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

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

http://bit.ly/2G7H0fM

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

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

http://bit.ly/2FWXiZI

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

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

http://bit.ly/2GeWbUe

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

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

http://bit.ly/2G7H0fM

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

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

http://bit.ly/2FWXiZI

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

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

http://bit.ly/2GeWbUe

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

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

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

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

http://bit.ly/2sSFUN1

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

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

http://bit.ly/2CQO2lV

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

Abstract

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

http://bit.ly/2RpyzhM

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

Abstract

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

http://bit.ly/2WpEszg

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

Abstract

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

http://bit.ly/2RpyzhM

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

Abstract

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

http://bit.ly/2WpEszg

Pediatric simulation training: Tips to make it effective for medics

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

http://bit.ly/2BaRxDD

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

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

http://bit.ly/2WuUvf1

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

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

http://bit.ly/2Rr6y9w

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

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

http://bit.ly/2WsW4KL

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

Abstract

Objective

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

Methods

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

Results

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

Conclusions

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

http://bit.ly/2RUPhdT

Tinnitus: psychosomatische Aspekte

Zusammenfassung

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

http://bit.ly/2HEIy35

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

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

http://bit.ly/2UonIqk

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

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

http://bit.ly/2UonIqk

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

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

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

Abstract

Objectives

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

Design

Retrospective chart review.

Participants

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

Main outcome measures

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

Results

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

Conclusions

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

http://bit.ly/2DEEpYT

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

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

Author(s): Zhenzhen Hu, Ying Wang

Abstract

Aim

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

Method

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

Results

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

Conclusions

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

http://bit.ly/2Ur3TyF

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

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

http://bit.ly/2BbFWUP

Surgical planning in pediatric skull base surgery

Publication date: Available online 28 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

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

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

http://bit.ly/2TliQlF

Pediatric Lateral Graft Tympanoplasty A Review of 78 Cases

Publication date: Available online 28 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

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

Abstract

Objectives

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

Methods

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

Results

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

Conclusions

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

http://bit.ly/2Uni9IB

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

Publication date: Available online 28 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

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

Abstract

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

http://bit.ly/2DFcQim

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

Objectives/Hypothesis

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

Study Design

Outcomes research.

Methods

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

Results

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

Conclusions

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

Level of Evidence

2c Laryngoscope, 2019

http://bit.ly/2G6oVyB

Eye movement desensitization and reprocessing as a treatment for tinnitus

Objectives/Hypothesis

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

Study Design

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

Methods

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

Results

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

Conclusions

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

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FVL8jF

Comparison of balance outcomes according to treatment modality of vestibular schwannoma

Objectives

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

Methods

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

Results

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

Conclusions

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

Level of Evidence

2a Laryngoscope, 2019

http://bit.ly/2G6oODb

Positive airway pressure ventilation and complications in pediatric tracheocutaneous fistula repair

Objectives

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

Methods

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

Results

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

Conclusion

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

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2FUEytF

Otolaryngology boot camps: Current landscape and future directions

Objectives

Simulation‐based boot camps have gained popularity over the past few years, with some surgical specialties implementing mandatory national boot camps. However, there is no consensus in otolaryngology on boot camp timing, learner level, or curriculum. The purpose of this study is to examine the current landscape and gather opinions regarding future curriculum and standardization of boot camps in otolaryngology.

Methods

A survey was developed to examine current resident participation and boot camp content while also seeking opinions regarding improving boot camp enrollment and standardizing curriculum. A cross‐sectional survey of all otolaryngology residency program directors in the United States and Puerto Rico was performed via SurveyMonkey. Responses were collected anonymously, and results were analyzed by descriptive statistical analysis.

Results

Of the 45% (48 of 106) who responded, 76.6% reported their residents participate in boot camps. The most common skills taught were basic suturing and airway management skills. The majority (95%) was likely to send residents to a local boot camp, with 56% favoring early postgraduate year (PGY)‐1 participation and 42% favoring a 1‐day boot camp. Subsidized expenses, improved regional access, and supplementary boot camp information would help the program director in their decision to send residents to boot camp. Only 32% felt boot camps should be standardized, and 27% felt they should be mandatory.

Conclusion

Many otolaryngology residency programs participate in boot camps. Additional data on the benefits of boot camps, improved access, and reduced financial burden may improve participation. Further discussion of ideal timing, PGY level, and standardized curriculum should occur in conjunction with the otolaryngology academic societies and oversight from accreditation and certifying bodies.

Level of Evidence

NA. Laryngoscope, 2019

http://bit.ly/2G6oLHv

In response to letter to the editor regarding: Clinical implications of magnetic resonance imaging in temporomandibular disorders patients presenting ear fullness

http://bit.ly/2FUkwj2

Organ preservation in laryngeal and hypopharyngeal cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Stephen Kang

http://bit.ly/2UnqnAv

Incidence, predictors and impact of positive bony margins in surgically treated T4 stage cancers of the oral cavity

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Arjun Singh, Manish Mair, Hitesh Singhvi, Ankit Mahuvakar, Deepa Nair, Sudhir Nair, Pankaj Chaturvedi

Abstract

Objectives

A sea of literature addressing the adequacy of mucosal/soft tissue surgical margins in oral cavity cancers is available, but no mention exists regarding bony margins. We aim to study the predictors and impact on survival of positive bony margins and propose a safe margin distance.

Methods

This is a retrospective study of 400 consecutive surgically treated pT4 oral cavity squamous cell carcinoma patients between January 2012 and December 2015. The factors predicting positive bony margins were determined using chi-square test. Kaplan Meier and Cox regression hazard models were used for survival analysis. The median follow up was 36 months.

Results

The only factor that significantly predicted positive bony margins was lymphovascular emboli. The 3-year OS with bony margin positivity was 36.9%, compared to 67.5% for patients with adequate margins. When the tumor infiltrated the bone beyond mucosa (20.25%) the survival outcomes were significantly worse than the other patterns. Microscopic spread was seen in 10% cases, at a distance of 8 mm, the presence of which significantly impacted survival outcomes. Analysis of the receiver operating curve identified a cutoff of more than 15 mm as appropriate for classifying adequate bony margins. When the margins were taken above this, a significant positive impact on survival outcomes was present.

Conclusion

The presence of lymphovascular emboli may impact the status of bony margins. Based on our results, to achieve an "adequate margin in bone" we propose taking the bony cut at least 15 mm away from the clinically discernible tumor when treating advanced oral cancers.

http://bit.ly/2DFBlvM

Computed tomography evaluation after induction chemotherapy for T3 laryngeal cancer: Does response correlate with vocal cord mobility?

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Gabriel C.T.E. Garcia, Philippe Gorphe, Dana Hartl, Samy Ammari, Caroline Even, Yungan Tao, Corinne Balleyguier, Arthur Varoquaux, François Bidault

Abstract

Objectives

After induction chemotherapy (IC) for laryngeal cancer, Computed Tomography (CT) is used to assess tumor response but lacks rationalized methods for measurement of this response. In T3 laryngeal cancer, remobilization of an initially fixed vocal cord (VC) is a major sign of tumor response. We compared the performances of RECIST1.1, WHO and volumetric methods of evaluating response with laryngeal remobilization to determine if these measurements could objectively assess tumor response.

Material and Methods

This monocentric retrospective cohort study included patients treated with T3 laryngeal cancer with initial VC fixation treated with an organ preservation protocol with IC between 1999 and 2012. Tumors were measured with CT using RECIST1.1, WHO and volumetric methods by two radiologists blinded to VC remobilization (VCR), before and after induction chemotherapy and VC mobility was clinically assessed. Radiologic tumor shrinkage was compared to VCR. AUCs of ROC curves were compared. Inter-reader reliability, sensitivity and specificity of optimal cutoffs were determined.

Results

Seven females and thirty-six males with a mean age of 59 years were included. AUCs were 0.759, [95%CI 0.614; 0.904] for RECIST1.1, 0.763, [95%CI 0.617; 0.909] for WHO and 0.752, [95%CI 0.608; 0.896] for volumetric evaluations with no significant difference among the three techniques. Inter-reader reader reliabilities were good (RECIST1.1) to excellent (WHO and volumetric methods).

Conclusion

RECIST1.1, WHO and volumetric measures match with VCR after IC in patient with T3 laryngeal cancer. WHO criteria combine accuracy, reproducibility and practical use; they may be best adapted for response assessment and protocol design.

http://bit.ly/2UqZVGk

Impressive oral lichen planus progression to invasive squamous cell carcinoma in a three months lapse

Publication date: Available online 28 January 2019

Source: Oral Oncology

Author(s): L. Atzori, E. Robustelli Test, C. Ferreli, L. Pilloni, F. Rongioletti

http://bit.ly/2DFBcIK

Speech-in-noise perception ability can be related to auditory efferent pathway function: a comparative study in reading impaired and normal reading children

Publication date: Available online 28 January 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Mehdi Akbari, Rasool Panahi, Ayub Valadbeigi, Morteza Hamidi Nahrani

Abstract

Introduction

Deficient auditory processing can cause problems with speech perception and affect the development and evolution of reading skills. The efferent auditory pathway has an important role in normal auditory system functions like speech-in-noise perception, but there is still no general agreement on this.

Objective

To study the performance of the efferent auditory system in a group of children with reading impairment in comparison with normal reading and evaluation of its relationship with speech-in-noise perception.

Methods

A total of 53 children between the ages of 8–12 years were selected for the study of which 27 were with reading impairment and 26 were normal reading children. Transient evoked otoacoustic emissions suppression and auditory recognition of words-in-noise test were performed for all the children.

Results

The average amplitude of transient evoked otoacoustic emissions suppression showed a significant difference between the two groups in the right (p = 0.004) and in the left ear (p = 0.028). Assessment of the relationship between transient evoked otoacoustic emissions suppression and monaural auditory recognition of words-in-noise scores showed a significant moderate negative relationship only in the right ear (p = 0.034, r = −0.41) of the normal reading children. Binaural auditory recognition of words-in-noise scores were significantly correlated with the amplitude of transient evoked otoacoustic emissions suppression in the right ear (p < 0.001, r = −0.75) and in the left ear (p < 0.001, r = −0.64) of normal reading children. In the reading impaired group, ‍a weaker correlation was observed between binaural auditory recognition of words-in-noise scores and transient evoked otoacoustic emissions suppression in the right (p = 0.003, r = −0.55) and in the left ear (p = 0.012, r = −0.47).

Conclusions

Transient evoked otoacoustic emissions suppression pattern in the reading impaired group was different compared with normal reading children, and this difference could be related to efferent system performance. Words-in-noise scores in children with impaired reading were lower than in normal reading children. In addition, a relationship was found between transient evoked otoacoustic emissions suppression and words-in-noise scores in both normal and impaired reading children.

Resumo

Introdução

O processamento auditivo deficiente pode causar problemas na percepção da fala e afetar o desenvolvimento e a evolução das habilidades de leitura. A via auditiva eferente tem um papel importante nas funções do sistema auditivo normal, como a percepção da fala no ruído, mas ainda não há um consenso geral sobre isso.

Objetivo

Estudar o desempenho do sistema auditivo eferente em um grupo de crianças com dificuldade de leitura em comparação às com leitura normal e avaliação de sua relação com a percepção da fala no ruído.

Método

Um total de 53 crianças com idades entre 8 e 12 anos foram selecionadas para o estudo, das quais 27 tinham dificuldade de leitura e 26 crianças apresentavam leitura normal. A avaliação por emissões otoacústicas evocadas transientes e o teste Auditory Recognition of Words-in-Noise foram realizados em todas as crianças.

Resultados

A amplitude média da supressão das emissões otoacústicas evocadas transientes mostrou diferença significante entre os dois grupos na orelha direita (p = 0,004) e esquerda (p = 0,028). A avaliação da relação entre a supressão das emissões otoacústicas evocadas transientes e os escores monoaurais do teste Auditory Recognition of Words-in-Noise mostrou uma relação negativa moderadamente significante apenas na orelha direita (p = 0,034, r = -0,41) das crianças com leitura normal. Os escores binaurais do Auditory Recognition of Words-in-Noise foram significantemente correlacionados com a amplitude de supressão das emissões otoacústicas evocadas transientes na orelha direita (p < 0,001, r = -0,75) e na orelha esquerda (p < 0,001, r = -0,64) das crianças com leitura normal. No grupo com dificuldade de leitura, uma correlação mais fraca foi observada entre os escores binaurais do Auditory Recognition of Words-in-Noise e supressão das emissões otoacústicas evocadas transientes, na orelha direita (p = 0,003, r = -0,55) e na esquerda (p = 0,012, r = -0,47).

Conclusões

O padrão de supressão das emissões otoacústicas evocadas transientes no grupo com dificuldade de leitura foi diferente em comparação com as crianças com leitura normal e esta diferença pode estar relacionada ao desempenho do sistema eferente. Os escores de palavras no ruído em crianças com dificuldade de leitura foram menores do que nas crianças com leitura normal. Além disso, foi encontrada uma relação entre a supressão das emissões otoacústicas evocadas transientes e os escores de palavras no ruído tanto em crianças com leitura normal quanto nas com dificuldade de leitura.

http://bit.ly/2sRZJE9

Techniques and outcomes in microsurgical soft palate reconstruction

Abstract

Introduction

The soft palate is a multilayered intrinsically mobile structure, with a critical role in maintaining the airway, swallowing, and speech. We describe our technique of microsurgical reconstruction and analyze patient reported outcomes.

Methods

A retrospective analysis was performed using the University of Washington head and neck disease specific Quality of Life (UWQOL) questionnaire and the Hirose Standard speech analysis tool. Swallowing function and diet were recorded.

Results

Twenty cases were reviewed; nine were available for post hoc analysis. Anterolateral thigh flaps were used in 19 cases, in combination with vastus lateralis muscle in 5 cases.

Speech intelligibility was graded "excellent" in 8 of 9 cases and moderate in 1 of 9. All tolerated an oral diet. Mean UWQOL score was 424.4/600 (SD ± 141.9) for physical and 461.7/600 (SD ± 141.9) for emotional‐social domains.

Conclusion

Reconstruction of the soft palate using velopharyngeal narrowing with free anterolateral thigh flap delivers good functional outcomes.

http://bit.ly/2DHZsdn

Developing a patient driven head and neck cancer care pathway

http://bit.ly/2UnKizm

Meta‐analysis comparing outcomes of different transoral surgical modalities in management of oropharyngeal carcinoma

Abstract

Background

Optimal transoral surgical modality for oropharyneal carcinoma is currently unclear. Transoral laser surgery (TLS), transoral robotic surgery (TORS), and conventional direct transoral (DT) oropharyngectomy are the main current transoral surgical modalities for oropharyngeal carcinoma.

Methods

MEDLINE was systematically searched through PubMed. Reference lists were reviewed. Random‐effects models were used to combine studies within each group. Tests for heterogeneity were used to explore difference in effect size between groups in subgroup analysis.

Results

Nine studies (404 patients) in TORS arm, five studies (498 patients) in TLS arm, and three studies (335 patients) in DT arm were included. Early T classification (T1‐T2) for TORS and DT were higher compared to TLS group (P < .001). There was no significant difference between groups in the rate of invaded margin, post‐operative oropharyngeal bleeding, temporary tracheotomy, and gastrostomy dependence.

Conclusion

The available data do not yet provide clear evidence of superiority of any one modality.

http://bit.ly/2DFWeXN

The prognostic value of tumor depth for cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas

Abstract

Background

To analyze the prognostic value of the clinicopathological parameters of primary lesions for predicting cervical lymph node metastasis in patients with hypopharyngeal and/or supraglottic carcinoma.

Methods

We enrolled 127 patients with squamous cell carcinomas originating in the hypopharyngeal and/or supraglottic regions.

Results

Multivariate analysis identified the tumor depth as an independent predictive factor for lymph node metastasis (odds ratio, 4.959; 95% confidence interval, 2.290‐10.739; P < 0.0001) with a predictive value of 0.966. A cutoff value of 4.5 mm was determined.

Conclusion

The tumor depth of the primary lesion is a potent predictor of cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas. In cases with clinically negative nodal status, elective neck dissection should be adopted for patients with a tumor depth reaching 4.5 mm. Regular outpatient follow‐up is recommended for patients with a tumor depth less than 1.0 mm. Close follow‐up or preventative therapy should be considered between 1.0 and 4.5 mm.

http://bit.ly/2UqYN5y

Depth of invasion in patients with early stage oral cancer staged by sentinel node biopsy

Abstract

Background

To investigate if depth of invasion (DOI) can predict occult nodal disease in patients with cT1‐2N0 (7th TNM) oral squamous cell carcinoma (OSCC) staged by sentinel lymph node biopsy (SLNB).

Methods

In 199 OSCC patients, DOI measurements and SLNB were performed.

Results

Metastases were found in 64 of 199 patients (32%). Of these 64 patients, the mean DOI was 6.6 mm compared to 4.7 mm in patients without metastases (P = .003). The ROC‐curve showed an area under the curve of 0.65 with a most optimal cutoff point of 3.4 mm DOI (sensitivity 83% and specificity 47%). Regional metastases were found in 15% of patients with DOI ≤ 3.4 mm.

Conclusion

DOI seems to be a poor predictor for regional metastasis in patients with cT1‐2N0 OSCC. Therefore, staging of the neck using SLNB in patients with early stage oral cancer should also be performed in tumors with limited DOI and probably in T3 (8th TNM) OSCC ≤4 cm diameter.

http://bit.ly/2DGSKnM

Quantitative evaluation of endolymphatic hydrops with MRI through intravenous gadolinium administration and VEMP in unilateral definite Meniere’s disease

Abstract

Purpose

To help clinicians to further understand the significance of vestibular-evoked myogenic potential (VEMP) examinations to diagnose MD and the quantitative relationship between VEMP and MRI in assessing the location and degree of endolymphatic hydrops (EH) in definite Meniere's disease (MD) patients.

Methods

Fifty-six patients with unilateral definite MD participated in this study, which used MRIs through intravenous gadolinium administration (IV-Gd), audiometry, caloric tests and VEMP tests. The VEMP results of 26 healthy volunteers were used as a normal reference value.

Results

The participants were found through MRI to have differing degrees of vestibular and cochlear EH. Quantitative comparison of MRI and VEMP results found that the response rates of oVEMP decreased with cochlear EH increasing; the asymmetry ratio (AR) of oVEMP can be used to find whether cochlear EH or not, and the P1–N1 amplitude was lower in the extreme cochlear EH group (P < 0.01). The AR of cVEMP was larger in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.01). The correlation between the degree of cochlear EH and the mean PTA threshold was statistically significant (P < 0.05). The duration of MD correlated positively with vestibular EH (P < 0.05). The abnormal rate of caloric tests was higher in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.05).

Conclusions

The advantages of MRIs by IV-Gd administration were obvious in assessing the location and degree of EH. oVEMP and PTA can be indirectly used to evaluate the extent of cochlear EH, cVEMP and caloric tests can be used to assess the extent of vestibular EH on the condition of absent MRIs.

http://bit.ly/2BbvLPY

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

http://bit.ly/2FZ9zNl

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