Clinical relevance of human papillomavirus outside of oropharynx

Purpose of review The role of HPV in oropharyngeal cancer is well recognized. HPV DNA is also found in a fraction of head and neck tumors outside of oropharynx but its clinical importance is unknown. The purpose of this review is to sum up the present knowledge about the prevalence and possible impact of HPV presence in head and neck tumors in nonoropharyngeal sites. Recent findings The data demonstrating prevalence of HPV presence in tumors outside of oropharynx are inconsistent. However, it can be stated that it is substantially lower than in oropharynx. Most articles report the HPV DNA presence only but very few prove also the transcriptionally active viral presence. The fraction of really HPV-induced tumors is probably very small. The majority of literature shows no impact of HPV on prognosis in nonoropharyngeal locations. Also the role of high-risk HPV in malignant transformation of lesions potentially linked to malignancy like inverted papillomas, recurrent respiratory papillomatosis or laryngeal dysplasia was up to date not demonstrated. Summary Despite of the unknown role of HPV and lack of evidence regarding any clinical use of HPV knowledge in other than oropharyngeal tumors, further research is warranted. Correspondence to Jan Klozar, MD, Department of Otolaryngology Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol Prague, V Úvalu 84, 150 06 Praha 5, Czech Republic. Tel: +420 727971911; e-mail: jan.klozar@fnmotol.cz Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RHfbwP

Photodynamic therapy in head and neck cancer: indications, outcomes, and future prospects

Purpose of review To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer. Recent findings Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy. Summary The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications. Correspondence to Vincent Vander Poorten, MD, PhD, MSc, Department of Otorhinolaryngology–Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32/16336340; e-mail: vincent.vanderpoorten@uzleuven.be Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2WJ9baQ

Medial femoral condyle free flap for head and neck reconstruction

Purpose of review The aim of this article is to review the literature on medial femoral condyle (MFC) free flap in head and neck reconstruction. Recent findings The MFC flap is a superb material for head and neck reconstruction, especially in smaller bony defects. As an alternative to fibular free flap, it presents many advantages. Combining the periosteal bone with skin and/or muscle paddle, the MFC flap is suitable for complex reconstructions with favorable healing process. Even though this flap has a longer history of orthopedic and traumatologic reconstructions, a number of cases in head and neck surgery have been recently reported. Summary The MFC flap has been successfully used to reconstruct various head and neck sites, from the orbit, maxilla, and mandible, to the laryngeal and tracheal scaffolds. Correspondence to Jacek Banaszewski, Department of Otolaryngology Head and Neck Surgery, Poznan University of Medical Sciences. Przybyszewskiego 49, 60355 Poznan, Poland. Tel: +48 61 8691387; e-mail: bananana@poczta.onet.pl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RIpcKa

Quality of life after microvascular mandibular reconstruction for osteoradionecrosis—A prospective study

Abstract

Background

Reconstructive surgery for mandibular osteoradionecrosis is increasing; however, evidence regarding the impact on health‐related quality of life is lacking. The current exploratory study prospectively investigates whether resection with reconstruction is associated with changes in HRQoL parameters for these patients.

Methods

Seventeen patients underwent microvascular reconstruction for mandibular osteoradionecrosis between 2012 and 2015, and 16 completed the EORTC quality of life questionnaires QLQ‐C30 and QLQ‐H&N35 1 month before and 1 year after surgery.

Results

Increases in emotional (P = 0.01) and social functioning (P = 0.004) were observed, together with improvements in the fatigue (P = 0.04), appetite loss (P = 0.02) and pain (P = 0.02) scores, as evaluated by the QLQ‐C30. Pain reduction was further confirmed by the QLQ‐H&N35 (P = 0.04), which also showed improved scores for feeling ill (P = 0.001) and sexual difficulties (P = 0.04).

Conclusion

This exploratory study suggests that microvascular reconstruction after mandibular osteoradionecrosis may improve HRQoL, with an emphasis on pain reduction; however, further studies are needed.

http://bit.ly/2Gr5wJ4

Evaluating the Predicted Impact of Changes to the AJCC/TMN Staging System for Differentiated Thyroid Cancer (DTC): A prospective observational study of patients in South East Scotland

Abstract

Objectives To assess the impact of the eighth edition AJCC/TMN staging system on patients with new diagnoses of differentiated thyroid cancers presenting to our regional multi‐disciplinary team meetings. Design We analysed Endocrine Cancer MDT meeting records from 2009‐2015 to identify all patients in the region presenting with a new diagnosis of differentiated thyroid cancer. We re‐staged patients according to the eighth edition AJCC/TNM staging classification and analysed the survival outcomes of patients in each stage under the seventh and eighth systems. Setting Tertiary referral centre in South East Scotland (NHS Lothian). Participants Three hundred and sixty one patients were newly diagnosed with DTC within South East Scotland during the study period and met our inclusion criteria. Main outcome measures Mortality at any time during follow‐up Results In total 119/361 (33%) patients were re‐staged when the eighth edition AJCC/TMN system was applied. The number of patients classified as having advanced stage (III/IV) disease fell from 76 (21%) to 8 (2%). The most common reason for down‐staging was re‐classification of tumour size, a factor in 96 (80.7%) down‐staged patients. The five‐year disease specific survival of the cohort overall was 98%. Overall 7 (1.9%) thyroid cancer –related deaths occurred during follow‐up, three of whom were down‐staged. Conclusions On implementation of the eighth edition of the AJCC/TMN staging system, we expect many patients who would previously have been considered to have advanced thyroid cancer will now be classified as early stage. This will accurately reflect their excellent survival outcomes.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MPiW2w

Cost‐effectiveness of trans‐nasal endoscopic sphenopalatine artery ligation vs. arterial embolisation for intractable epistaxis: long‐term analyses

Summary

Objectives

Trans‐nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost‐saving strategy. Our main aim was to perform cost‐effectiveness analyses on TESPAL compared to embolisation to treat patients with epistaxis.

Design

We performed a retrospective, monocentric, comparative analyses on patients referred to our center and treated with embolisation or TESPAL.

Setting

This economic evaluation was carried out from a payer's perspective (i.e., French National Health Insurance) within a time horizon of 12 months.

Participants

Thirty‐seven TESPAL procedures and thirty‐nine embolisation procedures to treat intractable epistaxis were used in the analyses.

Main outcome measures

The primary outcome is presented as the cost per 1% of non‐recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1‐year follow‐up. Cost estimates were performed from the payer's perspective.

Results

Hospitalisation costs were higher for embolisation compared to TESPAL (5,972 vs. 3,769 euros). On average, hospitalization costs decreased by 41% when a patient was treated by TESPAL compared to an embolisation strategy (p= 0.06). The presence of comorbidities increased hospitalization costs by 79% (p=0.04). TESPAL enabled 1,867€ to be gained in intractable epistaxis.

Conclusions

The outcomes from our decision model confirm that TESPAL is more cost‐effective for patients with intractable epistaxis.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DUWLFu

Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

Objectives/Hypothesis

To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea‐hypopnea syndrome (OSAHS) in awake patients.

Study Design

Prospective study.

Methods

Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal‐epiglottic aerospace (RPEA), modified Cormack‐Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS.

Results

The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack‐Lehane scoring (κ = 0.38). The presence of a mega‐epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega‐epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23‐18.56, P = .024), modified Cormack‐Lehane score of 2 (aOR: 15.3, 95% CI: 1.8‐130.3, P = .012), or modified Cormack‐Lehane score of 3 (aOR: 10.03, 95% CI: 1.3‐78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01‐1.14, P = .025).

Conclusions

Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega‐epiglottis, and modified Cormack‐Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients.

Level of Evidence

2 Laryngoscope, 2019

http://bit.ly/2RIvlGc

Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps

Objectives/Hypothesis

Establish treatment patterns and economic burden in US patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) versus without chronic rhinosinusitis (CRS). Determine comparative costs of subgroups with high clinical burden.

Study Design

Observational, retrospective, case‐control study.

Methods

This study matched patients with CRSwNP to patients without CRS (1:1) using the Truven Health MarketScan US claims database. Categorical and continuous variables were compared using McNemar test and paired t test (normal distribution) or Wilcoxon signed rank tests (non‐normal distribution). Within subgroups, χ² and Wilcoxon or t tests were used (normal distribution).

Results

There were 10,841 patients with CRSwNP and 10,841 patients without CRS included. Mean age in the CRSwNP cohort was 45.8 years; 56.2% were male. During follow‐up, patients with CRSwNP had an increased diagnosis of asthma versus patients without CRS (20.8% vs. 8.1%, respectively; P < .001). Annual incremental costs were $11,507 higher for patients with CRSwNP versus those without CRS. Costs were higher in subgroups of patients with CRSwNP undergoing functional endoscopy sinus surgery (FESS), with a comorbid diagnosis of asthma, receiving oral corticosteroids, or macrolides versus the overall CRSwNP group. Patients with CRSwNP undergoing FESS had the highest costs of the four subgroups ($26,724, $22,456, $20,695, and $20,990, respectively).

Conclusions

Annual incremental costs were higher among patients with CRSwNP versus without CRS. Patients with CRSwNP with high clinical burden had higher overall costs than CRSwNP patients without.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2WK59Pb

Cost and efficiency of myringotomy procedures in minor procedure rooms compared to operating rooms

Objectives

Minor pediatric surgeries performed in the minor procedure room (MPR) may be more time efficient and less costly compared to those performed in the operating room (OR).

Study Design

Retrospective review.

Methods

This was a retrospective study on cost and efficiency differences of bilateral myringotomy with tube insertions performed in the MPR versus the OR. Charts were reviewed from June 2015 to May 2017. Cost data was based on supply cost and case costing of medical personnel including nurses, aides, and anesthesia assistants.

Results

Two hundred eighteen patients were included in the study. The median age was 2.7 years (range: 0.8–16.7), and there were no differences in gender between locations. One hundred twenty‐three patients had surgery in the MPR (56.4%), and 95 had surgery in the OR (43.6%). The median length of time in the procedure room was 11 minutes shorter for patients who underwent surgery in the MPR (12.0 minutes, range: 3.0–33.0) compared to patients in the OR (23.0 minutes, range: 11.0–52.0; P < .0001). Median hospital stay (2.0 hours vs. 4.3 hours; P < 0.0001) and median patient turnover time (6.0 minutes vs. 14.0 minutes; P < .0001) was shorter in the MPR compared to OR. The total overall cost of a myringotomy with tube insertion, including labor and supply cost, was $189.41 in the MPR compared to $468.56 in the OR, a difference of $279.15 per case.

Conclusion

Bilateral myringotomy with tube insertions are more time and cost‐efficient when performed in the MPR. This study supports the need for increased availability of MPR time for appropriate surgeries.

Level of Evidence

3. Laryngoscope, 2019

http://bit.ly/2RGn3yw

Building a Renewed ImaGe After Head & Neck Cancer Treatment (BRIGHT) 2.0

Condition:   Head and Neck Cancer
Interventions:   Behavioral: BRIGHT;   Behavioral: Active Control
Sponsor:   Medical University of South Carolina
Not yet recruiting

http://bit.ly/2SxFpX2

Diagnostic Significance of FDG PET/CT Dynamic Imaging in Detecting Metastatic Lymph Nodes With Papillary Thyroid Cancer.

Conditions:   Positron-Emission Tomography;   Lymph Node Metastases;   Thyroid Cancer
Interventions:   Diagnostic Test: ^{18F-FDG PET/CT dynamic scan;   Diagnostic Test: B-ultrasonography
Sponsor:   Fifth Affiliated Hospital, Sun Yat-Sen University
Recruiting}

http://bit.ly/2Gr9wJl

Paclitaxel (Albumin Bound),Bleomycin And Cisplatin Or Carboplatin for Recurrent Or Metastatic Squamous Cell Carcinoma Of The Head And Neck

Condition:   Squamous Cell Carcinoma Of The Head And Neck
Intervention:   Drug: PaclitaxelPaclitaxel (Albumin Bound),Bleomycin combined with Cisplatin or Carboplatin
Sponsor:   Sun Yat-sen University
Not yet recruiting

http://bit.ly/2SuYMQH

Weekly Plasma EBV DNA for Non-metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Intervention:  
Sponsor:   The University of Hong Kong
Recruiting

http://bit.ly/2Gr9fGj

A Study to Assess the Safety, Tolerability and Pharmacokinetics of AZD9977 in Japanese Healthy Participants With Single and Multiple Ascending Dose Administration

Condition:   Heart Failure
Interventions:   Drug: AZD9977;   Drug: Placebo
Sponsors:   AstraZeneca;   Parexel
Recruiting

http://bit.ly/2Sza1HE

Statin use associated with improved overall and cancer specific survival in patients with head and neck cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Abhinav Gupta, William Stokes, Megan Eguchi, Mohammad Hararah, Arya Amini, Adam Mueller, Rustain Morgan, Cathy Bradley, David Raben, Jessica McDermott, Sana D Karam

Abstract

Objectives

Studies have shown the utility of lipid-lowering agents in improving outcomes in various cancers. We aim to explore how statins affect overall survival and cancer specific survival in head and neck cancer patients using population-based datasets.

Patients and methods

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset, we separated HNC patients into three groups: those with no hyperlipidemia (nH), those with hyperlipidemia and not taking a statin (HnS), and those with hyperlipidemia and taking a statin (H + S). Overall survival (OS) and cancer specific survival (CSS) were compared between the three groups based on disease subsite (oral cavity, oropharynx, and other) using Kaplan-Meier and multivariate Cox regression analysis (MVA), controlling for demographic, socioeconomic, staging, treatment, and comorbidity covariates. Using Pearson chi-square analysis, we also compared the incidence of cancer-related toxicity events.

Results

There were 495 nH, 567 HnS, and 530 H + S patients. H + S patients had superior OS and CSS (73.0, 81.2%) relative to nH (58.6, 69.1%) and HnS groups (61.7, 69.2%) (p < 0.01). On MVA, H + S patients showed improved OS (p < 0.01) and CSS (p = 0.04) compared to nH (HR = 1.64, 1.56) and HnS (HR = 1.40, 1.37). MVA stratified by subsite yielded similar results for oral cavity and oropharyngeal disease. Toxicity-related events did not differ significantly between the groups.

Conclusion

HNC patients with hyperlipidemia and taking a statin demonstrated improved outcomes compared to nH and HnS patients, further supporting statins' role as a potential adjuvant anti-neoplastic agent in HNC. Further prospective studies to investigate the impact of statins on HNC outcomes are warranted.

http://bit.ly/2G9DHW9

Editorial Board/Aims & Scope

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s):

http://bit.ly/2DavPzI

Acknowledgements to referees 2018

http://bit.ly/2SoTXbC

Neonatal Vocal Fold Motion Impairment After Complex Aortic Arch Reconstruction: What Should Parents Expect After Diagnosis?

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jennifer Rodney, Jess Thompson, Michael Anderson, Harold Burkhart

Abstract

Objectives

To study the incidence, sequelae, follow up, and recovery rate of vocal fold motion impairment (VFMI) after complex aortic arch reconstruction in neonates.

Study design

Retrospective case control study.

Methods

We retrospectively evaluated 105 neonates who underwent complex aortic arch reconstruction from 2014-2016. We compared patients that did have VFMI compared to a control group of patients with normal vocal fold movement. Descriptive statistics were computed for all demographic and clinical variables by treatment group.

Results

36% of patients were evaluated for VFMI (n=38) by an otolaryngologist. The incidence of VFMI was 22% (n= 23). Females were more likely to have VFMI (p= 0.02). Aspiration was more common in patients with VFMI (p=0.006). The difference in age, weight, incidence of pneumonia, nasogastric tube, gastrostomy, total length of stay, genetic anomaly, and reintubation was not significant between the VFMI group and control group (p> 0.05). Tracheostomy was not performed in any patients with unilateral paralysis. Only 61% of patients followed up in clinic (n=14). 64% of patients showed improvement or resolution (n=9). Average time to improvement was 4.8 months. Average time to complete resolution was 10.5 months.

Conclusions

VFMI after complex aortic arch reconstruction is relatively common. Despite increased aspiration in patients with VFMI, pneumonia did not occur at all in either group. Tracheostomy was not necessary in any patients with a unilateral paralysis. Most patients showed an improvement in the VFMI within 5 months of surgery. Our data support the need for otolaryngology follow-up.

http://bit.ly/2G9Am9v

The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: a randomized clinical trial

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hadiseh Ghomi, Fariba Yadegari, Farin Soleimani, Brenda Lessen Knoll, Mahdi Noroozi, Ali Mazouri

Abstract

Objective

Given the increase in the birth and survival rate of the premature infants, a need for supportive health care services becomes more evident. The goal of the present study was to examine the effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) in the feeding progression and early intervention. This study was a double-blind randomized clinical trial.

Methods

This clinical trial included premature infants in the neonatal intensive care units (NICUs) of two hospitals in Tehran, who were randomly assigned into intervention and control group, each containing 15 infants. The PIOMI was administered to the intervention group in the course of 10 days. The infants in the control group received routine nursing services. Repeated measures ANOVA (RMA) were analyzed. The postmenstrual age and weight of the participants were examined at the time points of accomplishing one, four, and eight oral feedings a day and at the time of hospital discharge.

Results

The intervention group reached the first oral feeding (with a mean of 7.2 days) and eight oral feeding (with a mean of 13.47 days) earlier than the control group. The length of hospital stay in intervention group was significantly shorter (P=0.03). RMA wasn't statistically significant between groups for weight (F: 0.76, P: 0.39, ŋ: 0.03); but within-subjects test showed that change of the weight over time and for interaction of time and group was significant (F: 74.437, P <0.001, ŋ: 0.727). The effect size of infants' age in the measurement times was 91%.

Conclusion

the results revealed that PIOMI is a fruitful method for premature infants. We suggest that PIOMI can be integrated in feeding rehabilitation programs of the premature infants born with gestational age of as young as 26-29 weeks, and applied at 29 weeks postmenstrual age (PMA).

The clinical trial registration number

IRCT20180410039260N1.

http://bit.ly/2DdkUFq

Regulatory T Lymphocytes are Associated with Increased Nasopharyngeal Colonization in Children

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jessica Jane Browne, Evan Howard Matthews, Andrew William Taylor-Robinson, Jennelle Maree Kyd

Abstract

Objectives

Regulatory T lymphocytes (T_reg) have been linked to survival of commensal bacteria at mucosal sites, but their presence and role in chronic otitis media (COM) and their response to otopathogens has not been evaluated previously. We investigated the association between T_reg lymphocytes and otopathogens in COM prone and non-COM prone children.

Methods

Forty children, 2 to 7 years of age, scheduled for adenoidectomy were enrolled into COM (n = 20) or non-COM (n = 20) groups. Adenoid biopsy and nasopharyngeal aspirate bacteriology were assessed by conventional culture techniques. Peripheral blood and adenoid lymphocytes were stained with viability stain, monoclonal anti-CD19, anti-CD3, anti-CD4, anti-CD8, anti-CD25 and anti-CD127. Cells were stained intracellularly with monoclonal anti-FoxP3 and then quantified by flow cytometry.

Results

Children with nasopharyngeal otopathogen-positive culture had significantly more circulating CD3⁺CD4⁺FoxP3⁺CD25^hi+CD127^lo+ lymphocytes (M = 4.4%) compared to culture-negative children (M = 3.1%, p = 0.005). Circulating CD19⁺ lymphocytes were significantly increased in children with positive Moraxella catarrhalis nasopharyngeal culture (M = 12.4%) compared to culture-negative children (M = 8.6%, p = 0.006). Adenoid-derived lymphocytes were not significantly different in children with any positive nasopharyngeal culture compared to negative culture. Lymphocyte subsets were not significantly different between COM and non-COM prone children.

Conclusion

Clinically-detectable otopathogen nasopharyngeal culture is positively associated with T_reg lymphocytes, potentially inducing suppressive effector responses to promote colonization and infection chronicity. This finding supports further investigation of T_reg lymphocyte activity and influence on upper airway colonization of young children.

http://bit.ly/2GchK90

Sleep disordered breathing in children – diagnostic questionnaires, comparative analysis

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Marcin Burghard, Eliza Brożek-Mądry, Antoni Krzeski

Abstract

Study Objectives

The purpose of this work is to present available questionnaires enabling diagnostic screening when obstructive sleep disordered breathing (SDB) in a child is suspected or its effects are observed and polysomnography is unavailable. These questionnaires are designed to facilitate further diagnostic process or even therapeutic decisions, aid in selecting the optimal one for the specified conditions of clinical practice, with the caveat that none of these represents a diagnostic equivalent to PSG.

Methods

The questionnaires subjected to analysis: Pediatric Sleep Questionnaire (PSQ), Sleep Clinical Record (SCR), OSA-18 score (OSA-18), Brouilette score (BS), "I'm Sleepy" questionnaire (I'M SLEEPY), and "Sleeping Sleepless Sleepy Disturbed Rest" questionnaire (SSSDR).

The comparative analysis of questionnaires included the following parameters: simplicity and time of administer; necessity to engage a physician or other trained individual; taking into account examination of the patient; type and scope of considered symptoms and consequences of obstructive SDB, sensitivity, specificity, recommendations of the guidelines.

Results

Seven questionnaires were subjected to analysis with presentation of their similarities and differences. Six out of seven were evaluated as simple in administration. Time required to fulfill the questionnaires ranged between 1 and 60 minutes. Three of them involved a physician or a trained personnel. Physical examination was necessary in two out of seven questionnaires. Sensitivity was estimated in 5 of them and ranged between 59 and 96%. Specificity ranged between 46 and 72%.

Conclusions

Several questionnaires enabling quick, simple, and inexpensive screening for OSAS have been created. Four (of the seven analyzed) questionnaires may be useful in diagnosis of obstructive SDB in children – two follow current (2015) recommendations. However, there is a need for further work on optimizing such tools, particularly on improving their specificity.

http://bit.ly/2DdkNtu

Using Anxiolytics in a Pediatric Otolaryngology Clinic to Avoid the Operating Room

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Quinn Orb, Aida Rezaie, Sheldon Furst, Jeremy D. Meier, Albert H. Park

Abstract

Introduction

There is increasing concern regarding the risks associated with the use of general anesthesia in pediatric patients. Many otolaryngologic procedures performed under general anesthesia can also be performed in clinic. We hypothesize that anxiolytics can aid in performing common procedures in clinic thus avoiding the need to undergo general anesthesia in the OR.

Methods

We performed a retrospective review of patients undergoing inoffice procedures with anxiolytics in our pediatric otolaryngology outpatient clinic between February 2013 and January 2017. Charts were reviewed for age, past medical history, procedure type/duration, and outcome. These results were then compared to a cohort undergoing similar procedures in the OR.

Results

A total of 34 patients underwent an in-office procedure with an anxiolytic. The success rate was 97% (33/34). The average age was 6.2 years. Six children (17%) had a known history of chromosomal abnormalities and 2 children (6%) had autism. The four most common procedures performed were cerumen impaction removal (8), flexible laryngoscopy (6), ear canal foreign body removal (5), and septal cautery (4). Performing similar procedures in the OR resulted in an average additional cost of $822.

Conclusions

Performing procedures with anxiolytics in a pediatric otolaryngology clinic is safe, expeditious, and cost-effective. Anxiolytics can provide an effective alternative to general anesthesia.

http://bit.ly/2G9YGIs

Genetic susceptibility to aminoglycoside ototoxicity

Publication date: Available online 4 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tien Nguyen, Anita Jeyakumar

Abstract

Introduction

Aminoglycosides are a well-known clinically relevant antibiotic family used to treat bacterial infections in humans and animals and can produce toxic side effects. Aminoglycoside-induced hearing loss (HL) has been shown to have a genetic susceptibility. Mitochondrial DNA mutations have been implicated in inherited and acquired hearing impairment.

Objective

Literature review of genetic mutations associated with aminoglycoside-induced ototoxicity.

Methods

PubMed was accessed from 1993 to 2017 using the search terms "aminoglycoside, genetic, ototoxicity, hearing loss". Exclusion criteria consisted of a literature in a language other than English, uncompleted or ongoing studies, literature with non-hearing related diseases, literature on ototoxicity due to cisplatin/carboplatin based chemotherapy, literature on ototoxicity from loop diuretics, animal studies, literature studying oto-protective agents, and literature without documented aminoglycoside exposure.

Results

108 articles were originally identified, and 25 articles were included in our review. Mitochondrial 12S rRNA mutations were identified in all 25 studies in a total of 220 patients. Eight studies identified A1555G mutation as primary genetic factor underlying HL in cases of aminoglycoside-induced ototoxicity. The next most common mutation identified was C1494T.

Discussion

Mitochondrial 12s rRNA mutation A1555G was present in American, Chinese, Arab-Israeli, Spanish and Mongolian ethnicities. All mutations leading to aminoglycoside ototoxicity were mitochondrial mutations.

Conclusions

Consideration of preexisting genetic defects may be valuable in treatments involving aminoglycosides. In particular populations such as those of Chinese origin, clinicians should continue to consider the increased susceptibility to aminoglycosides.

http://bit.ly/2Ddl9jO

Bite force measurements for objective evaluations of orthodontic tooth movement-induced pain in rats

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Hu Long, Di Shan, Renhuan Huang, He Liu, Yang Zhou, Muyun Gao, Fan Jian, Yan Wang, Wenli Lai

Abstract

Objective

To examine the reliability of bite force for evaluating orthodontic tooth movement-induced pain in rats.

Design

Orthodontic tooth movement-induced pain was induced by mounting springs (40 g) between incisors and ipsilateral molars in male Sprague-Dawley rats. Five group sets of animals were used: for the first group set, 20 rats were randomly divided into a force group (n = 10) and a sham group (n = 10); for the second group set, 20 rats were divided into a 20-g group and a 80-g group; for the third group set, 20 rats were randomly divided into either a CFA group (complete freund's adjuvant) (n = 10) receiving periodontal injections of CFA at baseline or a control group (n = 10) receiving periodontal injections of saline at baseline; for the forth group set, 24 rats were randomly divided into the following four groups: force + saline, control + saline, force + antiNGF and control + NGF (NGF: nerve growth factor). Rats in the fifth group set were used for immunostaining against CGRP. Bite force and bite frequency were measured at baseline (day 0) and following interventions (day 1, day 3, day 5, day 7 and day 14). Two-way ANOVA with repeated measures was used for statistical analysis and a p value less than 0.05 was considered statistical significance.

Results

Our results revealed that bite force was significantly smaller in the force group than in the sham group at all time points (p < .001). As compared to the control group, periodontal injections of CFA significantly decreased bite force on the 3^rd day (p < .01). Moreover, bite force was significantly higher in the force + antiNGF group than in the force + saline group (p = .01 < .05) while significantly smaller in the control + NGF group than in the control + saline group (p < .05). Bite force was similar between the force + antiNGF group and the control + saline group (p = .71 > .05) and between the control + NGF group and the force + saline group (p = .58 > .05). Similar results were found for bite frequency.

Conclusion

Bite force, an indicator of mechanical hyperalgesia, is a viable and reliable index for evaluating orthodontic tooth movement-induced pain.

http://bit.ly/2Bl7pmS

Heterogeneous localization of muscarinic cholinoceptor M1 in the salivary ducts of adult mice

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Atsara Rawangwong, Suthankamon Khrongyut, Surang Chomphoo, Kohtaro Konno, Miwako Yamasaki, Masahiko Watanabe, Hisatake Kondo, Wiphawi Hipkaeo

Abstract

We hypothesize variation in expression and localization, along the course of the glandular tubule, of muscarinic cholinergic receptor M₁ which plays as a distinct contribution, though minor in comparison with M₃ receptor, in saliva secretion. Localization of the M₁ receptor was examined using immunohistochemistry in three major salivary glands. Although all glandular cells were more or less M₁-immunoreactive, acinar cells were weakly immunoreactive, while ductal cells exhibited substantial M₁-immunoreactivity. Many ductal cells exhibited clear polarity with higher immunoreactivity in their apical/supra-nuclear domain. However, some exhibited indistinct polarity because of additional higher immunoreactivity in their basal/infra-nuclear domain. A small group of cells with intense immunoreactivity was found, mostly located in the intercalated ducts or in portions of the striated ducts close to the intercalated ducts. In immuno-electron microscopy, the immunoreactive materials were mainly in the cytoplasm including various vesicles and vacuoles. Unexpectedly, distinct immunoreactivity on apical and basal plasma membranes was infrequent in most ductal cells. The heterogeneous localization of M₁-immunoreactivity along the gland tubular system is discussed in view of possible modulatory roles of the M₁ receptor in saliva secretion.

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The addition of chemotherapy to radiotherapy did not reduce the rate of distant metastases in low‐risk HPV‐related oropharyngeal cancer in a real‐world setting

Abstract

Background

Distant metastases (DM) are a leading cause of death for patients with oropharyngeal cancer (OPSCC). The objective of this study was to compare the rates of DM after chemoradiotherapy (CRT) and radiotherapy alone (RT) in patients with human papillomavirus (HPV)‐positive and HPV‐negative OPSCC.

Method

In a retrospective population‐based study of 525 patients across Ontario, Canada, in 1998/99/03/04, we compared treatment effectiveness using cumulative incidence function curves and cause‐specific Cox regression models.

Results

Sixty of 525 patients developed DM. There was no difference in rates (overall 10%‐15%) between HPV‐positive and HPV‐negative patients or between CRT‐ and RT‐treated patients. CRT reduced the risk of DM for the 15% of all HPV‐positive patients with higher risk (T4 and/or N3) and not for HPV‐negative patients (hazard ratio, 1.82 [0.65‐5.07]).

Conclusion

The addition of platin‐based chemotherapy to conventional RT did not decrease the rates of DM in the majority of patients with HPV‐positive or in HPV‐negative OPSSC.

http://bit.ly/2MPJalF