OtoRhinoLaryngology News: 11/13/15

Παρασκευή 13 Νοεμβρίου 2015

[Congenital neck mass. Diagnosis and treatment].

[Congenital neck mass. Diagnosis and treatment].

Semergen. 2015 Nov 7;

Authors: Muñoz-Proto F, Sarría-Echegaray P, Epprecht-González MP, Alba-Mesquida J

Abstract
Congenital neck masses are a challenge for general practitioners and specialists. Although some of them are diagnosed in utero, most of them remain silent until complications appear in the adult age. The anatomical location, consistency and age are determinants in guiding the possible diagnosis. A midline infrahyoid mass may be a thyroglossal cyst, however a lateral neck mass is more possible to result in a brachial cyst. Complementary imaging studies are essential such as pathological tests like needle aspiration fine needle aspiration (FNA).

PMID: 26558520 [PubMed - as supplied by publisher]

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Optimizing frequency-to-electrode allocation for individual cochlear implant users.

Optimizing frequency-to-electrode allocation for individual cochlear implant users.

J Acoust Soc Am. 2014 Dec;136(6):3313

Authors: Grasmeder ML, Verschuur CA, Batty VB

Abstract
Individual adjustment of frequency-to-electrode assignment in cochlear implants (CIs) may potentially improve speech perception outcomes. Twelve adult CI users were recruited for an experiment, in which frequency maps were adjusted using insertion angles estimated from post-operative x rays; results were analyzed for ten participants with good quality x rays. The allocations were a mapping to the Greenwood function, a compressed map limited to the area containing spiral ganglion (SG) cells, a reduced frequency range map (RFR), and participants' clinical maps. A trial period of at least six weeks was given for the clinical, Greenwood, and SG maps although participants could return to their clinical map if they wished. Performance with the Greenwood map was poor for both sentence and vowel perception and correlated with insertion angle; performance with the SG map was poorer than for the clinical map. The RFR map was significantly better than the clinical map for three participants, for sentence perception, but worse for three others. Those with improved performance had relatively deep insertions and poor electrode discrimination ability for apical electrodes. The results suggest that CI performance could be improved by adjustment of the frequency allocation, based on a measure of insertion angle and/or electrode discrimination ability.

PMID: 25480076 [PubMed - indexed for MEDLINE]

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Perceptual learning of temporally interrupted spectrally degraded speech.

Perceptual learning of temporally interrupted spectrally degraded speech.

J Acoust Soc Am. 2014 Sep;136(3):1344

Authors: Benard MR, Başkent D

Abstract
Normal-hearing (NH) listeners make use of context, speech redundancy and top-down linguistic processes to perceptually restore inaudible or masked portions of speech. Previous research has shown poorer perception and restoration of interrupted speech in CI users and NH listeners tested with acoustic simulations of CIs. Three hypotheses were investigated: (1) training with CI simulations of interrupted sentences can teach listeners to use the high-level restoration mechanisms more effectively, (2) phonemic restoration benefit, an increase in intelligibility of interrupted sentences once its silent gaps are filled with noise, can be induced with training, and (3) perceptual learning of interrupted sentences can be reflected in clinical speech audiometry. To test these hypotheses, NH listeners were trained using periodically interrupted sentences, also spectrally degraded with a noiseband vocoder as CI simulation. Feedback was presented by displaying the sentence text and playing back both the intact and the interrupted CI simulation of the sentence. Training induced no phonemic restoration benefit, and learning was not transferred to speech audiometry measured with words. However, a significant improvement was observed in overall intelligibility of interrupted spectrally degraded sentences, with or without filler noise, suggesting possibly better use of restoration mechanisms as a result of training.

PMID: 25190407 [PubMed - indexed for MEDLINE]

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The role of creaky voice in Cantonese tonal perception.

The role of creaky voice in Cantonese tonal perception.

J Acoust Soc Am. 2014 Sep;136(3):1320

Authors: Yu KM, Lam HW

Abstract
There are few studies on the role of phonation cues in the perception of lexical tones in tonal languages where pitch is the primary dimension of contrast. This study shows that listeners are sensitive to creaky phonation in native tonal perception in Cantonese, a language in which the low falling tone, Tone 4, has anecdotally been reported to be sometimes creaky. First, in a multi-speaker corpus of lab speech, it is documented that creak occurs systematically more often on Tone 4 than other tones. Second, for stimuli drawn from this corpus, listeners identified Tone 4 with 20% higher accuracy when it was realized with creak than when it was not. Third, in a two-alternative forced choice task of identifying stimuli as Tone 4 or Tone 6 (the low level tone) isolating creak from any concomitant pitch cues, listeners had a higher proportion of Tone 4 responses for creaky stimuli. Finally, listeners had more Tone 4 responses for creaky stimuli with longer durations of nonmodal phonation. These results underscore that differences in voice quality contribute to human perception of tone alongside f0. Automatic tonal recognition and clinical applications for tone would benefit from attention to voice quality beyond f0 and pitch.

PMID: 25190405 [PubMed - indexed for MEDLINE]

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Microvascular head and neck reconstruction in the elderly: The University of Brescia experience.

Microvascular head and neck reconstruction in the elderly: The University of Brescia experience.

Head Neck. 2015 Nov 11;

Authors: Piazza C, Grammatica A, Paderno A, Taglietti V, Del Bon F, Marengoni A, Nicolai P

Abstract
BACKGROUND: Microvascular reconstruction in head and neck surgery is increasing in the elderly because of prolonged life expectancy. The purpose of this study was to evaluate the impact of age on outcomes after microvascular reconstruction.
METHODS: We retrospectively reviewed 453 microvascular reconstructions and stratified patients according to age (40.8% >65 years old). Medical and surgical complications and flap success rates were evaluated according to the American Society of Anesthesiologists (ASA) score for physical status and age.
RESULTS: Overall flap success and perioperative mortality were 96.1% and 0.7%, respectively. Minor medical complications were higher in the elderly (28.1% vs 15.3%; p = .001). High ASA scores affected rates of major surgical (20% vs 9.2%; p = .001) and minor medical complications (27.2% vs 13.3%; p < .001).
CONCLUSION: Microvascular reconstruction is reliable in the elderly. Age should not be considered a contraindication by itself; comorbidities play a stronger role in predicting adverse events. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26561407 [PubMed - as supplied by publisher]

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Prospective randomized controlled trial to compare 3-dimensional conformal radiotherapy to intensity-modulated radiotherapy in head and neck squamous cell carcinoma: Long-term results.

Prospective randomized controlled trial to compare 3-dimensional conformal radiotherapy to intensity-modulated radiotherapy in head and neck squamous cell carcinoma: Long-term results.

Head Neck. 2015 Nov 11;

Authors: Ghosh-Laskar S, Yathiraj PH, Dutta D, Rangarajan V, Purandare N, Gupta T, Budrukkar A, Murthy V, Kannan S, Agarwal JP

Abstract
BACKGROUND: Grade ≥2 acute xerostomia between 3D conformal radiotherapy (RT) and intensity-modulated radiotherapy (IMRT) was evaluated in patients with head and neck squamous cell carcinomas (HNSCCs) treated radically.
METHODS: Between 2005 and 2007, 59 patients with HNSCC (T1-3, N0-2b) were randomized to IMRT or 3D-RT. On RT, weekly xerostomia, dysphagia, dermatitis, and mucositis were graded by Radiation Therapy Oncology Group (RTOG) acute toxicity criteria. Patients underwent examination under anesthesia, positron emission tomography (PET)-CT, and toxicity assessments per protocol (NCT00652613) thereafter.
RESULTS: Incidence of grade ≥2 xerostomia at 8 weeks posttreatment was significantly lower with IMRT compared with 3D conformal RT (24% vs 53%; p = .024). At subsequent follow-up, significantly fewer patients receiving IMRT had grade ≥2 xerostomia. Long-term weight loss was higher in patients in the 3D conformal RT arm compared to IMRT (50% vs 21%; p = .038). Disease-related outcomes between arms (median follow-up, 70 months) were similar.
CONCLUSION: IMRT significantly reduces incidence of acute and late grade ≥2 xerostomia in patients with HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26561342 [PubMed - as supplied by publisher]

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Prognostic value of p16 expression in Epstein-Barr virus-positive nasopharyngeal carcinomas.

Prognostic value of p16 expression in Epstein-Barr virus-positive nasopharyngeal carcinomas.

Head Neck. 2015 Nov 11;

Authors: Jiang W, Chamberlain PD, Garden AS, Kim BY, Ma D, Lo EJ, Bell D, Gunn GB, Fuller CD, Rosenthal DI, Beadle BM, Frank SJ, Morrison WH, El-Naggar AK, Glisson BS, Sturgis EM, Phan J

Abstract
BACKGROUND: Overexpression of p16 is associated with improved outcomes among patients with oropharyngeal carcinoma. However, its role in the outcomes of patients with nasopharyngeal cancer (NPC) remains unclear.
METHODS: Eighty-six patients with NPC treated at MD Anderson Cancer Center from 2000 to 2014 were identified. Epstein-Barr virus (EBV) and human papillomavirus (HPV) status were determined by in situ hybridization (ISH) and p16 by immunohistochemical staining.
RESULTS: EBV positivity was associated with extended overall survival (OS; median, 95.0 vs 44.9 months; p < .004), progression-free survival (PFS; median, 80.4 vs 28.1 months; p < .013), and locoregional control (median, 104.4 vs 65.5 months; p < .043). In patients with EBV-positive tumors, p16 overexpression correlated with improved PFS (median, 106.3 vs 27.1 months; p < .02) and locoregional control (median, 93.6 vs 64.5 months; p < .02).
CONCLUSION: P16 overexpression is associated with improved PFS and locoregional control in patients with EBV-positive NPC. P16 expression may complement EBV status in predicting treatment outcomes for patients with NPC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26560893 [PubMed - as supplied by publisher]

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Raster-scanned intensity-controlled carbon ion therapy for mucosal melanoma of the paranasal sinus.

Raster-scanned intensity-controlled carbon ion therapy for mucosal melanoma of the paranasal sinus.

Head Neck. 2015 Nov 11;

Authors: Mohr A, Chaudhri N, Hassel JC, Federspil PA, Vanoni V, Debus J, Jensen AD

Abstract
BACKGROUND: The purpose of this study was to evaluate the use of raster-scanned intensity-controlled carbon ion therapy (ICCT) in the treatment of mucosal melanoma of the paranasal sinus.
METHODS: Patients received combined intensity-modulated radiotherapy (IMRT) plus carbon ion (C12). Records of 18 consecutive patients treated between 2009 and 2013 were analyzed retrospectively regarding toxicity (Common Terminology Criteria for Adverse Events, version 4), treatment response (Response Evaluation Criteria in Solid Tumors [RECIST]), and control/survival rates.
RESULTS: Most patients had advanced disease (T4, 94%; gross residual disease, 78%). Median dose was 74 GyE (median boost volume = 157 mL). C12 treatments were planned as ICCT, no concurrent chemotherapy was administered. Grade III or higher late toxicity was not observed. Overall survival (OS), progression-free survival (PFS), and locoregional control at 3 years were 16.2%, 0%, and 58.3%, respectively (median follow-up, 18 months). Resection status did not impact locoregional control or survival rates.
CONCLUSION: ICCT results in promising locoregional control at mild toxicity. OS is poor because of the occurrence of distant metastases; therefore, addition of systemic components to primary treatment should be investigated. © 2015 Wiley Periodicals, Head Neck, 2015.

PMID: 26560744 [PubMed - as supplied by publisher]

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Long-term functional results after open partial horizontal laryngectomy type IIa and type IIIa: A comparison study.

Long-term functional results after open partial horizontal laryngectomy type IIa and type IIIa: A comparison study.

Head Neck. 2015 Nov 11;

Authors: Schindler A, Pizzorni N, Fantini M, Crosetti E, Bertolin A, Rizzotto G, Succo G

Abstract
BACKGROUND: The purpose of this study was to compare long-term swallowing, voice results, and quality of life (QOL) after open partial horizontal laryngectomy (OPHL) type IIa and type IIIa.
METHODS: Twenty-three patients after OPHL type IIa and 18 patients after OPHL type IIIa were involved. Swallowing skills and neoglottis' motility and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic voice-related and swallowing-related QOL were assessed. Data were statistically compared using Mann-Whitney U test or Fisher exact tests, as appropriate.
RESULTS: Significant differences were found only for the residue with solids and for the intelligibility (I) parameter of the overall quality impression and intelligibility, additive and unnecessary noise, speech fluency, and presence of voiced segments scale with patients of the OPHL type IIIa group showing worse performances than the OPHL type IIa group.
CONCLUSION: Patients who underwent OPHL type IIa and type IIIa show comparable long-term functional outcomes. OPHL type IIIa represents a valid surgical alternative to OPHL type IIa. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26560504 [PubMed - as supplied by publisher]

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Automated analysis of confocal laser endomicroscopy images to detect head and neck cancer.

Automated analysis of confocal laser endomicroscopy images to detect head and neck cancer.

Head Neck. 2015 Nov 11;

Authors: Dittberner A, Rodner E, Ortmann W, Stadler J, Schmidt C, Petersen I, Stallmach A, Denzler J, Guntinas-Lichius O

Abstract
BACKGROUND: The purpose of this study was to develop an automated image analysis algorithm to discriminate between head and neck cancer and nonneoplastic epithelium in confocal laser endomicroscopy (CLE) images.
METHODS: CLE was applied to image head and neck cancer epithelium in vivo. Histopathologic diagnosis from biopsies was used to classify the CLE images offline as cancer or noncancer tissue. The classified images were used to train automated software based on distance map histograms. The performance of the final algorithm was confirmed by "leave 2 patients out" cross-validation and area under the curve (AUC)/receiver operating characteristic (ROC) analysis.
RESULTS: Ninety-two CLE videos and 92 biopsies were analyzed from 12 patients. One hundred two frames of classified neoplastic tissue and 52 frames of nonneoplastic tissue were used for cross-validation of the developed algorithm. AUC varied from 0.52 to 0.92.
CONCLUSION: The proposed software allows an objective classification of CLE images of head and neck cancer and adjacent nonneoplastic epithelium. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26560348 [PubMed - as supplied by publisher]

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Endoscope-guided coblator tongue base resection using an endoscope-holding system for obstructive sleep apnea.

Endoscope-guided coblator tongue base resection using an endoscope-holding system for obstructive sleep apnea.

Head Neck. 2015 Nov 11;

Authors: Cho HJ, Park DY, Min HJ, Chung HJ, Lee JG, Kim CH

Abstract
BACKGROUND: Multilevel obstruction in obstructive sleep apnea commonly includes retroglossal obstruction. To improve surgical success rates, tongue volume reduction with posterior midline glossectomy and/or lingual tonsillectomy is widely performed.
METHODS: Nasotracheal intubation was utilized, and the combined tongue procedure was performed as a final step after palatal surgery. The tongue was pulled maximally by a retraction suture and a McIVOR (Karl Storz, Tuttlingen, Germany) or Davis mouth gag (Karl Storz,Tuttlingen, Germany), and a medium-length tongue blade was applied to expose the tongue base. A 70-degree rigid endoscope was fixed by the holding system and introduced into the oral cavity. Endoscope-guided coblator tongue base resection was then performed.
RESULTS: The surgeon could use both hands for the surgery, enabling a more delicate resection of tongue base tissue.
CONCLUSION: This technique was acceptable and can be successfully used in patients with a large tongue, in whom exposing the tongue base for surgery is difficult. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26560073 [PubMed - as supplied by publisher]

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Valid and reliable techniques for measuring fibrosis in patients with head and neck cancer postradiotherapy: A systematic review.

Valid and reliable techniques for measuring fibrosis in patients with head and neck cancer postradiotherapy: A systematic review.

Head Neck. 2015 Nov 11;

Authors: Shaw SM, Skoretz SA, O'Sullivan B, Hope A, Liu LW, Martino R

Abstract
BACKGROUND: Fibrosis is a common side effect of radiotherapy for head and neck cancer. Although treatments for fibrosis have been developed, valid and reliable measurement tools are needed to verify their efficacy. The purpose of this review was to identify and appraise tools used to measure head and neck fibrosis.
METHODS: Electronic databases were searched for primary research published through April 2014. Main search terms included head and neck cancer, radiotherapy, fibrosis, validity, and reliability. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Two blinded raters conducted all assessments. Discrepancies were resolved by consensus.
RESULTS: The search retrieved 534 unique citations. Nine studies met our inclusion criteria, representing 9 different tools. Only 1 tool was assessed for reliability and validity. QUADAS-2 revealed that all studies were at risk for bias.
CONCLUSION: To date, there are no valid and reliable techniques for measuring fibrosis postradiotherapy for head and neck cancer, especially within the suprahyoid and pharyngeal regions. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26559913 [PubMed - as supplied by publisher]

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Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review.

Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review.

Head Neck. 2015 Nov 11;

Authors: Guimarães AV, Aires FT, Dedivitis RA, Kulcsar MA, Ramos DM, Cernea CR, Brandão LG

Abstract
BACKGROUND: The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy.
METHODS: The analyzed intervention was the use of a PMMF after total laryngectomy.
RESULTS: Pharyngocutaneous fistula occurred in 230 cases (global incidence, 30.9%). In the group of patients who underwent PMMFs, there were 49 cases of pharyngocutaneous fistula, compared with 181 cases in the control group. There was a 22% decreased risk of pharyngocutaneous fistula incidence in the PMMF group (p < .001). Patients who underwent a PMMF had lower risk of pharyngocutaneous fistula compared with the control group (p = .008). There were no changes when only patients who underwent total laryngectomy (p < .001) and those who underwent total pharyngolaryngectomy (p = .007) were separately assessed.
CONCLUSION: Prophylactic use of PMMF decreases the incidence of pharyngocutaneous fistula after salvage total laryngectomy. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26559777 [PubMed - as supplied by publisher]

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Feasibility of surgeon-performed ultrasound-guided core needle biopsy in the thyroid and lymph nodes.

Feasibility of surgeon-performed ultrasound-guided core needle biopsy in the thyroid and lymph nodes.

Head Neck. 2015 Nov 11;

Authors: Ahn D, Sohn JH, Yeo CK, Jeon JH

Abstract
BACKGROUND: The purpose of this study was to evaluate the feasibility of ultrasound-guided core needle biopsy (CNB) performed by a surgeon for mass lesions in the thyroid and lymph nodes.
METHODS: A single surgeon performed 30 office-based ultrasound-guided CNB procedures for mass lesions in the thyroid and lymph nodes that were previously biopsied by ultrasound-guided fine-needle aspiration cytology (FNAC). The procedure time, targeting success, pathological diagnosis, and complications were evaluated.
RESULTS: The mean procedure time for ultrasound-guided CNB was 6.7 minutes, and it reached a plateau of 4 to 7 minutes after the first 5 procedures. The overall unsatisfactory sampling rate was 3.3% (1 of 30). Specific pathological diagnoses that permitted the surgeon to establish an appropriate treatment plan were provided in 93.3% of the patients (28 of 30). There were no major complications.
CONCLUSION: Ultrasound-guided CNB is technically feasible for a head and neck surgeon and a useful adjunct technique when ultrasound-guided FNAC is inadequate for mass lesions in the thyroid and lymph nodes. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26559644 [PubMed - as supplied by publisher]

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In vitro model for gastroduodenal reflux-induced nuclear factor-kappaB activation and its role in hypopharyngeal carcinogenesis.

In vitro model for gastroduodenal reflux-induced nuclear factor-kappaB activation and its role in hypopharyngeal carcinogenesis.

Head Neck. 2015 Nov 11;

Authors: Sasaki CT, Issaeva N, Vageli DP

Abstract
BACKGROUND: The purpose of this study was to investigate whether gastroduodenal reflux can play a role in the pathogenesis of hypopharyngeal cancer; therefore, we assessed its effect on the nuclear factor-kappa B (NF-κB) pathway, as similarly noted in the esophagus.
METHODS: We exposed human cells derived from the hypopharyngeal epithelium to bile acids or deoxycholic acid. We centered our study on the transcriptional activation of NF-κB pathway, previously linked to head and neck squamous cell carcinoma (HNSCC).
RESULTS: We show that acidic-bile salts induce: (1) NF-κB activation with high cytoplasmic Bcl-2 expression; (2) significant increase in expression v-rel avian reticuloendotheliosis viral oncogene homolog A (RELA(p65)), v-rel avian reticuloendotheliosis viral oncogene homolog (c-REL) signal transducer and activator of transcription 3 (STAT3), isoform of transformation related protein p63 (ΔNp63), B-cell lymphoma 2 (Bcl-2), tumor necrosis factor alpha (TNF-α), epidermal growth factor receptor (EGFR), and wingless type MMTV integration site family member 5A (WNT5A) and a decrease in tumor protein p53 (Tp53); and (3) phenotypic changes that are similar to the phenotype of the untreated hypopharyngeal cancer cell line, University of Michigan squamous cell carcinoma (UMSCC)-11B. These changes are not seen when cells were exposed to neutral control or acid alone.
CONCLUSION: Our findings in vitro are consistent with the hypothesis that gastroduodenal reflux plays a role in hypopharyngeal carcinogenesis and its effect is mediated through activation of NF-κB pathway. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26559497 [PubMed - as supplied by publisher]

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Transoral robotic surgery for early T classification hypopharyngeal cancer.

Transoral robotic surgery for early T classification hypopharyngeal cancer.

Head Neck. 2015 Nov 11;

Authors: Wang CC, Liu SA, Wu SH, Wang CP, Liang KL, Jiang RS, Lin JC

Abstract
BACKGROUND: For hypopharyngeal cancer, transoral robotic surgery (TORS) has been reported as a new organ preserving treatment but outcomes are rarely reported.
METHODS: From 2010 to 2013, 10 patients with early T classification pyriform sinus cancer were selected to receive TORS and conventional neck dissection. The clinical parameters, including rates of adjuvant radiotherapy, survivals, as well as organ and function preservation, were retrospectively analyzed.
RESULTS: TORS was successful in all 10 patients, and 5 patients received adjuvant radiotherapy. After mean follow-up of 26 months, 1 patient died of distant metastasis and 1 patient died of other malignancy. There was no local recurrence and larynxes were all preserved. Eight surviving patients who were followed up continuously could receive oral intake and had a serviceable voice without tracheostomy or feeding tubes.
CONCLUSION: TORS is a feasible transoral approach for selected patients with early T classification hypopharyngeal cancer. The reported oncologic/functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26559383 [PubMed - as supplied by publisher]

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The efficacy and safety of systemic injection of Ginkgo biloba extract, EGb761, in idiopathic sudden sensorineural hearing loss: a randomized placebo-controlled clinical trial.

The efficacy and safety of systemic injection of Ginkgo biloba extract, EGb761, in idiopathic sudden sensorineural hearing loss: a randomized placebo-controlled clinical trial.

Eur Arch Otorhinolaryngol. 2015 Nov 11;

Authors: Koo JW, Chang MY, Yun SC, Kim TS, Kong SK, Chung JW, Goh EK

Abstract
Steroids are currently the most frequently accepted agents for idiopathic sudden sensorineural hearing loss (ISSNHL). However, the therapeutic effect of steroids is not always satisfactory. In this pilot study, we evaluated whether systemic treatment with Ginkgo biloba extract (EGb761) has an additive therapeutic effect in patients receiving a systemic steroid due to ISSNHL. A multicenter, randomized, double-blind clinical trial was performed. Fifty-six patients with ISSNHL were allocated to either EGb761 or placebo. In both groups, methylprednisolone was administered for 14 days. EGb761 was infused intravenously for 5 days in the EGb761 group, while the same amount of normal saline was infused in the placebo group. For the efficacy evaluation, pure-tone audiometry, speech audiometry, tinnitus handicap inventory (THI) and short form-36 health (SF-36) survey outcomes were obtained before administration and on days 3, 5, 14 and 28 of administration. Twenty-four patients in each group completed the study protocol. There was no difference in hearing loss between the two groups before treatment. At day 28, air conduction threshold values in the placebo and EGb761 groups were 34.63 ± 28.90 and 23.84 ± 25.42 dB, respectively (p = 0.082). Speech discrimination scores in the placebo and EGb761 groups were 69.17 ± 40.89 and 87.48 ± 28.65 %, respectively (p = 0.050). THI and SF-36 scores in the placebo and EGb761 groups were similar. Although a combination of steroid and EGb761 for initial treatment did not show better pure tone threshold, compared with steroid alone, speech discrimination was significantly improved in combination therapy. Further studies will be needed to know if addition of EGb761 actually improves the outcome of ISSNHL treatment.

PMID: 26559533 [PubMed - as supplied by publisher]

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Incidence of Suicide in Patients With Head and Neck Cancer.

Incidence of Suicide in Patients With Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg. 2015 Nov 12;:1-8

Authors: Kam D, Salib A, Gorgy G, Patel TD, Carniol ET, Eloy JA, Baredes S, Park RC

Abstract
Importance: Suicide rates among patients with cancer in the US are significantly higher than those of the general population. To our knowledge, large cohort studies examining suicide rates among patients with head and neck cancer have not been performed.
Objective: To identify incidence rate, trends, and risk factors of suicide in patients with cancer of the head and neck.
Design, Setting, and Participants: This was a retrospective cohort study of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program. In total, 350 413 cases of patients with head and neck cancer were recorded within the SEER registry between 1973 and 2011. Data analyses were performed in 2014. Incidence data were calculated from the subset of that population that had the cause of death category coded as "suicide and self-inflicted injury."
Exposures: Patients diagnosed as having a primary cancer of the head and neck region.
Main Outcomes and Measures: Influence of demographic factors, anatomic site of tumor, disease stage, and time since diagnosis on risk for suicide.
Results: Among 350 413 SEER registry patients with head and neck cancer, observed for 2 263 376 person-years, 857 suicides were identified with an age-, sex-, and race-adjusted suicide rate of 37.9/100 000 person-years. In contrast, the US general population suicide rate was 11.8 per 100 000 person-years. Suicide rates were higher in those treated with radiation alone (standardized mortality ratio [SMR], 5.12; 95% CI, 3.83-6.41) compared with those treated with surgery alone (SMR, 2.57; 95% CI, 1.66-3.49). The highest suicide risk was seen in patients with cancers of the hypopharynx (SMR, 13.91; 95% CI, 11.78-16.03) and larynx (SMR, 5.48; 95% CI, 4.14-6.81).
Conclusions and Relevance: Patients with head and neck cancer have more than 3 times the incidence of suicide compared with the general US population. Furthermore, suicide rates were highest among those with cancers of the larynx and hypopharynx.

PMID: 26562764 [PubMed - as supplied by publisher]

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Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: A series of 9 cases and a critical review of the literature.

Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: A series of 9 cases and a critical review of the literature.

Head Neck. 2015 Nov 11;

Authors: Bhattasali O, Holliday E, Kies MS, Hanna E, Garden AS, Rosenthal DI, Morrison WH, Gunn GB, Fuller CD, Zhu XR, Frank SJ

Abstract
BACKGROUND: The primary treatment for head and neck adenoid cystic carcinoma (ACC) is surgery. Infrequently, however, ACC's propensity for perineural and base of skull invasion can preclude definitive surgical management. We present our experience with proton radiation therapy (RT) and concurrent platinum-based chemotherapy.
METHODS: Nine patients with unresectable node-negative, nonmetastatic head and neck ACC received definitive proton RT and concurrent cisplatin. Outcomes and toxicities were recorded. A systematic review of the literature was performed.
RESULTS: Median follow-up was 27 months (range, 9.2-48.3 months). Four patients achieved complete response at the primary site, and an additional 4 patients achieved stabilization of local disease. Only 1 patient developed local disease progression. Four patients had 5 acute grade 3 (G3) toxicities, and 1 patient developed a chronic G4 optic nerve disorder.
CONCLUSION: Our preliminary results suggest proton RT and concurrent chemotherapy is a definitive treatment option for select patients with head and neck ACC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26561041 [PubMed - as supplied by publisher]

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Full-thickness skin burn caused by radiofrequency ablation of a benign thyroid nodule.

Full-thickness skin burn caused by radiofrequency ablation of a benign thyroid nodule.

Thyroid. 2015 Nov 11;

Authors: Bernardi S, Lanzilotti V, Papa G, Panizzo N, Dobrinja C, Fabris B, Stacul F

PMID: 26561213 [PubMed - as supplied by publisher]

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Efficacy of intraoperative neuro-monitoring to localize the external branch of the superior laryngeal nerve.

Efficacy of intraoperative neuro-monitoring to localize the external branch of the superior laryngeal nerve.

Thyroid. 2015 Nov 11;

Authors: Hurtado-López LM, Díaz-Hernández PI, Basurto-Kuba E, Zaldivar-Ramirez FR, Pulido-Cejudo A

Abstract
BACKGROUND: We studied whether visual localization of the external branch of the superior laryngeal nerve (EBSLN) coincides with its localization via intraoperative neuro-monitoring (IONM) during thyroidectomy and whether its use influences the frequency of injuries.
METHODS: We performed a prospective, comparative, cross-sectional, observational study in 240 superior thyroid poles. The metrics were visual identification of the EBSLN and its corroboration with IONM. We also determined the frequency of EBSLN injuries. Statistical analysis was achieved via a Kappa and chi-squared test (X2) as well as an odds ratio (OR).
RESULTS: Of the 240 superior thyroid poles, IONM identified 234 (97.5%) EBSLN, whereas 190 (79.1%) were identified visually; OR = 10.35 (CI95%; 4.37-24.65) X2 p < 0.0001. Of the 190 EBSLN identified visually, 150 were confirmed through IONM. Indeed, their structure corresponded to an EBSLN to yield a Kappa with a linear weighting value of 0.362. The standard error (SE) was 0.0467 (CI95%; 0.2686-0.4554) indicating a fair agreement between the visual and IONM classification.
CONCLUSION: IONM identified 97.5% of EBSLN cases. It was higher than the visual identification. There were no injuries to EBSLN identified through IONM.

PMID: 26560965 [PubMed - as supplied by publisher]

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GRADE in Systematic Reviews of Acupuncture for Stroke Rehabilitation: Recommendations based on High-Quality Evidence.

GRADE in Systematic Reviews of Acupuncture for Stroke Rehabilitation: Recommendations based on High-Quality Evidence.

Sci Rep. 2015;5:16582

Authors: Xin Z, Xue-Ting L, De-Ying K

Abstract
Systematic reviews (SRs) of randomized controlled trials (RCTs) have demonstrated acupuncture's effectiveness in stroke rehabilitation. The current study reviews the quality of evidence in SRs of acupuncture in stroke rehabilitation, and rates the strength of recommendation for its use based on this evidence using the GRADE (grading of recommendations, assessment, development and evaluations) approach. A comprehensive literature search was performed using multiple databases (e.g., Medline, Embase) with advanced search strategies. Two authors independently selected articles, collected data, and assessed the methodological quality of each identified SR according to AMSTAR (a measurement tool to assess systematic reviews) and OQAQ (Oxman and Guyatt's overview quality assessment questionnaire). Outcomes related to stroke rehabilitation were evaluated. SRs of high methodological quality (AMSTAR score ≥9 and OQAQ score ≥7) were graded using GRADE. Ultimately, acupuncture yields benefits in stroke rehabilitation (neurological function improvement: RR = 1.34; swallowing improvement: RR = 1.61, 1.49, 1.07; disability: SMD = 0.49 or 0.07). Poor evidentiary quality and insufficient information about harm led to weak recommendations. In conclusion, acupuncture may improve stroke rehabilitation, as the GRADE approach indicated a weak recommendation for acupuncture's usage in this context.

PMID: 26560971 [PubMed - in process]

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Delayed Pharyngeal Response in CHEW-SWALLOW Does Not Increase Risk of Aspiration in Individuals with Stroke.

http:--media.wiley.com-assets-2250-98-Wi

Delayed Pharyngeal Response in CHEW-SWALLOW Does Not Increase Risk of Aspiration in Individuals with Stroke.

J Am Geriatr Soc. 2015 Aug;63(8):1698-9

Authors: Kagaya H, Saitoh E, Shibata S, Onogi K, Aoyagi Y, Inamoto Y, Ozeki M, Ota K

PMID: 26289691 [PubMed - indexed for MEDLINE]

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Current-reported outcome domains in studies of adults with a focus on the treatment of tinnitus: protocol for a systematic review.

Current-reported outcome domains in studies of adults with a focus on the treatment of tinnitus: protocol for a systematic review.

BMJ Open. 2015;5(11):e009091

Authors: Hall DA, Szczepek AJ, Kennedy V, Haider H

Abstract
INTRODUCTION: In Europe alone, over 70 million people experience tinnitus. Despite its considerable socioeconomic relevance, progress in developing successful treatments has been limited. Clinical effectiveness is judged according to change in primary outcome measures, but because tinnitus is a subjective condition, the definition of outcomes is challenging and it remains unclear which distinct aspects of tinnitus (ie, 'domains') are most relevant for assessment. The development of a minimum outcome reporting standard would go a long way towards addressing these problems. In 2006, a consensus meeting recommended using 1 of 4 questionnaires for tinnitus severity as an outcome in clinical trials, in part because of availability in different language translations. Our initiative takes an approach motivated by clinimetrics, first by determining what to measure before seeking to determine how to measure it. Agreeing on the domains that contribute to tinnitus severity (ie, 'what') is the first step towards achieving a minimum outcome reporting standard for tinnitus that has been reached via a methodologically rigorous and transparent process.
METHODS AND ANALYSIS: Deciding what should be the core set of outcomes requires a great deal of discussion and so lends itself well to international effort. This protocol lays out the first-step methodology in defining a Core Domain Set for clinical trials of tinnitus by establishing existing knowledge and practice with respect to which outcome domains have been measured and which instruments used in recent registered and published clinical trials.
ETHICS AND DISSEMINATION: No ethical issues are foreseen. Findings will be reported at national and international ear, nose and throat (ENT) and audiology conferences and in a peer-reviewed journal, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines.
TRIAL REGISTRATION NUMBER: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525.

PMID: 26560061 [PubMed - in process]

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The efficacy and safety of systemic injection of Ginkgo biloba extract, EGb761, in idiopathic sudden sensorineural hearing loss: a randomized placebo-controlled clinical trial.

The efficacy and safety of systemic injection of Ginkgo biloba extract, EGb761, in idiopathic sudden sensorineural hearing loss: a randomized placebo-controlled clinical trial.

Eur Arch Otorhinolaryngol. 2015 Nov 11;

Authors: Koo JW, Chang MY, Yun SC, Kim TS, Kong SK, Chung JW, Goh EK

PMID: 26559533 [PubMed - as supplied by publisher]

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[Sleep Medicine: 1965 to 2015].

[Sleep Medicine: 1965 to 2015].

Sante Ment Que. 2015;40(2):239-55

Authors: Montplaisir J

Abstract
The Département de psychiatrie de l'Université de Montréal houses one of the first sleep centers founded 40 years ago. This center contributed to virtually every aspect of sleep medicine. It grew considerably over time to become one of the largest sleep centers worldwide. It is now called the Center for Advanced Research in Sleep Medicine (CARSM). Fourteen researchers and more than 30 research PhDs and postdoctoral fellows are working together in a 1,500 square-meter facility that includes separate units for fundamental and clinical studies and for the sleep disorders clinic. It has 10 polysomnographic recording rooms, 3 isolated units devoted to chronobiological studies, a high resolution SPECT imaging laboratory specifically devoted to sleep research, a high-density EEG unit and a psychophysiological laboratory to study the interaction between pain and sleep. This article relates the history of the CARSM and also presents a personal sleep odyssey.The CARSM has been very active in the description of clinical features and definitions of the phenotype of most sleep disorders. It contributed specifically to the development of diagnostic tools in narcolepsy (the multiple sleep latency test in different age groups), in nocturnal epilepsy (development of a method to localize the primary focus using in-depth electrodes recording during rapid eye movement sleep), in sleep bruxism (a method for scoring masticatory muscle activity during sleep and definition of cut-off values), in the restless legs syndrome (RLS: the suggested immobilisation test), in sleepwalking (sleep deprivation and experimental awakenings) and REM sleep behaviour disorder (RBD: development of the first polygraphic method to diagnose RBD).The CARSM also contributed to the knowledge on the epidemiology of sleep disorders, conducting the first population-based prevalence study of RLS and of sleep bruxism. Researchers at the CARMS also looked at the impact of sleep disorders like narcolepsy, RLS, sleep apnea and the parasomnias on daytime cognitive functions and cardiovascular health. The CARSM collaborates with researchers throughout the world to elucidate the genetic bases of several disorders, especially narcolepsy, RLS, RBD and parasomnias in children and adults, through large well-defined cohorts of patients and normal subjects.Finally, the CARSM has made original contributions to the development of new treatments of sleep disorders, especially the dopaminergic treatments of RLS (first with levodopa and then with pramipexole). Current research also involves the identification of prodromal markers of Parkinson disease and dementia in patients with RBD as to build a ready-to trial cohort to test the efficacy of neuroprotective agents.In summary, the CARSM is a center dedicated to basic and clinical research on sleep and circadian rhythms. It is located at the Hôpital du Sacré-Coeur de Montréal but involves several other researchers at the Université de Montréal and at other universities in Canada and in the world.

PMID: 26559218 [PubMed - in process]

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Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue.

Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue.

Laryngoscope. 2015 Sep;125(9):2139-42

Authors: Litts JK, Gartner-Schmidt JL, Clary MS, Gillespie AI

Abstract
OBJECTIVES/HYPOTHESIS: This study investigated financial and treatment implications of a speech-language pathologist (SLP) performing a voice evaluation at the initial laryngologic visit.
STUDY DESIGN: Retrospective chart review.
METHODS: Medical records from 75 consecutive adult voice therapy patients during a 3-month period were categorized into two groups: group 1 (n = 37) represented patients who underwent a medical speech evaluation (MSE) at the initial voice assessment with the laryngologist (+SLP), and group 2 (n = 38) represented patients who did not receive an MSE (-SLP). Data collected included age, gender, voice diagnosis, number of therapy sessions attended and cancelled, reason for discharge, and pre- and post-voice therapy Voice Handicap Index-10 (VHI-10) scores.
RESULTS: Patients in the +SLP group had fewer cancellations (P = 0.001), greater change in VHI-10 from pre- to post-therapy (P = .001), and were more likely to be discharged from therapy having met therapeutic goals (P = .007) than patients in the -SLP group. In addition, lost revenue over 3 months due to cancellations/no-shows was $2,260 in the +SLP group compared to $7,030 in the -SLP group (P < .001).
CONCLUSIONS: Concurrent voice evaluation by an SLP and laryngologist at initial diagnostic visit affects therapy attendance, voice therapy outcomes, and ultimately SLP and departmental billing revenue. Results may be due to more appropriate therapy referrals from SLP assessment of patients in conjunction with a laryngologist.
LEVEL OF EVIDENCE: 4.

PMID: 26013916 [PubMed - indexed for MEDLINE]

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Reliability and validity of the Turkish pediatric Voice Handicap index.

http:--linkinghub.elsevier.com-ihub-imag

Reliability and validity of the Turkish pediatric Voice Handicap index.

Int J Pediatr Otorhinolaryngol. 2015 May;79(5):680-4

Authors: Özkan ET, Tüzüner A, Demirhan E, Topbaş S

Abstract
OBJECTIVES: The aim of this study is to develop a Turkish version of the pediatric voice index (pVHI) and to evaluate its reliability and validity for cultural adaptation.
METHODS: The original pVHI was translated to Turkish. It was administered to 151 parents of 40 dysphonic children and 111 non-dysphonic children. A cross-sectional descriptive model is used with two-sample methodology. The reliability, validity measures, sensitivity, specifity and receiver operating characteristics (ROC) analysis with AUC values were calculated.
RESULTS: The findings showed that the Turkish version of the pVHI had highly significant validity, reliability and excellent internal consistency, sensitivity and specifity for functional, physical and emotional domains and the total score.
CONCLUSIONS: The Turkish version of the pVHI is a valid and reliable tool to assess the parents' perception about their children with voice disorders.

PMID: 25749577 [PubMed - indexed for MEDLINE]

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Incidence of Suicide in Patients With Head and Neck Cancer.

Incidence of Suicide in Patients With Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg. 2015 Nov 12;:1-8

Authors: Kam D, Salib A, Gorgy G, Patel TD, Carniol ET, Eloy JA, Baredes S, Park RC

PMID: 26562764 [PubMed - as supplied by publisher]

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Squamous Cell Carcinoma of the Larynx.

Squamous Cell Carcinoma of the Larynx.

Ultrasound Q. 2015 Nov 10;

Authors: Gross JS, Smith RJ

PMID: 26561221 [PubMed - as supplied by publisher]

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Risk factors for sleep impairment in adult patients with chronic rhinosinusitis.

Risk factors for sleep impairment in adult patients with chronic rhinosinusitis.

Auris Nasus Larynx. 2015 Nov 8;

Authors: Ando Y, Chiba S, Capasso R, Okushi T, Kojima H, Otori N, Wada K

Abstract
OBJECTIVE: Although sleep impairment is reported by patients with chronic rhinosinusitis, the associated factors have not been well studied. Therefore, we determined the associated risk factors for sleep impairment in patients with chronic rhinosinusitis (CRS).
METHODS: This study was a prospective cohort study. A total of 572 adult patients (171 women, 401 men; mean age, 49.0 years; range, 18-64 years) who completed a questionnaire, had a clinical examination, and underwent endoscopic sinus surgery were analyzed using stepwise multiple linear regression.
RESULTS: With regard to subjective symptoms, nasal obstruction (beta coef., 0.27; p<0.001), anterior nasal drainage (beta coef., 0.13; p=0.004), facial pain/pressure (beta coef., 0.09; p=0.048), headache (beta coef., 0.10; p=0.010), and cough (beta coef., 0.14; p<0.001) were predictors of an increased risk of sleep impairment of CRS (adjusted R(2), 0.240; p=0.048). In the matter of background parameters, total polyp score (polyp grading system) (beta coef., 0.16; p<0.001) and allergic rhinitis (beta coef., 0.09; p=0.034) were predictors of an increased risk of sleep impairment of CRS (adjusted R(2), 0.029; p=0.034).
CONCLUSION: These results suggest that sleep impairment in these patients is caused by the various mechanisms associated with nasal symptoms themselves, CRS and allergic rhinitis. However, the specific pathophysiology has not been clarified yet; further studies are expected to elucidate that of sleep impairment in patients with CRS.

PMID: 26559748 [PubMed - as supplied by publisher]

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Surgical results and psychological status in patients with intractable Ménière's disease.

Surgical results and psychological status in patients with intractable Ménière's disease.

Auris Nasus Larynx. 2015 Nov 8;

Authors: Yokota Y, Kitahara T, Sakagami M, Ito T, Kimura T, Okayasu T, Yamashita A, Yamanaka T

Abstract
OBJECTIVES: Mental disorder is often one of the causes to make treatments for Ménière's disease more difficult. The aim in the present study is to examine ratios of the neurosis and depression in patients with intractable Ménière's disease and also relationships between the ratios and surgical results after endolymphatic sac drainage with large doses of steroids.
METHODS: Between 1998 and 2009, we enrolled 263 intractable Ménière's patients and divided into two groups, 207 in surgical group and 56 in non-surgical group. We used the Cornell Medical Index (CMI) and the Self-rating Depression Scale (SDS) at the diagnosis in our hospital to evaluate their psychological condition before treatments. CMI domains III and IV were defined as neurosis and SDS scores more than 40 as depression as a matter of convenience. Two years as well as seven years after surgery, patients with vertigo zero/month and hearing change>-10dB were evaluated in success group and the others in non-success group.
RESULTS: Neurosis and depression were diagnosed in approximately 40% and 60%, respectively, of intractable Ménière's disease. Our results showed that surgical treatment significantly improved vertigo suppression and hearing gain in patients with no psychological symptoms compared with those exhibiting psychological symptoms both in surgical and non-surgical groups. Furthermore, surgical results in cases with mental disorder were superior to non-surgical results in cases without mental distress.
CONCLUSIONS: All taken together, psychological supports could be necessary for improving results both in the surgical and non-surgical treatments for patients with intractable Ménière's disease. Some cases with intractable Ménière's disease should really require additional surgical treatments even after psychological therapies.

PMID: 26559747 [PubMed - as supplied by publisher]

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Morbidity and mortality revue of the French group of transoral robotic surgery: a multicentric study.

Morbidity and mortality revue of the French group of transoral robotic surgery: a multicentric study.

J Robot Surg. 2015 Nov 11;

Authors: Aubry K, Vergez S, de Mones E, Moriniere S, Choussy O, Malard O, Dolivet G, Lallemant B, Ceruse P

Abstract
Transoral robotic assisted surgery (TORS) represents an innovative endoscopic therapeutic alternative in the treatment of head and neck tumors. Many publications favor this surgery, especially in terms of functional results. The aim of this study was to investigate the TORS morbidity and mortality and to identify the risk factors for complications. It is a multicenter retrospective study. All head and neck tumor patients treated by TORS were included in the study over a period of 5 years (2009-2014). The studied parameters were the intraoperative and post-operative complications including hemorrhage, fistula, tracheotomy, aspiration pneumonia and death. The parameters were correlated with age, tumor location, tumor stage, endoscopic exposure and patient's co-morbidities. 178 patients were included in the study. Malignant tumors classified as T1 were found in 169 cases (n = 51), T2 (n = 100), T3 (n = 16) and T4 (n = 2). The tumor locations were distributed as follows: larynx (n = 84), oropharynx (n = 51), and hypopharynx (n = 43). Fifty-three patients followed post-radiation therapy. We observed 12 intraoperative complications including 6 hemorrhage, 3 pharyngeal fistulas and 3 external surgical conversions. Postoperatively, we detected 33 hemorrhage, 27 aspiration pneumonia, 9 tracheostomy, 2 pharyngostomes, 2 cervical spondylitis and 2 deaths. The risk factors identified were (i) anticoagulant and/or antiplatelet therapy for hemorrhage, (ii) tumoral stage and the laryngeal location for aspiration pneumonia and (iii) laryngeal location for tracheostomy. Higher age over 65 years has been identified as a risk factor for all post-operative complications. TORS is a safe technique for the treatment of head and neck tumors. We identified some risk factors for complications which should systematically be studied in order to reduce its morbidity.

PMID: 26559537 [PubMed - as supplied by publisher]

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Technical tip for difficult injection laryngoplasty: The use of a hypodermic needle as a retractor.

Technical tip for difficult injection laryngoplasty: The use of a hypodermic needle as a retractor.

Laryngoscope. 2015 Sep;125(9):2157-8

Authors: Jayaram SC, Costello D

PMID: 26152367 [PubMed - indexed for MEDLINE]

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Differences in survival outcome between stage I and stage II glottic cancer: A SEER-based analysis.

Differences in survival outcome between stage I and stage II glottic cancer: A SEER-based analysis.

Laryngoscope. 2015 Sep;125(9):2093-8

Authors: Chen JJ, Stessin A, Christos P, Wernicke AG, Nori D, Parashar B

Abstract
OBJECTIVE: The purpose of this study was to investigate and compare the cause-specific survival (CSS) of stage I (tumor [T]1 node [N]0 metastasis [M]0) versus stage II (T2N0M0) glottic cancer in a large population cohort.
STUDY DESIGN: We analyzed data from the Surveillance, Epidemiology, and End Results 18 database from 1973 to 2009, comprising patients diagnosed with T1N0M0 or T2N0M0 squamous cell glottic cancer. Kaplan-Meier survival analysis, multivariable Cox proportional hazards regression analysis, and competing-risks survival regression were used for statistical analysis.
RESULTS: There were 4,422 patients who met all inclusion criteria. The 36-month CSS was 93.9% for stage I verus 86.5% for stage II, with P < 0.0001. Stage II status conferred a 2.494 hazard ratio for increased risk of cause-specific death compared to stage I.
CONCLUSIONS: Stage II glottic cancers have a significantly worse prognosis and may need a different approach to management than stage I tumors.
LEVEL OF EVIDENCE: 4.

PMID: 26109043 [PubMed - indexed for MEDLINE]

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Temporal characteristics of hyolaryngeal structural movements in normal swallowing.

Temporal characteristics of hyolaryngeal structural movements in normal swallowing.

Laryngoscope. 2015 Sep;125(9):2129-33

Authors: Nam HS, Oh BM, Han TR

Abstract
OBJECTIVES/HYPOTHESIS: To evaluate the relationship between movements of hyolaryngeal structures and fluid bolus transition in normal swallowing using automatized kinematic analysis of the videofluoroscopic swallowing study (VFSS).
STUDY DESIGN: A prospective, descriptive study.
METHODS: Seventy-five healthy volunteers underwent VFSS with 2 mL of diluted barium. The timing and sequence of structural movements were measured for laryngeal elevation (LE), hyoid excursion (HE), epiglottic rotation (ER), and fluid bolus transition.
RESULTS: The rapid movement of LE (reference time point) was initiated simultaneously with the fluid bolus head passing the mandibular angle (-0.05 s, P = .07), followed by rapid onset of HE with significant temporal difference (P < .001). After the hyoid onset, onset of ER (0.17 s, P < .001), entrance of the bolus through upper esophageal sphincter (0.33 s, P < .001), maximal point of LE (0.52 s, P < .001), HE (0.53 s, P = .344), and maximal point of ER (0.64 s, P < .001) followed sequentially. For subgroup analysis, we classified 50 subjects without premature bolus loss (PBL) or pharyngeal triggering delay (PTD) into the "early group," and 24 subjects with PBL or PTD for <1 s into the "late group." In both groups, the sequence of the structural movements did not change. The early group showed significant correlation between the fluid transition and structural movements; both LE and HE were initiated when the bolus passed the mandibular angle, and the ER was initiated when the bolus reached the vallecula.
CONCLUSIONS: We demonstrated a characteristic pattern of hyolaryngeal structural movements in normal swallowing. The results may serve as a basis for classifying and analyzing aspiration patterns in patients with dysphagia.
LEVEL OF EVIDENCE: NA.

PMID: 25783750 [PubMed - indexed for MEDLINE]

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Intestinal dendritic cells.

http:--pt.wkhealth.com-pt-pt-core-templa

Intestinal dendritic cells.

Curr Opin Gastroenterol. 2015 Mar;31(2):98-103

Authors: Schiavi E, Smolinska S, O'Mahony L

Abstract
PURPOSE OF REVIEW: The intestinal immune system is constantly exposed to foreign antigens, which for the most part should be tolerated, but the immune system retains the ability to react rapidly and effectively to eliminate pathogens. Dendritic cells are at the front line in maintaining intestinal integrity as they are widely distributed within the intestinal lamina propria, Peyer's patches and mesenteric lymph nodes.
RECENT FINDINGS: The identification of dendritic cell subsets and phenotypic markers within the healthy and diseased intestine has progressed significantly, including improved identification of dendritic cell subsets within the human intestine. Recently, the role for dietary factors and the microbiome in modulating the intestinal dendritic cell functions has begun to be better investigated, resulting in a number of new findings relating to retinoic acid metabolism, pattern recognition receptor triggering and G-protein-coupled receptor activation. In addition, the interactions between goblet cells and mucin with intestinal dendritic cells are being better defined.
SUMMARY: In this review, we discuss the recent findings relating to intestinal dendritic cells, in particular the importance of dendritic cells in sensing the intestinal microenvironment and the consequences for health and disease.

PMID: 25651073 [PubMed - indexed for MEDLINE]

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Estimation of inferior-superior vocal fold kinematics from high-speed stereo endoscopic data in vivo.

Estimation of inferior-superior vocal fold kinematics from high-speed stereo endoscopic data in vivo.

J Acoust Soc Am. 2014 Dec;136(6):3290

Authors: Sommer DE, Tokuda IT, Peterson SD, Sakakibara K, Imagawa H, Yamauchi A, Nito T, Yamasoba T, Tayama N

Abstract
Despite being an indispensable tool for both researchers and clinicians, traditional endoscopic imaging of the human vocal folds is limited in that it cannot capture their inferior-superior motion. A three-dimensional reconstruction technique using high-speed video imaging of the vocal folds in stereo is explored in an effort to estimate the inferior-superior motion of the medial-most edge of the vocal folds under normal muscle activation in vivo. Traditional stereo-matching algorithms from the field of computer vision are considered and modified to suit the specific challenges of the in vivo application. Inferior-superior motion of the medial vocal fold surface of three healthy speakers is reconstructed over one glottal cycle. The inferior-superior amplitude of the mucosal wave is found to be approximately 13 mm for normal modal voice, reducing to approximately 3 mm for strained falsetto voice, with uncertainty estimated at σ ≈ 2 mm and σ ≈ 1 mm, respectively. Sources of error, and their relative effects on the estimation of the inferior-superior motion, are considered and recommendations are made to improve the technique.

PMID: 25480074 [PubMed - indexed for MEDLINE]

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Modeling the effects of a posterior glottal opening on vocal fold dynamics with implications for vocal hyperfunction.

Modeling the effects of a posterior glottal opening on vocal fold dynamics with implications for vocal hyperfunction.

J Acoust Soc Am. 2014 Dec;136(6):3262

Authors: Zañartu M, Galindo GE, Erath BD, Peterson SD, Wodicka GR, Hillman RE

Abstract
Despite the frequent observation of a persistent opening in the posterior cartilaginous glottis in normal and pathological phonation, its influence on the self-sustained oscillations of the vocal folds is not well understood. The effects of a posterior gap on the vocal fold tissue dynamics and resulting acoustics were numerically investigated using a specially designed flow solver and a reduced-order model of human phonation. The inclusion of posterior gap areas of 0.03-0.1 cm(2) reduced the energy transfer from the fluid to the vocal folds by more than 42%-80% and the radiated sound pressure level by 6-14 dB, respectively. The model was used to simulate vocal hyperfucntion, i.e., patterns of vocal misuse/abuse associated with many of the most common voice disorders. In this first approximation, vocal hyperfunction was modeled by introducing a compensatory increase in lung air pressure to regain the vocal loudness level that was produced prior to introducing a large glottal gap. This resulted in a significant increase in maximum flow declination rate and amplitude of unsteady flow, thereby mimicking clinical studies. The amplitude of unsteady flow was found to be linearly correlated with collision forces, thus being an indicative measure of vocal hyperfunction.

PMID: 25480072 [PubMed - indexed for MEDLINE]

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Entrance loss coefficients and exit coefficients for a physical model of the glottis with convergent angles.

Entrance loss coefficients and exit coefficients for a physical model of the glottis with convergent angles.

J Acoust Soc Am. 2014 Sep;136(3):1312

Authors: Fulcher LP, Scherer RC, Anderson NV

Abstract
Pressure distributions were obtained for 5°, 10°, and 20° convergent angles with a static physical model (M5) of the glottis. Measurements were made for minimal glottal diameters from d = 0.005-0.32 cm with a range of transglottal pressures of interest for phonation. Entrance loss coefficients were calculated at the glottal entrance for each minimal diameter and transglottal pressure to measure how far the flows in this region deviate from Bernoulli flow. Exit coefficients were also calculated to determine the presence and magnitude of pressure recovery near the glottal exit. The entrance loss coefficients for the three convergent angles vary from values near 2.3-3.4 for d = 0.005 cm to values near 0.6 for d = 0.32 cm. These coefficients extend the tables of entrance loss and exit coefficients obtained for the uniform glottis according to Fulcher, Scherer, and Powell [J. Acoust. Soc. Am. 129, 1548-1553 (2011)].

PMID: 25190404 [PubMed - indexed for MEDLINE]

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Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions.

Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions.

CJEM. 2012 Nov;14(6):330-4

Authors: Robak O, Leonardelli M, Zedtwitz-Liebenstein K, Rützler K, Schuster E, Vaida S, Salem R, Frass M

Abstract
OBJECTIVES: Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions.
METHODS: Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs.
RESULTS: Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs.
CONCLUSION: The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.

PMID: 23131479 [PubMed - indexed for MEDLINE]

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Παρασκευή 13 Νοεμβρίου 2015