Neural Switch Asymmetry in Feature-Based Auditory Attention Tasks

Abstract

Active listening involves dynamically switching attention between competing talkers and is essential to following conversations in everyday environments. Previous investigations in human listeners have examined the neural mechanisms that support switching auditory attention within the acoustic featural cues of pitch and auditory space. Here, we explored the cortical circuitry underlying endogenous switching of auditory attention between pitch and spatial cues necessary to discern target from masker words. Because these tasks are of unequal difficulty, we expected an asymmetry in behavioral switch costs for hard-to-easy versus easy-to-hard switches, mirroring prior evidence from vision-based cognitive task-switching paradigms. We investigated the neural correlates of this behavioral switch asymmetry and associated cognitive control operations in the present auditory paradigm. Behaviorally, we observed no switch-cost asymmetry, i.e., no performance difference for switching from the more difficult attend-pitch to the easier attend-space condition (P→S) versus switching from easy-to-hard (S→P). However, left lateral prefrontal cortex activity, correlated with improved performance, was observed during a silent gap period when listeners switched attention from P→S, relative to switching within pitch cues. No such differential activity was seen for the analogous easy-to-hard switch. We hypothesize that this neural switch asymmetry reflects proactive cognitive control mechanisms that successfully reconfigured neurally-specified task parameters and resolved competition from other such "task sets," thereby obviating the expected behavioral switch-cost asymmetry. The neural switch activity observed was generally consistent with that seen in cognitive paradigms, suggesting that established cognitive models of attention switching may be productively applied to better understand similar processes in audition.

http://bit.ly/2R90hiL

Kimura’s Disease: A Diagnostic and Therapeutic Challenge

Abstract

Kimura's disease, also known as Eosinophilic Granuloma, is a rare chronic condition seen mainly in Oriental population. It presents with subcutaneous nodules, lymphadenopathy, salivary gland hypertrophy with peripheral eosinophilia and raised serum IgE levels; rarely renal involvement may also be present. Its etiology mainly remains unknown. We present a case series of two patients. Our first case is a middle aged female which presented with a parotid swelling, mimicking a parotid neoplasm. Further investigations revealed associated intra-parotid and cervical lymphadenopathy. An excisional biopsy in the form of Superficial Parotidectomy with lymph node excision was done. Histopathological examination of the excised specimen revealed it to be a case of Kimura's disease. Our second case, a young adult, presented with a gradually increasing post-auricular swelling. Preliminary investigations in this case pointed towards Kimura's disease. Excision biopsy of the lesion was done. Histopathological studies confirmed the diagnosis for the same. Both the patients are under our regular follow up and remain disease-free at a follow up of 1 year and 8 months respectively.

http://bit.ly/2HqWP3e

An Immunohistochemical Study of HIF-1 Alpha in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma

Abstract

To evaluate and compare the expression of HIF-1 Alpha (HIF-1α) in oral epithelial dysplasia (OED) and various grades of Oral squamous cell carcinoma (OSCC). 30 cases each of OEDand OSCC were stained with HIF-1α antibody. Quantification of HIF-1α positive cellswas carried out and the data was statistically analysed. The mean % HIF-1α labeling index (HIF-1α LI) increased significantly from mild OED (32.11%), moderate OED (55.07%), to severe OED (64.58%). There was a statistically significant increase in the expression of HIF-1α as grades of OED increased. The mean HIF-1α LI % in well differentiated OSCC was 46.3%, Moderately differentiated OSCC—76.31% and Poorly differentiated OSCC—89.9%. The mean HIF-1α LI was found to increase with increasing grades of OSCC which was statistically significant (P < 0.05). Further a comparison of mean HIF-1α LI in OED with different histologic grades of OSCC by Independent samples t test was performed. We found statistically significant difference between OED and moderately differentiated OSCC and OED and poorly differentiated OSCC (P = 0.000). Progressive increase in expression of HIF-1α was noted from OED to OSCC. It can be postulated that epithelial dysplastic lesions with increased HIF-1α expression are at greater risk of malignant transformation, suggesting that the expression of HIF-1α is an early event in oral carcinogenesis.

http://bit.ly/2S4Uq2r

To Be Cautious or Not: Tension Pneumothorax After First Tracheostomy Tube Exchange

Abstract

Tracheostomy tube change is a relatively common procedure once a tracheo-cutaneous tract matures. Regular tracheostomy tube changes prevent the formation of granulation tissue and reduce bacterial colonization (Yaremchuk and Yaremchuk in Laryngoscope 113(1):1–10, 2003). However, serious complications such as subcutaneous emphysema, loss of airway and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of tension pneumothorax following a tracheostomy tube exchange in a 50-year-old patient who underwent tracheotomy 3 days back. The patient was successfully managed conservatively with chest tube and supportive care.

http://bit.ly/2RWz3R1

Evaluation of Quality of Life and Pattern of Improvement of Bronchial Asthma in Chronic Rhinosinusitis Patients Treated by Functional Endoscopic Sinus Surgery

Abstract

Chronic inflammatory disorders of the upper airways are extremely prevalent and have a major impact on public health. Sinusitis and bronchial asthma are closely interrelated diseases and sinusitis is known to influence bronchial asthma in its severity and chronicity. Causal relationships have been proposed but not yet proved. The relationship between sinusitis and asthma is academically interesting and has important diagnostic and therapeutic implications. The present study is designed to evaluate the efficacy of functional endoscopic sinus surgery done as treatment for chronic rhinosinusitis on bronchial asthma patients, in terms of quality of life and pattern of improvement. Objectives of the study were to determine whether bronchial asthma and quality of life improved after functional endoscopic sinus surgery. This was an open labelled randomised control trial, done at ENT Department of Medical College, Thiruvananthapuram. Those in Group A underwent functional endoscopic sinus surgery and group B patients were given only medicines as per standard protocol. All of them received asthma treatment depending on asthma attacks and severity and followed up at specific intervals. Quality of life status and pattern of improvement of bronchial asthma among these patients were evaluated. Patients of chronic rhinosinusitis treated by functional endoscopic sinus surgery showed significant improvement in the mean asthma symptom score, asthma medication use score, pulmonary function test results, and quality of life assessment scores. Functional endoscopic sinus surgery could be considered early in the natural course of chronic rhinosinusitis with concomitant bronchial asthma.

http://bit.ly/2FHHo58

Leiomyosarcoma of Mandible: A Diagnostic Dilemma; Case Report and Review of Literature

Abstract

Leiomyosarcoma and its pleomorphic variant are rare entities in the head and neck region. Since they usually present as slow growing, discrete firm, and non-ulcerated painless mass, they seem to be deceptively benign and are thus misdiagnosed. Histopathological and immunohistochemical studies are the ways of getting a definitive diagnosis. Till date surgery has been the primary treatment but effectiveness of radiotherapy/chemotherapy is still questionable. Here, we describe a case of leiomyosarcoma in mandible along with discussion about the ways of diagnosis, its differentiation with its pleomorphic variant and their managements.

http://bit.ly/2CxPUQ7

Complications of Paediatric Cochlear Implantation in the Population of Uttarakhand

Abstract

Cochlear implants surgery is now routinely done at this center. Complications which have been experienced in cochlear implant surgery at our center are discussed, as a detailed knowledge about the complications and their early anticipation can save an expensive device and most importantly patients morbidity. To discuss the complications of the paediatric cochlear implantation in the population of Uttarakhand. The total of 60 patients were included in this study (age group 1–5 years) who had undergone the cochlear implantation surgery between Sept. 2015 and Sept. 2016. These patients were regularly monitored and followed up for 1 year. All the surgeries were performed by same team of surgeons. Rate of minor complications is 8.33% (reversible facial nerve paresis, injury to chorda tympani nerve, local skin reaction, perilymph gussher) and major complications is 5% (implant rejection and flap necrosis). The various complications should be closely monitored by the surgeon so that these can be avoided.

http://bit.ly/2RDtXd5

Suitable Alternative for Human Cadaver Temporal Bone Dissection: Comparative Micro Ear Anatomy of Cattle, Pig and Sheep with Human

Abstract

The study was undertaken to compare the micro ear anatomy of three commonly available animal models which are expected to have similar anatomy to human and to find out suitable model among them as an alternative for human cadaver temporal bone dissection. This is an observational study of comparison of micro ear anatomy of the three animal models with human. Decapitated heads of cattle, pig and sheep were collected from slaughter houses, soft tissues along with brain were removed and preserved in commercially available formalin preservative. CT scan was taken for the three specimens and 3D reconstructions were done. Each specimen was subjected to micro dissection and the anatomical features were studied and compared with human. Among the three animal models sheep is found to be an ideal model for a beginner because of ease of exposure of bone, very thin cortical bone, and no cellularity, good exposure of all the middle ear structures and similar interrelations of middle ear structures with human. Pig may not be an ideal model because of abundant fatty soft tissues, thick periosteum very narrow space occupied by the middle ear, difficulty in accessing cellularity small fragile ossicular chain and overhanging facial nerve.

http://bit.ly/2FMC6ES

A Study on Deep Neck Space Infections

Abstract

Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Management of DNSI is traditionally based on prompt surgical drainage of the abscess followed by antibiotics or nonsurgical treatment using appropriate antibiotics in the case of cellulitis. This study was conducted to investigate the age and gender, clinical symptoms, site involved, etiology, co-morbidities, bacteriology, complications and outcomes in the patients of DNSI. A prospective study of deep neck space infections was conducted during the period July 2017 to July 2018 on the patients who attended the outpatient department and were admitted as inpatient in Safdarjung hospital, New Delhi. 40 Cases with DNSI all ages and both genders were included in the study. Patients who didn't require surgical intervention to drain pus were excluded. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied. Due to advent of antibiotics, deep neck space infections are in decreasing trend. The common age group found to be affected is in 2nd and 3rd decade in our study. Out of all deep neck space infections, submandibular space infections were common (37.5%) followed by peritonsillar infections (12.5%). Infection of deep neck space remains fairly common and challenging disease for clinicians. Prompt recognition and treatment of DNSI are essential for an improved prognosis. Odontogenic and tonsillopharyngitis are the commonest cause. Key elements for improved results are the prompt recognition and early intervention. Special attention is required to high-risk groups such as diabetics, the elderly and patients with underlying systemic diseases as the condition may progress to life-threatening complications.

http://bit.ly/2FFiwLh

Teaching Ear Examination Skill to Undergraduate Students Using Check List

Abstract

For examination of ear, proper illumination is a pre requisite. Diseases related to ear may lead to altered sense of hearing and may affect normal balance system. If students are taught to examine ear using a check list, they may perform better. To teach ear examination to undergraduate students using a check list. Total 50 undergraduate students of M.B.B.S. attending E.N.T. clinic in Chirayu Medical College and Hospital were included in the study. They were given enrolment no. 1 to 50 and were divided into two groups. Group 1, enroll. no. 1 to 25 and group 2, enroll. no. 26 to 50. Group 1 was taught using check list and the Group 2 was taught without use of checklist. Both the groups were evaluated using check list. The group B students were again taught, using check list and were again evaluated using check list. Use of check list showed that there was statistically significant improvement in learning by students using check list in group 1 students compared to group 2 students who were taught without use of check list. The group 2 students also had improvement on evaluation, after they were taught using check list. Study suggests that use of check list for ear examination skill to undergraduate students has significant role and students learn better than when taught without use of checklist. Inclusion of checklist for teaching ear examination to undergraduate students may be considered.

http://bit.ly/2FLzHKp

Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis

Abstract

Sudden sensorineural hearing loss is a dire medical emergency which must be treated at the earliest to get better long term hearing results. Our study aims to determine the efficacy of intratympanic steroid (Methylprednisolone) on auditory outcomes in patients of sudden sensorineural hearing loss and study the relation between time of onset of hearing loss to start of therapy and frequency-wise recovery of hearing loss. A prospective cohort clinical study with 33 patients with sudden hearing loss of 30 dB or more were treated with the intratympanic injection of methylprednisolone and the effect of the drug was observed. In this study, 33 patients with sudden onset (unilateral or bilateral) of hearing loss were treated with intratympanic methylprednisolone. The duration at which the drug was administered and the age of the participants was taken into consideration. Main outcome measures included audiometry results at low, medium and high hearing loss frequencies. The specific frequency at which the hearing improvement took place was tabulated. It was observed that hearing improved significantly if the steroid is injected within the first 4 days of onset (p < 0.05) at all the frequencies. A gain of 15 dB or more was achieved in more than 78% patients after injecting methylprednisolone intratympanically. A statistically significant association was found between recovery rate and frequency of hearing loss with patients showing greater improvement at low hearing loss frequency in comparison to mid and high frequencies (p < 0.05). The drug efficacy does not change with the age of the patient.

http://bit.ly/2RVKxnH

Reconstructive Ladder for Transoral Resections of Oropharyngeal Cancers

Abstract

Purpose of Review

Transoral robotic surgery (TORS) now offers extended reach and capability to the head and neck oncologic surgeon, but in doing so, provides a reconstructive dilemma. The objective of this manuscript is to discuss the most recent advances and options available after resection with TORS.

Recent Findings

The latest research provides a common framework for surgeons to classify the type of oropharyngeal defect. A variety of reconstructive options described include secondary intent, modifications to existing local and regional flaps, and advances utilizing robotic assistance in free flap reconstruction.

Summary

There exists a multitude of reconstructive options with appropriate considerations for a stepwise approach based on patient-specific factors, surgeon capability, and the extent of the oropharyngeal defect. Just as robotic resection extends the capability in extirpation, it is now being used to refine free flap inset in the appropriate case.

http://bit.ly/2G0G0tU

Technical Challenges in Temporal Bone Paraganglioma Surgery: a Clinical Review

Abstract

Purpose of the Review

Temporal bone paragangliomas have always presented the otologist with their ultimate challenge. Surgical management is difficult, dangerous and demanding. It is also often associated with increased cranial nerve deficits and decreased quality of life for the patient. Management protocols for patients with temporal bone paragangliomas are changing as a result of advances in knowledge and technical developments. Multi-disciplinary care is now recommended for most patients with surgical intervention becoming restricted for the most difficult tumours.

Recent Findings

Previously considered unresponsive or resistant to radiotherapy, recent experiences using stereotactic radiosurgery techniques suggest that this is not correct. Tumour growth can be halted in some and slowed down in others. Advances in molecular medicine have defined a number of paraganglioma predisposition syndromes. Recognition of these syndromes is essential. Paragangliomas are now considered to be pioneer models of genetic-based personalised medical care.

Summary

This review aims to define the best current management plan for paragangliomas arising in, or involving, the temporal bone. It alerts surgeons to critical phases of surgical technique.

http://bit.ly/2FRV7Xj

Consumer Technology for Sleep-Disordered Breathing: a Review of the Landscape

Abstract

Purpose of Review

The consumer market for devices that quantify sleep is quickly evolving. We conducted a review of the consumer technology available for sleep disorders, including its potential and limitations to screen obstructive sleep apnea (OSA).

Recent Findings

There are many commercial devices claiming to objectively measure sleep, but only a few are tested rigorously in research. We critically review the technology available, including its overall ability to provide objective measures of sleep (total sleep time (TST), sleep efficiency (SE), sleep latency (SL), wake after sleep onset (WASO)), and to estimate apnea-hypopnea indexes in OSA patients.

Summary

Although consumer devices performed similarly to standard actigraphy, they still overestimated TST and SE, and underestimated WASO and SL. Biomotion sensors and mattress-based devices showed potential for use as an OSA screening tool. However, research in the sleep-disordered breathing (SDB) population is limited, needs further external validation, and should be implemented in the course of multiple days.

http://bit.ly/2G2Pdle

Drug-Induced Sleep Endoscopy as a Tool for Surgical Planning

Abstract

Purpose of Review

To review whether drug-induced sleep endoscopy (DISE) aids in obstructive sleep apnea surgical planning, if it changes the initial proposal, and if so, does it contribute to increased surgical success or unnecessary morbidity?

Recent Findings

A DISE and surgical outcomes multicenter cohort study (n = 275) reported no association for surgical outcomes with velopharyngeal and epiglottic collapse. Oropharyngeal and tongue base collapse on the other hand were associated with lower odds of surgical response.

Summary

DISE changes surgical planning mainly in regard to the approach of the tongue base and epiglottis, as these structures usually do not collapse in the awake state. The decision of velopharyngeal surgery usually does not change, as the vast majority demonstrate velopharyngeal collapse in DISE. Whether DISE increases or not, surgical success is controversial, with conflicting published data. However, poorer surgical outcomes have been associated with velopharyngeal concentric, oropharyngeal lateral wall, and tongue base collapse.

http://bit.ly/2FP5RFP

Clinical Outcomes in OSA—SLEEP GOAL—a More Holistic Approach

Abstract

Purpose of Review

Obstructive sleep apnea (OSA) is a systemic disease that is due to a narrow upper airway that collapses and obstructs during sleep, which results in frequent nocturnal hypoxemia, sympathetic overdrive, tachycardia, nocturnal hypertension, and oxidative metabolic stress. Symptoms include unrefreshed sleep, daytime tiredness, loss of memory, irritability, lack of concentration, poor work productivity, poor quality of life (QOL), mood swings, and even depression. This upper airway disorder can lead to systemic diseases such as hypertension, cardiovascular events, myocardial infarct, and fatal arrhythmias.

Recent Findings

The standard diagnostic test for OSA is commonly assumed to be the overnight polysomnography (PSG); however, it is widely known that there is discordance between the levels of AHI (apnea–hypopnea index) used to denote outcomes/success of therapy and real-world clinical outcomes such as QOL, patient perception of disease, cardiovascular measures, and/or survival.

Summary

Hence, the use of a single parameter AHI is inadequate and unrealistic; sleep specialists need more holistic and less biased parameters to assess treatment outcomes. Some of these parameters include snoring level, sleep satency, execution time, Epworth Sleepiness Scale, blood pressure, gross weight (BMI), oxygen duration below 90%, AHI, and QOL scores.

http://bit.ly/2G3jRv1

Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa

Abstract

White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.

http://bit.ly/2U9yVL4

A Rare Presentation of Inflammatory Myofibroblastic Tumor in the Nasolabial Fold

Inflammatory myofibroblastic tumor (IMT) is a benign lesion that occurs most frequently in the soft tissues and viscera. In the head and neck region, the tumor has been reported to occur in the orbit, tongue, nasopharynx, larynx, and paranasal sinuses and the central nervous system. Despite being a benign lesion, it exhibits infiltrative and destructive behaviours, making histopathological examination necessary to confirm the diagnosis. We report the case of a 38-year-old female presented with a right nasolabial fold mass, which was confirmed histologically to be an IMT. Surgical excision of the mass was achieved through a sublabial approach with an uneventful postoperative period. To the best of our knowledge, this is the first reported case of an IMT in the nasolabial fold.

http://bit.ly/2AX43X8

A Case of Respiratory Epithelial Adenomatoid Hamartoma (REAH) in a Patient with History of Radiation Exposure

Respiratory epithelial adenomatoid hamartomas (REAHs) are becoming a more commonly recognized otolaryngologic tumor and are often misdiagnosed as inverted papilloma. Here, we present such a case in a patient with history of previous radiation exposure. Otolaryngologists and pathologists should be aware of the mucinous histological appearance of REAH to help differentiate from other growths. Given our patient's history, an association between REAH and previous radiation exposure is worth consideration.

http://bit.ly/2Dppt0Y

VideoEndocrinology™ New Open Access Video

Parapharyngeal Dissection for Papillary Thyroid Cancer
Justin Tran, Mark Zafereo 

The post VideoEndocrinology™ New Open Access Video appeared first on American Thyroid Association.

http://bit.ly/2T4XFEg