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Πέμπτη 6 Μαΐου 2021

Use of Near-Infrared Molecular Imaging For Localizing Visually Occult Parathyroid Glands in Ectopic Locations

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This proof-of-principle clinical trial examines use of intraoperative molecular imaging for localizing visually occult parathyroid glands in both anatomic and ectopic locations.
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Prognostic Role of Tumor‐Infiltrating Lymphocytes and Tumor Budding in Early Oral Tongue Carcinoma

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Objectives/Hypothesis

Occult lymph metastasis is an important prognosticator for the treatment of early oral tongue squamous cell carcinoma (SCC). The objective of this study was to evaluate the prognostic significance of tumor‐infiltrating lymphocytes (TILs) in early oral tongue SCC. The combination of the TIL subtype and intermediate‐ or high‐grade budding scores was investigated as a prognostic marker for occult neck metastases.

Study Design

Retrospective study.

Methods

Specimens from 62 patients with early oral tongue SCC treated with only primary surgery were analyzed by immunohistochemistry for CD4+, CD8+, FoxP3+, and CD45RO+ T cells and CD163+ macrophages. The highest number of each TIL subtype was counted in two areas of parenchyma and stroma in the tumor (Tumor) and peripheral stroma of the invasion margin.

Results

Based on multivariate analysis, a high density of Tumor CD163+ macrophages served as the poorest prognostic factor for regional control (RC) and disease‐free survival (DFS). Patients with both a high density of Tumor CD163+ macrophages and an intermediate‐ or a high‐grade budding score had a poor prognosis for RC according to the log‐rank test.

Conclusions

In summary, each TIL subtype may use different mechanisms during early and advanced stages of oral tongue SCC. A high density of Tumor CD163+ macrophages was determined to be a risk factor for RC and DFS as well as an additional stratification factor for RC in patients with intermediate‐ or high‐grade budding scores. Therefore, identifying TIL subtypes in daily clinical practice can help determine a more successful and individualized therapeutic approach for early oral tongue SCC.

Level of Evidence

Step 4 (Level 4) Laryngoscope, 2021

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Intratympanic Lipopolysaccharide Elevates Systemic Fluorescent Gentamicin Uptake in the Cochlea

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Objectives/Hypothesis

Lipopolysaccharide (LPS), a key component of bacterial endotoxins, activates macrophages and triggers the release of inflammatory cytokines in mammalian tissues. Recent studies have shown that intratympanic injection of LPS simulates acute otitis media (AOM) and results in morphological and functional changes in the inner ear. Here we established an AOM mouse model with LPS to investigate the uptake of ototoxic gentamicin in the inner ear, and elucidated the underlying mechanism by focusing on cochlear inflammation as a result of AOM.

Study Design

Preclinical rodent animal model.

Methods

Fluorescently tagged gentamicin (GTTR) was systemically administered to mice with AOM. Iba1‐positive macrophage morphology and inner ear cytokine profile were evaluated by immunofluorescence technique and a mouse cytokine array kit, respectively.

Results

We observed characteristic symptoms of AOM in the LPS‐treated ears with elevated hearing thresholds indicating a conductive hearing loss. More importantly, the LPS‐induced AOM activated cochlear inflammatory responses, manifested by macrophage infiltration, particularly in the organ of Corti and the spiral ligament, in addition to the up‐regulation of proinflammatory cytokines. Meanwhile, GTTR uptake in the stria vascularis and sensory hair cells from all the LPS‐treated ears was significantly enhanced at 24, 48, and 72‐hour post‐treatment, as the most prominent enhancement was observed in the 48‐hour group.

Conclusion

In summary, this study suggests that the pathological cochlea is more susceptible to ototoxic drugs, including aminoglycosides, and justified the clinical concern of aminoglycoside ototoxicity in the AOM treatment. Laryngoscope, 2021

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Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

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Objectives/Hypothesis

We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability.

Study Design

Retrospective Study.

Methods

Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale.

Results

Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0–3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS‐2 and BDSS‐3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS‐1 (mild) or BDSS‐2. History of multiple and prolonged intubations were seen more frequently in BDSS‐2 or BDSS‐3. Post‐op pVHI reduced an average of 15 points for BDSS‐0 to BDSS‐2, but only 3 points for BDSS‐3. Post‐op pVHI matched normal values for preintervention dysphonic children.

Conclusions

The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher‐grade BDs, whereas low GA is more likely to be associated with BDSS‐1 to BDSS‐2.

Level of Evidence

4 Laryngoscope, 2021

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A Rare Case of Desmoplastic Fibroma. Spontaneous Mandibular Regeneration with 3 Years Follow up – Case Report

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Abstract

Desmoplastic fibroma is a benign, rare, but locally aggressive lesion. The intraosseous type rarely presents in the jaws. Desmoplastic fibroma represents the intraosseous counterpart of the soft tissue fibromatoses or desmoid tumor, affects predominantly young people with an affinity for the mandible. The aim of this article is to describe a rare case of spontaneous bone regeneration after resection of intraosseous type of Desmoplastic fibroma. We report a case of intraosseous Desmoplastic fibroma involving right body and ramus of the mandible of a 17 years old, male patient, that underwent surgical procedure by Risdon access to remove all lesion with 1 cm free margins and reconstructed with 2.4 mm plate. After 3 years follow up, spontaneous bone regeneration was found with no signs of recurrence of the lesion. In conclusion, cases of spontaneous bone regeneration after mandibular resection is rare and there are few studies and case report in the literature.

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Reweighting of Binaural Localization Cues Induced by Lateralization Training

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Abstract

Normal-hearing listeners adapt to alterations in sound localization cues. This adaptation can result from the establishment of a new spatial map of the altered cues or from a stronger relative weighting of unaltered compared to altered cues. Such reweighting has been shown for monaural vs. binaural cues. However, studies attempting to reweight the two binaural cues, interaural differences in time (ITD) and level (ILD), yielded inconclusive results. This study investigated whether binaural-cue reweighting can be induced by lateralization training in a virtual audio-visual environment. Twenty normal-hearing participants, divided into two groups, completed the experiment consisting of 7 days of lateralization training, preceded and followed by a test measuring the binaural-cue weights. Participants' task was to lateralize 500-ms bandpass-filtered (2–4 kHz) noise bursts containing various combinations of spatially consistent and inconsistent binaural cues. D uring training, additional visual cues reinforced the azimuth corresponding to ITDs in one group and ILDs in the other group and the azimuthal ranges of the binaural cues were manipulated group-specifically. Both groups showed a significant increase of the reinforced-cue weight from pre- to posttest, suggesting that participants reweighted the binaural cues in the expected direction. This reweighting occurred within the first training session. The results are relevant as binaural-cue reweighting likely occurs when normal-hearing listeners adapt to new acoustic environments. Reweighting might also be a factor underlying the low contribution of ITDs to sound localization of cochlear-implant listeners as they typically do not experience reliable ITD cues with clinical devices.

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Characterization of the mechanical properties of human parietal bones preserved in modified larssen solution, formalin and as fresh frozen

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Surg Radiol Anat. 2021 May 5. doi: 10.1007/s00276-021-02762-1. Online ahead of print.

ABSTRACT

PURPOSE: Although the fresh frozen (FF) cadaver is preferred for surgical applications, it is limited due to short usage time, unsuitable for reuse and the risk of infection. Due to its limited use, FF cadavers, which are covered by import in countries with insufficient body donation cause low-cost effectiveness. With the increase of real human tissue specimen necessities for surgi cal training, long-term preservation of the cadavers is crucial due to changes in mechanical properties. Therefore, studies on embalming solutions have increased in recent years.

METHODS: We quantify the biomechanical properties of human parietal bones preserved via modified larssen solution (MLS) and compare the results with the specimens preserved as FF and fixed with 10% formalin-based solution (F10). The rectangular samples of 24 parietal bones of male individuals were resected from MLS-embalmed, F10-embalmed and FF cadavers to form three groups each containing eight samples. These specimens were tested longitudinally to identify mechanical properties.

RESULTS: The tensile test results showed that there is not a significant difference between the groups in terms of stiffness, elastic modulus, strain at ultimate stress, failure strain and effective plastic strain. However, the yield stress, ultimate stress, yield strain, failure stress and total energy and post-yield properties are significantly lower in F10 than MLS and FF groups.

CONCLUSION: It is observed that the mechanical properties of MLS preserved and FF parietal bones have almost similar properties. Thus, it can be concluded that MLS is a suitable fixative solution for bone studies and bone-related surgical anatomy training applications.

PMID:33954823 | DOI:10.1007/s00276-021-02762-1

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Content validity of the tinnitus outcome questionnaire for sound management

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Via Tinnitus

journal.pone.0251244.t002&size=inline

by Hye Yoon Seol, Ga-Young Kim, Mini Jo, Soojin Kang, Young Sang Cho, Sung Hwa Hong, Il Joon Moon

Standardized instruments are often used to monitor one's progress in tinnitus relief although they were developed to screen and diagnose tinnitus. The need for the development for a tinnitus outcome assessment tool is high in the field of audiology and otolaryngology. The purpose of this study was to develop a tinnitus outcome questionnaire for sound management (listening to sound stimuli for tinnitus relief) and assess its content validity. A total of 32 questions with six domains (Tinnitus characteristics, the impact of tinnitus, tinnitus and hearing issues, handedness, tinnitus management, and sound management outcome) were generated after closely investigating major tinnitus questionnaires used worldwide (i.e. Tinnitus Handicap Inventory and Tinnitus Handicap Questionnaire) as well as literature. Ten healthcare professionals evaluated the appropriateness of the questionnaire items on a five-point Likert scale, where 1 is strongly inappropriate and 5 is strongly appropriate. Con tent relevance was assessed by computing the content validity index with the cut-off value of 0.75. Each response was first weighted as follows: 1 = 0; 2 = 0.25; 3 = 0.5; 4 = 0.75; and 5 = 1.0. The weighted average was then calculated. Items with a content validity index less than 0.75 were discarded and some items were revised according to the experts' feedback. As a result, 31 out of the 32 items had the content validity index higher than 0.75, indicating that the items are appropriate to obtain information about the six domains. Reflecting the experts' feedback, some questions were revised to be more specific. The study provides a baseline structure regarding potential questions to be included in a tinnitus outcome questionnaire for sound management. Development and standardization of such questionnaire would be a pathway to validating tinnitus relief via sound therapy.
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Sound localization with bilateral bone conduction devices

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Eur Arch Otorhinolaryngol. 2021 May 6. doi: 10.1007/s00405-021-06842-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate sound localization in patients bilaterally fitted with bone conduction devices (BCDs). Additionally, clinically applicable methods to improve localization accuracy were explored.

METHODS: Fifteen adults with bilaterally fitted percutaneous BCDs were included. At baseline, sound localization, (un)aided pure-tone thresholds, device use, speech, spatial and qualities of hearing scale (SSQ) and York hearing-related quality of life (YHRQL) questionnaire were measured. Settings to optimize sound localizing were added to the BCDs. At 1 month, sound localization was assessed again and localization was practiced with a series of sounds with visual feedback. At 3 months¸ localization performance, device use and questionnaire scores were determined again.

RESULTS: At baseline, one patient with congenital hea ring loss demonstrated near excellent localization performance and four other patients (three with congenital hearing loss) localized sounds (quite) accurately. Seven patients with acquired hearing loss were able to lateralize sounds, i.e. identify whether sounds were coming from the left or right side, but could not localize sounds accurately. Three patients (one with congenital hearing loss) could not even lateralize sounds correctly. SSQ scores were significantly higher at 3 months. Localization performance, device use and YHRQL scores were not significantly different between visits.

CONCLUSION: In this study, the majority of experienced bilateral BCD users could lateralize sounds and one third was able to localize sounds (quite) accurately. The localization performance was robust and stable over time. Although SSQ scores were increased at the last visit, optimizing device settings and a short practice session did not improve sound localization.

PMID:33956208 | DOI:10.1007/s00405-021-06842-1

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Low skeletal muscle mass predicts frailty in elderly head and neck cancer patients

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Eur Arch Otorhinolaryngol. 2021 May 6. doi: 10.1007/s00405-021-06835-0. Online ahead of print.

ABSTRACT

PURPOSE: Treatment of head and neck cancer (HNC) carries a high risk of adverse outcomes in patients, especially in frail elderly. Therefore, it is important to identify patients in which treatment benefits outweigh the risk of any adverse outcome. Although the comprehensive geriatric assessment (CGA) identifies frailty, it is a time-consuming tool. Instead, measurement of skeletal muscle mass and strength (sarcopenia) may be a promising and time-efficient biomarker for frailty. The aim of this study was to examine the association between sarcopenia and frailty assessment tools, such as the CGA, Fried criteria and the Groningen Frailty Indicator (GFI).

METHODS: A retrospective study was performed in elderly patients (≥ 70-years) with HNC. Sarcopenia was defined as the combination of reduced handgrip strength (HGS) and low ske letal muscle mass (SMM), according to the EWGSOP-2 criteria. SMM was measured on routinely available diagnostic imaging and corrected height: skeletal muscle index (SMI). A CGA was performed by a geriatrician. Frailty screening was performed using the GFI and the Fried criteria.

RESULTS: In total, 73 patients were included of which 33 were men (45.2%) and 40 women (54.8%). Frail patients diagnosed by CGA were more likely to have low SMI, sarcopenia, more comorbidities and were at high risk for malnutrition (all p < 0.05). In multivariate regression analysis, the only significant predictor for frailty diagnosed by CGA was SMI (OR 0.9, p < 0.01) independent of comorbidity and muscle strength.

CONCLUSION: Low SMI and sarcopenia are associated with frailty in elderly HNC patients. Low SMI predicts frailty and is a promising time-efficient and routinely available tool for clinical practice.

PMID:33956205 | DOI:10.1007/s00405-021-06835-0

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Effects of chitosan and platelet-rich plasma on facial nerve regeneration in an animal model

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Eur Arch Otorhinolaryngol. 2021 May 6. doi: 10.1007/s00405-021-06859-6. Online ahead of print.

ABSTRACT

PURPOSE: There is still no widely-accepted local agent proven to be effective in nerve regeneration. We aimed to investigate the effects of chitosan gel and platelet-rich plasma MATERIALS AND METHODS: Electrophysiological measurements were performed before and immediately after injury. The injured nerves were covered with spongostan impregnated with the following agents: Group 1 (Control Group): Saline at a dose of 50 µl; Group 2: Chitosan (CHT) at a dose of 50 µl; Group 3: PRP at a dose of 50 ml; and Group 4: a solution of CHT with PRP (1:1). The final measurements were performed after 3 weeks and the injured nerve of each rat was removed.

RESULTS: There were statistically-significant differences between the groups regarding the measurements of the after-treatment values of stimulus threshold (p < 0.05). The best improvem ent in electrophysiological measurement and histopathological evaluation was found in Group 4 (CHT-PRP).

CONCLUSION: Chitosan gel has a positive effect on nerve healing and applying it along with PRP can enhance the effect of chitosan.

PMID:33956207 | DOI:10.1007/s00405-021-06859-6

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