Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis.

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Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis.

Eur Arch Otorhinolaryngol. 2015 Jun;272(6):1525-8

Authors: Yildizoglu U, Polat B, Gumral R, Kilic A, Tosun F, Gerek M

Abstract
The aim of this study was to investigate the effects of commonly used antibiotics on bacterial flora of the tonsil core. Patients who underwent tonsillectomy for recurrent chronic tonsillitis were included in the study. Three groups were formed: group 1 was treated for 10 days preoperatively with amoxicillin/clavulanic acid; group 2 was treated for 10 days preoperatively with clarithromycin; and group 3 included patients who underwent tonsillectomy without preoperative antibiotic use. The removed palatine tonsils were sent to our microbiology department in sterile tubes for bacteriological analysis. Seventy-three patients (group 1 = 19, group 2 = 20, group 3 = 34 patients) aged 3-18 years (mean 7 years) were included in the study. At least one bacterium was isolated from all tonsils, except for two cases in group 1; the difference in single bacterial growth among groups was not significant (p = 0.06). On the other hand, the numbers of patients with pathogenic bacterial growth was significantly lower in group 2 (n = 2) compared with group 1 (n = 10) and group 3 (n = 27) (p < 0.001). The bacterium isolated most frequently from the tonsils was Streptococcus viridans. Pseudomonas aeruginosa was the only pathogenic bacterium that grew in all three groups. Clarithromycin was more effective than amoxicillin/clavulanic acid in eradicating pathogenic bacteria in the tonsil core. Pseudomonas aeruginosa might be responsible for resistant or recurrent tonsil infections. To prevent endocarditis, antibiotic prophylaxis toward S. viridians, which is the most prevalent bacterium in the tonsil core, should be kept in mind for patients with heart valve damage.

PMID: 25510984 [PubMed - indexed for MEDLINE]

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Nasal speech associated with hyperaeration of the sphenoid sinus.

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Nasal speech associated with hyperaeration of the sphenoid sinus.

In Vivo. 2015 Mar-Apr;29(2):281-7

Authors: Fraederich M, Aboelhasan MF, Knips J, Heiland M, Friedrich RE

Abstract
The sinus sphenoidalis is the paranasal sinus most centrally located in the skull base and known to vary extremely in dimensions. A very large volume of the sinus visible on skull radiographs is called sinus 'hyperaeration'. This finding has been described many times in the literature, but is generally rare. The term 'pneumosinus dilatans' is synonymously used to address an unexpectedly large paranasal sinus. In the majority of cases, sphenoid sinus hyperaeration is not associated with any clinical symptoms. On the other hand, different complaints have been described in cases of extensive sphenoid sinus volume, such as headache, inflammation or neoplasia. This is a report of an adult patient with nasal speech who was thoroughly investigated for alterations of the upper airway in order to clarify the reason for the speech anomaly. After extensive diagnostics, the patient was found to have normal anatomy and no functional alteration of the velo-pharyngeal complex. However, an impressively large sphenoid sinus was shown on computed tomograms. This is likely the first report detailing a patient with nasal speech and hyperaeration of the sinus.

PMID: 25792658 [PubMed - indexed for MEDLINE]

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Using network science in the language sciences and clinic.

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Using network science in the language sciences and clinic.

Int J Speech Lang Pathol. 2015 Feb;17(1):13-25

Authors: Vitevitch MS, Castro N

Abstract
A number of variables—word frequency, word length—have long been known to influence language processing. This study briefly reviews the effects in speech perception and production of two more recently examined variables: phonotactic probability and neighbourhood density. It then describes a new approach to study language, network science, which is an interdisciplinary field drawing from mathematics, computer science, physics and other disciplines. In this approach, nodes represent individual entities in a system (i.e. phonological word-forms in the lexicon), links between nodes represent relationships between nodes (i.e. phonological neighbours) and various measures enable researchers to assess the micro-level (i.e. the individual word), the macro-level (i.e. characteristics about the whole system) and the meso-level (i.e. how an individual fits into smaller sub-groups in the larger system). Although research on individual lexical characteristics such as word-frequency has increased understanding of language processing, these measures only assess the "micro-level". Using network science, researchers can examine words at various levels in the system and how each word relates to the many other words stored in the lexicon. Several new findings using the network science approach are summarized to illustrate how this approach can be used to advance basic research as well as clinical practice.

PMID: 25539473 [PubMed - indexed for MEDLINE]

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Sentence repetition: what does the task measure?

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Sentence repetition: what does the task measure?

Int J Lang Commun Disord. 2015 Jan-Feb;50(1):106-18

Authors: Polišenská K, Chiat S, Roy P

Abstract
BACKGROUND: Sentence repetition is gaining increasing attention as a source of information about children's sentence-level abilities in clinical assessment, and as a clinical marker of specific language impairment. However, it is widely debated what the task is testing and therefore how informative it is.
AIMS: (1) To evaluate the effects of different types of long-term linguistic knowledge on immediate recall, (2) to assess age sensitivity of repetition tasks designed to evaluate these effects, and (3) to establish if the effects are similar across typologically different languages. The study also considers the implications of the findings for the use of sentence repetition as a research and clinical assessment tool.
METHODS & PROCEDURES: Participants were 50 English-speaking and 50 Czech-speaking typically developing 4-5-year-olds. Children's ability to recall sequences of items was compared in seven linguistic conditions ranging from fully well-formed sentences to sequences of non-words. In each condition, children repeated blocks of successively longer stimuli to establish their span.
OUTCOMES & RESULTS: Results showed significant but differential effects of all linguistic factors in both languages. While syntactic violations and presence of non-words dramatically reduced children's span, semantic implausibility and the removal of sentence prosody played a significant but much smaller role. Familiarity of function words was more important than familiarity of content words. The effects of different linguistic factors on spans were the same for both languages and did not change between 4 and 5 years, although average spans increased over this age range.
CONCLUSIONS & IMPLICATIONS: Children's ability to repeat sentences is more dependent on their familiarity with morphosyntax and lexical phonology than semantics or prosody, with function words of particular importance. Findings have implications for the use of recall in clinical assessment and as a research tool.

PMID: 25208477 [PubMed - indexed for MEDLINE]

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Explaining pragmatic performance in traumatic brain injury: a process perspective on communicative errors.

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Explaining pragmatic performance in traumatic brain injury: a process perspective on communicative errors.

Int J Lang Commun Disord. 2015 Jan-Feb;50(1):63-83

Authors: Bosco FM, Angeleri R, Sacco K, Bara BG

Abstract
BACKGROUND: The purpose of this study is to investigate the pragmatic abilities of individuals with traumatic brain injury (TBI). Several studies in the literature have previously reported communicative deficits in individuals with TBI, however such research has focused principally on communicative deficits in general, without providing an analysis of the errors committed in understanding and expressing communicative acts. Within the theoretical framework of Cognitive Pragmatics theory and Cooperative principle we focused on intermediate communicative errors that occur in both the comprehension and the production of various pragmatic phenomena, expressed through both linguistic and extralinguistic communicative modalities.
AIMS: To investigate the pragmatic abilities of individuals with TBI.
METHODS & PROCEDURES: A group of 30 individuals with TBI and a matched control group took part in the experiment. They were presented with a series of videotaped vignettes depicting everyday communicative exchanges, and were tested on the comprehension and production of various kinds of communicative acts (standard communicative act, deceit and irony). The participants' answers were evaluated as correct or incorrect. Incorrect answers were then further evaluated with regard to the presence of different intermediate errors.
OUTCOMES & RESULTS: Individuals with TBI performed worse than control participants on all the tasks investigated when considering correct versus incorrect answers. Furthermore, a series of logistic regression analyses showed that group membership (TBI versus controls) significantly predicted the occurrence of intermediate errors. This result holds in both the comprehension and production tasks, and in both linguistic and extralinguistic modalities.
CONCLUSIONS & IMPLICATIONS: Participants with TBI tend to have difficulty in managing different types of communicative acts, and they make more intermediate errors than the control participants. Intermediate errors concern the comprehension and production of the expression act, the comprehension of the actors' meaning, as well as the respect of the Cooperative principle.

PMID: 25039503 [PubMed - indexed for MEDLINE]

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Factors predicting the technical difficulty of peroral endoscopic myotomy for achalasia.

Factors predicting the technical difficulty of peroral endoscopic myotomy for achalasia.

Surg Endosc. 2015 Dec 10;

Authors: Tang X, Ren Y, Wei Z, Zhou J, Deng Z, Chen Z, Jiang B, Gong W

Abstract
BACKGROUND: Peroral endoscopic myotomy (POEM) has been described as a novel treatment for esophageal achalasia. Owing to its technical difficulty, POEM is not widely performed. This study was aimed to prospectively assess the factor predicting technical difficulty of POEM in a single center with large volume cases.
METHODS: A total of 105 cases of achalasia treated by POEM from April 2011 to September 2014 were analyzed. Difficult cases of POEM were defined as procedure time ≥90 min and occurrence of adverse events, including mucosal perforation, pneumothorax, and major bleeding. Univariate and multivariate logistic regression analyses were performed to assess the predictive factors of difficult POEM.
RESULTS: POEM was successfully completed in all the patients, and no one was converted to laparoscopy. The number of cases with procedure time ≥90 min was 17. Mucosal perforations occurred in six (5.7 %) patients during submucosal tunnel creation, major bleeding occurred in seven (6.7 %) patients, and pneumothorax occurred in six (5.7 %) patients immediately after procedure. All the complications were managed conservatively. No other intraoperative and immediate postoperative complications, including infections and pneumoperitoneum, occurred. Multivariate analysis showed that early period (odds ratio [OR] 4.173, 95 % confidence interval [95 % CI] 1.36-6.829, P = 0.023) and triangular tip knife ([OR] 6.712, [95 % CI] 1.479-30.460, P = 0.014) were independent factors associated with technical difficulty regarding longer procedure time (procedure time ≥90 min).
CONCLUSION: POEM is safe for the treatment of esophageal achalasia. Triangular tip knife and early period were independent risk factors for longer procedural time.

PMID: 26659228 [PubMed - as supplied by publisher]

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Expression and mutational analysis of Cip/Kip family in early glottic cancer.

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Expression and mutational analysis of Cip/Kip family in early glottic cancer.

J Laryngol Otol. 2015 Feb;129(2):168-73

Authors: Kim DK, Lee JH, Lee OJ, Park CH

Abstract
BACKGROUND: Genetic alteration of cyclin-dependent kinase inhibitors has been associated with carcinogenesis mechanisms in various organs.
OBJECTIVE: This study aimed to evaluate the expression and mutational analysis of Cip/Kip family cyclin-dependent kinase inhibitors (p21CIP1/WAF1, p27KIP1 and p57KIP2) in early glottic cancer.
METHODS: Expressions of Cip/Kip family and p53 were determined by quantitative reverse transcription polymerase chain reaction and densitometry. For the analysis of p21 inactivation, sequence alteration was assessed using single-strand conformational polymorphism polymerase chain reaction. Additionally, the inactivation mechanism of p27 and p57 were investigated using DNA methylation analysis.
RESULTS: Reduced expression of p27 and p57 were detected in all samples, whereas the expression of p21 was incompletely down-regulated in 6 of 11 samples. Additionally, single-strand conformational polymorphism polymerase chain reaction analysis showed the p53 mutation at exon 6. Methylation of p27 and p57 was detected by DNA methylation assay.
CONCLUSION: Our results suggest that the Cip/Kip family may have a role as a molecular mechanism of carcinogenesis in early glottic cancer.

PMID: 25695279 [PubMed - indexed for MEDLINE]

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An anatomic study to determine the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws.

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An anatomic study to determine the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws.

Spine (Phila Pa 1976). 2015 Feb 15;40(4):E191-8

Authors: Hu Y, Dong WX, Spiker WR, Yuan ZS, Sun XY, Zhang J, Xie H, Albert TJ

Abstract
STUDY DESIGN: Anatomic study of the C1 lateral mass using fine-cut computed tomographic scans and Mimics software.
OBJECTIVE: To investigate the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws.
SUMMARY OF BACKGROUND DATA: Placing posterior C1 lateral mass screws is technically demanding, and a misplaced screw can result in injury to the vertebral artery, spinal cord, or internal carotid artery. Although various insertion angles have been proposed for posterior C1 lateral mass screw, no clear consensus has been reached on the ideal medial angle of the C1 lateral mass.
METHODS: The C1 lateral masses were evaluated using computed tomographic scans and Mimics software in 70 patients. The effective width and effective screw length of posterior C1 lateral mass screws were measured at different medial angulations relative to the midline sagittal plane. The height (H) for screw entry point on the posterior surface of C1 lateral mass and the distance (D) between screw entry point and the intersection of the midline sagittal plane and the posterior arch of the atlas were also measured.
RESULTS: The mean height (H) for screw entry on the posterior surface of the lateral mass was 4.25 mm, the mean distance (D) between screw entry point and the intersection of the midsagittal plane and the posterior arch of the atlas was 27.62 mm. The optimal medial angle was 20.86° with a corresponding effective width of 10.56 mm and effective screw length of 21.87 mm.
CONCLUSION: This study helps to define the specific anatomy related to C1 posterior lateral mass screw placement in an effort to facilitate instrumentation. However, variation is seen in lateral mass anatomy, and this study must be combined with customized surgical planning that includes advanced imaging for safe and effective instrumentation.
LEVEL OF EVIDENCE: 1.

PMID: 25398038 [PubMed - indexed for MEDLINE]

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Comprehensive Emergency Airway Response Team (EART) Training and Education: Impact on Team Effectiveness, Personnel Confidence, and Protocol Knowledge.

Comprehensive Emergency Airway Response Team (EART) Training and Education: Impact on Team Effectiveness, Personnel Confidence, and Protocol Knowledge.

Ann Otol Rhinol Laryngol. 2015 Dec 9;

Authors: Tsai AC, Krisciunas GP, Brook C, Basa K, Gonzalez M, Crimlisk J, Silva J, Grillone GA

Abstract
OBJECTIVE: To evaluate the efficacy and utility of simulation of the Emergency Airway Response Team (EART) at a tertiary care hospital to improve team dynamics and confidence and knowledge in managing an emergency airway.
METHODS: This was a descriptive, quantitative performance improvement study. From September 1, 2013, to December 1, 2013, 177 members of the EART from anesthesia, otolaryngology, trauma surgery, emergency medicine, ICU nursing, and respiratory therapy participated in emergency airway simulations. Team dynamics and confidence levels and knowledge of EART were assessed using pre-and post-simulation questionnaires.
RESULTS: All participants regardless of their role, experience in the medical field, or any prior exposure to a difficult airway showed significant improvement in self-rated team participation and confidence and objective knowledge regarding EART after undergoing simulation.
CONCLUSION: Our study highlights the efficacy and utility of simulation in assessing personnel team dynamics and confidence levels and knowledge of emergency airway scenarios. Practitioners in all fields and level of experience benefit in EART training and simulation. We hope that with this information, we will be able to conduct future studies on reduction of patient morbidity and mortality.

PMID: 26658070 [PubMed - as supplied by publisher]

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A Novel Approach to the Challenging Injection Laryngoplasty.

A Novel Approach to the Challenging Injection Laryngoplasty.

Ann Otol Rhinol Laryngol. 2015 Dec 9;

Authors: Mayerhoff RM, Kuo C, Meyer T

Abstract
INTRODUCTION: Injection laryngoplasty (IL) is typically performed either awake or under general anesthesia with paralysis. There is a subgroup of patients, however, for whom neither of these is a good option. For such patients, we report a hybrid technique that allows for a percutaneous injection without paralysis but with sedation to increase patient tolerance. Supraglottic airway laryngotracheal intervention (SALTI) brings the benefits of injection laryngoplasty to a group of patients previously underserved.
METHODS: Injection laryngoplasty cases using SALTI technique from July 1, 2013, to October 21, 2014, were reviewed. Data were collected regarding the indication, success of injection, comorbidities, and outcomes.
RESULTS: Seventeen subjects were reviewed. All were successfully injected without complications. Follow-up data were available for 15 subjects. The majority of patients experienced improved symptoms of dysphonia and/or dysphagia after the procedure.
DISCUSSION AND CONCLUSIONS: This study demonstrates the feasibility of the SALTI technique for IL. The technique may also be useful for other procedures. Advantages include maintenance of spontaneous ventilation without paralysis, no neck extension, improved patient tolerance, and accommodation of difficult anatomy. Disadvantages are increased time and cost related to the operating room and the need for an assistant. Overall, SALTI permits IL in previously ineligible patients.

PMID: 26658069 [PubMed - as supplied by publisher]

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The Effect of Initial Tracheoesophageal Voice Prosthesis Size on Postoperative Complications and Voice Outcomes.

The Effect of Initial Tracheoesophageal Voice Prosthesis Size on Postoperative Complications and Voice Outcomes.

Ann Otol Rhinol Laryngol. 2015 Dec 9;

Authors: Naunheim MR, Remenschneider AK, Scangas GA, Bunting GW, Deschler DG

Abstract
OBJECTIVES: The optimal initial size of tracheoesophageal voice prosthesis (TEVP) for tracheoesophageal voice restoration (TEVR) remains unclear. As purported advantages exist favoring the placement of both 16F and 20F prostheses, this study compares complications and voicing outcomes after placement of 16 and 20 French (F) prostheses.
METHODS: All cases of TEVR at an academic medical center were retrospectively reviewed (2007-2013). Complications including dislodgement, leakage, infection, and granulation tissue were compared. Outcomes including frequency of prosthesis change, acquisition of speech, and time to fluent speech were compared.
RESULTS: Of 47 patients, 25 received 20F prostheses, and 22 received 16F. Postoperative complications were similar between groups, including leakage around the prosthesis (P = .373) and aspiration pneumonia (P = .670). There were no significant differences in timing of voicing or ability to achieve fluency. Although the 20F group appeared to undergo fewer prostheses changes per year (3.0 vs 5.3) and had a longer duration of use before first prosthesis change (76 vs 43 days), neither difference was found to be statistically significant.
CONCLUSION: Voice restoration was successfully achieved using either 16F or 20F prostheses. Prosthesis diameter did not significantly affect complications or voicing. Both prostheses may be placed with safety and efficacy, allowing the practitioner to choose based on the potential individual benefits of either device.

PMID: 26658068 [PubMed - as supplied by publisher]

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Subtotal Petrosectomy for Cochlear Implantation: Lessons Learned After 110 Cases.

Subtotal Petrosectomy for Cochlear Implantation: Lessons Learned After 110 Cases.

Ann Otol Rhinol Laryngol. 2015 Dec 9;

Authors: Polo R, Medina MD, Arístegui M, Lassaletta L, Gutierrez A, Aránguez G, Prasad SC, Alonso A, Gavilán J, Sanna M

Abstract
OBJECTIVES: The purpose of this study was to review the indications for subtotal petrosectomy for cochlear implantation, report our management of complications, as well as review those technical factors that are critical for successful implantation.
METHODS: Patients (n = 104) that underwent subtotal petrosectomy with closure of the external auditory canal and obliteration of the cavity with abdominal fat in combination with cochlear implantation were analyzed.
RESULTS: The most frequent indication for subtotal petrosectomy was the existence of a previous canal wall down technique. Postoperative complications occurred in 13 patients (11.83%). Extrusion of the device took place in 5 cases (4.55%).
CONCLUSIONS: Subtotal petrosectomy in cochlear implantation permits obtaining a cavity isolated from the external environment, and when needed, it improves the access and visibility during the surgical procedure. Subtotal petrosectomy is a safe technique, with a low rate of complications.

PMID: 26658067 [PubMed - as supplied by publisher]

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Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis.

Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis.

Obes Surg. 2015 Dec 12;

Authors: Li J, Lai D, Wu D

Abstract
Our aim was to compare laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for treating morbid obesity and its related comorbidities. An electronic literature search was performed from inception to May 2015 and a total of 18,455 patients, enrolled in 62 recent studies, were included in this meta-analysis. Patients receiving LRYGB had a significantly higher percentage of excess weight loss and better resolution of hypertension, dyslipidemia, gastroesophageal reflux disease, and arthritis compared with those receiving LSG. LRYGB and LSG showed similar effects on type 2 diabetes mellitus and sleep apnea.

PMID: 26661105 [PubMed - as supplied by publisher]

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Functional dysphonia: strategies to improve patient outcomes.

Functional dysphonia: strategies to improve patient outcomes.

Patient Relat Outcome Meas. 2015;6:243-253

Authors: Behlau M, Madazio G, Oliveira G

Abstract
Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient's perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient's recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem.

PMID: 26664248 [PubMed - as supplied by publisher]

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Automatic Vagus Nerve Stimulation Triggered by Ictal Tachycardia: Clinical Outcomes and Device Performance-The U.S. E-37 Trial.

Automatic Vagus Nerve Stimulation Triggered by Ictal Tachycardia: Clinical Outcomes and Device Performance-The U.S. E-37 Trial.

Neuromodulation. 2015 Dec 13;

Authors: Fisher RS, Afra P, Macken M, Minecan DN, Bagić A, Benbadis SR, Helmers SL, Sinha SR, Slater J, Treiman D, Begnaud J, Raman P, Najimipour B

Abstract
OBJECTIVES: The Automatic Stimulation Mode (AutoStim) feature of the Model 106 Vagus Nerve Stimulation (VNS) Therapy System stimulates the left vagus nerve on detecting tachycardia. This study evaluates performance, safety of the AutoStim feature during a 3-5-day Epilepsy Monitoring Unit (EMU) stay and long- term clinical outcomes of the device stimulating in all modes.
MATERIALS AND METHODS: The E-37 protocol (NCT01846741) was a prospective, unblinded, U.S. multisite study of the AspireSR(®) in subjects with drug-resistant partial onset seizures and history of ictal tachycardia. VNS Normal and Magnet Modes stimulation were present at all times except during the EMU stay. Outpatient visits at 3, 6, and 12 months tracked seizure frequency, severity, quality of life, and adverse events.
RESULTS: Twenty implanted subjects (ages 21-69) experienced 89 seizures in the EMU. 28/38 (73.7%) of complex partial and secondarily generalized seizures exhibited ≥20% increase in heart rate change. 31/89 (34.8%) of seizures were treated by Automatic Stimulation on detection; 19/31 (61.3%) seizures ended during the stimulation with a median time from stimulation onset to seizure end of 35 sec. Mean duty cycle at six-months increased from 11% to 16%. At 12 months, quality of life and seizure severity scores improved, and responder rate was 50%. Common adverse events were dysphonia (n = 7), convulsion (n = 6), and oropharyngeal pain (n = 3).
CONCLUSIONS: The Model 106 performed as intended in the study population, was well tolerated and associated with clinical improvement from baseline. The study design did not allow determination of which factors were responsible for improvements.

PMID: 26663671 [PubMed - as supplied by publisher]

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Right visual loss due to choroidal metastasis of a papillary adenocarcinoma of the lung: a case report.

Right visual loss due to choroidal metastasis of a papillary adenocarcinoma of the lung: a case report.

Rom J Morphol Embryol. 2015;56(3):1173-1177

Authors: Turliuc MD, Sava A, Dumitrescu GF, Cucu A, Eşanu A, Tudorache C, Costache II, Costea CF

Abstract
The symptomatic choroidal metastasis is a rare manifestation of lung cancer. The aim of this study was to present a clinical case of choroidal metastasis associated with multiple intracerebral metastases from a papillary adenocarcinoma of the lung diagnosed simultaneously with its metastases. We present the case of a 40-year-old male patient, smoker, admitted to the Neurosurgery Clinic II, "Prof. Dr. Nicolae Oblu" Emergency Hospital, Iassy, Romania, for right hemiparesis, headache, right visual loss, dysphonia and swallowing disorders occurring six days earlier. Previous medical history showed that he was diagnosed with a stage IV cancer located in the lower lobe of the left lung a week before. Ophthalmoscopic examination of the right eye revealed total secondary serous retinal detachment. Contrast cranial-cerebral computed tomography (CT) scan revealed multiple lesions compatible with the diagnosis of supratentorial intracerebral metastases in the left hemisphere, as well as an intraocular choroidal metastasis. The rolandic brain tumor was surgically removed and the cyto- and histopathological exam established the diagnosis of an intracerebral metastasis from a papillary adenocarcinoma of the lung. After a week, the patient was referred to an oncology unit for the initiation of oncology and palliative care. We emphasize the importance of an ophthalmological screening of patients with intracerebral metastases in order to eventually identify a choroidal metastasis, as the recognition and early treatment of this entity could improve the quality of patient's life.

PMID: 26662155 [PubMed - as supplied by publisher]

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Primidone Therapy for Essential Vocal Tremor.

Primidone Therapy for Essential Vocal Tremor.

JAMA Otolaryngol Head Neck Surg. 2015 Dec 10;:1-5

Authors: Nida A, Alston J, Schweinfurth J

Abstract
Importance: Essential vocal tremor is difficult to treat. An effective pharmacologic treatment could allow patients to avoid or decrease the frequency or dosage of botulinum neurotoxin injections.
Objective: To evaluate the efficacy of primidone in the treatment of essential vocal tremor.
Design, Setting, and Participants: Medical records of all patients with a primary or secondary diagnosis of laryngeal spasm or essential tremor treated with primidone between June 1, 2012, and March 21, 2014, at a tertiary care medical center were reviewed. Data analysis occurred in April 2014.
Main Outcomes and Measures: Duration of therapy, improvement of symptoms, and whether the patient subsequently initiated botulinum neurotoxin therapy.
Results: All 30 patients were female (mean [SD] age, 71.9 [11.8] years). Mean (SD) therapy duration was 5.25 (7.22) months. Nine patients (30%) had other vocal conditions (4 had coexisting spasmodic dysphonia, 4 had laryngopharyngeal reflux disease, and 1 had muscle tension dysphonia). Twelve (40%) had previously undergone treatment. Fourteen of 26 patients (54%) reported an improvement in their vocal symptoms, and 16 of 29 (55%) did not discontinue primidone therapy. Twenty-two of 30 patients (73%) experienced adverse effects. Therapy was discontinued by 11 of 21 patients (52%) who experienced adverse effects and 2 of 8 patients (25%) who did not report adverse effects (P = .24) (1 patient who had adverse effects was missing data on discontinuation of therapy). Sixteen patients (53%) subsequently initiated botulinum toxin therapy, including 5 of 14 patients (36%) who reported clinical improvement with primidone therapy and 7 of 12 patients (58%) who did not report improvement (P = .43).
Conclusions and Relevance: Primidone therapy was an effective pharmacologic treatment for essential vocal tremor in 14 of 26 patients in this case series, providing an alternative to botulinum neurotoxin therapy.

PMID: 26660910 [PubMed - as supplied by publisher]

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Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis.

Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis.

J Voice. 2015 Dec 3;

Authors: Busto-Crespo O, Uzcanga-Lacabe M, Abad-Marco A, Berasategui I, García L, Maraví E, Aguilera-Albesa S, Fernández-Montero A, Fernández-González S

Abstract
OBJECTIVES: To investigate the long-term effectiveness of voice therapy in vocal outcomes of patients with unilateral vocal fold paralysis (UVFP) and vocal productions of patients with long-standing treatment-naïve UVFP treated with voice therapy.
STUDY DESIGN: Prospective observational study.
METHODS: A voice therapy protocol was applied individually in three stages. Fifteen sessions were scheduled twice a week in 70 patients with UVFP. Forty-seven patients were treated within a year of the diagnosis (group 1). The remaining patients had delayed therapy (at least 1 year after diagnosis) (group 2). Multidisciplinary assessment included nasofibroscopy, videostroboscopy, acoustic and aerodynamic parameters, and perception of voice impairment measures. A subgroup of the 70 patients (n = 32) was reassessed after 1 year of follow-up.
RESULTS: Our voice therapy protocol significantly improved voice productions and perception of voice impairment in group 1 (P < 0.0001). Patients in group 2 experienced less hoarseness and had improved perception of voice impairment (P = 0.007). The improvement was long lasting and persisted at 1 year of follow-up in both groups.
CONCLUSIONS: Voice therapy is effective in patients with UVFP and its benefits are sustained over time. Early referral for voice therapy seems to be associated with greater benefit, but quality of life also improves for patients despite delayed treatment.

PMID: 26658167 [PubMed - as supplied by publisher]

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The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

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The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

Ann Otol Rhinol Laryngol. 2015 Nov;124(11):859-63

Authors: Patel AB, Bansberg SF, Adler CH, Lott DG, Crujido L

Abstract
OBJECTIVE: Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies.
METHODS: Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded.
RESULTS: Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%).
CONCLUSIONS: Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias.

PMID: 26024910 [PubMed - indexed for MEDLINE]

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Photo quiz. A painful and disfiguring lesion on the face.

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Photo quiz. A painful and disfiguring lesion on the face.

Clin Infect Dis. 2015 Mar 15;60(6):928-9, 966-7

Authors: Sulaiman H, Ismail I, Azwa I, Jayalakshmi P, Bick J

PMID: 25733590 [PubMed - indexed for MEDLINE]

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