Benefit of contralateral hearing aid in adult cochlear implant bearers.

Benefit of contralateral hearing aid in adult cochlear implant bearers.

Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Dec 8;

Authors: Bouccara D, Blanchet E, Waterlot PE, Smadja M, Frachet B, Meyer B, Sterkers O

Abstract
OBJECTIVES: The present study assessed the interest of a contralateral hearing aid (HA) in adult cochlear implant (CI) bearers.
MATERIAL AND METHODS: The study recruited 10 French-speaking adult HA bearers with postlingual bilateral hearing loss, fitted for at least 2 years with a unilateral CI after loss of benefit from HA in one ear but continuing to use their contralateral HA: 4 male, 6 female; mean age, 58 years. All had regularly used bilateral HAs prior to CI. Audiometric assessment comprised: (1) individual ear hearing assessment on pure-tone audiometry and speech discrimination; and (2) free-field testing without aid, with CI only, with HA only and with CI plus HA, on pure-tone audiometry and speech discrimination with quiet background and on speech discrimination in noise.
RESULTS: Speech discrimination was significantly improved in the bimodal condition (CI plus HA) as compared to CI alone, on all tests. In quiet, discrimination for disyllabic words was>50% in 7 cases with HA alone, in 2 cases with CI alone and in 1 case in with HA+CI. Under 0dB signal-to-noise ratio, discrimination was>50% in 1 case with HA alone, in 3 cases with CI alone and in 6 cases with HA+CI.
CONCLUSION: The present results showed benefit in auditory perception in quiet and in noise with bimodal stimulation. When there is residual hearing in the non-implanted ear, a HA should be fitted; and in progressive bilateral hearing loss, CI should be suggested when HA benefit decreases in one ear.

PMID: 26679231 [PubMed - as supplied by publisher]

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Self-Retaining Retractor Widox® for Thyroid Surgeries: Technical Note.

Self-Retaining Retractor Widox® for Thyroid Surgeries: Technical Note.

Surg Technol Int. 2015 Nov;27:109-13

Authors: Inversini D, Frattini F, Annoni M, Pappalardo V, Leotta A, Lavazza M, Rausei S, Dionigi G

Abstract
During a thyroidectomy, perfect exposure of the vascular nerve structures, parathyroid gland, trachea, larynx, esophagus, and lymphnodes is crucial to facilitate the surgeon in the meticulous dissection. WIDOX® (MOSS Spa, Lesa, Italy) is an atraumatic self-retaining thyroidectomy retractor specifically designed for thyroid surgeries with an octagonal shape and six retractors (Fig. 1). It is a sterile, single-use device which keeps the surgical wound and the neck muscles retracted allowing the proper exposure of the operatory field. The device substitutes the manual retractors held by the surgeon's assistants. In our institute, we started using the self-retaining retractor WIDOX® from May 2015 for a total of 50 patients. From our preliminary experience, the self-retaining retractor WIDOX® is simple and practical and can be adapted to each patient. The use of energy-based devices and the neuromonitoring is not prevented by the presence of this retractor.

PMID: 26680387 [PubMed - in process]

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Dosimetric distribution to tooth-bearing areas in intensity-modulated radiation therapy for head and neck cancer: a pilot study.

Dosimetric distribution to tooth-bearing areas in intensity-modulated radiation therapy for head and neck cancer: a pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):43-8

Authors: Bak SY, Qi XS, Kelly JA, Alexander S, Chung Y, Gyurdzhyan S, Patton LL, Lee SP

Abstract
OBJECTIVES: Dosimetric distribution of intensity-modulated radiotherapy (IMRT) to tooth-bearing areas for common head and neck (H&N) cancer sites were analyzed to facilitate minimization of osteoradionecrosis (ORN) risk through preradiation dental treatment planning.
STUDY DESIGN: Fifty-four patients received IMRT with prescribed doses ranging from 6000 centigrays (cGy) (adjuvant) to 6930 cGy (primary) to treat base of tongue (BOT), tonsil, larynx, nasopharynx, and hypopharynx cancers. The average maximal radiation dose delivered was recorded in tooth-bearing areas (anteriors, premolars, and first, second, and third molars) of the maxilla and mandible.
RESULTS: All tooth-bearing areas in laryngeal cancer cases received less than 2500 cGy. Maxillary and mandibular molar regions for BOT, tonsil, and hypopharynx cancers received 5000 cGy or higher. In nasopharynx cancers, maxillary teeth received higher doses than mandibular teeth.
CONCLUSIONS: Among 5 H&N subsites, mandibular molar regions for BOT, tonsil, and hypopharynx cancers received higher IMRT doses on average, posing the greatest ORN risk.

PMID: 26679359 [PubMed - in process]

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Frequency Characteristics in Animal Species Typically Used in Laryngeal Research: An Exploratory Investigation.

Frequency Characteristics in Animal Species Typically Used in Laryngeal Research: An Exploratory Investigation.

J Voice. 2015 Dec 8;

Authors: Riley JL, Riley WD, Carroll LM

Abstract
OBJECTIVES: Laryngeal research is typically conducted on animal species that have similar features to the human larynx, yet little is known of the frequency characteristics of those animals. This study examines frequency characteristics of dog, cat, pig, and sheep across emotional communication events.
STUDY DESIGN: Prospective study.
METHODS: Acoustic data were gathered in domestic environment, with fundamental frequency (fo) computation of vocalization during happy, distress, and food request activities.
RESULTS: Dogs demonstrated reduced fo range and reduced vocalization as a factor of age (18 semitones for adult male dog, three semitones for aged male dog). When two barks were present, the second bark was typically shorter in length and had a higher fo. Male cat was observed to be more talkative and exhibited a much higher purr fo than his female housemate. Cat purr was varied by sex between the typical 25 Hz and a significantly higher fo, consistent with literature on use of cry-purr by some cats. Lambs exhibited phonation breaks, and an overall frequency range of 28 semitones in lambs compared with 49 semitones for mature sheep. Piglets exhibited fo range of 44 semitones with higher fo with distress and lowest fo for grunting.
CONCLUSIONS: Aged animals followed similar phonatory patterns of humans, with change of fo for communication need. The male cat was found to purr differently from female cats. Pigs and cats may have nonlaryngeal source signal coupling. Animal phonation changes with emotion. Observed fo patterns may improve interpretation of phonation among laboratory animals in laryngeal research.

PMID: 26678121 [PubMed - as supplied by publisher]

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IL-23, rather than IL-17, is crucial for the development of ovalbumin-induced allergic rhinitis.

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IL-23, rather than IL-17, is crucial for the development of ovalbumin-induced allergic rhinitis.

Mol Immunol. 2015 Oct;67(2 Pt B):436-43

Authors: Guo C, Chen G, Ge R

Abstract
Interleukin-23 (IL-23) and IL-17 are involved in the pathogenesis of allergic rhinitis (AR). However, the roles of IL-23 and IL-17 in ovalbumin (OVA)-induced AR remain unclear. Therefore in this study we aim to investigate the precise roles of IL-23 and IL-17 in a mouse model of OVA-induced AR. We found that during OVA-induced AR, eosinophil and goblet cells in the nose were significantly decreased in IL-23-deficient, but not in IL-17-deficient mice. However, there was no difference in the serum IgE and IgG1 levels between IL-23-deficient or IL-17-deficient and wild-type mice. Moreover, IL-4 levels in lymph node cell culture supernatants were significantly decreased in IL-23-deficient, but not IL-17-deficient, compared with wild-type mice. Furthermore, OVA-induced AR developed similarly in wild-type mice transferred with either IL-23-deficient BM cells or wild-type BM cells. These findings suggest that IL-23, but not IL-17 is crucial for the development of OVA-induced AR, and IL-23 neutralization may be a potential approach for treatment of OVA-induced AR in humans.

PMID: 26239416 [PubMed - indexed for MEDLINE]

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Single injection of basic fibroblast growth factor to treat severe vocal fold lesions and vocal fold paralysis.

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Single injection of basic fibroblast growth factor to treat severe vocal fold lesions and vocal fold paralysis.

Laryngoscope. 2015 Oct;125(10):E338-44

Authors: Kanazawa T, Komazawa D, Indo K, Akagi Y, Lee Y, Nakamura K, Matsushima K, Kunieda C, Misawa K, Nishino H, Watanabe Y

Abstract
OBJECTIVES/HYPOTHESIS: Severe vocal fold lesions such as vocal fold sulcus, scars, and atrophy induce a communication disorder due to severe hoarseness, but a treatment has not been established. Basic fibroblast growth factor (bFGF) therapies by either four-time repeated local injections or regenerative surgery for vocal fold scar and sulcus have previously been reported, and favorable outcomes have been observed. In this study, we modified bFGF therapy using a single of bFGF injection, which may potentially be used in office procedures.
STUDY DESIGN: Retrospective chart review.
METHODS: Five cases of vocal fold sulcus, six cases of scars, seven cases of paralysis, and 17 cases of atrophy were treated by a local injection of bFGF. The injection regimen involved injecting 50 µg of bFGF dissolved in 0.5 mL saline only once into the superficial lamina propria using a 23-gauge injection needle. Two months to 3 months after the injection, phonological outcomes were evaluated.
RESULTS: The maximum phonation time (MPT), mean airflow rate, pitch range, speech fundamental frequency, jitter, and voice handicap index improved significantly after the bFGF injection. Furthermore, improvement in the MPT was significantly greater in patients with (in increasing order) vocal fold atrophy, scar, and paralysis. The improvement in the MPT among all patients was significantly correlated with age; the MPT improved more greatly in younger patients.
CONCLUSIONS: Regenerative treatments by bFGF injection—even a single injection—effectively improve vocal function in vocal fold lesions.
LEVEL OF EVIDENCE: 4

PMID: 25953726 [PubMed - indexed for MEDLINE]

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Vocal characteristics of congenital anterior glottic webs in children: A case report.

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Vocal characteristics of congenital anterior glottic webs in children: A case report.

Int J Pediatr Otorhinolaryngol. 2015 Jun;79(6):941-5

Authors: Shah J, White K, Dohar J

Abstract
This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature.

PMID: 25912682 [PubMed - indexed for MEDLINE]

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Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility.

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Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility.

Int J Pediatr Otorhinolaryngol. 2015 Jun;79(6):895-9

Authors: Funk RT, Jabbour J, Robey T

Abstract
OBJECTIVE: Describe the natural history of all-cause bilateral vocal fold immobility (BVFI) in pediatric patients and analyze factors associated with tracheotomy and subsequent decannulation.
METHODS: This is a retrospective review of all patients diagnosed with complete or partial BVFI at a metropolitan private pediatric otolaryngology practice between 2001 and 2012. Records were reviewed for data on demographics, etiologies, vocal fold position, and BVFI resolution. Patients requiring tracheotomy were further investigated for tracheotomy duration and associated complications and procedures.
RESULTS: One hundred two patients were included, with a median (range) follow-up of 32.9 (0.3-124.2) months. Of these, 68.6% required tracheotomy. Tracheotomies were more likely in those with concomitant airway disease (p = 0.005) and paramedian vocal fold position compared to lateral position (p = 0.02). Among patients requiring tracheotomy, 64.3% underwent decannulation during follow up. Decannulation was more likely in those who demonstrated VFI resolution (p = 0.002) and those with idiopathic compared to neurogenic etiologies (p = 0.003). Median duration of cannulation was 30.6 (0.5-297.3) months. The most common tracheotomy-related complication requiring medical attention was tracheal and stomal granuloma formation (77.1%), while the most frequent associated procedures included granuloma excision (47.1%) and airway reconstruction (31.4%). Of those who avoided tracheotomy, 40.6% did not demonstrate BVFI resolution during median follow up of 13.4 (0.6-44.4) months.
CONCLUSIONS: Most pediatric BVFI patients require tracheotomy, with the majority of those undergoing eventual decannulation. A better understanding of the factors associated with tracheotomy and subsequent decannulation improves the otolaryngologist's ability to counsel parents and caregivers of children with BVFI.

PMID: 25887134 [PubMed - indexed for MEDLINE]

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Nebulized isotonic saline improves voice production in Sjögren's syndrome.

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Nebulized isotonic saline improves voice production in Sjögren's syndrome.

Laryngoscope. 2015 Oct;125(10):2333-40

Authors: Tanner K, Nissen SL, Merrill RM, Miner A, Channell RW, Miller KL, Elstad M, Kendall KA, Roy N

Abstract
OBJECTIVE: This study examined the effects of a topical vocal fold hydration treatment on voice production over time.
STUDY DESIGN: Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design.
METHODS: Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared.
RESULTS: Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05).
CONCLUSION: Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders.
LEVEL OF EVIDENCE: 2b.

PMID: 25781583 [PubMed - indexed for MEDLINE]

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Atrophy of the vocal fold: An usual cause of hoarseness in scleroderma.

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Atrophy of the vocal fold: An usual cause of hoarseness in scleroderma.

Joint Bone Spine. 2015 May;82(3):206

Authors: Bélénotti P, Lagier A, Granel B, Serratrice J, Giovanni A, Weiller PJ

PMID: 25553840 [PubMed - indexed for MEDLINE]

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Role of the protein tyrosine phosphatase Shp2 in homeostasis of the intestinal epithelium.

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Role of the protein tyrosine phosphatase Shp2 in homeostasis of the intestinal epithelium.

PLoS One. 2014;9(3):e92904

Authors: Yamashita H, Kotani T, Park JH, Murata Y, Okazawa H, Ohnishi H, Ku Y, Matozaki T

Abstract
Protein tyrosine phosphorylation is thought to be important for regulation of the proliferation, differentiation, and rapid turnover of intestinal epithelial cells (IECs). The role of protein tyrosine phosphatases in such homeostatic regulation of IECs has remained largely unknown, however. Src homology 2-containing protein tyrosine phosphatase (Shp2) is a ubiquitously expressed cytoplasmic protein tyrosine phosphatase that functions as a positive regulator of the Ras-mitogen-activated protein kinase (MAPK) signaling pathway operative downstream of the receptors for various growth factors and cytokines, and it is thereby thought to contribute to the regulation of cell proliferation and differentiation. We now show that mice lacking Shp2 specifically in IECs (Shp2 CKO mice) develop severe colitis and die as early as 3 to 4 weeks after birth. The number of goblet cells in both the small intestine and colon of Shp2 CKO mice was markedly reduced compared with that for control mice. Furthermore, Shp2 CKO mice showed marked impairment of both IEC migration along the crypt-villus axis in the small intestine and the development of intestinal organoids from isolated crypts. The colitis as well as the reduction in the number of goblet cells apparent in Shp2 CKO mice were normalized by expression of an activated form of K-Ras in IECs. Our results thus suggest that Shp2 regulates IEC homeostasis through activation of Ras and thereby protects against the development of colitis.

PMID: 24675817 [PubMed - indexed for MEDLINE]

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Pseudoxanthoma elasticum of the palate: a case report and a brief review of the literature.

Pseudoxanthoma elasticum of the palate: a case report and a brief review of the literature.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):e6-9

Authors: Decani S, Varoni EM, Baruzzi E, Moneghini L, Lodi G, Sardella A

Abstract
Pseudoxanthoma elasticum (PXE), which is a genetic, multi-target disorder characterized by progressive calcification and fragmentation of elastic fibers, affects several organs, including the eyes, skin, and cardiovascular system. Diagnosis of PXE is currently based on cutaneous and ocular signs, histopathologic findings, and a patient's family history. PXE-related oral mucosal lesions are rarely reported, possibly due to the potential for misdiagnosis as Fordyce spots; however, when such lesions are reported, they are primarily localized to the vestibular mucosa of the lower lip. Here, we report the case of a female with an intraoral presentation of PXE at the labial and palatal sites. PXE was previously suspected in this patient because of the presence of cardiovascular, ocular, and cutaneous signs; however, a cutaneous biopsy showed findings not consistent with PXE. Incisional biopsy of the palatal lesion confirmed the PXE diagnosis, leading to proper management of the disorder to prevent ophthalmologic and cardiovascular complications.

PMID: 26679366 [PubMed - in process]

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Erythema multiforme major secondary to a cosmetic facial cream: first case report.

Erythema multiforme major secondary to a cosmetic facial cream: first case report.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):e10-5

Authors: Farquharson AA, Stoopler ET, Houston AM, Brown RS

Abstract
BACKGROUND: Oral erythema multiforme (EM) major is an acute immune-mediated disorder typically involving the oral mucosa, triggered by a hypersensitivity reaction to an antigen.
CASE SUMMARY: A 59-year-old woman presented to an oral medicine clinic with a chief complaint of "mystery disease" of 1 year's duration. The condition was described as repeated episodes of severe, painful, asymmetric oral lesions that responded to systemic steroid therapy. A previous oral biopsy described fibrinoid necrosis, mixed inflammation, and granulation tissue. A regimen of descending-dose prednisone was administered, and 3 weeks later the tissues appeared to be partially healed. Direct immunofluorescence staining of a biopsied oral mucosal lesion was negative. To rule out a drug causation, the patient discontinued hydrochlorothiazide and escitalopram oxalate. However, on steroid tapering, episodic lesions recurred. The patient was placed on combination systemic prednisone and azathioprine. The oral lesions resolved again, but new episodes occurred immediately after tapering. The patient's daily facial cosmetics were evaluated, and she was asked to stop using cosmetics with the active ingredient octocrylene. After eliminating the use of facial cosmetics containing octocrylene, the episodes no longer recurred.
CONCLUSIONS: We report a case of cosmetic-induced EM major and suggest that the triggering allergen is octocrylene.

PMID: 26679365 [PubMed - in process]

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Reply to the letter to the editor.

Reply to the letter to the editor.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):107

Authors: Ariji Y

PMID: 26679364 [PubMed - in process]

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Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology.

Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):96-105

Authors: Gomes LR, Gomes MR, Gonçalves JR, Ruellas AC, Wolford LM, Paniagua B, Benavides E, Cevidanes LH

Abstract
OBJECTIVE: To quantitatively compare condylar morphology using cone beam computed tomography (CBCT) and multislice spiral computed tomography (MSCT) virtual three-dimensional surface models.
STUDY DESIGN: The sample consisted of secondary data analyses of CBCT and MSCT scans obtained for clinical purposes from 74 patients treated with condylar resection and prosthetic joint replacement. Three-dimensional surface models of 146 condyles were constructed from each scan modality. Across-subject models were approximated and voxel-based registration was performed between homologous CBCT and MSCT images, making it possible to create average CBCT- and MSCT-based condylar models. SPHARM-PDM software provided matching points on each corresponding model. ShapeAnalysisMANCOVA software assessed statistically significant differences between observers and imaging modalities. One-sample t-tests evaluated the null hypothesis that the mean differences between each CBCT- and MSCT-based model were not clinically significant (<.5 mm). Tests were conducted at a significance level of P < .05.
RESULTS: ShapeAnalysisMANCOVA showed no statistically significant difference between the average CBCT- and MSCT-based models (P > .68). During pairwise comparison, the mean difference observed was .406 mm (SD, .173). One sample t-test showed that mean differences between each set of paired CBCT- and MSCT-based models were not clinically significant (P = .411).
CONCLUSION: Three-dimensional surface models constructed from CBCT images are comparable to those derived from MSCT scans and may be considered reliable tools for assessing condylar morphology.

PMID: 26679363 [PubMed - in process]

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Vestibular function in cochlear implantation: Correlating objectiveness and subjectiveness.

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Vestibular function in cochlear implantation: Correlating objectiveness and subjectiveness.

Laryngoscope. 2015 Oct;125(10):2371-5

Authors: Batuecas-Caletrio A, Klumpp M, Santacruz-Ruiz S, Benito Gonzalez F, Gonzalez Sánchez E, Arriaga M

Abstract
OBJECTIVE: To evaluate vestibular function before and after cochlear implantation (CI) STUDY DESIGN: A prospective descriptive study.
MATERIAL AND METHODS: Thirty consecutive patients with profound sensorineural hearing loss undergoing CI. Objective assessment of vestibular function was performed with the caloric test and video head impulse test (vHIT) in patients before and after CI. Dizziness Handicap Inventory (DHI) was used for subjective assessment before and after CI.
RESULTS: Thirty patients received CI with 21 by round window approach and nine by anteroinferior cochleostomy. Vestibular results were categorized into four groups: no changes (20 patients), changes in the caloric test and vHIT (3 patients, all with DHI changes; P = 0.0001), changes in vHIT gain but not in caloric test (3 patients, all with DHI changes; P = 0.005), no changes in the caloric test and vHIT gain but only saccades appear (4 patients, all with DHI changes; P = 0.011).
CONCLUSIONS: Although CI is a safe surgery with few major complications, it is a procedure that can produce dizziness. The vHIT reveals that 30% of patients demonstrate postoperative change in vestibular function. Therefore, when examining a CI patient with postoperative symptoms of dizziness, results of the vHIT test and gain as well as the presence of saccades, along with an increase DHI score, are parameters to consider in their evaluation.
LEVEL OF EVIDENCE: 4.

PMID: 25891786 [PubMed - indexed for MEDLINE]

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The Reverse-Flow Facial Artery Buccinator Flap for Skull Base Reconstruction: Key Anatomical and Technical Considerations.

The Reverse-Flow Facial Artery Buccinator Flap for Skull Base Reconstruction: Key Anatomical and Technical Considerations.

J Neurol Surg B Skull Base. 2015 Dec;76(6):432-9

Authors: Farzal Z, Lemos-Rodriguez AM, Rawal RB, Overton LJ, Sreenath SB, Patel MR, Zanation AM

Abstract
Objective To highlight key anatomical and technical considerations for facial artery identification, and harvest and transposition of the facial artery buccinator (FAB) flap to facilitate its future use in anterior skull base reconstruction. Only a few studies have evaluated the reverse-flow FAB flap for skull base defects. Design Eight FAB flaps were raised in four cadaveric heads and divided into thirds; the facial artery's course at the superior and inferior borders of the flap was measured noting in which incisional third of the flap it laid. The flap's reach to the anterior cranial fossa, sella turcica, clival recess, and contralateral cribriform plate were studied. A clinical case and operative video are also presented. Results The facial artery had a near vertical course and stayed with the middle (⅝) or posterior third (⅜) of the flap in the inferior and superior incisions. Seven of eight flaps covered the sellar/planar regions. Only four of eight flaps covered the contralateral cribriform region. Lastly, none reached the middle third of the clivus. Conclusions The FAB flap requires an understanding of the facial artery's course, generally seen in the middle third of the flap, and is an appropriate alternative for sellar/planar and ipsilateral cribriform defects.

PMID: 26682122 [PubMed]

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Indications for open procedures in the endoscopic era.

Indications for open procedures in the endoscopic era.

Curr Opin Otolaryngol Head Neck Surg. 2015 Dec 16;

Authors: Konstantinidis I, Constantinidis J

Abstract
PURPOSE OF REVIEW: Endoscopic sinus surgery became the gold standard in inflammatory disorders of the nose and paranasal sinuses, in cerebrospinal fluid leak and epistaxis management, and established its efficacy in the oncology of the region. However, there are certain limitations which make an external approach mandatory. This article reviews the recent literature describing the cases where an open procedure is still indicated.
RECENT FINDINGS: Despite the evolution of endoscopic surgery external approaches are still indicated. Osteoplastic flap remains an option for the refractory inflammation of the frontal sinus. Benign and malignant tumours with lateral or superior extension, neurovascular involvement, and bony/soft tissue erosion usually require an external approach. Superior and lateral posterior wall defects of frontal sinus with cerebrospinal fluid leak may mandate an open procedure. Management of severe epistaxis may still necessitate in selected cases an external approach when endoscopic surgery fails and embolization setting is not available.
SUMMARY: Although advances in endoscopic instrumentation and techniques steadily decrease the indications for external approaches, they continue to have a role in the management of nasal disorders. This study summarizes the recent literature and provides a comprehensive review of the up-to-date remaining indications for open procedures in the nose and paranasal sinuses.

PMID: 26679780 [PubMed - as supplied by publisher]

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[Prevention of postoperative cerebrospinal fluid leakage with absorbable hemostatic fluid gelatin].

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[Prevention of postoperative cerebrospinal fluid leakage with absorbable hemostatic fluid gelatin].

Zhongguo Gu Shang. 2015 Aug;28(8):717-21

Authors: Ma LT, Liu H, Gong Q, Li Tao, Ang Bei Y, Feng GJ

Abstract
OBJECTIVE: To explore the effectiveness of absorbable hemostatic fluid gelatin in preventing postoperative cerebrospinal fluid leakage.
METHODS: The clinical data of 17 patients with dura mater tear were retrospectively analyzed from March to September in 2003. There were 16 males and 1 female, aged from 16 to 67 years old with an average of (39.6 ± 15.4) years. The injury site was at cervical vertebrae in 1 case, thoracic vertebrae in 9 cases, thoracolumbar junction in 4 cases, lumbar vertebrae in 3 cases. There were burst fracture in 4 cases and fracture-dislocation in 13 cases. According to ASIA grade, 12 cases were grade A, 2 cases were grade B, 2 cases were grade D, 1 case were grade E. Two cases caused by traffic accident, 10 by high falling, 4 by heavy parts crash, 1 by stairs fell during the earthquake. Absorbable hemostatic fluid gelatins were used to plug the dura mater tear,in order to prevent postoperative cerebrospinal fluid leakage. Postoperative drainage were recorded every day.
RESULTS: Of 17 patients, 15 cases did not develop with cerebrospinal fluid leakage. Two cases develop with cerebrospinal fluid leakage after operation and their drainage were removed at 6 to 7 days after operation. In all cases, no complications related with cerebrospinal fluid leakage occurred, such as headache, dizzy, fever,neck resistance, rash, incision disunion, incision infection, hematoma, neurologic symptoms aggravation. No abnormal phenomena was found on incision surrounding at follow-up of 9 months.
CONCLUSION: Using absorbable hemostatic fluid gelatin to plug the dura mater tear during operation is an effective method in preventing postoperative cerebrospinal fluid leakage.

PMID: 26502522 [PubMed - indexed for MEDLINE]

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What is the evidence for postoperative lumbar drains in endoscopic repair of CSF leaks?

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What is the evidence for postoperative lumbar drains in endoscopic repair of CSF leaks?

Laryngoscope. 2015 Oct;125(10):2245-6

Authors: Bakhsheshian J, Hwang MS, Friedman M

PMID: 25994316 [PubMed - indexed for MEDLINE]

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MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension.

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MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension.

AJNR Am J Neuroradiol. 2014 Oct;35(10):2007-12

Authors: Chazen JL, Talbott JF, Lantos JE, Dillon WP

Abstract
BACKGROUND AND PURPOSE: CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR myelography in the detection of CSF leak.
MATERIALS AND METHODS: We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT myelography followed by intrathecal gadolinium MR myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT myelography and subsequent intrathecal gadolinium MR myelography with multiplanar T1 fat-suppressed sequences. CT myelography and intrathecal gadolinium MR myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure.
RESULTS: Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT myelography followed by intrathecal gadolinium MR myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT myelography and intrathecal gadolinium MR myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR myelography related to meningeal diverticula. CT myelography did not identify any leaks independently. There were no reported adverse events.
CONCLUSIONS: Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.

PMID: 24852289 [PubMed - indexed for MEDLINE]

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Ear and vestibular symptoms in train operators after sudden air pressure changes in trains.

Ear and vestibular symptoms in train operators after sudden air pressure changes in trains.

BMJ Case Rep. 2015;2015

Authors: Francois HM, Vantrappen L, Van Rompaey V, Godderis L

Abstract
A healthy 31-year-old train operator presented to our occupational health clinic reporting ear aches, headaches, dizziness, unsteadiness and even slight tinnitus. These symptoms first appeared when the patient started operating from a new train cabin. He described a sudden pressure gradient, experienced on some parts of the trajectory, which might have caused these problems. Although the cabins were equipped with a pressure equalising device, this was usually switched off because of the device creating an uncomfortable feeling in the cabin. The literature describes sudden pressure gradients as possible factors for passenger discomfort.

PMID: 26678694 [PubMed - in process]

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The hidden loss of otolithic function in children with profound sensorineural hearing loss.

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The hidden loss of otolithic function in children with profound sensorineural hearing loss.

Int J Pediatr Otorhinolaryngol. 2015 Jun;79(6):852-7

Authors: Xu XD, Zhang Q, Hu J, Zhang Y, Chen YF, Zhang XT, Xu M

Abstract
OBJECTIVE: This study sought to define the profile of ocular and cervical vestibular-evoked myogenic potential (oVEMP and cVEMP) in children with profound sensorineural hearing loss (PSHL).
METHODS: The ACS-evoked oVEMPs and cVEMPs of 43 children with PSHL and 20 healthy children were investigated. The response rates, thresholds, amplitudes, P1 and N1 latencies, and interpeak latencies of VEMPs were analyzed. Each patient's medical record was summarized and classified.
RESULTS: The response rates of oVEMP and cVEMP in patients with PSHL were 58.1% and 61.9% respectively, which were significantly less than those in healthy children (both were 100%). In the children patients whose oVEMP or cVEMP could still be elicited, significant elevated thresholds and decreased amplitudes in VEMPs could be observed (p<0.05). However, in the summary of the medical records of all the 43 patients, it was showed that neither the patients and their parents nor the doctors noticed the balance problem and the loss of otolithic function.
CONCLUSIONS: The otolithic dysfunction, which could be easily ignored in children with PSHL, could be observed in VEMPs. In the process of diagnosis and treatment of PSHL, the vestibular function should obtain enough attention. VEMPs have special value in observation of the hidden loss of otolithic function, and could be an important vestibular assessment method for children with PSHL.

PMID: 25843786 [PubMed - indexed for MEDLINE]

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Evaluation of a wireless audio streaming accessory to improve mobile telephone performance of cochlear implant users.

Evaluation of a wireless audio streaming accessory to improve mobile telephone performance of cochlear implant users.

Int J Audiol. 2016 Feb;55(2):75-82

Authors: Wolfe J, Morais Duke M, Schafer E, Cire G, Menapace C, O'Neill L

Abstract
OBJECTIVE: The objective of this study was to evaluate the potential improvement in word recognition in quiet and in noise obtained with use of a Bluetooth-compatible wireless hearing assistance technology (HAT) relative to the acoustic mobile telephone condition (e.g. the mobile telephone receiver held to the microphone of the sound processor).
DESIGN: A two-way repeated measures design was used to evaluate differences in telephone word recognition obtained in quiet and in competing noise in the acoustic mobile telephone condition compared to performance obtained with use of the CI sound processor and a telephone HAT.
STUDY SAMPLE: Sixteen adult users of Nucleus cochlear implants and the Nucleus 6 sound processor were included in this study.
RESULTS: Word recognition over the mobile telephone in quiet and in noise was significantly better with use of the wireless HAT compared to performance in the acoustic mobile telephone condition. Word recognition over the mobile telephone was better in quiet when compared to performance in noise.
CONCLUSIONS: The results of this study indicate that use of a wireless HAT improves word recognition over the mobile telephone in quiet and in noise relative to performance in the acoustic mobile telephone condition for a group of adult cochlear implant recipients.

PMID: 26681229 [PubMed - in process]

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Bone-impacted fibular free flap: Long-term dental implant success and complications compared to traditional fibular free tissue transfer.

Bone-impacted fibular free flap: Long-term dental implant success and complications compared to traditional fibular free tissue transfer.

Head Neck. 2015 Dec 17;

Authors: Barber BR, Dziegelewski PT, Chuka R, O'Connell D, Harris JR, Seikaly H

Abstract
BACKGROUND: The purpose of this study was to compare complications and dental implant success between the bone-impacted fibula free flap (BIFFF) and the traditional fibular free flap used in mandibular and midface reconstruction.
METHODS: Retrospective review of all patients undergoing BIFFF or traditional fibular free flap reconstruction from 2001 to 2009 was undertaken. Complications related to the BIFFF and traditional fibular free flap site of reconstruction were compared. Dental implant success rates for each type of flap were compared at 1-year intervals for 5 years.
RESULTS: One hundred fourteen patients underwent 81 BIFFFs and 35 traditional fibular free flaps. No significant difference in complications between BIFFF (20.9%) and traditional fibular free flap (25.7%) reconstruction was observed. Logistic regression analysis revealed only the site as a predictor of both single and multiple complications. At 5 years postimplantation, dental implant success rates were 95.5% and 77.1% for BIFFF and traditional fibular free flap, respectively (p = .006).
CONCLUSION: BIFFF reconstruction is a novel surgical technique that may improve long-term dental implant success rates with no additional risk of complications. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681661 [PubMed - as supplied by publisher]

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Effect of training frequency on the learning curve on the da Vinci Skills Simulator.

Effect of training frequency on the learning curve on the da Vinci Skills Simulator.

Head Neck. 2015 Dec 17;

Authors: Walliczek U, Förtsch A, Dworschak P, Teymoortash A, Mandapathil M, Werner J, Güldner C

Abstract
BACKGROUND: The purpose of this study was to evaluate the effect of training on the performance outcome with the da Vinci Skills Simulator.
METHODS: Forty novices were enrolled in a prospective training curriculum. Participants were separated into 2 groups. Group 1 performed 4 training sessions and group 2 had 2 training sessions over a 4-week period. Five exercises were performed 3 times consecutively. On the last training day, a new exercise was added.
RESULTS: A significant skills gain from the first to the final practice day in overall performance, time to complete, and economy of motion was seen for both groups. Group 1 had a significantly better outcome in overall performance, time to complete, and economy of motion in all exercises. There was no significant difference found regarding the new exercise in group 1 versus group 2 in nearly all parameters.
CONCLUSION: Longer time distances between training sessions are assumed to play a secondary role, whereas total repetition frequency is crucial for improvement of technical performance. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681572 [PubMed - as supplied by publisher]

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PRISM: Phase 2 trial with panitumumab monotherapy as second-line treatment in patients with recurrent or metastatic squamous cell carcinoma of the head and neck.

PRISM: Phase 2 trial with panitumumab monotherapy as second-line treatment in patients with recurrent or metastatic squamous cell carcinoma of the head and neck.

Head Neck. 2015 Dec 17;

Authors: Rischin D, Spigel DR, Adkins D, Wein R, Arnold S, Singhal N, Lee O, Murugappan S

Abstract
BACKGROUND: Panitumumab Regimen In Second-line Monotherapy of Head and Neck Cancer (PRISM) trial evaluated the safety and efficacy of panitumumab as second-line monotherapy in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN).
METHODS: This was an open-label, single-arm, multicenter trial that enrolled patients with progressive disease or intolerance to first-line systemic chemotherapy for recurrent or metastatic SCCHN. Patients received panitumumab 9 mg/kg Q3W. The primary endpoint was overall response rate; secondary endpoints included disease control rate, overall survival (OS), progression-free survival (PFS), and safety.
RESULTS: The overall response rate was 4% (2 of 51 patients) and the disease control rate was 39% (20 of 51 patients). Median PFS was 1.4 months (95% confidence interval [CI] = 1.3-2.4 months). Median OS was 5.1 months (95% CI = 4.3-8.3 months). The most common adverse events were rash/dermatitis acneiform (69%), fatigue (33%), dry skin (21%), and hypomagnesemia (21%). There was one treatment-related death (angioedema).
CONCLUSION: Panitumumab monotherapy had limited activity in previously treated patients with recurrent or metastatic SCCHN. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681429 [PubMed - as supplied by publisher]

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Tumor volume as a predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Tumor volume as a predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Head Neck. 2015 Dec 17;

Authors: Davis KS, Lim CM, Clump DA, Heron DE, Ohr JP, Kim S, Duvvuri U, Johnson JT, Ferris RL

Abstract
BACKGROUND: Increasing evidence exists that tumor volume may be a superior prognostic model than traditional TNM staging. It has been observed that oropharyngeal squamous cell carcinoma (oropharyngeal SCC) in the setting of human papillomavirus (HPV) positivity have a greater propensity for cystic nodal metastases, and, thus, presumably larger volume with relatively smaller primary tumors. The influence of HPV status on the predictive value of tumor volume is unknown.
METHODS: Fifty-three patients with HPV-positive oropharyngeal SCC were treated with definitive chemotherapy and intensity-modulated radiotherapy (IMRT).
RESULTS: The estimated 2-year overall survival (OS) and disease-free survival (DFS) was 92.2% and 83.6%, respectively. Nodal classification did not predict OS (p = .096) or DFS (p = .170). Similarly, T classification did not predict OS (p = .057) or DFS (p = .309). Lower nodal volume was associated with greater DFS (p = .001).
CONCLUSION: Nodal tumor volume was found to be predictive of DFS. DFS was best predicted by nodal gross tumor volume (GTV) at 24 months. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681273 [PubMed - as supplied by publisher]

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Lateral bracing of the tongue during the onset phase of alveolar stops: an EPG study.

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Lateral bracing of the tongue during the onset phase of alveolar stops: an EPG study.

Clin Linguist Phon. 2015 Mar;29(3):236-45

Authors: Lee A, Gibbon FE, Oebels J

Abstract
Although raising the sides of the tongue to form a seal with the palate and upper teeth--lateral bracing--plays a key role in controlling airflow direction, providing overall tongue stability and building up oral pressure during alveolar consonant production, details of this articulatory gesture remain poorly understood. This study examined the dynamics of lateral bracing during the onset of alveolar stops /t/, /d/, /n/ produced by 15 typical English-speaking adults using electropalatography. Percent tongue palate contact in the lateral regions over a 150-ms period from the preceding schwa to stop closure was measured. Rapid rising of the sides of the tongue from the back towards the front during the 50-ms period before closure was observed, with oral stops showing significantly more contact than nasal stops. This feature corresponds to well-documented formant transitions detectable from acoustic analysis. Possible explanations for increased contact for oral stops and clinical implications are discussed.

PMID: 25495013 [PubMed - indexed for MEDLINE]

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Effects of aging on the neuromagnetic mismatch detection to speech sounds.

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Effects of aging on the neuromagnetic mismatch detection to speech sounds.

Biol Psychol. 2015 Jan;104:48-55

Authors: Cheng CH, Baillet S, Hsiao FJ, Lin YY

Abstract
The ability to discriminate speech sounds is crucial for higher language functions in humans. However, it remains unclear whether physiological aging affects the functional integrity of pre-attentive phonological discrimination. The neuromagnetic cortical responses during automatic change detection of speech sounds (/ba/versus/da/) were recorded in 24 young and 21 aged male adults. We used minimum norm estimate of source reconstruction to characterize the spatiotemporal dynamics of magnetic mismatch responses (MMNm). Distributed activations to phonetic changes were identified in the temporal, frontal and parietal regions. Compared to younger participants, elderly volunteers exhibited a significant reduction of cortical responses to phonetic-MMNm, except for the left orbitofrontal cortex and anterior inferior temporal gyrus. However, among the identified regions of interest, we did not observe significant between-group differences in the hemispheric asymmetry of phonetic-MMNm. Conclusively, our results suggest an altered phonetic processing at the perceptual level during physiological aging.

PMID: 25451380 [PubMed - indexed for MEDLINE]

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Perceived articulatory precision in patients with Parkinson's disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta.

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Perceived articulatory precision in patients with Parkinson's disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta.

Clin Linguist Phon. 2015 Feb;29(2):150-66

Authors: Eklund E, Qvist J, Sandström L, Viklund F, Van Doorn J, Karlsson F

Abstract
The effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and caudal zona incerta (cZi) on speech articulation in patients with Parkinson's disease (PD) was investigated. Read speech samples were collected from nine patients with STN-DBS and 10 with cZi-DBS. The recordings were made pre-operatively and 12 months post-operatively with stimulator on and off (on medication). Blinded, randomised, repeated perceptual assessments were performed on words and isolated fricatives extracted from the recordings to assess (1) overall articulatory quality ratings, (2) frequency of occurrence of misarticulation patterns and (3) fricative production. Statistically significant worsening of articulatory measures on- compared with off-stimulation occurred in the cZi-DBS group, with deteriorated articulatory precision ratings, increased presence of misarticulations (predominately altered realisations of plosives and fricatives) and a reduced accuracy in fricative production. A similar, but not significant, trend was found for the STN-DBS group.

PMID: 25333411 [PubMed - indexed for MEDLINE]

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