Deep Neck Space Infection: Study of 52 Cases

Abstract

Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.

http://bit.ly/2SHy3Ak

Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

Abstract

Background

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible.

Methods

The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software.

Results

At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased.

Conclusions

This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.

http://bit.ly/2SlSGmr

Ectoine lozenges in the treatment of acute viral pharyngitis: a prospective, active-controlled clinical study

Abstract

Purpose

Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis.

Methods

This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients' pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients.

Results

The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported "very good" general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did.

Conclusion

Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.

http://bit.ly/2Bsrgk6

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

http://bit.ly/2SJDfUi

The prevalence of hearing loss and use of hearing aids among adults in Germany: a systematic review

Abstract

Background

Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a systematic review.

Methods

A systematic literature search was carried out in electronic databases as well as by means of hand-searching. Studies published after 1975 and indicating the prevalence or incidence of hearing impairment among German adults were included. Study selection, data extraction and additional quality assessments were made by two independent reviewers.

Results

By means of a systematic literature search it was possible to identify 6 sources, which provided solely cross-sectional data, whereby the reported data are based on a study population of between some hundred and 10 million people living in Germany. The prevalences ascertained showed a broad range of between 16% and 25% and varied according to age, study setting, definition of hearing loss and method of data capture. At present there are no utilizable data on the extent of the use of hearing aids.

Discussion

The present review demonstrates clearly that evidence-based information relating to Germany can only be made on the basis of a clear definition of hearing loss within the framework of an up-to-date and representative epidemiological study carried out with appropriate methodology. In view of the high prevalence of illnesses causing hearing impairment and of the risks to health associated with untreated hearing impairment as well as of socio-economic costs, such an epidemiological study is of great social significance.

http://bit.ly/2UNmWmQ

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

http://bit.ly/2SJDfUi

Sonografie von Schilddrüsenknoten

Laryngo-Rhino-Otol 2019; 98: 79-84
DOI: 10.1055/a-0790-0849

Die Sonografie gehört zu den Standardverfahren bei der Evaluation von Schilddrüsenknoten. Verschiedene sonografische Veränderungen sind mit einem erhöhten Malignitätsrisiko assoziiert. Basierend hierauf wurden in den letzten Jahren Klassifizierungssysteme entwickelt, um leichter diejenigen Knoten zu selektieren, welche einer weiteren Abklärung bedürfen (TI-RADS: thyroid imaging and reporting systems). Bis jetzt werden in diesen Systemen nur morphologische Kriterien eingeschlossen. Resultate einer Farbdoppler-Sonografie als ergänzendem Verfahren werden in diesen Klassifizierungen nicht berücksichtigt, obwohl eine erhöhte intranoduläre Vaskularisation bei follikulären Neoplasien mit einem erhöhten Malignitätsrisiko assoziiert ist. Aktuell werden die neuen Systeme evaluiert und müssen gegebenenfalls für die klinische Praxis optimiert werden. Außerdem gibt es erste Ansätze, die Dokumentation der Ultraschallergebnisse weiter zu standardisieren, um die diagnostischen Möglichkeiten der Ultraschalluntersuchung im Sinne der Verbesserung der Patientenversorgung zu optimieren.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2019; 98: 68-69
DOI: 10.1055/a-0784-9800

© Georg Thieme Verlag KG Stuttgart · New York

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Nachruf Prof. Dr. Heinz R. Stammberger

Laryngo-Rhino-Otol 2019; 98: 76-76
DOI: 10.1055/a-0828-5454

© Georg Thieme Verlag KG Stuttgart · New York

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Kehlkopf-Karzinom: Wundbettbiopsien nach TLM-Behandlung sinnvoll

Laryngo-Rhino-Otol 2019; 98: 71-72
DOI: 10.1055/a-0785-0981

Hendriksma M et al. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control. Eur Arch Otorhinolaryngol 2018; 275: 2333–2340 Bei Patienten mit primärem Kehlkopf-Plattenepithelkarzinom (Tis-T2) beurteilten niederländische Kopf- und Hals-Chirurgen den Effekt des Resektionsrand-Status auf die lokale Kontrollrate nach Behandlung mit transoraler CO2-Laser-Mikrochirurgie (TLM). Darüber hinaus überprüften die Bedeutung zusätzlicher Wundbettbiopsien.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Assoziation von allergischer Rhinitis und Hypertonie untersucht

Laryngo-Rhino-Otol 2019; 98: 74-75
DOI: 10.1055/a-0651-4041

Sakallioglu O et al. Allergic rhinitis and arterial blood pressure: a population-based study. J Laryngol Otol 2018; 132: 418–422 Gibt es einen Zusammenhang von allergischer Rhinitis und arteriellem Blutdruck sowie Bluthochdruck? In einer bevölkerungsbasierten Untersuchung wollten türkische Ärzte diese Frage klären.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Beurteilung der Tubenfunktionsstörung mit dem ETDQ-7

Laryngo-Rhino-Otol 2019; 98: 72-74
DOI: 10.1055/a-0621-2000

Harju T et al. Eustachian Tube Dysfunction–Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement. Ann Otol Rhinol Laryngol 2017; 126: 798–803 Ärzte des Universitätskrankenhauses von Tampere, Finnland, beurteilten den Zusammenhang zwischen chronischer Nasenverstopfung durch Vergrößerung der unteren Nasenmuschel und Symptomen, die durch eine Eustachi-Tubendysfunktion bedingt sind, mit Hilfe des „Eustachian Tube Dysfunction Questionnaire" (ETDQ-7) als Instrument zur Evaluation einer Tubenfunktionsstörung.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Spiegeluntersuchung in der HNO

Laryngo-Rhino-Otol 2019; 98: 77-78
DOI: 10.1055/a-0784-9833

© Georg Thieme Verlag KG Stuttgart · New York

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Wenn gehörlose Kinder hörend werden – Auswirkungen der CI-Versorgung von gehörlosen Kindern gehörloser Eltern auf deren Familiensituation

Laryngo-Rhino-Otol 2019; 98: 85-90
DOI: 10.1055/a-0790-0934

1993 wurden erstmalig gehörlose Kinder von gehörlosen Eltern mit CI versorgt. Die Situation dieser Kinder und ihrer Eltern ist immer wieder Gegenstand von Forschungen des seit 2000 bestehenden Münchner Forschungsprogramms „Gehörlose Eltern und Kinder mit CI". Zu diesem gehört die Teilstudie „Familiensituation von gehörlosen Eltern mit CI-Kindern". Eines der Ergebnisse dieser Studie ist, dass die implantierten Kinder die Rolle von Codas übernehmen. Das zeigt sich insbesondere in der Übernahme von Dolmetschleistungen für die Eltern.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Faziale Hauttumore: Resektion und plastische Defektrekonstruktion – Teil 1

Laryngo-Rhino-Otol 2019; 98: 117-128
DOI: 10.1055/a-0784-9844

Die Häufigkeit von Tumoren der Gesichtshaut nimmt aufgrund der steigenden UV-Exposition und der zunehmenden Alterung der Bevölkerung zu. Gleichzeitig steigen die Ansprüche an die Funktion und Ästhetik der rekonstruktiven Chirurgie im Gesicht. Die In-sano-Resektion mit Sicherheitsabstand ist der entscheidende erste Schritt eines operativen Vorgehens. Die anschließende Rekonstruktion ist von patientenspezifischen und weiteren Faktoren abhängig.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Retinovaskuläre Zeichen des Susac-Syndroms

Laryngo-Rhino-Otol 2019; 98: 108-113
DOI: 10.1055/a-0747-6968

Hintergrund Das Susac-Syndrom ist eine Vaskulopathie mit Manifestationen am zentralen Nervensystem, an der Retina und am Innenohr und ist gekennzeichnet durch die klinische Trias aus Enzephalopathie und/oder fokalen neurologischen Symptomen, Hörminderung und retinalen Arterienastverschlüssen. Bisher wurden nur etwa 300 Fälle in der medizinischen Literatur beschrieben. Patienten/Methoden Drei Patienten mit gesichertem Susac-Syndrom wurden retrospektiv auf das Vorhandensein krankheitstypischer retinaler Veränderungen untersucht. Ergänzend wurde der Krankheitsverlauf analysiert mit der Zielsetzung, ein besseres Krankheitsverständnis zu erreichen. Ergebnisse In allen 3 beschriebenen Fällen besteht eine okklusive retinale Mikroangiopathie mit einhergehenden Arterienastverschlüssen. In der cMRT zeigen sich bei 2 von 3 Fällen krankheitstypische, umschriebene „snowball"-artige Läsionen des Corpus callosum, die gemeinsam mit dem Netzhautbefund die diagnostische Zuordnung ermöglichten. Die klassische Trias aus Innenohrschwerhörigkeit, retinalen Arterienastverschlüssen und ZNS-Symptomatik war allerdings in keinem der Fälle bei ärztlichem Erstkontakt vollständig ausgeprägt. Schlussfolgerung Die Diagnosesicherung setzt eine enge interdisziplinäre Zusammenarbeit zwischen Neurologen, Psychiatern, HNO- und Augenärzten voraus. Die typischen okulären Zeichen einer segmentalen Mikrovaskulopathie mit Okklusion kleiner Arterien sollten auch bei isoliertem Auftreten Anlass dazu geben, das Krankheitsbild in die Differenzialdiagnose einer okklusiven retinalen Vaskulopathie mit einzubeziehen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Mindestmengen: Die Qual der Zahl oder Mittel der Qualitätssicherung?

Laryngo-Rhino-Otol 2019; 98: 114-116
DOI: 10.1055/a-0784-9855

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2019; 98: 129-130
DOI: 10.1055/a-0784-9866

© Georg Thieme Verlag KG Stuttgart · New York

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Erratum: Stellenwert der Sialendoskopie an deutschen HNO-Kliniken im Jahr 2016

Laryngo-Rhino-Otol 2019; 98: E1-E1
DOI: 10.1055/a-0849-2046

© Georg Thieme Verlag KG Stuttgart · New York

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Fehlbildungschirurgie von Nase und Lippe

Laryngo-Rhino-Otol 2019; 98: 131-133
DOI: 10.1055/a-0784-9910

© Georg Thieme Verlag KG Stuttgart · New York

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Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy.

http://bit.ly/2E0Eq9X

The Rationale for Endoscopic Inferior Meatal Antrostomy

Background: Complete removal of some maxillary sinus pathologies may be challenging. We describe our experience in performing endoscopic inferior meatal antrostomy (EIMA) when approaching certain chronic maxillary sinus disease. Methods: Retrospectively reviewing charts of all patients whose surgery included EIMA between the years 2012 and 2015. EIMA was performed either after routine endoscopic middle meatal antrostomy (EMMA) failed to completely resect the lesion, or as the sole selected approach for specific maxillary pathologies. Results: A total of 56 patients were included in the study. Indications for EIMA included antrochoanal polyps (ACP), maxillary sinus chronic inflammatory disease, maxillary sinus pathology before sinus lift, and odontogenic maxillary sinusitis. In nearly one third of the patients, sinus surgery included only EIMA, of which, the majority were resection of ACP. Follow-up time ranged between 12 and 34 months (mean 14). Residual EIMA opening was variable in size. In the vast majority of our patients, the maxillary sinus cavities were cleared of disease. No major complications and no recirculation were observed in any of the patients. Conclusion: EIMA should be considered for various maxillary sinus pathologies. It provides better access to anteroinferior lesions of the maxillary sinus. EMMA is not mandatory for every maxillary sinus disease.
ORL 2019;81:41–47

http://bit.ly/2BqjSGf

Oral cancer of Sigmund Freud

http://bit.ly/2Sh3KkK

Real-time PCR HPV genotyping in fine needle aspirations of metastatic head and neck squamous cell carcinoma: Exposing the limitations of conventional p16 immunostaining

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): F. El-Salem, M. Mansour, M. Gitman, B.A. Miles, M.R. Posner, R.L. Bakst, E.M. Genden, W.H. Westra

Abstract

Background

Given the propensity for HPV-positive head and neck squamous cell carcinoma (HPV-HNSCC) to metastasize to cervical lymph nodes, fine needle aspiration (FNA) plays an important diagnostic role in their initial detection. Indeed, there is now an unwavering commitment to HPV testing of FNAs even in the absence of clear methodologic guidelines and threshold criteria. A particular difficulty pertains to the interpretation of p16 staining.

Design

Data was collected for 210 patients with suspected regionally metastatic HNSCC that had undergone FNA as part of standard clinical care. Initial HPV screening was performed on cell blocks with real-time PCR using primers targeting L1 of high-risk HPV types. Additional genotyping was performed on HPV-positive cases. The results were compared to p16 staining and subsequent excisions when available.

Results

Of the 207 samples with sufficient DNA, 175 (85%) were HPV positive. HPV-16 was the most commonly detected genotype (90%). Of the HPV-positive cases, the primary site was the oropharynx (n = 154, 88.0%), supraglottic larynx (n = 2, 1.1%), nasal cavity (n = 1, 0.6%), hypopharynx (n = 1, 0.6%) or unknown (n = 17, 9.7%). On comparison with 31 paired surgical excisions, HPV status was concordant in all cases (100% correlation). Of 142 HPV-positive cases with matching p16 stains, p16 staining was reported as positive (n = 85, 60%), focal (n = 27, 19%), negative (n = 24, 17%) or non-contributory (n = 6, 4%); and only 33% reached the standard threshold limit (i.e. 70%) for HPV positivity.

Conclusion

For patients with metastatic HNSCC, real-time PCR of FNAs reliably reflects HPV status, and is superior to conventional p16 immunostaining.

http://bit.ly/2BoK4RC

Oesophagectomy and Chest Wall and Respiratory Function

Conditions:   Esophageal Cancer;   Esophagectomy;   Respiratory Function Loss
Interventions:   Other: 3D motion capture system;   Other: Incentive spirometry;   Other: Questionnaires
Sponsor:   Imperial College London
Not yet recruiting

http://bit.ly/2MWSXpV

The Bacterial Composition of the Stomach in Reflux Disease

Conditions:   GORD;   Oesophageal Cancer;   Oesophageal Reflux;   Gastric Cancer;   Gastro Esophageal Reflux;   Oesophageal Carcinoma;   Barrett Esophagus;   Esophagitis
Intervention:   Diagnostic Test: No intervention but patients are undergoing an upper GI endoscopy and biopsies for clinical purposes
Sponsor:   Imperial College London
Recruiting

http://bit.ly/2SCb5KR

Endocytosis of CF in marginal cells of stria vascularis regulated by ROCK and MLCK signaling cascade, but not G-proteins

Publication date: Available online 8 February 2019

Source: Auris Nasus Larynx

Author(s): Akinobu Kakigi, Teruhiko Okada, Taizo Takeda, Natsumi Uehara, Ken-ichi Nibu

Abstract

Objective The endocytosis of cationized feritin (CF) via a clathrin-mediated pathway is regulated by a signaling network. Marginal cells showed the active endocytosis of CF via a clathrin-mediated pathway. The internalization of receptors through this clathrin-mediated pathway is an important regulatory event in signal transduction. Numerous kinases are involved in endocytosis, and each endocytic route is subjected to high-order regulation by cellular signaling mechanisms. In this study, we investigated whether ROCK and MLCK signaling cascades and G-proteins regulate the endocytosis of CF in marginal cells of the stria vascularis.

Methods CF was infused into the cochlear duct with pertussis toxin (PTX),Clostridium botulinum C3 toxin (BTX), guanosine(g-thio)-triphosphate (GTP-γS), ML-7, Y-27632. Endocytic activity was measured at 30 min after the start of infusion under an electron microscope.

Results In marginal cells, CF was internalized via a clathrin-mediated pathway that depends on F-actin and microtubules (MT). Its processes were controlled by myosin light chain kinase (MLCK) and Rho-associated kinase (ROCK), but not affected by G-protein-coupled receptor (GPCR) or the RhoA signaling cascade.

Conclusion Our previous study showed that the main endocytotic pathway of microperoxidase (MPO) did not depend on the Rho/ROCK molecular switch or actin/myosin motor system, but was mainly regulated by the RhoA signaling cascade. The present study results indicate that these signaling cascades regulating CF internalization completely differ from the cascades for MPO internalization.

http://bit.ly/2GfRiva

Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

Publication date: Available online 8 February 2019

Source: Auris Nasus Larynx

Author(s): Seiichiro Makihara, Shin Kariya, Mai Noujima-Harada, Nobuya Ohara, Tomoyuki Naito, Junya Matsumoto, Yohei Noda, Mitsuhiro Okano, Tadashi Yoshino, Kazunori Nishizaki

Abstract

As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy. After withdrawal of MTX, the multiple bilateral pulmonary nodules and bilateral cervical lymphadenopathy disappeared without chemotherapy in both cases. From these results, patients with pulmonary nodules and cervical lymphadenopathy should be examined for head and neck malignant tumors. Also, physicians should carefully check the administration of MTX. In patients with an MTX-associated LPD, we need to make an early diagnosis and consider discontinuing the administration of MTX as soon as possible.

http://bit.ly/2HYRC39

Retrieval of inhaled foreign bodies in laryngectomised patients: Novel technique using a flexible nasendoscope under local anaesthetic

Abstract

Laryngectomised patients are at inherent risk of inhalation of foreign bodies, which can be an emergency airway situation.

A retrofitted flexible nasendoscope can be a safe, effective and a more familiar instrument for otolaryngologists, especially when the procedure needs to be undertaken out of hours.

Conducting the procedure with nebulised local anaesthetic and sedation is favourable in patients with high burden of comorbid disease and makes the procedure well tolerated.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DYYMjU

Proposal of a New Clinical Method for removal of Button Batteries and other Ferrous Material from the External Auditory Ear Canal and Nasal Cavity using a Fine Magnet Probe

Abstract

Battery foreign bodies in the external auditory canal or nasal cavity are an ENT emergency, and require immediate removal.

The purposely‐designed fine magnet probe as described in this paper, allows safe and prompt removal of a ferrous foreign body from the ear canal with minimal trauma.

Widespread use of a fine magnet probe is proposed in ENT clinics and in the acute situation, for removal of ferrous foreign bodies. This method is quick, safe, well tolerated and cost efficient.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GvV5Uv

The clinical value of 4‐hour delayed‐enhanced 3D‐FLAIR MR images in sudden hearing loss

Abstract

Objective

The aim of this study was to investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla (3T) 3D‐fluid attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL).

Study Design

Case series with comparisons.

Setting

Tertiary referral centre.

Participants

Eighty‐seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment.

Intervention

Pre‐contrast, 10‐minute and 4‐hour delayed‐enhanced 3D‐FLAIR MR images were obtained using double‐dose IV gadolinium.

Main outcome measures

The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion‐side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analyzed, and the relationships between hearing recovery and MR image findings were assessed.

Results

Lesion‐side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8(9.2%) patients, based on 4‐hour delayed, 10‐minute delayed, and pre‐contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion‐side laterality on 4‐hour delayed images (p < .001). In a multivariate analysis, lesion‐side laterality on 4‐hour delayed images was associated with poor prognosis (OR=5.6) after adjusting other prognostic factors including initial hearing level, lesion‐side laterality on 10‐min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (p=.001).

Conclusions

Contrast enhancement of inner ear structures can be seen on 4‐hour delayed‐enhanced 3T 3D‐FLAIR MR images in idiopathic sudden sensorineural hearing loss. Asymmetric lesion‐side enhancement of the inner ear may be associated with a poor prognosis.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DYs0zt

Our Experience With Home Self‐Assessment of Speech Recognition in the Care Pathway of 10 Newly‐Implanted Adult Cochlear Implant Users

Abstract

The number of CI users has grown rapidly, resulting in an increased workload for CI centres and a need for new and innovative ways to provide healthcare to users of a CI.

A telehealth application was developed with a functionality to self‐administer speech recognition tests at home, which was evaluated in 10 newly‐implanted patients.

Speech recognition in quiet and in noise improved steadily during the first few weeks of rehabilitation, after which it stabilized.

The home tests provided a good alternative to testing in the clinic for newly‐implanted patients who were able and willing to perform part of their CI care from home, and felt confident in using the technology required.

Frequently administered speech recognition self‐tests provide fine‐grained progress details which enable clinicians to monitor their CI user's speech recognition ability over time without the need for users of a CI to visit the clinic.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GAWmtc

Soft palate bi‐pedicle flaps: a modification of VY repair of cleft soft palate

Abstract

Palatal fistula and velopharyngeal insufficiency are the commonest complications of cleft palate surgery.

For patients with cleft soft palate, beside hard palate VY push back flaps, two soft palate bi‐pedicle flaps were made on each sides of the posterior palate to dissect and push soft palate back and medial closing the VP valve.

In operated 26 children, sutures were tensionless and palatal integrity could be achieved in all patients without reported postoperative bleeding, fistula, infection, suture release, or granulation.

Postoperative nasoendoscopy registered grade 4 VP closure in all with restoration of normal speech (0 grade of nasality) at 6 months postoperatively.

The newly designed bi‐pedicle soft palate flaps with the VY repair of the cleft palate helps to avoid palatal fistula, elongate the soft palate and achieve proper VP closure.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DZ2Z6Z

Relationship Between Otorhinologic Trauma and Attention Deficit Hyperactivity Disorder Symptoms In Children

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ali Karayağmurlu, İsmail Aytaç, Secaattin Gülşen

Abstract

Objevtives

Otorhinologic trauma is an important condition at the ear, nose and throat (ENT) outpatient clinic in children. Attention deficit hyperactivity disorder (ADHD) has been identified as a potential risk factor that may contribute to the incidence of traumatic injuries. The aim of the study was to investigate whether there is an association between otorhinologic trauma and ADHD symptoms in children.

Methods

A prospective study was conducted between September 2017 and March 2018. Fifty-six pediatric patients admitted to the Ear Nose and Throat (ENT) outpatient clinic of a research and training hospital aged between 4 and 18 years were included. The control group consisted of 56 age- and gender-similar children without otorhinologic trauma. Conner's parent Rating Scale (CPRS) was used to evaluate the ADHD symptoms.

Results

The children with otorhinologic trauma had significantly higher mean scores in all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder (ODD) (p < 0.05). Furthermore, analysis of the study group showed that the hyperactivity score in the subgroup with a history of repetitive injuries were significantly higher than those of the subgroup without a history of repetitive injuries (p < 0.05).

Conclusions

These findings suggest that patients admitted to the ENT outpatient clinic for otorhinologic trauma had a higher number of ADHD and ODD symptoms than those who did not have otorhinologic trauma. Psychiatric evaluation for ADHD and ODD should be considered for patients admitted to clinics with similar injuries, especially those who have a history of repetitive injuries.

http://bit.ly/2SA3Rat

Histoanatomical structures of laryngeal atresia: Functional considerations

Objective

To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of laryngeal atresia repair.

Methods

Twenty‐one consecutives cases of laryngeal atresia were diagnosed at our institution between 2009 and 2016. Morphological analysis by macroscopic exam during autopsy was performed in 19 cases. Histological study of the larynx included hematoxylin and eosin staining and protein S100 immunostaining. Our analysis focused on the vocal folds, structures of the lamina propria, cricoarytenoid joints, muscles, and innervation. For each case, associated malformations were classified into two groups: severe and moderate.

Results

Antenatal diagnosis was suspected because of congenital high airway obstruction syndrome in nine cases (37%).

Associated malformations were present in 19 cases (90%), including severe malformations in 12 cases (57%). Atresia involved the cricoid in all cases, with a residual lumen in only one case and the glottis in 18 cases. Separation between the cricoid and arytenoid cartilages was observed in all cases. Fusion of the vocal process of the arytenoids in the midline was present in 13 cases.

According to the gestational age, posterior maculae flavae (MF) were present in 17 of 19 cases, with abnormal structure and median fusion in 13 cases. Anterior MF were present in nine of 18 cases, with fusion on the midline in five cases.

Intrinsic abductors and adductors muscles were identifiable in all cases, with fusion of thyroarytenoids muscles in the midline in 18 cases. Both recurrent laryngeal nerves were observed in all cases.

Conclusion

Laryngeal atresia is generally associated with other malformations, with a high risk of fatal outcomes. We observed that the functional structures of the glottic plane were present in most cases, with the exception of MF, which were frequently abnormal.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2TEw8K2

In‐Office Injection Pharyngoplasty for Velopharyngeal Insufficiency After Oropharyngeal Cancer Treatment

http://bit.ly/2BsEz4f

Multidisciplinary oral rehabilitation of an adolescent suffering from juvenile Gorlin-Goltz syndrome – a case report

Abstract

Background

The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation of the syndrome occurs in the adolescent years.

Case presentation

An 11-year-old boy was referred to our clinic due to the persistence of the lower deciduous molars. The further diagnosis revealed bilateral keratocystic odontogenic tumors in the region of teeth 33 and 45 representing a symptom of a Gorlin-Goltz syndrome. This case of the oral rehabilitation of an adolescent with bilateral keratocystic odontogenic tumors shows the approach of a multidisciplinary treatment concept including the following elements: Enucleation and bone defect augmentation using a prefabricated bone graft; distraction osteogenesis to extend the graft-block vertically after cessation of growth; accompanying orthodontic treatment, guided implant placement and prosthetic rehabilitation. Six months after implant insertion, a new keratocystic odontogenic tumor in the basal part of the left sinus maxillaris had to be removed combined with the closure of the oroantral fistula. During the follow-up period of 18 months in semi-annual intervals, the patient showed no sign of pathology.

Conclusion

In the presented case could be shown that distraction osteogenesis of prefabricated bone blocks is possible. With a multidisciplinary approach in a long-term treatment a sufficient oral rehabilitation of the patient suffering from extended keratocystic odontogenic tumors was possible.

http://bit.ly/2SmVfEH

Adamantinoma-Like Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature

Abstract

Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.

http://bit.ly/2E0qHzS

Adamantinoma-Like Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature

Abstract

Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.

http://bit.ly/2E0qHzS