Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

http://bit.ly/2SAbAW3

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

Abstract

Purpose

A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach.

Methods

In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations.

Results

The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel.

Conclusions

Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

http://bit.ly/2UJvyee

Does procalcitonin have a role in the pathogenesis of nasal polyp?

Abstract

Purpose

The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps.

Methods

The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically.

Results

Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863–1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748–0.972)] activity (CI: 95%).

Conclusions

This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.

http://bit.ly/2MUziXA

Cervical Haematoma Secondary to Spontaneous Bleeding of Parathyroid Adenoma

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Alberto Martínez-Martínez, Jade García-Espinosa

http://bit.ly/2WUb3h4

Macrostomia: The defining feature of the oculo-auriculo-vertebral spectrum

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Mainak Dutta, Indranil Chatterjee

http://bit.ly/2RMTSdq

Digestive Migration and Spontaneous Expulsion of a Montgomery Salivary Derivation Tube

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Pablo Torrico Román

http://bit.ly/2WT1qil

Guideline on Cochlear Implants

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Manuel Manrique, Ángel Ramos, Carlos de Paula Vernetta, Elisa Gil-Carcedo, Luis Lassaletta, Isabel Sanchez-Cuadrado, Juan Manuel Espinosa, Ángel Batuecas, Carlos Cenjor, María José Lavilla, Faustino Núñez, Laura Cavalle, Alicia Huarte

Abstract

Introduction

In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants.

Objectives

To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general.

Methods

The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted.

Results

The clinical guideline on cochlear implants provides information on: (a) definition and description of Cochlear Implant; (b) indications for cochlear implants; (c) organisational requirements for a cochlear implant programme.

Conclusions

A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.

Resumen

Introducción

En la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC.

Objetivos

Ofrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares.

Métodos

Las comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado.

Resultados

La guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC.

Conclusiones

Se ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva.

http://bit.ly/2RMTOKI

Diagnosis and Treatment of Otitis Media With Effusion: CODEPEH Recommendations

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Faustino Núñez-Batalla, Carmen Jáudenes-Casaubón, Jose Miguel Sequí-Canet, Ana Vivanco-Allende, Jose Zubicaray-Ugarteche

Abstract

The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of surgical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.

Resumen

La incidencia y prevalencia de la otitis media secretora infantil (OMS) son elevadas, sin embargo, existen evidencias de que solo una minoría de profesionales sigue las recomendaciones de las guías para su manejo clínico. Con objeto de mejorar el diagnóstico y el tratamiento de la OMS, para prevenir y/o reducir sus consecuencias sobre el desarrollo del niño, la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) ha realizado una amplia revisión de la literatura científica sobre la materia y ha elaborado un documento de recomendaciones para una correcta actitud clínica ante la OMS, abordando métodos diagnósticos y tratamiento médico y quirúrgico. Entre otros, no usar ninguna medicación, especialmente corticoides y antibióticos, siendo la espera vigilada la primera medida a tomar durante 3 meses. Si persiste la OMS, el otorrinolaringólogo valorará el tratamiento quirúrgico. En niños que presentan comorbilidades de diversa entidad, el impacto de la OMS es superior por lo que hay que actuar de forma inmediata, sin espera vigilada.

http://bit.ly/2WUIgbR

Congenital Aural Atresia prevalence in the Argentinian population

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Mario Emilio Zernotti, Carlos A. Curet, Susana Cortasa, Mario Chiaraviglio, Maria Fernanda Di Gregorio

Abstract

Introduction

Congenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world.

Objective

To determine the prevalence of microtia, considering the different ethnical structure of the population.

Methods

A retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions.

Results

The incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1).

Conclusion

This study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).

Resumen

Introducción

La atresia aural congénita (AAC) o microtia es una malformación que produce problemas funcionales y estéticos. Existe falta de información de prevalencia en Argentina, teniendo en cuenta además que Latinoamérica es la región más afectada del mundo.

Objetivo

Determinar la prevalencia de microtia, teniendo en cuenta la estructura étnica de la población según las regiones.

Métodos

Análisis retrospectivo de historias clínicas en hospitales públicos de recién nacidos en diferentes zonas del país.

Resultados

La prevalencia de atresia en Argentina fue de uno de cada 7.500 recién nacidos (1,3/10.000). Se encontraron marcadas diferencias de acuerdo al área geográfica. En el área caucásica: 2,47/10.000 (± 1,2), en el área mestiza: 3,99/10.000 (± 0) y en el área amerindia: 20,93/10.000 (± 0,1).

Conclusión

El estudio muestra una diferente incidencia con arreglo a las características demográficas de la población, de entre 1,90/10.000 y 20,9/10.000. Estos datos permitirían asociar la atresia con problemas genéticos (origen étnico).

http://bit.ly/2RRd9dN

Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Rita Chiaramonte, Carmela Di Luciano, Ignazio Chiaramonte, Agostino Serra, Marco Bonfiglio

Abstract

Introduction and objectives

The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time.

Materials and methods

22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing.

Results

In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration.

Conclusions

A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.

Resumen

Introducción y objetivos

El objetivo de este estudio fue examinar la función de los diferentes especialistas en el diagnóstico de la esclerosis lateral amiotrófica (ELA), para comprender quèc) cambios se produjeron en cuanto a expresión verbal, dinámica fonatoria y respiratoria, y deglución, en un breve periodo de tiempo.

Materiales y mèc)todos

Se sometió a 22 pacientes con ELA bulbar a evaluación de la voz, examen ORL, programa de voz multi-dimensional (MDVP), espectrograma, electroglotografía y evaluación de la deglución mediante endoscopía de fibra óptica.

Resultados

En la etapa temprana de la enfermedad, el tracto oral y el cierre velofaríngeo se vieron comprometidos. Transcurridos 3 meses de los síntomas iniciales, la mayoría de los pacientes presentó ronquera, voz entrecortada, disartria, problemas de modulación de la afinación y dificultades de pronunciación de las consonantes oclusivas, velares y linguales. Los valores del MDVP se vieron alterados. El espectrograma reflejó un formante adicional, debido a la resonancia nasal. La electroglotografía mostró una oscilación periódica de las cuerdas vocales únicamente durante el ciclo vocal corto. La deglución se vio caracterizada por debilidad y descoordinación de los músculos orofaríngeos, con penetración o aspiración.

Conclusiones

Se diseñó un protocolo clínico multidisciplinar específico para reportar los parámetros vocales y los trastornos deglutorios que experimentan un cambio más rápido en los pacientes con ELA bulbar. Además, se estratificaron los pacientes con arreglo al compromiso de las estructuras faríngeas y el índice de gravedad.

http://bit.ly/2WVlIYu

Predictive Value of EGFR-PI3K-pAKT-mTOR-pS6 Pathway in Sinonasal Squamous Cell Carcinomas

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): María Gabriela Muñoz-Cordero, Fernando López, Cristina García-Inclán, Alejandro López-Hernández, Sira Potes-Ares, Laura Fernández-Vañes, José Luis Llorente, Mario Hermsen

Abstract

Background and objectives

We have previously indicated that EGFR has a role in carcinogenesis in a subgroup of sinonasal squamous cell carcinomas (SNSCC). In addition, EGFR activates 2 of the most important intracellular signalling pathways: PI3K/pAKT/mTOR/pS6 and MAP pathway kinases. The objective of this study was to evaluate the involvement of the EGFR/PI3K/pAKT/mTOR/pS6 pathway and its relationship with clinical–pathological parameters and follow-up of sinonasal squamous cell carcinoma.

Material and methods

The immunohistochemical expression of different components of the PI3K/AKT/mTOR/pS6 pathway and its relationship with various clinical-pathological parameters was studied in a series of 54 patients with SNSCC.

Results

Loss of PTEN expression was observed in 33/54 cases (61%) and pAKT, mTOR and pS6 pre-expression was observed in 19/54 cases (35%), 8/54 cases (15%), and 47/54 cases (87%), respectively. Loss of PTEN expression was related to intracranial invasion and development of regional metastases (P=.005). Overexpression of pS6 was associated with a decrease in survival (P=.008), presence of local recurrences (P=.055), and worsening of overall prognosis (P=.007). No significant relationships were observed between pAKT and mTOR expression and the clinicopathological parameters studied.

Conclusions

Alterations in the expression of EGFR/PI3K/pAKT/mTOR/pS6 pathway components are common in a subgroup of SNSCC. This study reveals that the absence of pS6 overexpression is associated with better clinical outcomes. Therefore, pS6 expression could be considered as an unfavourable prognostic marker.

Resumen

Antecedentes y objetivos

En estudios previos hemos indicado que EGFR tiene un papel en la carcinogénesis en un subgrupo de carcinomas epidermoides nasosinusales (CENS). Además, EGFR activa a 2 de las más importantes vías de señalización intracelular como son la PI3K/pAKT/mTOR/pS6 y la vía MAP-cinasas. El objetivo de este estudio fue evaluar la participación de la ruta de EGFR/PI3K/pAKT/mTOR/pS6 y su relación con parámetros clínico-patológicos y de seguimiento de los CENS.

Material y métodos

La expresión proteica de PTEN, pAKT, mTOR y pS6 fue analizada mediante inmunohistoquímica en 54 CENS. Los resultados fueron relacionados con diversos parámetros clínico-patológicos y la supervivencia.

Resultados

La pérdida de expresión de PTEN se observó en 33/54 casos (61%) y la sobreexpresión de pAKT, mTOR y pS6 se observó en 19/54 casos (35%), 8/54 casos (15%) y 47/54 casos (87%), respectivamente. La pérdida de expresión de PTEN se relacionó con la invasión intracraneal y el desarrollo de metástasis regionales (p = 0,005). La ausencia de sobreexpresión de pS6 se relacionó con una supervivencia específica (p = 0,008) y global (p = 0,007) más favorables y la ausencia de recidivas locales (p = 0,055). No se observaron relaciones significativas entre la expresión de pAKT y mTOR y los parámetros clínico-patológicos estudiados.

Conclusiones

Las alteraciones en la expresión de los componentes de la vía EGFR/PI3K/pAKT/mTOR/pS6 son frecuentes en un subgrupo de CENS. Este estudio revela que la ausencia de sobreexpresión de pS6 se relaciona con mejores resultados clínicos, por lo que la expresión pS6 podría considerarse como un marcador pronóstico.

http://bit.ly/2Sr0rrq

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Miguel Sá Breda, Joaquim Castro Silva, Eurico Monteiro

Abstract

Objective

To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries.

Methods

A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate.

Results

In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization.

Conclusion

The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

Resumen

Objetivo

Analizar el impacto de las complicaciones infecciosas en el período posoperatorio de las cirugías oncológicas mayores de cabeza y cuello, y estudio de los agentes microbianos implicados.

Métodos

Estudio retrospectivo realizado en un instituto oncológico, en pacientes que desarrollaron complicaciones infecciosas después de la cirugía oncológica mayor de cuello, entre octubre de 2012 y mayo de 2016 (44 meses). Entre otros se recogieron el estadio TNM, la puntuación ASA, el índice de masa corporal, las comorbilidades, los hábitos tóxicos, los niveles de hemoglobina pre y postoperatoria, los niveles séricos de albúmina, los tratamientos previos a la cirugía, la duración de la hospitalización y los microorganismos aislados, así como las complicaciones sufridas y la tasa de mortalidad.

Resultados

En este período se realizaron 761 cirugías cervicales mayores. De estas, 96 pacientes presentaron complicaciones (12,6%). Las que con mayor frecuencia se registraron fueron la fístula faringocutánea (FFC) (56%) y la neumonía nosocomial (23%). Fueron aislados 26 tipos de microorganismos, siendo la Pseudomonas aeruginosa la más frecuente (15%). Se registraron 12 fallecimientos. Tras el estudio estadístico con regresión lineal múltiple, se detecta que la necrosis cutánea o del colgajo y la FFC fueron las complicaciones con un mayor impacto estadístico en la estancia hospitalaria. Asimismo, fueron los factores que más influyeron en las hospitalizaciones de 30 días o más.

Conclusión

Una buena evolución durante el período postoperatorio es fundamental para obtener éxito en el tratamiento de los pacientes oncológicos de cabeza y cuello. La FFC y la necrosis de colgajo o cutánea constituyeron las principales complicaciones con un mayor impacto en los resultados obtenidos. La detección precoz de estas complicaciones, así como su tratamiento, son cruciales.

http://bit.ly/2DomK6F

Clinical Experience With Patients With Spasmodic Dysphonia and Primary Meige Syndrome

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): María Fernanda Pedrero-Escalas, Isabel García-López, Susana Santiago-Pérez, Francisco Vivancos, Javier Gavilán

Abstract

Introduction

Meige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS.

Material and methods

A retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner.

Results

Fifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71 years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire.

Conclusion

In the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD.

Resumen

Introducción

El síndrome de Meige (SM) es considerado una distonía craneal segmentaria que afecta a dos o más músculos craneales. Específicamente, asocia blefaroespasmo a otra distonía craneal (oromandibular, cervical o laríngea). El objetivo de este artículo es presentar nuestra experiencia clínica en pacientes con disfonía espasmódica (DE) asociada a SM primario.

Material y métodos

Estudio retrospectivo realizado entre mayo de 2010 y junio de 2015. Incluyó 8 pacientes. Las variables recogidas fueron: sexo, edad, distonías asociadas, electromiografía laríngea y tratamiento. Los resultados clínicos objetivados fueron realizados, siempre por el mismo investigador, con la escala GRBAS(i) y el cuestionario VHI-30.

Resultados

Cincuenta y seis pacientes fueron tratados de SM por el servicio de Neurología. Ocho pacientes asociaron DE (prevalencia 14%). El 100% de nuestros pacientes tenían DE aductora. La mediana de edad para la aparición de DE fue de 71 años. Todos los pacientes fueron tratados con infiltración intralaríngea de toxina botulínica bajo control electromiográfico. Se objetivó mejoría clínica tanto en la escala GRBAS(i) como en los cuestionarios VHI-30.

Conclusión

En el estudio de la DE siempre debe tenerse presente su posible asociación con el SM. Desde el punto de vista otorrinolaringológico, el uso conjunto de la escala GRBAS(i) y los cuestionarios VHI-30 es útil, fiable y eficiente como método para evaluar evolución y respuesta a tratamiento. La infiltración laríngea de toxina botulínica bajo control electromiográfico es la alternativa terapéutica que provee mejores resultados clínicos. El manejo de la DE asociada al SM no difiere del de la DE aislada.

http://bit.ly/2SnINo6

The relationship between health-related quality of life and speech in patients with cleft palate

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Laura Bruneel, Kim Bettens, Kristiane Van Lierde

Abstract

Introduction

In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire.

Materials and methods

Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients.

Results

Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (r_s= -0.476), speech understandability (r_s= -0.657), passive CSC's (r_s= -0.654), speech acceptability (r_s= -0.591) and the need for C(L)P-related speech therapy (r_s= -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire.

Discussion and conclusion:Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.

http://bit.ly/2DozI4a

Radiologic Recognition of Cochlear Implant Magnet Displacement- A Case Report

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Madison V. Epperson, Hayley L. Born, John Greinwald

Abstract

Despite various studies that have demonstrated risk of cochlear implant magnet displacement following MRI, minimal literature is available on radiologic recognition of magnet displacement. Current literature emphasizes the status and placement of the electrode component of the implant. This case report examines the consequences of a delay in radiologic diagnosis of a displaced magnet including hospital admission, unnecessary radiation, and prolonged patient discomfort. Additionally, it provides a framework for successful radiologic recognition of a displaced magnet, detailing specific imaging modalities and magnet characteristics that should be evaluated to expedite and facilitate radiologic recognition of displacement.

http://bit.ly/2SnZEY0

Pediatric Tracheostomy First Tube Change: When is it Safe?

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): R. Woods, L. Geyer, R. Mehanna, J. Russell

Abstract

Objectives

The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

Methods

We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula.

Results

93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure.

Conclusions

This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.

http://bit.ly/2DiUIsY

Genetic diversity of Streptococcus mutans serotype c isolated from white spot and cavitated caries lesions from schoolchildren

Publication date: Available online 8 February 2019

Source: Archives of Oral Biology

Author(s): Ramiro Javier Rincón-Rodríguez, Monica Tatiana Parada-Sanchez, Claudia María Bedoya-Correa, David Arboleda-Toro

Abstract

Objective

To determine the genetic diversity ofStreptococcus mutans (S. mutans) serotype c isolated from white spot and cavitated caries lesions of schoolchildren.

Methods

S. mutans isolates were obtained and identify by Polymerase Chain Reaction (PCR) from 28 schoolchildren. A total of 92 S. mutans isolates, identified as serotype c by PCR, were analyzed by pulsed field gel electrophoresis after digestion of genomic DNA with SmaI enzyme. 62 isolates were obtained from white spot and cavitated caries lesions of schoolchildren that presented both lesions simultaneously and 30 isolates were from saliva and biofilm samples of schoolchildren without dental caries. Cluster analyses were performed using the Dice coefficient of the BioNumerics software version 6.0.

Results

It was possible to determine the serotype in 190 isolates out of 255 isolates identified as S. mutans. Serotype c was the most frequent (n = 139), followed by serotype f (n = 31) and serotype e (n = 20). After analyzing the dendograms of the 92 serotype c isolates, this study identified three strains present in both types of lesions, two strains specific to the type of lesion: one strain from the white spot lesion and one strain from the cavitated caries lesion, and five strains specific to children with caries versus four strains for children without caries.

Conclusion

S. mutans serotype c genetic variability is similar in terms of the number of strains present according to the caries status and type of lesion.

http://bit.ly/2SiMawN

Drop attacks, hydrops severity, and disease duration in hydropic ear disease (Menière’s)

http://bit.ly/2RMNbYQ

The SNOT-22 factorial structure in European patients with chronic rhinosinusitis: new clinical insights

Abstract

Purpose

The sino-nasal outcomes test-22 (SNOT-22) represents the reference questionnaire to assess patients with chronic rhinosinusitis (CRS). As weak correlations between objective CRS parameters and SNOT-22 total score have been observed, factor analyses have aimed to identify underlying factorial structures. However, ambiguous factor loadings and problematic item-domain assignments have resulted. Moreover, such factor analyses have mainly been performed in non-European CRS patients, while European data remain sparse. This study thus sought to address these issues.

Methods

Principal component analysis and confirmatory factor analysis were performed from SNOT-22 questionnaires completed by European CRS patients. Goodness of fit, internal consistencies, and factor loadings were calculated. Item-domain assignment was based on statistical grounds and clinical meaningfulness. Additionally, this study investigated correlations between SNOT-22 domains and external reference criteria, including Lund–Mackay score, Lund–Naclerio score and the brief symptom inventory 18 (BSI-18).

Results

One hundred and thirty-four European CRS patients were included. Principal component analysis proposed four SNOT-22 domains ("nasal symptoms", "otologic symptoms", "sleep symptoms", "emotional symptoms"), which explained 63.6% of variance. Observed item-domain-assignment differed from previously proposed item-domain assignments. All factor loadings were > 0.5, except "cough" (0.42) and "facial pain or pressure" (0.49). For confirmatory factor analysis, satisfactory goodness of fit (RMSEA = 0.66; CFI = 0.92; TLI = 0.90) and internal consistencies (Cronbach-α: total score = 0.93; domains = 0.75–0.91) were observed. Significant positive correlations were found between the "nasal symptoms" domain and both the Lund–Mackay score (r = 0.48; p < 0.001) and the Lund–Naclerio score (r = 0.27, p < 0.01). Significant positive correlations were also identified between "emotional symptoms" and BSI-18 total score (r = 0.64, p < 0.001).

Conclusions

Principal component analysis performed for SNOT-22 questionnaires completed by European CRS patients indicated a different item-domain-assignment than previously reported. Confirmatory factor analysis suggested acceptable and clinically plausible psychometric properties for the resulting factorial structure. Significant correlations between the "nasal symptoms" and the "emotional symptoms" domains were observed with objective CRS parameters. The resulting factorial structure with different item-domain assignments may thus be more suitable for European CRS patients.

http://bit.ly/2WR1DTj

Changes in Maxillary Sinus Volume and It’s Walls Thickness Due to Chronic Rhinosinusitis: A Prospective Study

Abstract

This is a prospective observational cross sectional study comprising of 57 patients who were having symptoms of chronic rhinosinusitis which were evaluated with the help of computed tomography scan (coronal and axial sections) to measure the thickness of all walls of maxillary sinus and it's volume. Computed tomographic imaging of sinonasal region has become the gold standard in the evaluation of patients with chronic sinusitis. The maxillary sinus is pyramidal in shape with lateral wall of nose forming its base and its apex is directed towards zygomatic process. All three dimensions of the maxillary sinus were measured and the volume of each maxillary sinus was also calculated. Hyperostosis of maxillary sinus tended to increase maxillary sinus walls thickness which ultimately results into decrease in maxillary sinus volume in chronic rhinosinusitis patients.

http://bit.ly/2tg2DTv

A New Method Using Tissue Expander Makes Auricular Reconstruction Easier In 115 Microtia Patients

Abstract

1、New method using expander makes auricular reconstruction easier.

2、Most patients were satisfied with reconstructed ears.

3、Reconstructed ears showed good three‐dimensional shape with clear anatomical details and symmetric cranioauricular angle.

4、Retroauricular and chest scars were much smaller.

5、Compared with traditional method,new method takes shorter operation time in the second stage.

This article is protected by copyright. All rights reserved.

http://bit.ly/2SF2ZBj

Transcanal sound recordings as a screening tool in the clinical management of patients with pulsatile tinnitus. A pilot study of twenty patients with pulsatile tinnitus eligible for digital subtraction angiography

Abstract

In pulsatile tinnitus, the differential diagnosis includes neurovascular pathology, which can be occult on non‐invasive imaging techniques. Therefore, if a clear diagnosis is lacking, digital subtraction angiography (DSA) is indicated to rule out a potentially hazardous vascular lesion, particularly a dural arteriovenous fistula (dAVF). However, a DSA carries a procedural risk of 1‐2%.

In a tertiary care setting, the incidence of a dAVF in pulsatile tinnitus patients lacking a diagnosis after non‐invasive imaging is about 25‐35%. Therefore, the majority of this group of patients is unnecessarily exposed to the risks of DSA.

We report on 20 consecutive patients in a tertiary care setting with pulsatile tinnitus who were referred for DSA to rule out neurovascular pathology. We found that the absence of a pulsatile sound detected by transcanal sound recordings, excludes a dAVF (100% sensitivity).

Consequently, the use of transcanal sound recordings as a screening tool may prevent patients for the unnecessary risks of DSA in the diagnostic work‐up of pulsatile tinnitus.

Conventional peri‐auriculair and neck auscultation with stethoscope is not always sufficient to objectify the presence of a pulsatile tinnitus.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MXSV0X

The Effect of Polycythemia Vera on Hearing Functions: Evaluation of Twenty‐one Patients

Abstract

•Patients with PV may present with sensorineural hearing loss, acute hearing loss, and vertigo. The aim of this study was to determine the effect of Polycytemia vera (PV) on hearing functions.

•Patients with known PV (n=21) were compared to healthy controls with no history of otologic or neurologic disorders (n = 20). Cochlear impairment was found to be significantly increased in PV group (p=0,004). There was no statistically significant difference between the groups in means of Hgb and Htc (p=0,629). But

•Platelet count was found to be significantly higher in PV group (p<0,001). The relationship between high platelet counts and cochlear involvement in PV group was found to be statistically significant (p=0,005).

•The degree of cochlear involvement was higher in patients with Hgb value >15,5 g/dL, indicating that high Hgb/Hct levels may cause hearing loss related to cochlear involvement.

•Cochlear involvement was more common in the patients with high platelet counts. The management of PV treatment is important for hearing functions.

This article is protected by copyright. All rights reserved.

http://bit.ly/2SCJw49

Changes in Maxillary Sinus Volume and It’s Walls Thickness Due to Chronic Rhinosinusitis: A Prospective Study

Abstract

This is a prospective observational cross sectional study comprising of 57 patients who were having symptoms of chronic rhinosinusitis which were evaluated with the help of computed tomography scan (coronal and axial sections) to measure the thickness of all walls of maxillary sinus and it's volume. Computed tomographic imaging of sinonasal region has become the gold standard in the evaluation of patients with chronic sinusitis. The maxillary sinus is pyramidal in shape with lateral wall of nose forming its base and its apex is directed towards zygomatic process. All three dimensions of the maxillary sinus were measured and the volume of each maxillary sinus was also calculated. Hyperostosis of maxillary sinus tended to increase maxillary sinus walls thickness which ultimately results into decrease in maxillary sinus volume in chronic rhinosinusitis patients.

http://bit.ly/2tg2DTv

Editorial Board

Publication date: February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 1

Author(s):

http://bit.ly/2RQsNpH

A competing risk nomogram to predict severe late toxicity after modern re-irradiation for squamous carcinoma of the head and neck

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Matthew C. Ward, Nancy Y. Lee, Jimmy J. Caudell, Alexander Zajichek, Musaddiq J. Awan, Shlomo A. Koyfman, Neal E. Dunlap, Sara J. Zakem, Comron Hassanzadeh, Samuel Marcrom, Drexell H. Boggs, Derek Isrow, John A. Vargo, Dwight E. Heron, Farzan Siddiqui, James A. Bonner, Jonathan J. Beitler, Min Yao, Andy M. Trotti, Nadeem Riaz

Abstract

Purpose

Severe late toxicity is common after re-irradiation for recurrent or second primary (RSP) squamous carcinoma of the head and neck. However, many patients experience complications from tumor progression before manifesting late effects. We constructed a nomogram to examine this relationship between late toxicity and competing risks.

Methods and materials

Patients with RSP squamous carcinoma originating in a field previously irradiated to ≥40 Gy and treated with IMRT-based re-irradiation to ≥40 Gy were collected. Grade ≥3 late toxicity developing ≥90 days after re-irradiation was collected. A multivariable competing-risk model was fit to the actuarial risk of late toxicity with progression or death as the competing risk. The final bootstrap optimized model was converted into a nomogram.

Results

From 9 institutions, 505 patients were included. The 2-year incidence of grade ≥3 late toxicity was 16.7% (95% CI 13.2–20.2%) whereas progression or death was 64.2% (95% CI 59.7–68.8%). The median freedom from late toxicity, progression or death was 10.7, 5.5 and 3.2 months for RPA class I-III patients respectively, whereas the median OS was 44.9, 15.9 and 7.9 months, respectively. The final model included six clinical factors. Notably, dose, volume and fractionation did not significantly impact toxicity.

Conclusions

After re-irradiation, the risk of progression or death is approximately four times the risk of radiation-related severe late toxicity. The risk of late toxicity may be more dependent on patient and disease factors than modifiable treatment factors. This model is useful for patient selection, pre-treatment consent and post-treatment survivorship following re-irradiation.

http://bit.ly/2Dp9azW

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

Migraine: Stigma in Society

Abstract

Migraine is a prevalent disease with a substantial socioeconomic impact. However, stigma affects social attitude toward migraine, accruing additional burden on individuals with migraine and isolating them from a society that should be supporting them.

Purpose of this Review

This review will discuss the following concepts: (1) the emergence of stigma toward migraine and its impact on medical care; (2) internalized stigma among those with migraine and its detrimental effect on quality of life and patient-physician relationships; (3) the structural impact of stigma on research funding, workplace support, and specialized care; and (4) strategies for "rebranding" the disease and alleviating stigma toward migraine.

Recent Findings

Recent literature on condition rebranding offers strategies on how to define and communicate migraine to the public.

Summary

Rebranding of migraine to alleviate societal stigma is paramount. This involves use of unified language, education, and advocacy.

http://bit.ly/2Dipja4

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

Article in Thieme eJournals:
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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

Article in Thieme eJournals:
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http://bit.ly/2IanLoC

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

Article in Thieme eJournals:
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http://bit.ly/2GgV4EA

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

Article in Thieme eJournals:
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http://bit.ly/2I2G2Eh

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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http://bit.ly/2GiMftI

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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http://bit.ly/2HWvvu2

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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http://bit.ly/2I2G1Ad

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

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

http://bit.ly/2Gi0AHa

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

Article in Thieme eJournals:
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http://bit.ly/2I033HR

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

Article in Thieme eJournals:
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http://bit.ly/2GmzFKn

Fragen für die Facharztprüfung

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

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://bit.ly/2I1irnh

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

Article in Thieme eJournals:
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http://bit.ly/2GmzE9h

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

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2I095IA

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

Computer Algorithms in Assessment of Obstructive Sleep Apnoea Syndrome and Its Application in Estimating Prevalence of Sleep Related Disorders in Population

Abstract

The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common co-morbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

http://bit.ly/2Diq1UP

Papillary Thyroid Carcinoma with Cervical Lymph Node Metastasis Arising from Lingual Thyroid

Abstract

Although lingual thyroid is the most common site for ectopic thyroid gland but carcinomas originating from lingual thyroid are extremely rare, accounting only for 1% of all ectopic thyroids. Here we represent a young female with a bleeding mass at the base of her tongue and review the diagnostic approach towards papillary thyroid carcinoma of lingual thyroid. The surgical treatment and follow up are discussed. A combination of radiological studies and histological evaluation should be deployed to investigate suspicious lingual thyroids. The perspective of diagnostic and therapeutic approaches for carcinomas of lingual thyroid is the same as orthotopic thyroid tissue.

http://bit.ly/2SfYfmv