated among the three groups of Peripheral vestibular disorder (PVD) patients when compared with controls. It revealed a significant deviation in counterclockwise tilt between left diseased ears in relation to controls. Conclusions: Normal adults displayed a narrow range of one-degree SVV deviation (1.06° and 0.91°) in clockwise and counterclockwise direction, respectively. The three vestibular disorders significantly deviate the SVV in counterclockwise direction compared to control with no gender difference. SVV test alone cannot differentiate between different PVD.

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Comparative study of clinical and audiological outcome between anterior tucking and circumferential flap methods of type I tympanoplasty in large central perforation

N Dhanapala, S Mohammed Hussain, L Sudarshan Reddy, Ramya Bandadka

Indian Journal of Otology 2018 24(3):190-193

Background: Tympanoplasty is a common operation performed by otolaryngologists worldwide. During the last 100 years various modifications in this surgical technique have come up because of continued efforts made by otologists all over the world to achieve the best surgical outcome. Objective: The aim of this study is to compare the surgical and audiological outcomes of anterior tucking and circumferential flap methods of type 1 tympanoplasty. Materials and Methods: This prospective randomized study included 100 patients who presented in the ENT outpatient Department of Bangalore Medical College and Research Institute with chronic otitis medialarge central perforation in an inactive stage. Patients were randomly allocated to two groups of 50 cases each. Group A contained 50 patients who underwent Type I tympanoplasty by circumferential flap method, and Group B contained 50 patients who underwent Type I tympanoplasty by anterior tucking method. Patients were followed up at the 3rd month postoperatively by otomicroscopy and pure tone audiometry (PTA), graft uptake and hearing gain were assessed. Results: There was a statistically significant mean hearing gain postoperatively compared to preoperative PTA in both techniques, among the two techniques, there was no statistically significant difference regarding hearing gain and graft uptake. Conclusion: Anterior tucking and circumferential flap methods of type 1 tympanoplasty are good regarding graft placement, graft uptake, and audiological outcome for chronic otitis media with large central perforation, especially with little or no anterior remnant of pars tensa.

http://bit.ly/2Ce9FMG

Comparison of tragal perichondrium and temporal fascia grafts in tympanoplasties

Selma Hodzic-Redzic, Lana Kovac-Bilic, Srecko Branica

Indian Journal of Otology 2018 24(3):168-171

Objective: The objective of this study was to compare the anatomic and functional outcomes of the different graft materials used in tympanoplasty. Settings and Design: This was an observational, cross-sectional study. Patients and Methods: The study included 243 patients operated at Tertiary Care University Hospital, from January 2011 to December 2015. The study excluded patients who had previous ear surgery and patients with cholesteatoma and nose and paranasal sinuses diseases. Tympanoplasty was done under general anesthesia. The retroauricular approach was primarily used. All grafts were placed using the underlay technique. Audiological testing of all patients was done preoperatively and postoperatively. Statistical Analysis Used: All data were entered into Excel and analyzed using MedCalc Statistical Software version 15.8 (MedCalc Software bvba, Ostend, Belgium). Descriptive statistics was used. Audiological findings were compared using a paired t-test. The value of P < 0.05 was considered statistically significant. Results: The temporal fascia was used as the graft material in 160 patients, and tragal perichondrium was used in 83 patients. Improvement of audiological outcome in patients with temporal fascia amounted 62.5% and in patients with perichondrium amounted 60.24%. The graft success rate 3 months postoperatively was 92.5% in the fascia group whereas it was 95.18% in the perichondrium group. Conclusion: Improvement of audiological outcome was slightly better (62.5%) in the fascia group while graft acceptance in the postoperative period was slightly better (95.18%) in the perichondrium group.

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Vestibular dysfunction and glycemic control in diabetes mellitus: Is there a correlation?

Chetana S Naik, Raviraj Tilloo

Indian Journal of Otology 2018 24(3):199-203

Objectives: The aim of this study is to evaluate and find the proportion of patients with Type-II diabetes mellitus (DM) with sensorineural hearing loss (SNHL) and vestibular dysfunction (VD) and association with glycemic control. Materials and Methods: An observational cross-sectional study was carried out in 100 patients (age group: 30–60 years) diagnosed with Type-II DM coming to the outpatient department of our Rural Tertiary Care Teaching Hospital, fulfilling the inclusion criteria. Prior approval of the Institutional Ethics Committee and written informed consent was obtained. All patients were subjected to investigations to assess their diabetes control, hearing, and vestibular function. The findings were subjected to statistical analysis. Results: Out of 100 patients, 62 were male and 38 were female between the age group of 30 and 60 years. The mean hemoglobin A1c (HbA1c) level was 9.16 ± 2.4. The patients were divided into three groups depending on HbA1c level, to denote control, good (≤7%), moderate (>7, ≤12%), and poor (>12%). There were a total of 69 patients with SNHL and 70 patients with VD. SNHL was present in 57.6% of good control group, 66.1% of moderate control group, and 100% of poor control group. Analysis with Chi-square test for correlation between glycemic control and SNHL was statistically significant. Out of the 70 patients with VD, 51.4% had right vestibulopathy, 41.4% had left vestibulopathy, and 7.2% had a bilateral vestibulopathy. Twenty-two patients had benign paroxysmal positional vertigo. VD was present in 42.3% of good control group, 74.5% of moderate control group, and 100% of poor control group. Chi-square test was statistically significant. Conclusion: There is a significant association between Type II DM, and SNHL and VD, especially with worsening of glycemic control. Screening for these debilities should be a part of the routine workup of a diabetic patient. VD is a potential cause for imbalance and vertigo in DM.

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Does postural instability in type 2 diabetes relate to vestibular function?

Marniza Omar, Nor Haniza Abdul Wahat, Mohd Fawwaz Afif Zulkafli, Nur Fajarina Husain, Suhaina Sulaiman

Indian Journal of Otology 2018 24(3):172-178

Introduction: Diabetes mellitus (DM) can lead to complications including postural instability that may be related to impaired function of the vestibular system. Aims and Objectives: This study aims to measure vestibular and balance function in adults diagnosed with type 2 noninsulin-dependent diabetes mellitus (NIDDM) and to compare their findings with healthy age-matched control group. Materials and Methods: This is an experimental cross-sectional study, using purposive sampling method. Eight NIDDM patients (mean age = 36.8 ± 11.4 years) and eight age-matched healthy controls (mean age = 34.6 ± 11.0 years) were recruited. Vestibular end organs (i.e., saccule, utricle, and semicircular canals) were assessed using cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVEMPs) and video head impulse test. Upright stance postural stability was assessed using force plate in four testing conditions, i.e., standing on firm or foam surface with eyes opened or closed. Dynamic stability was measured using Timed Up and Go (TUG) and functional gait assessment (FGA). Results: There was no statistically significant difference for all vestibular tests between groups. However, reduced p13-n23 interamplitudes (for cVEMPs) and n10 amplitudes (for oVEMPs) were observed in NIDDM patients. Upright stance postural stability was not significantly worse in patients. For dynamic postural stability, NIDDM patients demonstrated significantly poor performance in TUG and FGA than the healthy controls. Functionally, NIDDM patients walked significantly slower and less stable, and this is evident from poor performance in both TUG and FGA results. Conclusion: Our findings showed significant reduction in dynamic postural stability in NIDDM patients. However, we did not find any significant abnormal vestibular function in the patients as reported by previous studies. Further research studies are advocated.

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Bilateral bullous myringitis in a teenager

Nurul Syeha Abdull Rasid, Shiun Chuen Chew, Mohd Khairi Md Daud

Indian Journal of Otology 2018 24(3):207-208

Bullous myringitis is commonly encountered in otorhinolaryngology clinic. The most common presenting symptoms are otalgia, reduced hearing, and tinnitus. It can affect patients of any age in spite of the fact that children are frequently affected. In our recent encounter in our clinic, a teenager presented with bilateral otalgia with reduced hearing. Otoscopic findings revealed bilateral bullous myringitis that is indeed rare. He responded well with antibiotic treatment and recovered completely.

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Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

Abstract

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.

http://bit.ly/2AGIGcm

Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

Abstract

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.

http://bit.ly/2AGIGcm

Is CT or MRI the optimal imaging investigation for the diagnosis of large vestibular aqueduct syndrome and large endolymphatic sac anomaly?

Abstract

Background and purpose

We explored whether there was a difference between measurements obtained with CT and MRI for the diagnosis of large vestibular aqueduct syndrome or large endolymphatic sac anomaly, and whether this influenced diagnosis on the basis of previously published threshold values (Valvassori and Cincinnati). We also investigated whether isolated dilated extra-osseous endolymphatic sac occurred on MRI. Secondary objectives were to compare inter-observer reproducibility for the measurements, and to investigate any mismatch between the diagnoses using the different criteria.

Materials/methods

Subjects diagnosed with large vestibular aqueduct syndrome or large endolymphatic sac anomalies were retrospectively analysed. For subjects with both CT and MRI available (n = 58), two independent observers measured the midpoint and operculum widths. For subjects with MRI (± CT) available (n = 84), extra-osseous sac widths were also measured.

Results

There was no significant difference between the width measurements obtained with CT versus MRI. CT alone diagnosed large vestibular aqueduct syndrome or large endolymphatic sac anomalies in 2/58 (Valvassori) and 4/58 (Cincinnati), whilst MRI alone diagnosed them in 2/58 (Valvassori). There was 93% CT/MRI diagnostic agreement using both criteria. Only 1/84 demonstrated isolated extra-osseous endolymphatic sac dilatation. The MRI-based LVAS/LESA diagnosis was less dependent on which criteria were used. Midpoint measurements are more reproducible between observers and between CT/MR imaging modalities.

Conclusion

Supplementing MRI with CT results in additional diagnoses using either criterion, however, there is no net increased diagnostic sensitivity for CT versus MRI when applying the Valvassori criteria. Isolated enlargement of the extra-osseous endolymphatic sac is rare.

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Early onset oral tongue squamous cell carcinoma: Associated factors and patient outcomes

Abstract

Background

Incidence of oral tongue squamous cell carcinoma (OTC) is rising among those under age 50 years. The etiology is unknown.

Methods

A total of 395 cases of OTC diagnosed and/or treated at Vanderbilt University Medical Center between 2000 and 2017 were identified. Of those, 113 (28.6%) were early onset (age < 50 years). Logistic regression was used to identify factors associated with early onset OTC. Cox proportional hazards models evaluated survival and recurrence.

Results

Compared to typical onset patients, patients with early onset OTC were more likely to receive multimodality treatment (surgery and radiation; adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI], 1.2‐6.3) and report a history of snuff use (aOR, 5.4; 95% CI, 1.8‐15.8) and were less likely to report a history of cigarette use (aOR, 0.5; 95% CI, 0.2‐0.9). Early onset patients had better overall survival (adjusted hazard ratio, 0.6).

Conclusions

This is the largest study to evaluate factors associated with early onset OTC and the first to report an association with snuff.

http://bit.ly/2M4jxgu

Ultraviolet light‐related DNA damage mutation signature distinguishes cutaneous from mucosal or other origin for head and neck squamous cell carcinoma of unknown primary site

Abstract

Background

Head and neck squamous cell carcinoma of unknown primary site (HNSCCUP) is a diagnostic challenge. Identification of an ultraviolet (UV) light‐related DNA damage signature using next‐generation sequencing (NGS) can classify the primary site of origin as cutaneous.

Methods

A 62‐year‐old male was seen with 2 months of left neck swelling. He was a lifetime nonsmoker but had a history of cutaneous squamous cell carcinoma (SCC) of the left helix. He was also found to have left hilar adenopathy. He had a p16‐negative HNSCCUP on fine needle aspiration (FNA) biopsy of the left neck.

Results

NGS of the FNA specimen revealed a high number of somatic mutations that were mostly C to T transitions, indicating a UV mutation signature and confirming the diagnosis of cutaneous SCC.

Conclusions

Identification of a UV DNA damage signature with NGS distinguishes HNSCCUP of cutaneous vs mucosal or other squamous cell carcinoma origin.

http://bit.ly/2snUhZG

Intratumoral generation of 2‐fluoroadenine to treat solid malignancies of the head and neck

Abstract

This report describes treatment of locoregional head and neck squamous cell carcinoma (HNSCC) by an innovative, experimental strategy involving generation of a robust anti‐cancer agent (2‐fluoroadenine [F‐Ade]) following transduction by Escherichia coli purine nucleoside phosphorylase (PNP) in a small number of tumor cells. F‐Ade works by a unique mechanism of action (ablation of RNA and protein synthesis) and confers tumor regressions of otherwise refractory HNSCC in human subjects. Clinical studies have now advanced to a pivotal (registration‐directed) trial involving locoregional HNSCC, with plans to begin subject enrollment late in 2018. The present review is the first to summarize use of PNP in the context of HNSCC, and provides background regarding this emerging anti‐cancer approach.

http://bit.ly/2M3D8NG

Treatment modalities and outcomes of Fanconi anemia patients with head and neck squamous cell carcinoma: A series of 9 cases and review of the literature

Abstract

Background

Fanconi anemia (FA) is associated with an increased risk of developing head and neck squamous cell cancer (HNSCC) and presents a treatment dilemma due to concerns of increased toxicities from chemotherapy and radiation therapy (RT).

Methods

We reviewed the literature on HNSCC in FA patients and report on our experience treating 9 FA patients with HNSCC.

Results

Surgery was generally well‐tolerated and surgery alone resulted in durable local control for 2 patients. Four patients received adjuvant RT that was tolerable in most cases, although 1 patient required a treatment break and early cessation of RT. Three of the irradiated patients received concurrent cetuximab.

Conclusions

In patients with adverse features, adjuvant radiation with concurrent cetuximab may be feasible with careful monitoring, although local disease control is infrequent. Early detection via screening permitting a surgery‐alone approach represents the best opportunity for cure in FA patients with HSNCC.

http://bit.ly/2spWzHn

Importance of tumor budding grade as independent prognostic factor for early tongue squamous cell carcinoma

Abstract

Background

Factors involved in neck lymph node metastasis (NLM) and prognosis of early tongue squamous cell carcinoma (SCC) remain unknown.

Methods

We analyzed disease‐specific survival (DSS) and NLM including tumor budding grade (TBG) among 64 patients with cT1/2N0 tongue SCC.

Results

Univariate analysis of DSS of primary lesions uncovered significant differences in new cT, pT, new pT, pDiameter, venous infiltration, and TBG. Multivariate analysis selected only TBG3 as a predictor of NLM (odds ratio, 9.55; 95% confidence interval [CI], 1.80‐50.8; P = .008), and a prognostic factor for DSS (hazard ratio, 4.41; 95% CI, 1.34‐14.5; P = .02).

Conclusion

The sole predictor of NLM and the prognosis of early tongue SCC was TBG, indicating that it might help to select overwhelming risk patients.

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Preoperative neutrophil lymphocyte ratio but not platelet lymphocyte ratio predicts survival and early relapse in patients with oral, pharyngeal, and lip cancer

Abstract

Background

To evaluate the prognostic value of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in oral, pharyngeal, and lip cancer for survival and relapse.

Methods

Clinic‐pathologic and hematological records were retrospectively retrieved. Patients completed follow‐up period were included for survival and relapse analysis.

Results

The preoperative NLR value was a prognostic factor for both overall survival and relapse‐free survival. The high NLR group demonstrated higher total relapse rate, higher local relapse rate, and higher relapse rate within 12 months. However, the preoperative PLR did not associate with survival or relapse.

Conclusions

The preoperative NLR, not PLR, is an independent prognostic indicator of survival. It also exhibits predictive value for relapse, particularly early relapse within 12 months. The preoperative NLR value might be recommended as a useful tool for predicting the outcomes and stratifying patients for different management strategies.

http://bit.ly/2slXtVk

Paraganglioma of the head and neck region, treated with radiation therapy, a Rare Cancer Network study

Abstract

Background

Paraganglioma of the head and neck (HNPGL) are rare often benign tumors. Surgery and radiation therapy (RT) are the main treatment choices. We present an analysis of outcome and toxicity after RT from 13 institutions of the Rare Cancer Network.

Methods

Data were collected using a questionnaire concerning patients' characteristics, treatment, and outcome. A total of 81 patients with 82 HNPGL were analyzed.

Results

The median follow‐up was 48 months (1‐456). Sixty‐two lesions were treated with conventional RT and 20 lesions with stereotactic RT. Local control (LC) was achieved in 69 out of 77 lesions. Late toxicity occurred in 17 patients. Patients treated with stereotactic RT experienced neither disease progression nor late toxicity. Four patients with a follow‐up longer than 20 years experienced disease progression.

Conclusion

RT for HNPGL offered good local control with acceptable toxicity. Stereotactic RT might offer better results. Long‐term follow‐up is required.

http://bit.ly/2M3VD4v

Impact of extent of parotidectomy on early and long‐term complications: A prospective multicenter cohort trial

Abstract

Background

In this prospective nonrandomized multicenter trial, we analyze the incidence of early and late complications after parotidectomy in correlation to the extent of dissection.

Methods

A total of 148 patients underwent a parotidectomy for a benign lesion in the superficial lobe. The number of intraoperatively dissected main facial nerve branches was photo‐documented and defined the extent of tissue dissection. Early postoperative complications including sialocele were evaluated until 4 weeks after surgery. Late complications as facial nerve palsy, Frey´s syndrome (FS) and the outcome of the scar and substance loss were furthermore assessed after 6 and 12 months.

Results

Early complications occurred in 22 patients (14%) and did not depend on the extent of facial nerve dissection (all P > .05). However, patients with higher number of intraoperatively dissected facial nerve branches showed significantly higher palsy scores on the first postoperative day (P = .026). FS occurred with incidence of 69% and correlated significantly to the extent of dissection (P = .003). Appearance of the scar and substance loss improved significantly during the follow‐up (P < .001 and P < ,005, respectively) without significant correlation to the extent of dissection (P > .05 for both variables after 12 months).

Conclusions

Less extensive tissue dissection resulted in better postoperative facial nerve function on the first postoperative day and in lower incidence of FS after 12 months. However, incidence of early complications did not depend on the extent of surgery.

The study was registered in the German Clinical Trials Register prior to conducting the research. DRKS‐ID: DRKS00008967, URL:http://apps.who.int/trialsearch/.

http://bit.ly/2M9FmLG

Das maximale Einsilberverstehen als Prädiktor für das Sprachverstehen mit Cochleaimplantat

Zusammenfassung

Ziel der Arbeit

Ziel war die Untersuchung des Sprachverstehens von Trägern eines Cochleaimplantats (CI) mit präoperativ messbarem ipsilateralem Einsilberverstehen. Diese Ergebnisse sollen die individuelle Beratung von CI-Kandidaten unterstützen.

Material und Methoden

Es erfolgte die Analyse von prä- und postoperativen sprachaudiometrischen Größen wie dem maximalem Einsilberverstehen (mEV) sowie dem Einsilberverstehen bei einem Umgangssprachpegel von 65 dB_SPL, also bei einer üblichen Sprechlautstärke, mit Hörgerät einerseits und mit CI andererseits. Hierzu wurden die Daten von 284 erfahrenen erwachsenen CI-Trägern in Abhängigkeit von ihrem präoperativen mEV gruppiert und ausgewertet.

Ergebnisse

Das postoperative Einsilberverstehen übertraf das präoperative mEV in 96 % der Fälle. Im Median lag das postoperative Einsilberverstehen bei 72,5 %. Die Gruppen mit präoperativem mEV über 0 % erreichten ein signifikant besseres Einsilberverstehen mit CI als die Gruppe mit mEV = 0 %. Die Verbesserung gegenüber dem präoperativen Einsilberverstehen mit Hörgerät lag im Median bei 65 Prozentpunkten, unabhängig von der Höhe des präoperativen Sprachverstehens.

Schlussfolgerung

Das präoperative mEV kann als untere Abschätzung für das Sprachverstehen mit CI interpretiert werden. Insbesondere für CI-Kandidaten mit präoperativem Sprachverstehen ist dieser Befund von hoher klinischer individueller Relevanz.

http://bit.ly/2sph7Qx

Dramatic response under combination of immune-oncology in head & neck cancer included in the Condor study: A case report

Publication date: Available online 11 January 2019

Source: Oral Oncology

Author(s): Amaury Daste, Laurence Digue, Alain Ravaud, Charlotte Domblides

http://bit.ly/2RjmDD0

Endoscopic revision stapes surgery: surgical findings and outcomes

Abstract

Purpose

Hearing results in revision stapes surgery are largely dependent on the cause of failure, and an appropriate intraoperative diagnosis is crucial for a good outcome. The endoscope allows a detailed exploration of the middle ear cavity and is particularly suitable for the intraoperative assessment of the cause of failure of previous stapes surgery. The present study analyzes the intraoperative findings and outcomes of patients undergoing revision stapes surgery through the endoscopic transcanal approach.

Methods

Surgical videos and charts of patients undergoing endoscopic revision stapes surgery from 2008 to 2017 were reviewed retrospectively. Intraoperative findings, difficulties encountered during the surgery and hearing outcomes were evaluated. The feasibility of each surgical step with the totally endoscopic approach or the need for bimanual manipulation was assessed as well.

Results

Thirty-four patients were included in the study. The endoscopic transcanal approach allowed a detailed exploration of the middle ear cavity and an accurate intraoperative diagnosis and management of the different causes of failure of the previous surgery. 89.8% of patients achieved an air-bone gap for the PTA ≤ 20 dBHL and 68.5% a closure of the air-bone gap.

Conclusions

The present study showed that totally endoscopic revision stapes surgery is a feasible, safe and effective procedure. The transcanal endoscopic approach allowed an accurate intraoperative diagnosis without the need for an endaural or retroauricular approach, with the possibility to manage all the possible intraoperative scenarios. A larger series with a longer follow-up is needed to validate the results.

http://bit.ly/2M9f3oU

Accuracy of lateral cephalogram for diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a meta-analysis

Publication date: Available online 11 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hanzhong Duan, Li Xia, Wangfang He, Yongdong Lin, Zhihui Lu, Qing Lan

Abstract

Introduction

Accurate diagnosis of adenoid hypertrophy and posterior upper airway obstruction using a lateral cephalogram is challenging. No universal guidelines for assessing adenoidal enlargement and upper airway obstruction have been established. We performed a meta-analysis to assess the diagnostic accuracy of a lateral cephalogram for adenoid hypertrophy.

Methods

After searching a wide range of electronic databases and screening titles and abstracts, we evaluated full papers describing potentially eligible studies according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 checklist, and a 2 × 2 contingency table was constructed based on these results. Two authors independently judged the studies and extracted the data. The diagnostic accuracy of a lateral cephalogram for adenoid hypertrophy and posterior upper airway obstruction was calculated using a bivariate meta-analysis model. The Q-test and I² index were used to test the heterogeneity.

Results

Nine studies were included in the meta-analysis. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 0.86 [95% confidence interval (CI): 0.76–0.92], 0.59 (95% CI: 0.42–0.73), 9.00 (95% CI: 5–17), 2.1 (95% CI: 1.5–3.0), and 0.24 (95% CI: 0.15–0.37), respectively. The area under the summary receiver operator characteristic curve was 0.83 (95% CI: 0.80–0.86). Meta-regression analysis revealed that the sample size and study design significantly contributed to the heterogeneity of sensitivity.

Conclusions

Our findings suggest that the lateral cephalogram exhibits very good diagnostic accuracy (area under the curve: 0.86) for the diagnosis of adenoid hypertrophy and posterior upper airway obstruction. Nevertheless, the rate of false-positive diagnoses should be further considered.

http://bit.ly/2M5NbSl

Morphological analysis of sigmoid sinus anatomy: clinical applications to neurotological surgery

Abstract

Objectives

The primary objective of this study was to use high-resolution micro-CT images to create accurate three-dimensional (3D) models of several intratemporal structures, and to compare several surgically important dimensions within the temporal bone. The secondary objective was to create a statistical shape model (SSM) of a dominant and non-dominant sigmoid sinus (SS) to provide a template for automated segmentation algorithms.

Methods

A free image processing software, 3D Slicer, was utilized to create three-dimensional reconstructions of the SS, jugular bulb (JB), facial nerve (FN), and external auditory canal (EAC) from micro-CT scans. The models were used to compare several clinically important dimensions between the dominant and non-dominant SS. Anatomic variability of the SS was also analyzed using SSMs generated using the Statismo software framework.

Results

Three-dimensional models from 38 temporal bones were generated and analyzed. Right dominance was observed in 74% of the paired SSs. All distances were significantly shorter on the dominant side (p < 0.05), including: EAC – SS (dominant: 13.7 ± 3.4 mm; non-dominant: 15.3 ± 2.7 mm), FN – SS (dominant: 7.2 ± 1.8 mm; non-dominant: 8.1 ± 2.3 mm), 2nd genu FN – superior tip of JB (dominant: 8.7 ± 2.2 mm; non-dominant: 11.2 ± 2.6 mm), horizontal distance between the superior tip of JB – descending FN (dominant: 9.5 ± 2.3 mm; non-dominant: 13.2 ± 3.5 mm), and horizontal distance between the FN at the stylomastoid foramen – JB (dominant: 5.4 ± 2.2 mm; non-dominant: 7.7 ± 2.1). Analysis of the SSMs indicated that SS morphology is most variable at its junction with the transverse sinus, and least variable at the JB.

Conclusions

This is the first known study to investigate the anatomical variation and relationships of the SS using high resolution scans, 3D  models and statistical shape analysis. This analysis seeks to guide neurotological surgical approaches and provide a template for automated segmentation and surgical simulation.

http://bit.ly/2RjbVMV

Antifungal activities against Candida albicans, of cell-free supernatants obtained from probiotic Pediococcus acidilactici HW01

Publication date: Available online 11 January 2019

Source: Archives of Oral Biology

Author(s): Hyunjin Kim, Seok-Seong Kang

Abstract

Objective

The aim of this study was to investigate the antifungal activities of cell-free supernatants of a probiotic strain,Pediococcus acidilactici HW01, against Candida albicans.

Design

C. albicans was cultured in the presence of different concentration of cell-free supernatants obtained from P. acidilactici HW01 (HW01 CFS) and the growth of C. albicans was determined. C. albicans was incubated with HW01 CFS for 24 h and the biofilm formation of C. albicans was determined by staining crystal violet and by using a scanning electron microscope. Biofilm quantification was determined by 2, 3-Bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay.

Results

HW01 CFS inhibitedC. albicans growth, whereas bacteriocin, which is a well-known antimicrobial peptide of lactic acid bacteria, failed to inhibit C. albicans growth. Pre-treatment and simultaneous treatment with HW01 CFS exhibited a significant inhibition of C. albicans biofilm. Although post-treatment with HW01 CFS did not disrupt the established biofilm of C. albicans at 3 h-incubation, significant reduced C. albicans biofilm was observed after 6 h-incubation in the presence of HW01 CFS.

Conclusion

These results suggested that the CFS fromP. acidilactici HW01 was revealed as an effective antifungal agent against C. albicans by reducing the growth and biofilm formation.

http://bit.ly/2D2jbnE

Down-regulation of mitochondrial NADH and cytochrome b gene associated with high tumor stages in head and neck squamous cell carcinoma

Publication date: Available online 10 January 2019

Source: Archives of Oral Biology

Author(s): Pitsapaporn Wangpermtam, Songsak Petmitr, Phaibul Punyarit, Boworn Klongnoi, Sirima Sanguansin

Abstract

Objective

This study aimed to determine mitochondrial mRNA expression levels and the relationships between these expression levels and various adverse clinicopathological characteristics.

Methods

The mRNA expression levels of all 12 genes encoded protein, located on the heavy-strand of mitochondrial DNA including cytochrome b, NADH1, NADH2, NADH3, NADH4, NADH4L, NADH5, ATPase6, ATPase8, cytochrome c oxidase subunit 1, cytochrome c oxidase subunit 2, cytochrome c oxidase subunit 3 were analyzed in 30 head and neck squamous cell carcinoma (HNSCC) and the corresponding normal tissues using reverse transcriptase quantitative real time PCR. Pearson Chi-square test was used to determine the relationships between these expression levels and categorical parameters.

Results

The expression levels of 12 mitochondrial mRNAs were observed in all 30 HNSCC patients with down-regulation, ranging from 43.3% - 76.7% and up-regulation, ranging from 10.0% – 36.7%. Furthermore, the number of cases with down-regulations in all 6 NADH and cytochrome b mRNA with TMN stages III and IV were significantly higher than that in stages I and II (p=0.049 and 0.007, respectively).

Conclusion

Down-regulation of all mitochondrial NADH mRNA as well as mitochondrial cytochrome b mRNA was associated with high tumor stage among HNSCC patients.

http://bit.ly/2THLrS8

Immunonkologie von Kopf-Hals-Tumoren

Zusammenfassung

Die Behandlung von Patienten mit Plattenepithelkarzinomen des Kopf-Hals-Bereichs ist multimodal unter Einschluss modernster operativer, strahlentherapeutischer sowie medikamentöser Verfahren. Dennoch bleibt die Prognose über alle Stadien unbefriedigend. Bei einem Rezidiv oder einer Metastasierung nach definitiver Therapie besteht die Indikation zur systemischen palliativen Therapie, wobei sich neben der klassischen platinbasierten Chemotherapie und Cetuximab, einem Antikörper gegen den epidermalen Wachstumsfaktorrezeptor („epidermal growth factor receptor", EGFR), in den letzten Jahren die immunonkologische (IO-)Therapie erfolgreich etabliert hat. Für die Zulassung von „Checkpointinhibitoren" in der palliativen Situation nach Platinversagen relevante Studienergebnisse sowie derzeit laufende Studien zu deren Stellenwert in Erstlinientherapie, Kombination mit definitiver oder adjuvanter Bestrahlung, präoperativ beim resektablen Kopf-Hals-Tumor sowie in IO-Kombinationstherapie werden erörtert.

http://bit.ly/2FmjWdM

Favorable outcomes of culture‐based Helicobacter pylori eradication therapy in a region with high antimicrobial resistance

Abstract

Background

The eradication rate of Helicobacter pylori has declined, mainly due to antimicrobial resistance. To overcome resistance‐associated treatment failure, the efficacy of culture‐based, susceptibility‐guided therapy was demonstrated as the first‐line eradication therapy for H pylori infection.

Aims

To evaluate the efficacy of culture‐based therapy as the first‐line eradication therapy in regions with high levels of antimicrobial resistance.

Methods

Helicobacter pylori‐positive patients without previous eradication treatment history were recommended to undergo culture to determine the minimal inhibitory concentration (MIC). If they consented, 7‐day clarithromycin‐containing PPI triple; 7‐day esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy; or 7‐ or 14‐day esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapy were administered based on the agar dilution‐determined MIC. Eradication, treatment compliance, and adverse events were examined.

Results

In total, 74 patients were enrolled, and 69 patients completed the protocols. The overall resistance rates to amoxicillin, clarithromycin, metronidazole, and moxifloxacin were 6.7%, 31.0%, 41.8%, and 39.2%, respectively. The patients were allocated to the PPI triple (n = 50), MEA (n = 8) or quadruple (n = 16) therapy. The eradication rate in the intention‐to‐treat analysis was 93.1% (69 of 74 patients). The eradication rates in the per‐protocol analysis were 100.0% (69 of 69 patients). Epigastric pain, nausea, and vomiting were less common than those of other empirical therapies.

Conclusions

Culture‐based, susceptibility‐guided therapy is effective first‐line eradication therapy, especially in regions with high levels of antimicrobial resistance.

http://bit.ly/2TG2X9e

Bell Palsy and the Risk of Cardio‐Cerebrovascular Disease: A Population‐Based Follow‐Up Study

Objective

To evaluate the risk of cardio‐cerebrovascular disease (CCVD), such as ischemic stroke and acute myocardial infarction (AMI), in patients diagnosed with Bell palsy

Study Design

Population‐based follow‐up study.

Methods

We used the National Sample Cohort 2002 to 2013 data from the Korea National Health Insurance Service. The Bell palsy group comprised all patients diagnosed with Bell palsy (n = 730). The comparison group comprised patients selected randomly using propensity score matching (n = 1,460). The Kaplan‐Meier survival analysis, log‐rank test, and Cox proportional‐hazards regression models were used to calculate the disease‐free survival rate and hazard ratio (HR) of CCVD for each group.

Results

Of the total study population, ischemic stroke developed in 15.7% of patients with Bell palsy and 9% of patients in the comparison group during the 12‐year follow‐up period. After adjusting for other factors, the HR of ischemic stroke during the 12‐year follow‐up period was 1.84 times greater in the Bell palsy group than in the comparison group (95% confidence interval [CI], 1.43–2.36). However, the adjusted HR of developing ischemic stroke for patients with Bell palsy treated concurrently with antiviral agents and steroids was 1.12 (95% CI, 0.62.–2.04). There was no significant relationship between Bell palsy and risk of AMI development (HR, 1.13; 95% CI, 0.71–1.82).

Conclusion

Bell palsy is linked with an increased incidence of ischemic stroke. Our data suggest that Bell palsy may be used as an indicator of increased stroke risk, and concurrent treatment with antiviral agents and steroids may be effective in preventing ischemic stroke.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2TKYMJn

Nonsquamous cell laryngeal cancers: Incidence, demographics, care patterns, and effect of surgery

Objectives

To analyze the incidence and clinical profile of nonsquamous cell (non‐SCC) laryngeal carcinomas and to analyze the effect of surgery on survival.

Study Design

A retrospective analysis of the National Cancer Database (2004–2014).

Methods

Adult patients with non‐SCC laryngeal cancers were divided into six major histological subtypes. A descriptive clinical profile was obtained for non‐SCC patients, and multivariate regressions were performed to analyze the effect of surgery on survival within the non‐SCC cohort.

Results

We identified 878 cases of non‐SCC laryngeal cancers, representing 1.02% of all malignant laryngeal cancers. Neuroendocrine tumors and bone/cartilage sarcomas made up the largest groups (37.02% and 32.35%, respectively). Metastasis (M) was higher in neuroendocrine tumors, representing 19.1% of those with known clinical M stages. Of those treated, the majority of patients with bone/cartilage sarcomas (80.9%) and minor salivary gland tumors (82.6%) received surgery as part of their treatment. Survival varied significantly based upon histology, with bone/cartilage sarcomas having the highest 5‐year survival at 90.4%, and neuroendocrine tumors exhibiting the poorest 5‐year survival at 25.7%. Multivariate analyses found surgery to be significantly associated with improved survival (hazard ratio: 0.679; 95% confidence interval: 0.472–0.976; P = 0.036). The specific surgical method (i.e., local excision vs. partial vs. total laryngectomy) did not have any effect on survival.

Conclusion

Approximately 1% of all malignant laryngeal cancers are non‐SCC in origin. At presentation, neuroendocrine tumors have the highest rate of distant metastasis and have the worst prognosis of the non‐SCC cancers. Most non‐SCC patients received surgery as part of their treatment regimen.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2D4yxIh

Basaloid nasopharyngeal carcinoma: A population‐based analysis of a rare tumor

Objectives

Basaloid nasopharyngeal carcinoma (BNPC) is an extremely rare malignancy with a paucity of cases reported in the literature. This analysis represents the largest cohort of BNPC to date.

Study Design

Retrospective population‐based analysis.

Methods

The Surveillance, Epidemiology, and End Results registry from 2001 to 2015 was utilized to extract a total of 82 cases of BNPC. Data were analyzed for incidence trends, demographic, and tumor characteristics, as well as potential outcome prognosticators.

Results

White male patients between the ages of 40 to 79 years were most commonly affected. The incidence was measured at 0.06 per 100 thousand people. The majority of tumors were considered high grade (grade III/IV; 92.2%). At presentation, patients were most commonly advanced stage (American Joint Committee on Cancer [AJCC] stage IV) at 29.3%, followed by AJCC stages II and III (20.7%, respectively). T2 tumors were most common at 28.8%. Cervical node involvement and distant metastasis were measured at 53.7% and 10.4%, respectively. One‐year, 5‐year, and 10‐year disease‐specific survival was 87.7%, 60.7%, and 29.8%, respectively. No prognostic factors were identified in this study.

Conclusion

Basaloid squamous cell carcinoma represents a histologic subtype of nasopharyngeal carcinoma with excellent short‐term outcomes but poor survival at 10 years when compared to conventional squamous cell carcinomas.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2TI7LLg

Outcomes of transmastoid resurfacing for superior canal dehiscence using a cartilage overlay technique

Objective

Superior semicircular canal dehiscence is a well‐described syndrome with potentially debilitating symptoms. We report on the audiologic and long‐term symptom outcomes of 10 patients (12 ears) undergoing a cartilage overlay transmastoid resurfacing technique.

Methods

Retrospective chart review and cross‐sectional outcomes recall survey were used. A mailed questionnaire quantifying the effect of surgery on symptom severity and patient satisfaction were used. Nonlinear regression curves of pre‐/postoperative air and bone pure‐tone audiometric data were used to evaluate postoperative changes in hearing. Surgical failure was defined as requiring revision surgery, and rates were estimated over time using a Kaplan‐Meier analysis.

Results

Most patients reported improved symptoms postoperatively and were satisfied overall with the surgical outcomes. However, four of 12 ears (33%) had a second (revision) surgery before achieving these results. Postoperatively, hearing through air and bone conduction tended to decrease at frequencies greater than 2500 Hz. The chance of avoiding a re‐operation at 36 months (and up to 120 months) was estimated to be 57.1% (95% confidence interval [confidence interval]: 100%, 32.6%). The most common surgical complication was intraoperative cerebrospinal fluid (CSF) leak, encountered exclusively during dural elevation, seen in four of 12 ears (33%).

Conclusion

Although subjectively successful at reducing symptoms, in our small sample this surgical approach did not provide a long‐term stable repair and was frequently associated with intraoperative CSF leak. Offering transmastoid resurfacing to patients should involve a detailed discussion on the potential for revision surgery and risks of diminished hearing and CSF leak.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2D57FrB

Vestibular atelectasis: Myth or reality?

Objectives/Hypothesis

Because delayed post‐contrast three‐dimensional fluid‐attenuated inversion recovery imaging sequences enable the distinction between the utricle and the saccule, we raised the hypothesis that patients with vestibular atelectasis (VA) could show unilateral collapse of the utricle and the ampullas on imaging.

Study Design

Retrospective case series.

Methods

We retrospectively reviewed 200 patients who underwent 3 T magnetic resonance imaging (MRI) after intravenous administration of gadolinium. MRI scans were assessed for the presence of VA. The endolymphatic space was considered as collapsed when the utricle and at least two ampullas were not visible or were barely visible.

Results

We reported four patients with VA on MRI responsible for atypical clinical presentations of acute vestibular deficit. All patients presented a specific involvement of the pars superior sensory captors (utricle, ampullas), preserving the pars inferior sensory captors (cochlea and saccule). This was confirmed both clinically and on MRI.

Conclusions

Our study is the first to describe in vivo unilateral collapse of the pars superior on delayed postcontrast MRI in patients with a clinical unilateral vestibular loss.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2TC3fxM

Laryngeal mask versus intubation for adenoidectomies in children: Analysis of 1,500 operations

Objectives/Hypothesis

To evaluate whether endotracheal intubations are superior to the use of laryngeal masks in the airway management for adenoidectomies in pediatric patients in terms of safety and duration of surgery.

Study Design

Retrospective case series.

Methods

A retrospective analysis of 1,500 adenoidectomies in children using laryngeal mask or endotracheal intubation for intraoperative ventilation between 2009 and 2017. Data collected included complications, duration of surgery, and duration of induction and emergence from anesthesia.

Results

The use of laryngeal masks did not accelerate the time needed for induction and emergence of anesthesia although significantly increasing the duration of surgery itself. There also were significantly more complications during and after anesthesia when using a laryngeal mask. In 10% of the children, the laryngeal mask had to be replaced by an endotracheal tube intraoperatively.

Conclusions

There is no reason to recommend the use of a laryngeal mask as the first choice of airway management regarding adenoidectomies in children.

Level of Evidence

3 Laryngoscope, 2019

http://bit.ly/2D4yfBb

Tracheo‐innominate fistula in children: A systematic review of literature

Objective

Tracheo‐innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience.

Methods

We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included.

Results

Fifty‐four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9–565.5). Fifty‐four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow‐up periods.

Conclusion

TIF may occur in long‐term tracheostomy‐dependent children, contrary to the conventionally described 3‐week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well‐designed cohort studies are needed to guide an evidence‐based approach to TIF.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2THX77f

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Objectives/Hypothesis

To describe the evolution of the butterfly graft technique for the treatment of nasal valve compromise, with specific attention to technical developments allowing for expanded indications. To review the impact on patient‐reported outcomes of nasal airway function and nasal aesthetics.

Study Design

Retrospective chart review.

Methods

A review of a single surgeon's patients at a private practice and tertiary care center undergoing surgical correction for nasal valve compromise using the butterfly graft technique between July 2002 and April 2017. Data collected included etiology of nasal valve compromise, additional procedures performed, complications, and functional and aesthetic patient‐reported outcomes.

Results

Over the study period, 512 patients underwent surgery to correct nasal valve compromise utilizing the butterfly graft technique. The overall patient‐reported relief of nasal obstructive symptoms was complete in 87%, improved but not completely relieved in 10%, and not improved in 4%. No patients reported a worsening in their nasal obstructive symptoms. The overall patient‐reported change in nasal appearance was improved 53%, the same 32%, worse in 15%. The patients in the latter half of the study tended to report better aesthetic results.

Conclusions

The results of this study suggest that the surgical technique for the butterfly graft evolved over time and allowed for improved aesthetic outcomes, without reduction in the efficacy in correction of nasal valve compromise. The evolution in technique allowed for expansion of the indications for the butterfly graft while maintaining the favorable patient‐reported aesthetic and functional results.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2D4y4G1

Sex‐based outcomes in type I thyroplasty for nonparalytic glottic incompetence

Objective

Clinical outcomes for type I Gore‐Tex thyroplasty (GMT) for nonparalytic glottic incompetence (GI) have been reported in the literature. Given differences in male and female laryngeal anatomy, sex‐based outcomes should also be evaluated. We endeavored to evaluate sex‐specific post‐GMT voice outcomes.

Methods

We performed a retrospective review of patients undergoing GMT for nonparalytic GI. Multidimensional voice outcome measures including voice‐related quality of life (VRQOL), Glottal Function Index (GFI), and grade/roughness/breathiness/asthenia/strain (GRBAS) were analyzed at postoperative time frames: 0 to 3 months, 3 to 9 months, and 9 to 18 months.

Results

Eighty‐five subjects (43 females, 42 males) with mean age 53.5 undergoing GMT for nonparalytic GI from 2005 to 2017 met inclusion criteria. Etiologies included vocal fold hypomobility (N = 36, 42%), paresis (N = 18, 21%), vocal fold atrophy (N = 17, 20%), and scarring (N = 14, 17%). Females had significantly greater improvement on VRQOL at 0 to 3 months and 9 to 18 months timeframes compared to males, with mean change in VRQOL: 41.3 versus 22.4 (P = 0.0002) and 42.5 versus 20.8 (P = 0.002), respectively. Similarly, women had significantly greater improvement in GFI at 0 to 3 months follow‐up (mean difference − 10.8 vs. −4.9, respectively, P = 0.0002). There was no statistically significant sex difference in GRBAS at any follow‐up interval.

Conclusion

Following GMT, females had greater improvement in patient‐reported voice outcomes in the early postoperative period. No significant difference between sexes was noted in perceptual measures (GRBAS). Sex‐specific outcomes should be evaluated for clinical interventions to improve specificity of preoperative counseling.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2TLf7hd

Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy

Objective

Prevention of granulation tissue formation and acceleration of epithelialization of the mastoid cavity in canal wall down (CWD) mastoidectomy by use of amniotic membrane (AM) as a biologic dressing.

Study Design

Prospective and randomized study.

Methods

During CWD mastoidectomy, an inferiorly base musculoperiosteal flap was rotated into the cavity. In order to coverage of this flap, the AM (75 ears) or the temporalis fascia (control group, 73 ears) was used. The times for mastoid cavity epithelialization were compared in both groups.

Results

In the AM group, duration of complete epithelialization of the cavity was 41.4 ± 7.7 days, whereas in the control group it was 59.2 ± 9.1 days. Duration of time for complete epithelialization in the AM group was shorter than in the control group, which was significant (P < 0.0001).

Conclusion

The use of AM in CWD mastoidectomy is beneficial in minimizing postoperative epithelialization time.

Level of Evidence

1b. Laryngoscope, 2018

http://bit.ly/2D4xW9v

Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

Objective

To determine the effectiveness of education in evidence‐based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir‐Alam and Imam Khomeini Hospitals.

Methods

In a quasi‐experimental (before‐and‐after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed.

Results

A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001).

Conclusion

The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents.

Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

Level of Evidence

2. Laryngoscope, 2018

http://bit.ly/2TGpEKk

Clinical management and outcomes of lacrimal sac squamous cell carcinoma

Abstract

Background

To investigate the management and outcomes of patients with lacrimal sac squamous cell carcinoma (SCC).

Methods

This retrospective study examined 69 lacrimal sac SCC cases treated at our hospital between 1992 and 2017. The potential risk factors for prognosis, a new staging method, treatment outcomes, and complications were investigated.

Results

The 5‐year overall survival (OS) and progression‐free survival (PFS) were 87.6 ± 4.8% and 76.3 ± 6.4%, respectively. Positive lymph node was associated with worse OS and PFS. We divided lacrimal sac SCC into four clinical stages, with significant differences in OS (P = .026) and PFS (P = .042) among each stage. Definitive radiotherapy was equivalent to surgery plus radiotherapy in 26.1% (18/69) of cases, and the incidence of complications was not higher.

Conclusions

Lymph node status was a key factor in determining outcomes. Our staging method could effectively classify tumor stage and predict prognosis, which can contribute to optimizing treatment regimes. Radiotherapy played an important role in treatment.

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The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program

Abstract

Background

Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes.

Methods

Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes.

Results

At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups.

Conclusion

Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.

http://bit.ly/2FkNTdZ

Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients

Abstract

Background

The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN).

Methods

Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015.

Results

Twenty percent (33/168) of the patients developed a recurrence. Sixty‐six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow‐up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow‐up. Among the 7 patients who were NED, the mean time from recurrence to last follow‐up was 735 days.

Conclusions

Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.

http://bit.ly/2FpBe8M

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Abstract

Background

The effect of treatment modality on long‐term opioid dependence in patients with oropharyngeal cancer has not been reported.

Methods

A retrospective cohort of 122 patients with T1/T2 oropharyngeal cancer undergoing treatment was generated. Risk factors associated with chronic opioid use were investigated by univariate and multivariate analyses.

Results

The prevalence of chronic opioid use was 45.9%. On multivariate analysis, primary nonsurgical treatment (odds ratio [OR] 4.5, 95% confidence interval [CI]: 1.7‐11.4), pretreatment opioid use (OR 14.9, 95% CI: 3.5‐62.5), psychiatric disorder (OR 4.3, 95% CI: 1.03‐18.5), alcohol use (OR 2.6, 95% CI: 1.03‐6.5), and younger age (OR 1.1, 95% CI: 1.02‐1.11) were significantly associated with chronic opioid use.

Conclusion

Primary nonsurgical treatment, younger age, pretreatment opioid use, alcohol use, and psychiatric disorder were independently associated with an increased risk of chronic opioid use. Preventative strategies should be especially focused toward these patients to reduce their risk of long‐term opioid use.

http://bit.ly/2FhGewY