Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians

Abstract

Purpose

Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ear, nose, and throat (ENT) physicians, and general practitioners (GPs), and to explore potential reasons for the underuse of the maneuvers.

Methods

Neurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically.

Results

In total, 97 neurologists, 85 ENT physicians and 142 GPs (21.1%, 26.8%, and 5.7%, respectively, of all corresponding licensed Lithuanian physicians) completed the questionnaire. 24% of neurologists, 33% ENT physicians and 50% GPs do not perform diagnostic maneuvers for patients with suspected BPPV, and 28%, 61%, and 84%, respectively, do not perform CRPs. Years of clinical experience was a negative predictor of CRP performance [OR 0.97 (95% CI 0.95–0.99), p = 0.001]. Frequent reasons for not performing CRPs were time taken for the procedure, fear of provoking symptoms, and lack of knowledge. All physicians frequently ordered additional imaging or consultations for suspected BPPV and reported prescribing a range of medications.

Conclusions

A significant proportion of Lithuanian neurologists, ENT physicians, and GPs do not employ diagnostic maneuvers and CRPs for BPPV patients, contrary to established guidelines. Lack of expertise and time available is a common culprit that leads to unnecessary drug prescribing and investigation.

http://bit.ly/2G93cpY

A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

Abstract

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.

http://bit.ly/2TfsKp2

Tongue Lumps and Bumps: Histopathological Dilemmas and Clues for Diagnosis

Abstract

Exophytic lesions of the tongue encompass a diverse spectrum of entities. These are most commonly reactive, arising in response to local trauma but can also be neoplastic of epithelial, mesenchymal or miscellaneous origin. In most cases, the microscopic examination is likely to provide a straightforward diagnosis. However, some cases can still raise microscopic diagnostic dilemmas, such as conditions that mimic malignancies, benign tumors with overlapping features and anecdotal lesions. A series of "lumps and bumps" of the tongue are presented together with suggested clues that can assist in reaching a correct diagnosis, emphasizing the importance of the clinico-pathological correlations.

http://bit.ly/2G7qH2u

A Rainbow of Colors and Spectrum of Textures: An Approach to Oral Mucosal Entities

http://bit.ly/2FZ9zNl

HPV-Related Papillary Lesions of the Oral Mucosa: A Review

Abstract

Human papillomaviruses (HPVs) are causative of a group of clinically papillary lesions. The HPV-related lesions of the oral cavity include squamous papilloma, condyloma acuminatum, verruca vulgaris, and multifocal epithelial hyperplasia. Benign entities, such as verruciform xanthoma or giant cell fibroma, as well as malignancies, such as papillary squamous cell carcinoma and verrucous carcinoma, may be considered in the clinical and/or histologic differential diagnoses of these lesions. Mechanisms of infection, epidemiology, clinical presentations, histologic features, and differential diagnoses of the HPV-related oral pathologies are discussed. Current concepts of viral transmission, especially as pertaining to lesions in pediatric patients, and the impacts of HPV vaccination are reviewed.

http://bit.ly/2FYoPtE

Candidiasis: Red and White Manifestations in the Oral Cavity

Abstract

Candidiasis is a very common malady in the head neck region. This review will concentrate on intraoral, pharyngeal and perioral manifestations and treatment. A history of the origins associated with candidiasis will be introduced. In addition, oral conditions associated with candidiasis will be mentioned and considered. The various forms of oral and maxillofacial candidiasis will be reviewed to include pseudomembranous, acute, chronic, median rhomboid glossitis, perioral dermatitis, and angular cheilitis. At the end of this review the clinician will be better able to diagnose and especially treat candidal overgrowth of the oral facial region. Of particular interest to the clinician are the various treatment modalities with appropriate considerations for side effects.

http://bit.ly/2G7qMmO

Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions

Abstract

Excluding human papillomavirus (HPV)-driven conditions, oral papillary lesions consist of a variety of reactive and neoplastic conditions and, on occasion, can herald internal malignancy or be part of a syndrome. The objectives of this paper are to review the clinical and histopathological features of the most commonly encountered non-HPV papillary conditions of the oral mucosa. These include normal anatomic structures (retrocuspid papillae, lingual tonsils), reactive lesions (hairy tongue, inflammatory papillary hyperplasia), neoplastic lesions (giant cell fibroma), lesions of unknown pathogenesis (verruciform xanthoma, spongiotic gingival hyperplasia) and others associated with syndromes (for instance Cowden syndrome) or representing paraneoplastic conditions (malignant acanthosis nigricans). Common questions regarding differential diagnosis, management, and diagnostic pitfalls are addressed, stressing the importance of clinico-pathologic correlation and collaboration.

http://bit.ly/2FUqLDk

Lumps and Bumps of the Gingiva: A Pathological Miscellany

Abstract

Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.

http://bit.ly/2FWagql

Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities

Abstract

Erythematous lesions of the oral mucosa are common and can reflect a variety of conditions, ranging from benign reactive or immunologically-mediated disorders to malignant disease. Together with vascular abnormalities, which can vary from reddish to bluish-purple in color, the differential diagnosis for erythematous oral mucosal change is quite diverse. This review focuses on salient clinical features and histopathologic findings of selected conditions which clinically present as red or vascular-like oral mucosal alterations, including oral vascular malformations and neoplasms, pyogenic granuloma, localized juvenile spongiotic gingival hyperplasia, denture stomatitis, benign migratory glossitis (geographic tongue), orofacial granulomatosis, granulomatosis with polyangiitis (Wegener granulomatosis), megaloblastic anemia, and erythroplakia. Recognition of the characteristic clinical features of these conditions, in conjunction with thorough patient history, will allow clinicians to narrow the differential diagnosis and guide appropriate clinical decision making, including the need for tissue biopsy, in order to complete the diagnostic process and initiate optimal patient care.

http://bit.ly/2G7qUmo

Black and Brown Oro-facial Mucocutaneous Neoplasms

Abstract

Black and brown-colored mucocutaneous lesions present a differential diagnostic challenge, with malignant melanoma being the primary clinical concern. The vast majority of pigmented lesions in the head and neck region are the result of benign, reactive factors such as post-inflammatory melanosis. However, it is not uncommon to discover a range of muco-cutaneous black and brown neoplasms in the oro-facial area. The majority of black/brown pigmented neoplasms are melanocytic in origin; these are neoplasms of neural crest derivation. Melanocytic nevi are a diverse group of benign neoplasms that are the result of specific oncogenic mutations. They are common on cutaneous surfaces but can manifest in mucosal sites. Currently, nevi are classified based on clinical and histological criteria. The most common cutaneous and oral mucosal nevus is the acquired melanocytic nevus; nevi do not pose an increased risk for the development of malignant melanoma. Emerging information on specific genetic differences supports the notion of biologically distinct nevi. This article will review the classic clinical and microscopic features of nevi commonly found in the head and neck region, and discuss emerging concepts in nevus pathogenesis and taxonomy. Melanoma is a malignant melanocytic neoplasm and is a result of cumulative genetic deregulation. The etiology of malignant melanoma (MM) is multifactorial and includes underlying genetic susceptibility, UV radiation, skin-type, and race. The majority of MM occurs on cutaneous surfaces and less commonly on mucosal and extra-cutaneous visceral organs. Regardless of location, MM exhibits clinical-pathological features that relate to horizontal or vertical tumor spread. Cutaneous and mucosal MM typically present as asymmetrical, irregularly bordered, large (> 0.5 cm), heterogeneous brown-black lesions with foci of erythema, atrophy or ulceration. As with melanocytic nevi, advances in melanomagenesis research have revealed primary oncogenic BRAF and NRAS mutations associated with cutaneous MM. Unlike their cutaneous counterparts, mucosal melanomas exhibit primary oncogenic alterations in c-KIT and other genes. This article will discuss the role of specific primary oncogenic and secondary/tertiary genetic defects in differential clinical presentation, anatomic distribution, future classification changes, and targeted therapy of melanoma. The clinical and microscopic features of mucosal melanomas and a summary of management guidelines will be discussed. Additionally, this article will cover the salient features of melanocytic neuroectodermal tumor of infancy, a neoplastic entity that can involve the oro-facial region, and the clinical-pathological features of selected, commonly occurring pigmented ectodermally-derived neoplasms that are often part of the clinical differential diagnosis of black–brown pigmented lesions.

http://bit.ly/2G6YR6q

A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

Abstract

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.

http://bit.ly/2TfsKp2

Black and Brown Oro-facial Mucocutaneous Neoplasms

Abstract

Black and brown-colored mucocutaneous lesions present a differential diagnostic challenge, with malignant melanoma being the primary clinical concern. The vast majority of pigmented lesions in the head and neck region are the result of benign, reactive factors such as post-inflammatory melanosis. However, it is not uncommon to discover a range of muco-cutaneous black and brown neoplasms in the oro-facial area. The majority of black/brown pigmented neoplasms are melanocytic in origin; these are neoplasms of neural crest derivation. Melanocytic nevi are a diverse group of benign neoplasms that are the result of specific oncogenic mutations. They are common on cutaneous surfaces but can manifest in mucosal sites. Currently, nevi are classified based on clinical and histological criteria. The most common cutaneous and oral mucosal nevus is the acquired melanocytic nevus; nevi do not pose an increased risk for the development of malignant melanoma. Emerging information on specific genetic differences supports the notion of biologically distinct nevi. This article will review the classic clinical and microscopic features of nevi commonly found in the head and neck region, and discuss emerging concepts in nevus pathogenesis and taxonomy. Melanoma is a malignant melanocytic neoplasm and is a result of cumulative genetic deregulation. The etiology of malignant melanoma (MM) is multifactorial and includes underlying genetic susceptibility, UV radiation, skin-type, and race. The majority of MM occurs on cutaneous surfaces and less commonly on mucosal and extra-cutaneous visceral organs. Regardless of location, MM exhibits clinical-pathological features that relate to horizontal or vertical tumor spread. Cutaneous and mucosal MM typically present as asymmetrical, irregularly bordered, large (> 0.5 cm), heterogeneous brown-black lesions with foci of erythema, atrophy or ulceration. As with melanocytic nevi, advances in melanomagenesis research have revealed primary oncogenic BRAF and NRAS mutations associated with cutaneous MM. Unlike their cutaneous counterparts, mucosal melanomas exhibit primary oncogenic alterations in c-KIT and other genes. This article will discuss the role of specific primary oncogenic and secondary/tertiary genetic defects in differential clinical presentation, anatomic distribution, future classification changes, and targeted therapy of melanoma. The clinical and microscopic features of mucosal melanomas and a summary of management guidelines will be discussed. Additionally, this article will cover the salient features of melanocytic neuroectodermal tumor of infancy, a neoplastic entity that can involve the oro-facial region, and the clinical-pathological features of selected, commonly occurring pigmented ectodermally-derived neoplasms that are often part of the clinical differential diagnosis of black–brown pigmented lesions.

http://bit.ly/2G6YR6q

HPV-Related Papillary Lesions of the Oral Mucosa: A Review

Abstract

Human papillomaviruses (HPVs) are causative of a group of clinically papillary lesions. The HPV-related lesions of the oral cavity include squamous papilloma, condyloma acuminatum, verruca vulgaris, and multifocal epithelial hyperplasia. Benign entities, such as verruciform xanthoma or giant cell fibroma, as well as malignancies, such as papillary squamous cell carcinoma and verrucous carcinoma, may be considered in the clinical and/or histologic differential diagnoses of these lesions. Mechanisms of infection, epidemiology, clinical presentations, histologic features, and differential diagnoses of the HPV-related oral pathologies are discussed. Current concepts of viral transmission, especially as pertaining to lesions in pediatric patients, and the impacts of HPV vaccination are reviewed.

http://bit.ly/2FYoPtE

Candidiasis: Red and White Manifestations in the Oral Cavity

Abstract

Candidiasis is a very common malady in the head neck region. This review will concentrate on intraoral, pharyngeal and perioral manifestations and treatment. A history of the origins associated with candidiasis will be introduced. In addition, oral conditions associated with candidiasis will be mentioned and considered. The various forms of oral and maxillofacial candidiasis will be reviewed to include pseudomembranous, acute, chronic, median rhomboid glossitis, perioral dermatitis, and angular cheilitis. At the end of this review the clinician will be better able to diagnose and especially treat candidal overgrowth of the oral facial region. Of particular interest to the clinician are the various treatment modalities with appropriate considerations for side effects.

http://bit.ly/2G7qMmO

Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions

Abstract

Excluding human papillomavirus (HPV)-driven conditions, oral papillary lesions consist of a variety of reactive and neoplastic conditions and, on occasion, can herald internal malignancy or be part of a syndrome. The objectives of this paper are to review the clinical and histopathological features of the most commonly encountered non-HPV papillary conditions of the oral mucosa. These include normal anatomic structures (retrocuspid papillae, lingual tonsils), reactive lesions (hairy tongue, inflammatory papillary hyperplasia), neoplastic lesions (giant cell fibroma), lesions of unknown pathogenesis (verruciform xanthoma, spongiotic gingival hyperplasia) and others associated with syndromes (for instance Cowden syndrome) or representing paraneoplastic conditions (malignant acanthosis nigricans). Common questions regarding differential diagnosis, management, and diagnostic pitfalls are addressed, stressing the importance of clinico-pathologic correlation and collaboration.

http://bit.ly/2FUqLDk

Tongue Lumps and Bumps: Histopathological Dilemmas and Clues for Diagnosis

Abstract

Exophytic lesions of the tongue encompass a diverse spectrum of entities. These are most commonly reactive, arising in response to local trauma but can also be neoplastic of epithelial, mesenchymal or miscellaneous origin. In most cases, the microscopic examination is likely to provide a straightforward diagnosis. However, some cases can still raise microscopic diagnostic dilemmas, such as conditions that mimic malignancies, benign tumors with overlapping features and anecdotal lesions. A series of "lumps and bumps" of the tongue are presented together with suggested clues that can assist in reaching a correct diagnosis, emphasizing the importance of the clinico-pathological correlations.

http://bit.ly/2G7qH2u

Lumps and Bumps of the Gingiva: A Pathological Miscellany

Abstract

Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.

http://bit.ly/2FWagql

Effects of Musical Training and Hearing Loss on Fundamental Frequency Discrimination and Temporal Fine Structure Processing: Psychophysics and Modeling

Abstract

Several studies have shown that musical training leads to improved fundamental frequency (F₀) discrimination for young listeners with normal hearing (NH). It is unclear whether a comparable effect of musical training occurs for listeners whose sensory encoding of F₀ is degraded. To address this question, the effect of musical training was investigated for three groups of listeners (young NH, older NH, and older listeners with hearing impairment, HI). In a first experiment, F₀ discrimination was investigated using complex tones that differed in harmonic content and phase configuration (sine, positive, or negative Schroeder). Musical training was associated with significantly better F₀ discrimination of complex tones containing low-numbered harmonics for all groups of listeners. Part of this effect was caused by the fact that musicians were more robust than non-musicians to harmonic roving. Despite the benefit relative to their non-musicians counterparts, the older musicians, with or without HI, performed worse than the young musicians. In a second experiment, binaural sensitivity to temporal fine structure (TFS) cues was assessed for the same listeners by estimating the highest frequency at which an interaural phase difference was perceived. Performance was better for musicians for all groups of listeners and the use of TFS cues was degraded for the two older groups of listeners. These findings suggest that musical training is associated with an enhancement of both TFS cues encoding and F₀ discrimination in young and older listeners with or without HI, although the musicians' benefit decreased with increasing hearing loss. Additionally, models of the auditory periphery and midbrain were used to examine the effect of HI on F₀ encoding. The model predictions reflected the worsening in F₀ discrimination with increasing HI and accounted for up to 80 % of the variance in the data.

http://bit.ly/2SdY0au

Effects of Musical Training and Hearing Loss on Fundamental Frequency Discrimination and Temporal Fine Structure Processing: Psychophysics and Modeling

Abstract

Several studies have shown that musical training leads to improved fundamental frequency (F₀) discrimination for young listeners with normal hearing (NH). It is unclear whether a comparable effect of musical training occurs for listeners whose sensory encoding of F₀ is degraded. To address this question, the effect of musical training was investigated for three groups of listeners (young NH, older NH, and older listeners with hearing impairment, HI). In a first experiment, F₀ discrimination was investigated using complex tones that differed in harmonic content and phase configuration (sine, positive, or negative Schroeder). Musical training was associated with significantly better F₀ discrimination of complex tones containing low-numbered harmonics for all groups of listeners. Part of this effect was caused by the fact that musicians were more robust than non-musicians to harmonic roving. Despite the benefit relative to their non-musicians counterparts, the older musicians, with or without HI, performed worse than the young musicians. In a second experiment, binaural sensitivity to temporal fine structure (TFS) cues was assessed for the same listeners by estimating the highest frequency at which an interaural phase difference was perceived. Performance was better for musicians for all groups of listeners and the use of TFS cues was degraded for the two older groups of listeners. These findings suggest that musical training is associated with an enhancement of both TFS cues encoding and F₀ discrimination in young and older listeners with or without HI, although the musicians' benefit decreased with increasing hearing loss. Additionally, models of the auditory periphery and midbrain were used to examine the effect of HI on F₀ encoding. The model predictions reflected the worsening in F₀ discrimination with increasing HI and accounted for up to 80 % of the variance in the data.

http://bit.ly/2SdY0au

Factors associated with suicidal ideation risk in head and neck cancer: A longitudinal study

Objectives/Hypothesis

The risk factors associated with suicidal ideation among patients with head and neck cancer (HNC) have rarely been investigated. Thus, this study proposed an effective screening model to facilitate the identification of patients with HNC who are at risk of committing suicide.

Study Design

Retrospective longitudinal study.

Methods

We recruited 286 inpatients with HNC who were referred to the psychiatry department for an emotional distress assessment during cancer treatment. Sociodemographic and clinical factors, as well as Distress Thermometer (DT) scoring, were gathered and analyzed using multivariate logistic regression.

Results

Among the patients, 27 (9.4%) were recognized as having suicidal ideation. A logistic regression analysis revealed five significant indicators associated with suicidal ideation, namely depression (odds ratio [OR]: 42.83), dysphoria (OR: 8.06), hypopharyngeal cancer (OR: 4.61), cancer history (OR: 4.53), and average DT scores (OR: 1.84). Based on the receiver operating characteristic and logistic regression, the model can predict suicidal ideation with 93.4% accuracy (area under the curve value).

Conclusions

Our findings provide strong evidence that patients with depression, hypopharyngeal cancer, higher DT scores, and previous cancer history can be quickly screened for suicidal ideation, which may help to prevent suicide events in patients with HNC.

Level of Evidence

3b Laryngoscope, 2019

http://bit.ly/2TgGQ9u

EMS quality improvement through clinical specialty teams

Harness a passion for care to identify improvement opportunities in clinical specialty areas and propose change

http://bit.ly/2B5P1ys

Development of a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination

Abstract

Introduction

A new approach to treat obstructive sleep apnea (OSA) is upper airway stimulation therapy (UAS). Electrical pulses applied to the hypoglossal nerve induce tongue protrusion, increase airway patency and decrease the frequency of apneic and hypopneic events. Thus, the main objective of this study was to design a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination.

Method

This study has designed the Tongue Adverse Event and Satisfaction Questionnaire (TAESQ) and an endobuccal examinations divided into an endobuccal lesion examination (ELE) and an endobuccal risk factor examination (ERFE). Evaluations were conducted at month 6 post-implantation.

Results

The study population after implantation of UAS device consisted of ten Caucasian males with a mean age of 51.9 ± 11.8 years, and a mean BMI of 28.6 ± 3.3. The AHI of the ten participants ranged from 46.7 ± 12.2/h at baseline to 14.5 ± 8.9/h with the Inspire therapy at the 6-month follow-up. The TAESQ revealed pain (30%), followed by less tongue sensitivity (20%) and tongue weakness (10%). The ELE did not reveal any lesions. The ERFE revealed that some participants had tissue and dental risk factors but not associated to more adverse events.

Conclusion

The TAESQ, ELE and ERFE have been designed and studied on a small number of participants. These evaluations could systematically be included in the care pathway of patients treated by UAS to better investigate tongue discomfort and tongue lesion for patients treated with this technology.

http://bit.ly/2GbmdYT

Teaching communication skills to OTL-HNS residents: multisource feedback and simulated scenarios

Effective communication has been linked to a reduction in adverse events and improved patient compliance. Currently in Otolaryngology – Head and Neck Surgery (OTL-HNS) residency programs, there is limited expl...

http://bit.ly/2HyDg9m

Skeletal open bite with amelogenesis imperfecta treated with compression osteogenesis: a case report

Abstract

Background

We successfully treated a 37-year-old male who had skeletal open bite with severe amelogenesis imperfecta (AI) with orthodontics, compression osteogenesis, and prosthodontics.

Case presentation

The patient was diagnosed with severe anterior open bite caused by severe AI. Corticotomy was performed on both buccal and palatal sides of the molar regions, and anchor plates were placed onto the bilateral zygomatic buttress and the center of the hard palate. After corticotomy, posterior maxillary segments were moved 3.5 mm superiorly to correct skeletal open bite with elastic chains. After 8-month, overbite had decreased by 2.0 mm. After further 5 months of prosthodontic preparation, orthodontic appliances were removed, and provisional crowns were set on all teeth. The anterior open bite was corrected, and ideal occlusion with a Class I molar relationship was achieved. The upper first molars were intruded 3.5 mm, resulting in 3.0^o counter-clockwise rotation of the mandible. The total active treatment period was 16 months. Acceptable occlusion with a good facial profile was well maintained throughout the 8-year retention period.

Conclusions

Our results indicate long-term stability after interdisciplinary treatment combining orthodontics, oral surgery, and prosthodontics in a patient with severe anterior open bite and AI.

http://bit.ly/2RV4ZG8

Teaching communication skills to OTL-HNS residents: multisource feedback and simulated scenarios

Abstract

Background

Effective communication has been linked to a reduction in adverse events and improved patient compliance. Currently in Otolaryngology – Head and Neck Surgery (OTL-HNS) residency programs, there is limited explicit teaching of communication skills. Our objective was to implement an educational program on communication skills for residents using multisource assessment in several simulation-based contexts throughout residency.

Methods

For three consecutive years, OTL-HNS residents were recruited to participate in a total of nine simulation-based clinical scenarios in which communication skills could be honed. This educational program was designed to provide instruction and practice of challenging ethics scenarios, with communication efficacy as a secondary goal. To facilitate this goal, a multisource assessment was paired with a debriefing process that involved attending staff, observing and participating residents, standardized patients, and invited content experts.

Results

Seventeen residents completed the curriculum for at least two consecutive years from 2009 to 2011. The internal-consistency reliability of the scenarios ranged from 0.88 to 0.96. The intraclass correlation was 0.19, as expected in this context. There was no statistical difference in the mean ratings of performance across post-graduate year (PGY) level (p = 0.201). Results from the random-intercept regression indicated that, on average, a learner's mean rating at baseline was 3.6/5 and increased significantly by 0.25 points per year (p < 0.05) as assessed by OTL-HNS staff members and peers. No significant improvement across time was found for ratings by non-medical assessors.

Conclusion

Implementing an educational program focused on communication skills using a multisource assessment in various contexts has shown to be potentially effective at our institution, and resulted for yearly improvement and consolidation of performance of OTL-HNS residents as judged by faculty and residents. The inclusion of a multisource assessment in the simulation curriculum is key to allow for the representation of different perspectives on communication skills, for both the assessment and the debriefing process. Future studies are needed to explore the possibility of fully integrating this educational program into residence training in order to support deliberate communication skills teaching.

http://bit.ly/2FXjin8

Recurrent apocrine hidrocystoma of the external auditory canal

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

Author(s): Jack Birkenbeuel, Khodayar Goshtasbi, Hossein Mahboubi, Hamid R. Djalilian

http://bit.ly/2Wq182j

Prospective evaluation of pretreatment and intratreatment FDG PET‐CT SUV stability in primary head and neck cancer

Abstract

Purpose

To evaluate standardized uptake value (SUV) stability on pretreatment and intratreatment 18‐fluorodeoxyglucose (FDG) positron emission tomography‐computed tomography (PET‐CT) in patients undergoing definitive CRT for head and neck cancer (HNC).

Methods

Primary tumor and nodal volumes of interest (VOIs) from HNC patients were contoured on the pretreatment and intratreatment PET‐CT by two independent observers. SUV stability was measured with intersection calculations (DICE, overlap fraction, center to center) between the VOIs at threshold levels of 50%, 60%, 70%, 80%, and 90% of the SUV maximum.

Results

The mean calculated DICE of the 50%, 60%, 70%, 80%, 90% SUV threshold was 0.53, 0.48, 0.41, 0.28, and 0.12, respectively. The mean calculated overlap fraction was 0.71, 0.65, 0.58, 0.43, and 0.2, respectively. Center‐center difference demonstrates spatial variability of 7.8, 8.2, 8.6, 9.5, and 11.2 mm for these SUV subvolumes of interest.

Conclusions

HNC subvolumes defined by SUV thresholding technique in FDG PET‐CT imaging do not remain physically stable during (chemo)RT.

Highlights

All pretreatment and intratreatment SUV thresholds (50%‐90%) overlap indexes are low during the course of (chemo)radiation.

Pretreatment and intratreatment center to center variation further corroborates that all FDG threshold volumes do not remain stable during treatment.

No difference in SUV threshold stability was seen between p16 positive and negative tumors.

http://bit.ly/2DDR8eE

Parental Expectation and Perception of CI Benefits in Their Implanted Wards

Abstract

Parents of implanted children develop a set of expectations prior to implantation about future performance and outcomes of their child. This set of expectations has an important impact on post-implant satisfaction levels. The position of the parent in the household makes them uniquely placed to assess the impact of implantation in the context within which the child grows up. There is strong need to find out expectations of parents from CI outcomes in implanted children. The functional benefits of CI may be measured by administering the parental perception of CI benefits in their implanted wards. The primary aim of the study was to find out different expectations of CI outcomes in parents of CI users and the perception of CI outcomes in the parents of CI users. Secondary aim was to find out the most important concerns of parents towards their implanted children. Twenty families with a child implanted for duration of more than 2 years were selected for the study. Two questionnaires (1) Parent Expectations Questionnaire for Cochlear Implants (Nemours children clinic) and (2) Parents and their cochlear implanted child Questionnaire (O'Neill Int J Pediatr Otorhinolaryngol 68: 149–160 2004) were administered on these parents. Results were analyzed qualitatively. Parents expected their implanted children to use the telephone, to be able to detect soft sounds, to listen in crowds, to be able to easily understand others, and to show improvement in communication skills. The quality of speech, process of implantation, to take time off for the appointments at the implant centre and making decision to proceed with implantation were main concerns of the parents. Parents have a high expectation from their implanted children in all domains of life i.e. communication abilities, social and academic skills. Parents have high positive views about the outcomes of the CI. However there are areas which need attention for a positive outcome from the point of view of parents of implanted children.

http://bit.ly/2sRpzs0

Obstructive sleep apnea in children and adolescents with and without obesity

Abstract

Purpose

To investigate the prevalence of obstructive sleep apnea (OSA) in children referred for obesity treatment, and to compare the prevalence with that of a normal-weight group. Moreover, we examined the association between Body Mass Index Standard Deviation Score (BMI SDS) and the Apnea–Hypopnea Index (AHI).

Methods

This cross-sectional study included 139 children aged 7–18 years with overweight/obesity (BMI SDS >1.28) recruited from an obesity treatment clinic. The normal-weight group consisted of 33 children (BMI SDS ≤ 1.28) aged 7–18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor (Nox T3). OSA was defined as AHI ≥ 2. Height and weight were measured and the tonsillar size was clinically estimated using the Brodsky scale.

Results

The OSA prevalence was 44.6% in children with overweight/obesity compared with 9.1% in the normal-weight group (p = 0.0002), and the relative risk of OSA was 4.9 (95% CI 1.6–14.7). In a logistic regression, a one-unit increase in the BMI SDS increased the odds of having OSA by a factor of 1.92 independent of age, sex, tonsillar hypertrophy, and asthma (95% CI 1.33–2.76, p = 0.0005). A generalized linear regression adjusted for the same variables revealed an association between BMI SDS and AHI (a one-unit increase in the BMI SDS equaled an average increase in the AHI of 35% (95% CI 19–53%, p < 0.0001)).

Conclusions

In this study, children with overweight/obesity had a significantly higher prevalence of OSA compared with a normal-weight group. Increased BMI SDS was associated with increased AHI.

http://bit.ly/2FUkrfj

Parental Expectation and Perception of CI Benefits in Their Implanted Wards

Abstract

Parents of implanted children develop a set of expectations prior to implantation about future performance and outcomes of their child. This set of expectations has an important impact on post-implant satisfaction levels. The position of the parent in the household makes them uniquely placed to assess the impact of implantation in the context within which the child grows up. There is strong need to find out expectations of parents from CI outcomes in implanted children. The functional benefits of CI may be measured by administering the parental perception of CI benefits in their implanted wards. The primary aim of the study was to find out different expectations of CI outcomes in parents of CI users and the perception of CI outcomes in the parents of CI users. Secondary aim was to find out the most important concerns of parents towards their implanted children. Twenty families with a child implanted for duration of more than 2 years were selected for the study. Two questionnaires (1) Parent Expectations Questionnaire for Cochlear Implants (Nemours children clinic) and (2) Parents and their cochlear implanted child Questionnaire (O'Neill Int J Pediatr Otorhinolaryngol 68: 149–160 2004) were administered on these parents. Results were analyzed qualitatively. Parents expected their implanted children to use the telephone, to be able to detect soft sounds, to listen in crowds, to be able to easily understand others, and to show improvement in communication skills. The quality of speech, process of implantation, to take time off for the appointments at the implant centre and making decision to proceed with implantation were main concerns of the parents. Parents have a high expectation from their implanted children in all domains of life i.e. communication abilities, social and academic skills. Parents have high positive views about the outcomes of the CI. However there are areas which need attention for a positive outcome from the point of view of parents of implanted children.

http://bit.ly/2sRpzs0

Comparison of the oral microbiome of patients with generalized aggressive periodontitis and periodontitis-free subjects

Publication date: Available online 28 January 2019

Source: Archives of Oral Biology

Author(s): Susanne Schulz, Martin Porsch, Ivo Grosse, Katrin Hoffmann, Hans-Günter Schaller, Stefan Reichert

Abstract

Objective

The primary objectives of the study were to assess differences in complex subgingival bacterial composition between periodontitis-free persons and patients with generalized aggressive periodontitis (gAgP).

Background

The composition of the oral microbiota plays an important role for both oral and systemic diseases. However, the complex nature of the oral microbiome and its homeostasis is still poorly understood.

Material and methods

We compared the microbiome of 13 periodontitis-free persons to 13 patients with gAgP. The 16S rRNA genes were amplified, targeting the V3/V4 region using the MiSeq platform.

Results

In total, 1713 different bacterial species were mapped according to the Greengenes database. Using the Shannon index, no significant differences in alpha diversity were found between the two study groups. In principal component and linear discriminant analyses, disease-specific differences in beta diversity of the microbiome composition were evaluated. Bacteroidetes, Spirochaetes, and Synergistetes were more abundant in gAgP whereas Proteobacteria, Firmicutes, and Actinobacteria were associated with a healthy periodontium. At the bacterial species level, we showed that Porphyromonas gingivalis is the strongest indicator of gAgP. Treponema denticola and Tanerella forsythia of the "red complex" as well as Filifactor alocis were among the ten best biomarkers for gAgP.

Conclusions

These results broaden our knowledge of disease-specific differences in the microbial community associated with generalized AgP. A more complex view of the composition of the oral microbiome describes the etiology of generalized AgP in more detail. These results could help to individually adapt periodontal therapy in these patients.

http://bit.ly/2sQ1VvT

Perspektiven der Genomeditierung in der Hals-Nasen-Ohren-Heilkunde

Zusammenfassung

Hintergrund

Die Fortschritte in der DNA-Sequenzierung ermöglichen die genetischen Auslöser von Erkrankungen zu identifizieren. Zudem ist es heute möglich, mit „CRISPR-Cas9" („clustered regularly-interspaced short palindromic repeats und crispr-associated protein 9") genomische DNA-Sequenzen präzise und mit hoher Effizienz zu editieren. In kürzlich veröffentlichten präklinischen Studien wurde diese Technologie bereits für mögliche therapeutische Anwendungen evaluiert. Da auch in der HNO-Heilkunde viele Erkrankungen genetische Ursachen haben, birgt diese neue Technologie Chancen für neue Therapien.

Fragestellung

In diesem Übersichtsartikel erklären wir, wie die Genomeditierung als Therapieansatz genutzt werden könnte, und stellen dar, welche Erfolge in diesen Bereich bereits erreicht wurden und welche Herausforderungen auf dem Weg zur therapeutischen Nutzung bestehen.

Material und Methoden

Die Strategien zum Targeting von Genmutationen wurden anhand von Genomsequenzierungsdaten aus Online-Datenbanken und der Literatur entwickelt.

Ergebnisse

Kürzlich veröffentlichte Forschung an Tiermodellen hat gezeigt, dass die Genomeditierung erfolgreich für die Behandlung genetischer Erkrankungen benutzt werden kann. Dabei wurde z. B. in einer präklinischen Studie an Mäusen dominant-autosomaler Hörverlust erfolgreich mit CRISPR-Cas9 behandelt. Gleichermaßen könnten ähnliche Strategien auch für die Therapie von Kopf-Hals-Tumoren genutzt werden. Die größte Herausforderung scheint die Entwicklung eines Systems für die effiziente und sichere Applikation der therapeutischen Moleküle in den Zielgeweben der Patienten zu sein.

Schussfolgerungen

In der Theorie kann die Genomeditierung für mutationsspezifische genetische Therapien in der HNO genutzt werden. Jedoch müssen noch viele technologische Hürden auf dem Weg zur klinischen Anwendung überwunden werden.

http://bit.ly/2G2cL9Q

Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis

Abstract

Purpose

Cystic Fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of Endoscopic Sinus Surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients underwent the surgical procedure rather than in the not treated ones, particulary in lung transplant patients.

Methods

We studied 54 adult patients affected by CF. Lund–Kennedy, Lund–Mackay scores, and SNOT-22 were analysed. 14 had lung transplant and 9 had both lung tranplant and ESS procedures.

Results

22 (40.7%) out of 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund–Kennedy and Lund–Mackay scores appeared higher in the ESS group: 10 (range of 6–12) and 15 (range of 12–20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 20 (range of 3–68) and 40 (range of 10–73), respectively.

Conclusions

ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy, with a stabilization of respiratory function after transplantation.

http://bit.ly/2S6CpAZ

The Methodology and Electro-physiological Classification of Pre-operative Trans-tympanic Electrically-Evoked Auditory Brainstem Response (TT-EABR)

http://bit.ly/2B5NZlY

Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra

Abstract

Objectives

Skeletal muscle mass (SMM) is most often assessed in cancer patients on abdominal computed tomography (CT) imaging at the level of the third lumbar vertebra (L3). Abdominal CT imaging is not routinely performed in head and neck cancer (HNC) patients. Recently, a novel method to assess SMM on a single transversal CT slice at the level of the third cervical vertebra (C3) was published. The objective of this study was to assess the robustness of this novel C3 measurement method in terms of interobserver agreement.

Patients and methods

Patients diagnosed with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) at our center between 2007 and 2011 were evaluated. Fifty-four patients with were randomly selected for analysis. Six observers independently measured the cross-sectional muscle area (CSMA) at the level of C3 using a predefined, written protocol as instruction. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs), a Bland–Altman plot and Fleiss' kappa (κ).

Results

The agreement in vertebra selection between all observers was excellent (Fleiss' κ: 0.96). There was a substantial agreement between all observers in single slice selection (Fleiss' κ: 0.61). For all CSMA measurements, ICCs were excellent (0.763–0.969; all p < 0.001). The Bland–Altman plot showed good agreement between measurements, with narrow limits of agreement.

Conclusion

Interobserver agreement for SMM measurement at the level of C3 was excellent. Assessment of SMM at the level of C3 is easy and robust and can performed on routinely available imaging in HNC patients.

http://bit.ly/2ThF6gp

The Methodology and Electro-physiological Classification of Pre-operative Trans-tympanic Electrically-Evoked Auditory Brainstem Response (TT-EABR)

http://bit.ly/2B5NZlY