Making Decisions Together

I love working with kids. It's one of the reasons I got into this gig, and it makes the day...

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The Whole Ball of Wax: A Longer Than Normal Post About Your Cerumen

"But what do I do with my ear wax?" says the man in my chair, a fully grown man who...

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Analysis of Venture Capital Investment in Therapeutic Otolaryngologic Devices

This cross-sectional analysis characterizes venture capital investments in otolaryngologic devices by therapeutic area using data from a private capital market data provider from 2008 through 2017.

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Chondrosarcoma in the Mastoid Involving the Intratemporal Facial Nerve

This case study describes a man in his 60s who presented with a 2-year history of gradual-onset right facial weakness leading to paralysis.

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Association of Head and Neck Cancer With Mental Health Disorders in a Large Insurance Claims Database

This cohort study assesses the prevalence of mental health disorders and their associations with survival and recurrence among patients with head and neck cancer in a large insurance claims database.

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Failure to Report Related Studies

To the Editor On behalf of my coauthors, I write to report our failure to include discussion of and reference to previously published, related articles in our Original Investigation titled, "Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction," which was published online in the January 3, 2019, issue of JAMA Otolaryngology–Head & Neck Surgery. In this study, we analyzed a cohort of 515 patients who had undergone free flap reconstruction at The Ohio State University Comprehensive Care Center (2006-2012) to assess risk factors associated with development of postoperative delirium after surgery. We identified a number of risk factors, including preoperative alcohol abstinence as predictor associated with a reduced risk of postoperative delirium.

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Addition of 2 References and Discussion of These Studies

In the article titled "Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction," 2 references and a brief discussion of these references were added to help contextualize the cohort of patients examined in the study. A letter of explanation describes these changes in more detail. This article was corrected online.

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Submucosal Masses of the Right Upper Lip

A woman in her 60s reported a several-week history of right upper lip submucosal masses with no tenderness, mucosal abnormality, or recent trauma to the lip. What is your diagnosis?

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A Rare Case of Vocal Cord Aspergillosis

Abstract

Primary aspergillosis of larynx is very rare. Till now only 28 cases of isolated laryngeal aspergillosis are documented in the English literature. In the field of otorhinolaryngology, aspergillosis most frequently affects external auditory canal or nasal sinuses and larynx is usually secondarily involved. It usually affects the patients with immunocompromised state and usually presents with hoarseness of voice. Laryngeal lesions usually mimics malignancy, so accurate diagnosis with direct laryngoscopy and biopsy is needed for further management. As these lesions responds very well to antifungal therapy, early diagnosis and starting antifungal therapy is important. Here we are presenting a case report of 67 years old male with aspergillosis of vocal folds without any immunodeficiency.

https://ift.tt/2NAdMrm

A Rare Case of Vocal Cord Aspergillosis

Abstract

Primary aspergillosis of larynx is very rare. Till now only 28 cases of isolated laryngeal aspergillosis are documented in the English literature. In the field of otorhinolaryngology, aspergillosis most frequently affects external auditory canal or nasal sinuses and larynx is usually secondarily involved. It usually affects the patients with immunocompromised state and usually presents with hoarseness of voice. Laryngeal lesions usually mimics malignancy, so accurate diagnosis with direct laryngoscopy and biopsy is needed for further management. As these lesions responds very well to antifungal therapy, early diagnosis and starting antifungal therapy is important. Here we are presenting a case report of 67 years old male with aspergillosis of vocal folds without any immunodeficiency.

https://ift.tt/2NAdMrm

A Prospective Study of Apatinib Plus Concurrent Neoadjuvant Chemoradiotherapy in Patients With Esophageal Squamous Cell Carcinoma

Condition:   Esophageal Squamous Cell Carcinoma
Intervention:   Combination Product: Apatinib,Paclitaxel,Cisplatin,RT
Sponsor:   Hebei Medical University Fourth Hospital
Not yet recruiting

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Laryngo-pharyngeal reflux in clinical practice: The relevance of age

Publication date: Available online 27 February 2019

Source: Acta Otorrinolaringológica Española

Author(s): Giorgio Ciprandi, Matteo Gelardi

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Geriatric assessment and 1‐year mortality in older patients with cancer in the head and neck region: A cohort study

Abstract

Background

The aim is to describe the association of functional capacity and cognitive functioning with 1‐year mortality in older patients with cancer in the head and neck region.

Methods

We performed a cohort study in which all patients aged 70 years and older received a geriatric screening before treatment. Main outcome was 1‐year mortality.

Results

A total of 102 patients were included. Median age was 78.7 years (interquartile range [IQR], 72.3‐84.5), 25% were cognitive impaired, 40% were malnourished, and 28.4% used a walking device. Overall, 1‐year mortality was 42.3%. Male sex (hazard ratio [HR], 4.30; 95% confidence interval [CI], 1.35‐13.67), malnutrition (HR, 2.55; 95% CI, 1.19‐5.16), and using a walking device (HR, 2.80; 95% CI 1.13‐6.93) were associated with higher mortality risk, independent of stage and comorbidities.

Conclusion

In older patients with head and neck cancer, the mortality rates are high. Nutritional status and mobility are determinants of 1‐year mortality, independent of tumor stage, age, and comorbidity.

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Results of a combination treatment with intensity modulated radiotherapy and active raster-scanning carbon ion boost for adenoid cystic carcinoma of the minor salivary glands of the nasopharynx

Publication date: April 2019

Source: Oral Oncology, Volume 91

Author(s): Sati Akbaba, Dina Ahmed, Kristin Lang, Thomas Held, Matthias Mattke, Juliane Hoerner-Rieber, Klaus Herfarth, Stefan Rieken, Peter Plinkert, Juergen Debus, Sebastian Adeberg

Abstract

Objectives

We aimed to present the first clinical results for adenoid cystic carcinoma (ACC) of the nasopharynx after primary radiotherapy (RT) with the focus on local control (LC) and patterns of recurrence.

Materials and methods

We retrospectively analyzed 59 patients with ACC of the nasopharynx, who were treated with bimodal radiotherapy (RT) consisting of intensity modulated radiotherapy and carbon ion boost at the Heidelberg Ion-Beam Therapy Center between 2009 and 2018. The patients had predominantly inoperable (n = 42, 72%) or incompletely resected (n = 17, 29%) tumors. Kaplan-Meier estimates and the log-rank (Mantel-Cox) test were used for univariate and multivariate analyses.

Results

The median follow-up was 32 months. At last follow-up, 67% of the patients were still alive (n = 39/58), of whom 74% were free of progression (n = 29/39). The 2-year LC, distant progression-free survival (DPFS) and overall survival (OS) were 83%, 81%, 87% and the estimated 5-year LC, DPFS and OS were 49%, 54%, 69%, respectively. LC was significantly inferior in patients with large tumor volumes (gross tumor volume, GTV > 100 cc, p = 0.020) and T4 tumors (p = 0.021). The majority of the recurrences occurred at the margin, where critical structures were spared (n = 11/19, 58%). Overall, grade 3 toxicity was moderate with 12% acute and 8% late side effects.

Conclusion

Bimodal RT including active raster-scanning carbon ion boost for nasopharyngeal ACC resulted in adequate LC and OS rates with moderate toxicity. T4 stage, large tumor volume and the necessary dose sparing in critical structures, i.e. optic nerves, brain stem and orbit, negatively affected LC.

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Subglottic Stenosis in Children: Our Experience at a Pediatric Tertiary Center for 8 Years in South Korea

Publication date: Available online 27 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jin-Choon Lee, Min-Sik Kim, Dong-Jo Kim, Da-Hee Park, IL-Woo Lee, Hwan-Jung Roh, Byung-Joo Lee, Young-A. Kim, Sunghwa Ko, Eui-Suk Sung

Abstract

Objective

The incidence of SGS has been reported to be less than 8% after endotracheal intubation. Therefore there is an increasing trend in the number of patients with acute acquired SGS due to mechanical ventilation in the intensive care unit. However, there have been no reports describing the treatment of SGS in children in South Korea. The objective of this study was to evaluate the management and outcomes of children with SGS at a pediatric tertiary center in South Korea over an 8-year period.

Methods

All patients underwent microlaryngobronchoscopy (MLB) with bougination, incision using cold knife or laser and balloon dilatation. Data on age, sex, grade of SGS, number of management interventions, tracheostomy, comorbidities, mean follow-up period, complications, and outcome were reviewed from patient medical charts.

Results

Twenty patients (13 [65%] males, 7 [35%] females; mean [±SD] age at the diagnostic procedure 15.26±22.54 months) underwent MLB between March 2009 and December 2017. According to the Myer-Cotton scale, twelve of the 20 (60%) patients had grade III SGS, 7 (35%) had grade II and 1 (5%) had grade 1; there were no patients with grade IV SGS. Nine (45%) patients were diagnosed with acute SGS, and 11 (55%) with chronic SGS. Patients with SGS underwent MLB with interventions (mean 2.41±2.23 per patient). Tracheostomy was performed in 13 of 20 (65%) patients, 2 of 9 (22.2%) with acute SGS, and 11 of 11 (100%) with chronic SGS. Two of 13 (15.3%) patients underwent successful decannulation. One of 2 (50%) patients with acute SGS underwent successful decannulation. Seven of 9 (77.7%) patients with acute SGS underwent MLB only without tracheostomy.

Conclusions

In patients with acute acquired SGS, the outcome was good due to the lower rate of tracheostomy and higher decannulation rate. Therefore, it is recommended that MLB with balloon laryngoplasty be performed at the earliest in patients with acute acquired SGS.

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Comparison of distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (AABR) for neonatal hearing screening in a hospital with high delivery rate

Publication date: Available online 27 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ling Xiu Ngui, Ing Ping Tang, Narayanan Prepageran, Zhun Wieng Lai

Abstract

Introduction

Congenital hearing loss is one of the commonest congenital anomalies. Neonatal hearing screening aims to detect congenital hearing loss early and provide prompt intervention for better speech and language development. The two recommended methods for neonatal hearing screening are otoacoustic emission (OAE) and automated auditory brainstem response (AABR).

Objective

To study the effectiveness of distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (AABR) as first screening tool among non-risk newborns in a hospital with high delivery rate.

Method

A total of 722 non-risk newborns (1444 ears) were screened with both DPOAE and AABR prior to discharge within one month. Babies who failed AABR were rescreened with AABR ± diagnostic auditory brainstem response tests within one month of age.

Results

The pass rate for AABR (67.9%) was higher than DPOAE (50.1%). Both DPOAE and AABR pass rates improved significantly with increasing age (p-value<0.001). The highest pass rate for both DPOAE and AABR were between the age of 36-48 hours, 73.1% and 84.2% respectively. The mean testing time for AABR (13.54 mins +/-7.47) was significantly longer than DPOAE (3.52 mins +/-1.87), with a p-value of <0.001.

Conclusions

OAE test is faster and easier than AABR, but with higher false positive rate. The most ideal hearing screening protocol should be tailored according to different centre.

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The histological properties and possible origin of cervical thymus with cysts – a case report and hypotheses about its development

Publication date: Available online 27 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ivan Varga, Lenka Fedorová, Martin Klein, Jozef Babala, René Jáger, Ildikó Bódi, Lukáš Plank

Abstract

Ectopic accessory thymic tissue usually presents as an asymptomatic neck mass found at any level corresponding to the embryonic descent of the thymus. This tissue may contain smaller or larger cysts. However, the exact pathogenesis of "enigmatic" cervical thymic cysts remains controversial. A 7-year-old boy was referred to our workplace for the evaluation of a cervical mass. An ultrasound suggested a multi-loculated cystic mass, while CT and MRI indicated a left-sided, anteriorly located cervical mass beneath the sternocleidomastoid muscle. Following the radiological findings, surgical excision revealed a cystic mass. The mass of tissue was covered by a capsule. In H&E staining, the cervical mass had the same structure as normal thymus. Additionally, immunohistochemical findings suggest that the cellular microenvironment of cervical thymus also displays a place for development of T-lymphocytes. Within the parenchyma multiple cysts lined with cytokeratin-positive thymic epithelial cells were found. Inside the cysts, there were CD68-positive multinucleated giant cells and cholesterol clefts. A tendency to cystic degeneration inside the thymic tissue occurs more often in cervical thymuses than in normally located ones. The reason for the formation of cysts is unknown. We summarized seven possible histological, embryological and evolutional backgrounds for the development of these thymic cysts.

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Binaural Hearing Advantages for Children with Bimodal Fitting

Publication date: Available online 27 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Younes Lotfi, Mahdieh Hasanalifard, Abdollah Moossavi, Enayatollah Bakhshi, Mohammad Ajaloueyan

Abstract

Objectives

Bimodal fitting (BF) allows children with cochlear implant to benefit from binaural hearing advantages. Three major binaural hearing advantages, which enhance hearing function of people with normal hearing, are head shadow effect (HSE), binaural squelch effect (BSQ) and binaural summation effect (BSU). This study in pediatric patients attempting to measure the auditory benefits of bimodal stimulation in children with long-standing use of a cochlear implant (CI), and residual hearing on the contralateral side.

Methods

This cross-sectional study investigated binaural advantages in 24 children of 8-12 years who had undergone cochlear implantation in a cochlear implant center in Tehran and continuously used BF. Improved score of speech perception in noise (SPiN) under BF condition, as compared to the application of cochlear implant alone, was a binaural advantage found in this study. Each binaural advantage was measured by obtaining the SPiN score under different listening and noise conditions, using relevant formulas. The measured value of each advantage reflects the improved score of SPiN, caused by that certain advantage.

Results

In this study, improved mean SPiN score caused by the HSE, BSQ and BSU was, respectively, 3.13, 1.42 and 2.04dB, indicating greater binaural advantages and hence improved SPiN, under BF condition in comparison with cochlear implant alone.

Conclusion

Children with unilateral cochlear implant and measurable residual hearing in non-implanted ear can benefit from binaural advantages and better SPiN when hearing aid is used in the unaided ear.

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Ift88 limits bone formation in maxillary process through suppressing apoptosis

Publication date: Available online 27 February 2019

Source: Archives of Oral Biology

Author(s): Momoko Watanabe, Maiko Kawasaki, Katsushige Kawasaki, Atsushi Kitamura, Takahiro Nagai, Yasumitsu Kodama, Fumiya Meguro, Akane Yamada, Paul T. Sharpe, Takeyasu Maeda, Ritsuo Takagi, Atsushi Ohazama

Abstract

Objective

The development of the maxillary bone is under strict molecular control because of its complicated structure. Primary cilia play a critical role in craniofacial development, since defects in primary cilia are known to cause congenital craniofacial dysmorphologies as a wide spectrum of human diseases: the ciliopathies. The primary cilia also are known to regulate bone formation. However, the role of the primary cilia in maxillary bone development is not fully understood.

Design

To address this question, we generated mice with a mesenchymal conditional deletion ofIft88 using the Wnt1Cre mice (Ift88^fl/fl;Wnt1Cre). The gene Ift88 encodes a protein that is required for the function and formation of primary cilia.

Results

It has been shown thatIft88^fl/fl;Wnt1Cre mice exhibit cleft palate. Here, we additionally observed excess bone formation in the Ift88 mutant maxillary process. We also found ectopic apoptosis in the Ift88 mutant maxillary process at an early stage of development. To investigate whether the ectopic apoptosis is related to the Ift88 mouse maxillary phenotypes, we generated Ift88^fl/fl;Wnt1Cre;p53^−/− mutants to reduce apoptosis. The Ift88^fl/fl;Wnt1Cre;p53^−/− mice showed no excess bone formation, suggesting that the cells evading apoptosis by the presence of Ift88 in wild-type mice limit bone formation in maxillary development. On the other hand, the palatal cleft was retained in the Ift88^fl/fl;Wnt1Cre;p53^−/− mice, indicating that the excess bone formation or abnormal apoptosis was independent of the cleft palate phenotype in Ift88 mutant mice.

Conclusions

Ift88 limits bone formation in the maxillary process by suppressing apoptosis.

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Oxycodone’s Unparalleled Addictive Potential: Is it Time for a Moratorium?

Abstract

Purpose of Review

This study and literature review were carried out to investigate whether oxycodone is the most addictive prescription opioid.

Recent Findings

This was a cross-sectional survey from a pain management practice in south-central Alaska and review of the literature involving 86 patients diagnosed with opioid dependence/opioid use disorder from 2013 to 2018. Patients were given a list of prescription opioids and asked to identify the one (1) most desirable to themselves, (2) most desirable among drug-using associates or community, and (3) they deemed most addictive. Patients with a history of heroin use were asked which, if any, served as their gateway drug to heroin. The literature was reviewed using a PubMed search for articles containing the words "oxycodone" and "abuse," "addiction," "dependence," "disorder," and "euphoria." Oxycodone was ranked most highly in all four questions (n = 50, 60.2%; n = 46, 75.4%; n = 38, 60.2%; n = 14, 77.8%, respectively) by a wide margin.

Summary

Numerous observational studies performed over the past few decades have demonstrated the supreme "likability" and abuse and dependence liability/addictiveness of oxycodone, with more recent mechanistic studies illuminating biological underpinnings including markedly increased active transport across the blood-brain barrier, increased phasic dopaminergism in the ventral tegmental area, nucleus accumbens and related striatal reward centers, and possibly increased kappa opioid receptor-mediated withdrawal dysphoria. Oxycodone possesses pharmacologic qualities that render it disproportionately liable to abuse and addiction and the risks of any long-term prescription outweigh the benefits.

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