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Κυριακή 20 Φεβρουαρίου 2022

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population‐Based Study

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Objectives/Hypothesis

To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study.

Study Design

Cross-sectional study.

Methods

Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis.

Results

701 were enrolled (54.8% female, 45.2% male; mean age, 50.2 ± 13.3 years). The mean apnea-hypopnea index score was 17 ± 18.3 events/hr, and the mean RSI score was 7.0 ± 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires.

Conclusions

Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep.

Level of Evidence

3 Laryngoscope, 2022

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The effect of noise on the amplitude and morphology of cortical auditory evoked potentials

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Braz J Otorhinolaryngol. 2021 Dec 7:S1808-8694(21)00197-X. doi: 10.1016/j.bjorl.2021.11.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the effect of noise on electrophysiological measurements (P1-N1-P2 complex) of cortical auditory evoked potentials in normal hearing individuals of different ages.

METHODS: The inclusion criteria for the study were young individuals, adults and elderly, aged 18-75 years, with auditory thresholds up to 25 dB. Participants were separated according to their age group: G1 (18-25 years old), G2 (31-59 years old) and G3 (60-75 years old). Cortical auditory evoked potentials were elicited with synthetic speech stimulus /da/ presented in two conditions: without masking and with masking (Delta-t 64 ms). The results were expressed and analyzed using statistical measures.

RESULTS: High latencies and reduced amplitudes were observed in the Delta-t 64 ms condition, in all age groups. There were sign ificant differences between the groups, both in P1 latencies for the two conditions and in N1 latencies in the Delta-t 64 ms condition. P1 latencies in the condition without masking were lower in G1 and P1 and N1 latencies in the Delta-t 64 ms condition were higher in G3. The described results show the influence of noise on cortical responses in all age groups, with G3 being the most affected by the masking presentation.

CONCLUSION: The latency and amplitude measurements vary according to the stimulus presentation condition and age group. The forward masking phenomenon occurred with greater precision in G3.

LEVEL OF EVIDENCE: (2c).

PMID:35177355 | DOI:10.1016/j.bjorl.2021.11.006

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Management of recurrent acquired choanal atresia with radial forearm free flap transfer

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Ear Nose Throat J. 2022 Feb 17:1455613211070894. doi: 10.1177/01455613211070894. Online ahead of print.

ABSTRACT

Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis.

PMID:35176899 | DOI:10.1177/01455613211070894

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Interpretation of P16 expression as a marker of HPV in colorectal cancer

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Histol Histopathol. 2022 Feb 18:18439. doi: 10.14670/HH-18-439. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer is one of the most prevalent types of tumors worldwide. P16ᴵᴺᴷ⁴ᵃ is a widely used immunohistochemical marker for high-risk HPV infection. The purpose of this study is to explore the relationship between P16 expression as an indicator of HPV infection and colorectal cancer in Egyptian patients, as well as its association with histopathological characteristics.

MATERIAL AND METHODS: The study was performed on 59 cases of colorectal carcinoma cases and 30 specimens of normal colonic mucosa.

RESULTS: p16 protein was detected in 22% (13 of 59) of patients with colorectal carcinoma. No evidence of P16 expression in all 30 cases of non-neoplastic colonic mucosa was found. More frequent expression of P16 was seen in distal carcinomas.

CONCLUSION: our study demonstrated that P16 protein is exp ressed in a reasonable percent of colorectal carcinoma cases, suggesting a role of HPV in colorectal carcinogenesis. The present study highlights the role of p16 protein expression which is important in the pathogenesis in colorectal carcinoma, especially regarding distal tumors.

PMID:35178697 | DOI:10.14670/HH-18-439

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The effect of noise on the amplitude and morphology of cortical auditory evoked potentials

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Braz J Otorhinolaryngol. 2021 Dec 7:S1808-8694(21)00197-X. doi: 10.1016/j.bjorl.2021.11.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the effect of noise on electrophysiological measurements (P1-N1-P2 complex) of cortical auditory evoked potentials in normal hearing individuals of different ages.

METHODS: The inclusion criteria for the study were young individuals, adults and elderly, aged 18-75 years, with auditory thresholds up to 25 dB. Participants were separated according to their age group: G1 (18-25 years old), G2 (31-59 years old) and G3 (60-75 years old). Cortical auditory evoked potentials were elicited with synthetic speech stimulus /da/ presented in two conditions: without masking and with masking (Delta-t 64 ms). The results were expressed and analyzed using statistical measures.

RESULTS: High latencies and reduced amplitudes were observed in the Delta-t 64 ms condition, in all age groups. There we re significant differences between the groups, both in P1 latencies for the two conditions and in N1 latencies in the Delta-t 64 ms condition. P1 latencies in the condition without masking were lower in G1 and P1 and N1 latencies in the Delta-t 64 ms condition were higher in G3. The described results show the influence of noise on cortical responses in all age groups, with G3 being the most affected by the masking presentation.

CONCLUSION: The latency and amplitude measurements vary according to the stimulus presentation condition and age group. The forward masking phenomenon occurred with greater precision in G3.

LEVEL OF EVIDENCE: (2c).

PMID:35177355 | DOI:10.1016/j.bjorl.2021.11.006

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Feasibility of a snowball sampling survey to study active surveillance for thyroid microcarcinoma treatment among endocrinologists and surgeons of Brazil

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Braz J Otorhinolaryngol. 2022 Feb 4:S1808-8694(22)00006-4. doi: 10.1016/j.bjorl.2022.01.005. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to investigate if a sampling method using virtual networks is feasible to survey AS adoption among this "hard-to-reach" population of Brazilian doctors.

METHODS: An online piloted 11-point structured survey questionnaire (designed using Googleforms®) probed the actual treatment patterns for adult patients with PTMCs, including treatment decision-making nonoperative options, was undertaken between 10 November and 30 November 2020. Participants were reached by the mobile phone Application (APP) and a snowball sampling strategy was used to recruit a total of 4783 members (maximum number of potential reach), which is the total of doctors of the all 21 social media WhatsApp® groups.

RESULTS: From a total of 4783 members (maximum number of potential reach), there were 657 (13.7 %) doctors (actual reach) who clicked the web link of the questionnaire, out of whom 512 (10.7%) fully completed the online survey. Among the survey respondents, 361 were endocrinologists (70.5%) and 151 were surgeons (29.5%). Overall, for low-risk PTMCs in an elderly patient, 118 responders (23%) recommend AS, while 390 (76%) recommend immediate surgery as the management, including lobectomy (18.5%) and Total Thyroidectomy (58.2%). The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or raised the size during the follow-up.

CONCLUSION: Using snowball sampling strategy as an innovative route to conduct surveys was feasible and applicable but the rate of response was still very low. Our data also suggests the need to investigate if AS is embraced by Brazilian doctors.

PMID:35177356 | DOI:10.1016/j.bjorl.2022.01.005

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The reliability and validity of decreased sound tolerance scale-screening

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Braz J Otorhinolaryngol. 2021 Dec 23:S1808-8694(21)00212-3. doi: 10.1016/j.bjorl.2021.11.009. Online ahead of print.

ABSTRACT

OBJECTIVES: Decreased Sound Tolerance (DST) is a negative reaction to a sound that does not cause any reaction in an individual with normal hearing. DST's subclasses include hyperacusis, phonophobia, and misophonia, which are distinct and have therapy variations. There is no diagnostic method or scale that distinguishes them in the literature. This study's purpose was to develop a screening scale that distinguishes these three DSTs.

METHODS: The study comprised 257 willing participants with normal hearing. Cronbach alpha coefficient, item-total correlation, and item differentiation of the Decreased Sound Tolerance Scale-Screening (DSTS-S) were evaluated. Structural validity of DSTS-S was performed by Varimax rotation with Kaiser normalization using Explanatory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA) was performed to assess its structural compatibility. The scale's total scores from each section were compared using the Mann-Whitney U test in symptom (+) and symptom (-) participants.

RESULTS: The Cronbach alpha value for hyperacusis, phonophobia, and misophonia sections of DSTS-S was calculated as 0.881, 0.775, and 0.938, respectively. The difference between the independent samplet-test and the variables was statistically significant (p < 0.01). The Mann-Whitney U test showed a significant difference between the median values of the total groups' scores with and without hyperacusis, phonophobia, and misophonia (HTS, PTS, and MTS, respectively) (p < 0.05). Evaluation by ROC analysis showed that hyperacusis was useful in predicting the presence of hyperacusis, phonophobia was useful in predicting the presence of phonophobia, and misophonia was useful in predicting the presence of misophonia (p < 0.001). Hyperacusis and misophonia sections showed high reliability, and phonophobia section showed a moderately reliable level. The Kappa test showed that the compatibility between test-retest for the total scores was statistically significant (p < 0.001).

CONCLUSION: The study's results indicated that DSTS-S is a valid and reliable scale for identifying subtypes/problems/classes of decreased sound tolerance.

PMID:35177354 | DOI:10.1016/j.bjorl.2021.11.009

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Delay of initial radioactive iodine therapy beyond 3 months has no effect on clinical responses and overall survival in patients with thyroid carcinoma: A cohort study and a meta-analysis

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Cancer Med. 2022 Feb 18. doi: 10.1002/cam4.4607. Online ahead of print.

ABSTRACT

BACKGROUND: More than a third of thyroid carcinoma (TC) patients require treatment with radioactive iodine (RAI), but the timing of initial RAI therapy after thyroidectomy remains controversial.

METHODS: We included 1224 differentiated thyroid carcinoma (DTC) patients during 2015-2019, divided them into the early (≤3 months) and the delayed (>3 months) groups based on the interval between su rgery and the initial RAI. Clinical outcomes were assessed within 6-8 months of treatment with RAI, including excellent response (ER), indeterminate response (IDR), biochemical incomplete (BIR) and structural incomplete response (SIR). Further transformed them into dichotomous outcomes, we therefore introduced the ordered/binary logistic regression to assess the relation of time interval and quaternary/dichotomous outcomes, respectively. Finally, we conducted a meta-analysis for cohort study to investigate the effect of timing of RAI therapy on the prognosis of TC.

RESULTS: Delay RAI therapy beyond 3 months reduced the IR (BIR + SIR) rate in the present cohort study (RR = 0.67, 95% CI: 0.49-91). Following meta-analysis including 38,688 DTC patients confirmed these results (RR = 0.77, 95% CI: 0.66-0.91), further revealed the duration of treatment does not influence OS (pooled RR = 1.05, 95% CI: 0.83-1.33).

CONCLUSION: Delayed initial RAI therapy beyond 3 months but no lat er than 6 months did not impair the prognosis of TC.

PMID:35179295 | DOI:10.1002/cam4.4607

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Vocal Fry Patterns While Reading

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The use of vocal fry is common in running speech and has potential psychosocial and vocal health consequences. Determining the different patterns of vocal fry is relevant to differentiating phonatory function, understanding cultural and linguistic use of vocal fry, and clinical diagnostics and intervention. The purpose of this project was to study and categorize patterns of vocal fry in running speech.
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Features of Odontogenic Sinusitis Associated With Dental Implants

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Objectives

With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS).

Study Design

Case–control study.

Methods

This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS.

Results

The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption–extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7–276.5) for extrusion length >4 mm, 11.8 (3.0–46.5) for peri-implantitis, and 34.1 (3.3–347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively).

Conclusion

Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted–extruded bone grafts show significant association with IR-ODS.

Level of Evidence

4 Laryngoscope, 2022

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Clinical characteristics and treatment of chest submammary accessory breasts

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J Plast Reconstr Aesthet Surg. 2022 Jan 31:S1748-6815(22)00066-3. doi: 10.1016/j.bjps.2022.01.051. Online ahead of print.

ABSTRACT

Accessory breast tissue is remnant mammary gland tissue resulting from a failure of regression during the embryonic development and can occur anywhere along the mammary ridge. Patients with accessory breast tissue may also have chest submammary accessory breasts, which are rare and painless, but are often removed for cosmetic reasons. Herein, we report the clinical characteristics and treatment of patients with chest submammary accessory breasts. This retrospective study included 104 women who had undergone liposuction for chest submammary accessory breast from January 2014 to December 2019. chest submammary accessory breasts were diagnosed by ultrasonography and physical examination. The overall satisfaction of patients with chest submammary accessory breast was evaluated using a 5-point Likert scale. The mean operation time was mean 20.7 min and the mean liposuction volume was mean 223.3 mL. The overall satisfaction score (incisional scar, pain and cosmesis) 6 months after chest submammary accessory breast liposuction was 4.7 (range 4-5). The chest submammary accessory breast consisted mainly of fatty tissue rather than mammary gland tissue; thus, chest submammary accessory breasts are painless and are treated purely for cosmetic reasons. In conclusion, liposuction is therefore a simple and effective treatment for chest submammary accessory breast.

PMID:35181247 | DOI:10.1016/j.bjps.2022.01.051

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