The efficacy of vestibular rehabilitation in patients with benign paroxysmal positional vertigo: a rapid review.

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The efficacy of vestibular rehabilitation in patients with benign paroxysmal positional vertigo: a rapid review.

Otolaryngol Head Neck Surg. 2014 Nov;151(5):740-5

Authors: van der Scheer-Horst ES, van Benthem PP, Bruintjes TD, van Leeuwen RB, van der Zaag-Loonen HJ

Abstract
OBJECTIVE: To systematically review the evidence on the effectiveness of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo.
DATA SOURCES: A literature search was performed in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE databases.
REVIEW METHODS: A comprehensive search was performed up to July 2013. Two authors independently scanned the search results to identify randomized controlled trials of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies were methodologically assessed using the Cochrane risk of bias tool. Primary outcome was the effect on vertigo attacks and balance.
RESULTS: Of 76 identified trials, only 2 trials fulfilled our inclusion criteria and were included in this review, involving 106 patients. One study was methodologically weak, the other strong. The studies differed in type of intervention, type of outcome, and follow-up time. Both studies reported no significant difference in the vertigo intensity between groups. A small effect was found on balance.
CONCLUSION: Two level II studies in benign paroxysmal positional vertigo showed no effect of vestibular rehabilitation in addition to a canalith repositioning maneuver on vertigo intensity and a small, beneficial effect on balance. We therefore conclude that there is no evidence for an effect of vestibular rehabilitation in addition to a canalith repositioning maneuver in patients with benign paroxysmal positional vertigo.

PMID: 25155900 [PubMed - indexed for MEDLINE]

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[Tanakan as a multimodal cytoprotective factor in general medicine (part II)].

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[Tanakan as a multimodal cytoprotective factor in general medicine (part II)].

Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(12):177-82

Authors: Esin RG, Naprienko MV, Mukhametova ER, Khairullin IKh, Esin OR

Abstract
The second section of the review provides an update of the data on mechanisms of action of a standardized extract of Ginkgo biloba EGb761® (tanakan) and its efficacy in treatment of depression, pain, complications of diabetes, Parkinson disease, tinnitus and dizziness, reproductive dysfunction. Updated data enable to use EGb761® (tanakan) as a highly-effective cytoprotective agent in treatment of cardiovascular, degenerative and metabolic diseases of the nervous system, inner ear disturbances (tinnitus), dysfunction of reproductive system as well as in prevention and treatment of stress-induced disorders.

PMID: 26978514 [PubMed - indexed for MEDLINE]

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Why Acute Dizziness and Vertigo? Articulating the Emergency Neuro-Otology Imperative.

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Why Acute Dizziness and Vertigo? Articulating the Emergency Neuro-Otology Imperative.

Neurol Clin. 2015 Aug;33(3):xiii-xv

Authors: Newman-Toker DE, Kerber KA, Meurer WJ, Omron R, Edlow JA

PMID: 26231282 [PubMed - indexed for MEDLINE]

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Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

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Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

Neurol Clin. 2015 Aug;33(3):687-98, xi

Authors: Lee SH, Kim JS

Abstract
Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic examination can reliably differentiate acute vestibular syndrome due to stroke from more benign inner ear disease. Sometimes acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Accurate identification of isolated vascular vertigo is very important because misdiagnosis of acute stroke may result in significant morbidity and mortality.

PMID: 26231280 [PubMed - indexed for MEDLINE]

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TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo.

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TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo.

Neurol Clin. 2015 Aug;33(3):577-99, viii

Authors: Newman-Toker DE, Edlow JA

Abstract
Diagnosing dizziness can be challenging, and the consequences of missing dangerous causes, such as stroke, can be substantial. Most physicians use a diagnostic paradigm developed more than 40 years ago that focuses on the type of dizziness, but this approach is flawed. This article proposes a new paradigm based on symptom timing, triggers, and targeted bedside eye examinations (TiTrATE). Patients fall into 1 of 4 major syndrome categories, each with its own differential diagnosis and set of targeted examination techniques that help make a specific diagnosis. Following an evidence-based approach could help reduce the frequency of misdiagnosis of serious causes of dizziness. In the spirit of the flipped classroom, the editors of this Neurologic Clinics issue on emergency neuro-otology have assembled a collection of unknown cases to be accessed electronically in multimedia format. By design, cases are not linked with specific articles, to avoid untoward cueing effects for the learner. The cases are real and are meant to demonstrate and reinforce lessons provided in this and subsequent articles. In addition to pertinent elements of medical history, cases include videos of key examination findings.

PMID: 26231273 [PubMed - indexed for MEDLINE]

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Mandibular melanotic neuroectodermal tumor of infancy: a role for neoadjuvant chemotherapy.

Mandibular melanotic neuroectodermal tumor of infancy: a role for neoadjuvant chemotherapy.

Eur Arch Otorhinolaryngol. 2016 Apr 23;

Authors: Maroun C, Khalifeh I, Alam E, Akl PA, Saab R, Moukarbel RV

Abstract
Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare, locally aggressive neoplasm with a predilection for the head and neck area, most commonly occurring in the maxilla. The vast majority of treatment modalities for all cases of MNTI to date have involved surgical intervention only, with just 9.6 % involving some sort of chemotherapy, radiotherapy, or a combination of the prior mentioned modalities. There is very limited information available regarding the use of neoadjuvant chemotherapy, due to its rare nature. In this report, a 4 month old girl presented to our clinic with a chief complaint of a large oral mass of about 2.5 months in duration. Intraoral examination showed an oral mass arising from the lingual aspect of inferior alveolar ridge with extensive mandibular invasion. The patient received three cycles of vincristine, Adriamycin, and cyclophosphamide as neodajuvant therapy. Upon completion, the tumor had decreased significantly in size. The patient was then scheduled for surgery and underwent surgical resection of the tumor. We were able to obtain adequate shrinkage of the tumor to allow better resectability, easier surgical access and a more minimally invasive approach with no lip split and a smaller neck incision. In conclusion, we have reported an extremely rare case of MNTI of the mandible that was successfully treated with neoadjuvant chemotherapy and surgical resection. This approach was advantageous to minimize the chance of recurrence and improve resectability in particularly large tumors, while maximizing functional outcomes and minimizing deformity.

PMID: 27107579 [PubMed - as supplied by publisher]

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Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

Auris Nasus Larynx. 2016 Apr 20;

Authors: Yasumatsu R, Nakashima T, Sato M, Nakano T, Kogo R, Hashimoto K, Sawatsubashi M, Nakagawa T

Abstract
OBJECTIVE: The aim of this study was to investigate the clinical features and prognosis of patients with squamous cell carcinoma (SCC) associated with sinonasal inverted papilloma (IP).
METHODS: The medical records of 95 patients who were diagnosed with IP or SCC associated with IP were retrospectively reviewed. Out of 95 patients, 15 were diagnosed with SCC associated with IP. The clinical characteristics, treatment modalities, and survival outcomes of the patients were analyzed.
RESULTS: The incidence of SCC associated with IP was 15.8%. Although differential diagnosis between IP and SCC associated with IP is difficult, epistaxis may be the specific symptom in SCC associated with IP cases. The 3-year disease-specific survival rate was higher in cases with T1, 2 and 3 than in cases with T4. There was no significant difference in survival rate between maxillary sinus and other primary sites. On the other hand, there was a significant difference in survival rate between the microscopic SCC with IP cases and the other cases. In addition, the patients with <70 years old better than those with >70 years old with a 3-year disease free survival of 80% versus 0%.
CONCLUSIONS: Some T4 patients were found to have a highly aggressive disease. Therefore, complete surgical resection followed by chemo-radiation therapy is the recommended treatment for patients with T4 disease to control of the primary tumor site.

PMID: 27108101 [PubMed - as supplied by publisher]

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[Acantholytic squamous cell carcinoma of larynx as an uncommon variant of squamous cell carcinoma].

[Acantholytic squamous cell carcinoma of larynx as an uncommon variant of squamous cell carcinoma].

Kulak Burun Bogaz Ihtis Derg. 2016 May-Jun;26(3):176-80

Authors: Tiken EE, Çolpan Öksüz D, Batur Ş, Uzel EK, Öz B, Öz F, Uzel Ö, Turkan S

Abstract
Acantholytic squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. Acantholytic squamous cell carcinoma occurs in the sun-exposed areas of the skin and lip. It is rarely observed in the respiratory and digestive tract and may present more aggressively. The incidence of distant metastases of squamous cell head and neck cancers is low and the lungs are the most common metastatic sites. Metastasis to the soft tissue, skin, and adrenal glands from the laryngeal region is very uncommon. In this article, we report a 58-year-old female case who underwent postoperative radiation therapy with the diagnosis of acantholytic squamous cell carcinoma of the larynx and developed metastasis to the soft tissue and adrenal gland at the early period.

PMID: 27107606 [PubMed - as supplied by publisher]

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[Assessing the risk of falls for the elderly in Basic Health Units].

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[Assessing the risk of falls for the elderly in Basic Health Units].

Rev Esc Enferm USP. 2012 Apr;46(2):320-7

Authors: de Pinho TA, Silva AO, Tura LF, Moreira MA, Gurgel SN, Smith Ade A, Bezerra VP

Abstract
The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.

PMID: 22576534 [PubMed - indexed for MEDLINE]

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[Epidemiological characteristic of the patients presenting with cochleovestibular disorders associated with labyrinthine hydrops].

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[Epidemiological characteristic of the patients presenting with cochleovestibular disorders associated with labyrinthine hydrops].

Vestn Otorinolaringol. 2011;(4):40-2

Authors: Levina IuV, Kunel'skaia NL, Krasiuk AA, Baush IaA

Abstract
A total of 1,067 patients complaining of hearing impairment, dizziness, and tympanophony were admitted for the treatment to the Surdological Department of N.I. Pirogov City Clinical Hospital No 1 during the period from 2000 to 2010. As many as 326 (30.5%) patients were preliminarily diagnosed with Meniere's disease based on their medical histories, clinical condition, and the results of questionnaire studies. All of them were subjected to comprehensive audiologic and vestibulogic examination with the use of up-to-date techniques. The data thus obtained allowed to reveal labyrinthine hydrops in 275 (84%) patients. It is concluded that 101 (9.5%) patients presenting with the typical symptoms of Meniere's disease had labyrinthine hydrops.

PMID: 21983667 [PubMed - indexed for MEDLINE]

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Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences.

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Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences.

World Neurosurg. 2015 Dec;84(6):1726-38

Authors: Zhu Y, Pan J, Shen J, Liu C, Fan Z, Shen Y, Wen L, Tong Y, Zhan R

Abstract
OBJECTIVE: Unruptured paraophthalmic aneurysms present unique challenges, and the ideal management remains unknown.
METHODS: We performed a pooled analysis of single-center experiences to compare the risks and effectiveness involving patients with unruptured paraophthalmic aneurysms treated with clipping, coiling alone, stent-assisted coiling, and flow-diversion. The MEDLINE database was searched and thirty-three series (including our institutional experience) were included.
RESULTS: Clipping caused more intracranial hemorrhage (ICH) and neurologic complications (NCs) than coiling alone (ICH: odds ratio [OR] = 3.058, P = 0.013; NC: OR = 5.809, P < 0.001), stent-assisted coiling (ICH: P = 0.018; NC: OR = 7.367, P < 0.001), and flow-diversion (ICH: P = 0.006; NC: OR = 16.954, P < 0.001). Clipping also caused more unfavorable visual outcomes than both coiling alone (OR = 3.037, P = 0.001) and stent-assisted coiling (OR = 6.055, P = 0.005). Clipping resulted in a lower reoperation rate than coiling alone in large/giant aneurysm group, which approached statistical significance (OR = 0.133, P = 0.057). Clipping, stent-assisted coiling, and flow-diversion all showed higher occlusion rates compared with coiling alone (OR [clipping vs. coiling alone] = 2.852, P ≤ 0.001; OR [coiling alone vs. stent-assisted coiling] = 0.302, P = 0.003; OR [coiling alone vs. flow-diversion] = 0.400, P = 0.013). Flow-diversion showed comparative complication rate, clinical outcomes, and angiographic result compared with stent-assisted coiling. No significant differences were found among all 4 treatment modalities on mortality and poor outcome.
CONCLUSIONS: Endovascular therapies have benefits over surgical clipping in terms of fewer intracranial hemorrhage complications, fewer NCs, and lower unfavorable visual outcome rate. Flow diversion showed comparative safety and effectiveness to stent-assisted coiling, and they both achieved better radiologic results than coiling alone. Further validation by randomized cohort studies is still needed to provide robust evidence.

PMID: 26210711 [PubMed - indexed for MEDLINE]

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Middle ear pain and trauma during air travel.

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Middle ear pain and trauma during air travel.

BMJ Clin Evid. 2007;2007

Authors: Basu A

Abstract
INTRODUCTION: Changes in air pressure during flying can cause ear-drum pain and perforation, vertigo, and hearing loss. It has been estimated that 10% of adults and 22% of children might have damage to the ear drum after a flight, although perforation is rare. Symptoms usually resolve spontaneously.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent middle ear pain during air travel? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 4 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: nasal balloon inflation, oral pseudoephedrine, and topical nasal decongestants.

PMID: 19450303 [PubMed - indexed for MEDLINE]

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[A case-series study on clinical presentation neuroradiological characteristics and outcome of 56 consecutive patients suspected of having spontaneous intracranial hypotension].

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[A case-series study on clinical presentation, neuroradiological characteristics, and outcome of 56 consecutive patients suspected of having spontaneous intracranial hypotension].

Rinsho Shinkeigaku. 2015;55(9):623-9

Authors: Arai M

Abstract
The author reviewed the clinical records and neuroradiologic examinations of 86 consecutive patients with orthostatic headache who visited our clinic between April 1995 and December 2014. Fifty-six patients were suspected to have spontaneous intracranial hypotension (SIH). The baseline characteristics of these patients were essentially similar to those reported in other published case series of SIH: female preponderance, mean age of approximately 40 years, and frequent association with nausea, hearing disturbances, or vertigo. In 43 patients who underwent gadolinium-enhanced MRI, 15 had partial dural enhancement and 15 had diffuse enhancement. Of 13 patients who underwent radionuclide cisternography, a direct finding of cerebrospinal fluid (CSF) leakage was demonstrated in six patients. Ordinal scales were formulated for regression of the extent of dural enhancement on cranial MRI (none: 0, partial: 1, diffuse: 2) and severity of orthostatic headache (not so severe: 1, severe: 2). Ordinal logistic regression analysis demonstrated that the extent of dural enhancement was negatively associated with the severity of orthostatic headache. A possible explanation was that patients suspected of having SIH who showed severe orthostatic headache may lack the ability to compensate for CSF loss. Epidural blood patch (EBP) is targeted at the CSF leak site or at the lumbar level when the site of CSF leak has not been determined. The interval from EBP to disappearance of orthostatic headache did not significantly differ in six patients treated with targeted EBP and five patients with lumbar EBP. Linear regression analysis demonstrated that the duration of orthostatic headache was associated with the interval from onset of headache to initial visit to our clinic, with the slope of the regression line 1.243 and intercept 14.8 days. Thus, early diagnosis of SIH appeared to correlate with earlier disappearance of orthostatic headache. No other factors were found to predict the outcome of SIH.

PMID: 26156257 [PubMed - indexed for MEDLINE]

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Identifying at Diagnosis the Vestibular Schwannomas at Low Risk of Growth in a Long-term Retrospective Cohort.

Identifying at Diagnosis the Vestibular Schwannomas at Low Risk of Growth in a Long-term Retrospective Cohort.

Clin Otolaryngol. 2016 Apr 18;

Authors: Wolbers JG, Dallenga AH, van Linge A, Te West M, Kummer EE, Méndez Romero A, Pauw BK, Wieringa MH

Abstract
OBJECTIVES: Identification at time of diagnosis of those vestibular schwannomas that will not grow.
DESIGN: Retrospective cohort study of consecutive patients diagnosed with a sporadic vestibular schwannoma that were entered in the wait-and-scan protocol.
SETTING: Academic referral centre.
PARTICIPANTS: The study group contained 155 patients with a sporadic vestibular schwannoma first seen in the full 8-year period 2000-2007: continual wait-and-scan (n = 89) and initial wait-and-scan until intervention (n=66).
MAIN OUTCOME MEASURES: Tumour growth, defined as more than 2 mm linear difference in any plane between the diagnostic MRI scan and the last available scan, was related to clinical parameters at diagnosis: localization of the tumour (solely intracanalicular versus cisternal extension), sudden sensorineural hearing loss, sensorineural hearing loss longer than 2 years and vertigo/instability.
RESULTS: Hearing loss longer than 2 years and an entirely intracanalicular localization were associated with no tumour growth by univariate and multivariate Cox analysis. Combining both factors at time of diagnosis resulted in a group with low risk of growth (n=36, median follow-up of 6.2 years) with a Hazard Ratio for growth of 0.37 (95% CI, 0.19-0.69). This subgroup is about 25% of the wait-and-scan population. Thirty-one percent showed growth, while in the remaining higher risk group of 119 patients 62% showed growth. For the growing schwannomas the median time for growth becoming manifest is 1.9 years after diagnostic MRI.
CONCLUSIONS: In this study on vestibular schwannoma patients that start in a wait-and-scan protocol, about a quarter may be set apart having a low risk for growth. These patients at diagnosis combine a history of F hearing loss longer than 2 years and a fully intracanalicular schwannoma. They appear not to need yearly MRI checks. This article is protected by copyright. All rights reserved.

PMID: 27086938 [PubMed - as supplied by publisher]

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STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness.

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STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness.

Behav Neurol. 2015;2015:456850

Authors: Best C, Tschan R, Stieber N, Beutel ME, Eckhardt-Henn A, Dieterich M

Abstract
Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (Q H/V ), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: Q H/V = 0.31 versus controls: Q H/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles.

PMID: 26843786 [PubMed - indexed for MEDLINE]

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Anti-Ri-associated paraneoplastic brainstem cerebellar syndrome with coexisting limbic encephalitis in a patient with mixed large cell neuroendocrine lung carcinoma.

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Anti-Ri-associated paraneoplastic brainstem cerebellar syndrome with coexisting limbic encephalitis in a patient with mixed large cell neuroendocrine lung carcinoma.

J Clin Neurosci. 2015 Feb;22(2):421-3

Authors: Mitchell AN, Bakhos CT, Zimmerman EA

Abstract
Paraneoplastic neurologic syndromes (PNS) can be the first manifestations of occult malignancies. If left untreated, PNS often lead to significant morbidity and mortality. Anti-Ri (anti-neuronal nuclear antibody type 2 [ANNA-2]) autoantibodies are commonly associated with breast and small cell lung cancers. Cases of anti-Ri paraneoplastic cerebellar degeneration are reported, but few describe severe nausea and coexisting limbic encephalitis as the major presenting features. We report a 75-year-old woman with medically-intractable emesis, encephalopathy, diplopia, vertigo, and gait ataxia for 3 months. Examination revealed rotary nystagmus, ocular skew deviation, limb dysmetria, and gait ataxia. After two courses of intravenous immunoglobulin, there was minimal improvement. Anti-Ri antibodies were positive in serum only. CT scan identified a 2.0 cm left lung mass, and histopathology revealed large cell neuroendocrine carcinoma with admixed adenocarcinoma non-small cell lung carcinoma (NCSLC). Though the patient achieved nearly complete clinical recovery after tumor resection, anti-Ri levels remained high at 20 months post-resection. To our knowledge this is the first report of a paraneoplastic brainstem cerebellar syndrome with coexisting limbic encephalitis involving anti-Ri positivity and associated mixed neuroendocrine/NSCLC of the lung with marked improvement after tumor resection.

PMID: 25443085 [PubMed - indexed for MEDLINE]

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Physical functioning in older persons with dizziness: a population-based study.

Physical functioning in older persons with dizziness: a population-based study.

Aging Clin Exp Res. 2016 Apr 16;

Authors: Kollén L, Hörder H, Möller C, Frändin K

Abstract
BACKGROUND: Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.
AIMS: To report physical functioning, health-related aspects and gender differences in elderly persons with and without dizziness in a population-based sample of 75-year-olds.
METHODS: A cross-sectional sample of 75-year-olds from Gothenburg, Sweden (n = 675, 398 women and 277 men) was examined by means of questionnaires and functional tests. The questions concerned dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication. The tests included were self-selected and maximum gait speed, stair climbing capacity, one leg stance and grip strength.
RESULTS: More women than men reported dizziness/imbalance (40 vs 30 %, p < 0.001). Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level (summer: 62 vs 74 %, p < 0.001; winter: 41 vs 51 %, p < 0.001), less often took a daily walk (p < 0.05), had lower scores on the FES(S) (p < 0.001), more often reported general fatigue (p < 0.001), more often had fallen in the previous year (40 vs 23 %, p < 0.001) and had a higher intake of medical drugs (4.6 vs 3.3, p < 0.001). They also performed worse regarding gait speed, stair climbing and one leg stance (p < 0.001), but there was no difference in grip strength.
CONCLUSION: Older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.

PMID: 27086001 [PubMed - as supplied by publisher]

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Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome.

Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome.

J Neurol. 2016 Apr;263(Suppl 1):90-96

Authors: Brandt T, Strupp M, Dieterich M

Abstract
The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute and occur in a series of up to 30 or more per day. VP may manifest when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. The symptoms are usually triggered by direct pulsatile compression with ephaptic discharges, less often by conduction blocks. MR imaging reveals the neurovascular compression of the eighth nerve (3D constructive interference in steady state and 3D time-of-flight sequences) in more than 95 % of cases. A loop of the anterior inferior cerebellar artery seems to be most often involved, less so the posterior inferior cerebellar artery, the vertebral artery, or a vein. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages (200-600 mg/d or 300-900 mg/d, respectively), which have been shown to also be effective in children. Alternative drugs to try are lamotrigine, phenytoin, gabapentin, topiramate or baclofen or other non-antiepileptic drugs used in trigeminal neuralgia. The results of ongoing randomized placebo-controlled treatment studies, however, are not yet available. Surgical microvascular decompression of the eighth nerve is the "ultima ratio" for medically intractable cases or in exceptional cases of non-vascular compression of the eighth nerve by a tumor or cyst. The International Barany Society for Neuro-Otology is currently working on a consensus document on the clinical criteria for establishing a diagnosis of VP as a clinical entity.

PMID: 27083889 [PubMed - as supplied by publisher]

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Vestibular migraine: the most frequent entity of episodic vertigo.

Vestibular migraine: the most frequent entity of episodic vertigo.

J Neurol. 2016 Apr;263(Suppl 1):82-89

Authors: Dieterich M, Obermann M, Celebisoy N

Abstract
Vestibular migraine (VM) is the most common cause of episodic vertigo in adults as well as in children. The diagnostic criteria of the consensus document of the International Bárány Society for Neuro-Otology and the International Headache Society (2012) combine the typical signs and symptoms of migraine with the vestibular symptoms lasting 5 min to 72 h and exclusion criteria. Although VM accounts for 7 % of patients seen in dizziness clinics and 9 % of patients seen in headache clinics it is still underdiagnosed. This review provides an actual overview on the pathophysiology, the clinical characteristics to establish the diagnosis, the differential diagnosis, and the treatment of VM.

PMID: 27083888 [PubMed - as supplied by publisher]

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Current concepts and future approaches to vestibular rehabilitation.

Current concepts and future approaches to vestibular rehabilitation.

J Neurol. 2016 Apr;263(Suppl 1):65-70

Authors: Tjernström F, Zur O, Jahn K

Abstract
Over the last decades methods of vestibular rehabilitation to enhance adaptation to vestibular loss, habituation to changing sensory conditions, and sensory reweighting in the compensation process have been developed. However, the use of these techniques still depends to a large part on the educational background of the therapist. Individualized assessment of deficits and specific therapeutic programs for different disorders are sparse. Currently, vestibular rehabilitation is often used in an unspecific way in dizzy patients irrespective of the clinical findings. When predicting the future of vestibular rehabilitation, it is tempting to foretell advances in technology for assessment and treatment only, but the current intense exchange between clinicians and basic scientists also predicts advances in truly understanding the complex interactions between the peripheral senses and central adaptation mechanisms. More research is needed to develop reliable techniques to measure sensory dependence and to learn how this knowledge can be best used-by playing off the patient's sensory strength or working on the weakness. To be able using the emerging concepts, the neuro-otological community must strive to educate physicians, physiotherapists and nurses to perform the correct examinations for assessment of individual deficits and to look for factors that might impede rehabilitation.

PMID: 27083886 [PubMed - as supplied by publisher]

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Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review.

Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review.

J Neurol. 2016 Apr;263(Suppl 1):36-44

Authors: Grill E, Penger M, Kentala E

Abstract
Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms 'vertigo' or 'dizziness' or 'vestibular and primary care' to identify suitable studies. We included all studies that were published in the last 10 years in English with the primary diagnoses of vertigo, dizziness and/or vestibular disease. We excluded drug evaluation studies and reports of adverse drug reactions. Data were extracted and appraised by two independent reviewers; 16 studies with a total of 2828 patients were included. Mean age of patients ranged from 45 to 79 with five studies in older adults aged 65 or older. There were considerable variations in diagnostic criteria, referral and therapy while the included studies failed to show significant improvement of patient-reported outcomes. Studies are needed to investigate current practice of care across countries and health systems in a systematic way and to test primary care-based education and training interventions that improve outcomes.

PMID: 27083883 [PubMed - as supplied by publisher]

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Update on the pharmacotherapy of cerebellar and central vestibular disorders.

Update on the pharmacotherapy of cerebellar and central vestibular disorders.

J Neurol. 2016 Apr;263(Suppl 1):24-29

Authors: Kalla R, Teufel J, Feil K, Muth C, Strupp M

Abstract
An overview of the current pharmacotherapy of central vestibular syndromes and the most common forms of central nystagmus as well as cerebellar disorders is given. 4-aminopyridine (4-AP) is recommended for the treatment of downbeat nystagmus, a frequent form of acquired persisting fixation nystagmus, and upbeat nystagmus. Animal studies showed that this non-selective blocker of voltage-gated potassium channels increases Purkinje cell excitability and normalizes the irregular firing rate, so that the inhibitory influence of the cerebellar cortex on vestibular and deep cerebellar nuclei is restored. The efficacy of 4-AP in episodic ataxia type 2, which is most often caused by mutations of the PQ-calcium channel, was demonstrated in a randomized controlled trial. It was also shown in an animal model (the tottering mouse) of episodic ataxia type 2. In a case series, chlorzoxazone, a non-selective activator of small-conductance calcium-activated potassium channels, was shown to reduce the DBN. The efficacy of acetyl-DL-leucine as a potential new symptomatic treatment for cerebellar diseases has been demonstrated in three case series. The ongoing randomized controlled trials on episodic ataxia type 2 (sustained-release form of 4-aminopyridine vs. acetazolamide vs. placebo; EAT2TREAT), vestibular migraine with metoprolol (PROVEMIG-trial), cerebellar gait disorders (sustained-release form of 4-aminopyridine vs. placebo; FACEG) and cerebellar ataxia (acetyl-DL-leucine vs. placebo; ALCAT) will provide new insights into the pharmacotherapy of cerebellar and central vestibular disorders.

PMID: 27083881 [PubMed - as supplied by publisher]

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DIZZYNET-a European network initiative for vertigo and balance research: visions and aims.

DIZZYNET-a European network initiative for vertigo and balance research: visions and aims.

J Neurol. 2016 Apr;263(Suppl 1):2-9

Authors: Zwergal A, Brandt T, Magnusson M, Kennard C

Abstract
Vertigo is one of the most common complaints in medicine. Despite its high prevalence, patients with vertigo often receive either inappropriate or inadequate treatment. The most important reasons for this deplorable situation are insufficient interdisciplinary cooperation, nonexistent standards in diagnostics and therapy, the relatively rare translations of basic science findings to clinical applications, and the scarcity of prospective controlled multicenter clinical trials. To overcome these problems, the German Center for Vertigo and Balance Disorders (DSGZ) started an initiative to establish a European Network for Vertigo and Balance Research called DIZZYNET. The central aim is to create a platform for collaboration and exchange among scientists, physicians, technicians, and physiotherapists in the fields of basic and translational research, clinical management, clinical trials, rehabilitation, and epidemiology. The network will also promote public awareness and help establish educational standards in the field. The DIZZYNET has the following objectives as regards structure and content: to focus on multidisciplinary translational research in vertigo and balance disorders, to develop interdisciplinary longitudinal and transversal networks for patient care by standardizing and personalizing the management of patients, to increase methodological competence by implementing common standards of practice and quality management, to internationalize the infrastructure for prospective multicenter clinical trials, to increase recruitment capacity for clinical trials, to create a common data base for patients with vertigo and balance disorders, to offer and promote attractive educational and career paths in a network of cooperating institutions. In the long term, the DIZZYNET should serve as an internationally visible network for interdisciplinary and multiprofessional research on vertigo and balance disorders. It ideally should equally attract the afflicted patients and those managing their disorders. DIZZYNET will not compete with the traditional national or international societies active in the field, but will function as an additional structure that addresses some of the above problems.

PMID: 27083879 [PubMed - as supplied by publisher]

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The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo.

The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo.

Audiol Neurootol. 2016 Apr 15;21(3):132-140

Authors: Morita S, Nakamaru Y, Fujiwara K, Iizuka K, Masuya M, Homma A, Fukuda A, Fukuda S

Abstract
OBJECTIVES: To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up.
METHODS: We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year.
RESULTS: Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups.
CONCLUSIONS: Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.

PMID: 27077389 [PubMed - as supplied by publisher]

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Acetyl-DL-leucine improves gait variability in patients with cerebellar ataxia-a case series.

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Acetyl-DL-leucine improves gait variability in patients with cerebellar ataxia-a case series.

Cerebellum Ataxias. 2016;3:8

Authors: Schniepp R, Strupp M, Wuehr M, Jahn K, Dieterich M, Brandt T, Feil K

Abstract
Acetyl-DL-leucine is a modified amino acid that was observed to improve ataxic symptoms in patients with sporadic and hereditary forms of ataxia. Here, we investigated the effect of the treatment with Acetyl-DL-leucine on the walking stability of patients with cerebellar ataxia (10x SAOA, 2x MSA-C, 2x ADA, 1x CACNA-1A mutation, 2x SCA 2, 1x SCA 1). Treatment with Acetyl-DL-leucine (500 mg; 3-3-4) significantly improved the coefficient of variation of stride time in 14 out of 18 patients. Moreover, subjective ambulatory scores (FES-I and ABC) and the SARA scores were also improved under treatment. Further prospective studies are necessary to support these class III observational findings.

PMID: 27073690 [PubMed]

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The effect of intratympanic gentamicin for treatment of Ménière's disease on lower frequency hearing.

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The effect of intratympanic gentamicin for treatment of Ménière's disease on lower frequency hearing.

Int J Clin Pharm. 2016 Apr 12;

Authors: Sam G, Chung DW, van der Hoeven R, Verweij S, Becker M

Abstract
Background The intratympanic application of the ototoxic aminoglycoside gentamicin has shown promising results as an ablative treatment for vertigo associated with Ménière's disease. Objective To evaluate the efficacy and safety of intratympanic gentamicin and to specifically analyse the effect of this treatment on high and low hearing frequencies in patients with unilateral definite Ménière's disease. Method Subjects were treated with intratympanic gentamicin and were evaluated on vertigo, tinnitus, mean pure tone audiometry threshold and speech discrimination score. Subjects were followed for evaluation for up to 2 years after treatment. Results The number of vertigo spells per month decreased and subjects experienced less tinnitus. During follow up there was an increase of hearing loss in the low (0.25-, 0.5-, 1-kHz) frequency range (13.3 dB; p = 0.03). There was no significant increase of hearing loss in the high (2-, 4-, 8-kHz) frequency range. A clinically significant change in speech discrimination score was found in 50 % of the subjects. Conclusion Our results indicate that intratympanic gentamicin especially affects the mean pure tone audiometry threshold in the low frequency range, which may have clinical implications. Though many of our results are (statistically) substantial the study was limited by the small cohort size.

PMID: 27073077 [PubMed - as supplied by publisher]

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[Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma].

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[Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma].

HNO. 2016 Apr 12;

Authors: Müller B, Volk GF, Guntinas-Lichius O

Abstract
BACKGROUND: Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life.
OBJECTIVE: This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo.
METHODS: The present review describes a PubMed-based search of the literature of the past 10 years.
RESULTS: There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control.
CONCLUSION: There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.

PMID: 27072637 [PubMed - as supplied by publisher]

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Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials.

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Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials.

Braz J Otorhinolaryngol. 2016 Mar 28;

Authors: Celis-Aguilar E, Hinojosa-González R, Vales-Hidalgo O, Coutinho-Toledo H

Abstract
INTRODUCTION: Even today, the treatment of intractable vertigo remains a challenge. Vestibular ablation with intratympanic gentamicin stands as a good alternative in the management of refractory vertigo patients.
OBJECTIVE: To control intractable vertigo through complete saccular and horizontal canal vestibular ablation with intratympanic gentamicin treatment.
METHODS: Patients with refractory episodic vertigo were included. The inclusion criteria were: unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to other treatments. Included patients underwent 0.5-0.8mL of gentamicin intratympanic application at a 30mg/mL concentration. Vestibular ablation was confirmed by the absence of response on cervical vestibular evoked myogenic potentials and no response on caloric tests. Audiometry, electronystagmography with iced water, and vestibular evoked myogenic potentials were performed in all patients.
RESULTS: Ten patients were included; nine patients with Meniere's disease and one patient with (late onset) delayed hydrops. Nine patients showed an absent response on vestibular evoked myogenic potentials and no response on caloric tests. The only patient with low amplitude on cervical vestibular evoked myogenic potentials had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30dB.
CONCLUSIONS: Cervical vestibular evoked myogenic potentials confirmed vestibular ablation in patients treated with intratympanic gentamicin. High-grade vertigo control was due to complete saccular and horizontal canal ablation (no response to iced water in electronystagmography and no response on cervical vestibular evoked myogenic potentials).

PMID: 27068887 [PubMed - as supplied by publisher]

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Developing and piloting a multifactorial intervention to address participation and quality of life in nursing home residents with joint contractures (JointConImprove): study protocol.

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Developing and piloting a multifactorial intervention to address participation and quality of life in nursing home residents with joint contractures (JointConImprove): study protocol.

Ger Med Sci. 2015;13:Doc13

Authors: Müller M, Bartoszek G, Beutner K, Klingshirn H, Saal S, Stephan AJ, Strobl R, Grill E, Meyer G

Abstract
BACKGROUND: Joint contractures are common problems in frail older people in nursing homes. Irrespective of the exact extent of older individuals in geriatric care settings living with joint contractures, they appear to be a relevant problem. Also, the new emphasis on the syndrome of joint contractures, e. g. by the German statutory long term care insurance, led to an increase in assessment and documentation efforts and preventive interventions in clinical care. However, more attention should be paid to the actual situation of older individuals in nursing homes with prevalent joint contractures, particularly their experience of related activity limitations and participation restrictions. Thus, the aim of this study is 1) to develop a tailored intervention to improve functioning, and especially participation and quality of life in older residents with joint contractures in nursing homes and 2) to test the feasibility of the intervention accompanied by a rigorous process evaluation.
METHODS: The complex intervention, which will be developed in this project follows the UK Medical Research Council (MRC) framework and integrates the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development process will comprise a systematic literature review, reanalysis of existing data and the integration of the knowledge of the affected individuals and experts. The developed intervention including a comprehensive process evaluation will be pilot tested with residents with joint contractures in three nursing homes.
DISCUSSION: The projected study will provide a tailored intervention to improve functioning, participation and quality of life in older residents with joint contractures in nursing homes. With this focus, the intervention will support patient relevant outcomes. The pilot study including process evaluation will offer a first opportunity to indicate the size of the intervention's effect and prepare further studies.

PMID: 26195926 [PubMed - indexed for MEDLINE]

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Cochlear implant outcomes in patients with superior canal dehiscence.

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Cochlear implant outcomes in patients with superior canal dehiscence.

Cochlear Implants Int. 2015 Jul;16(4):213-21

Authors: Puram SV, Roberts DS, Niesten ME, Dilger AE, Lee DJ

Abstract
OBJECTIVE: To determine whether adult cochlear implant (CI) users with superior canal dehiscence syndrome (SCDS) or asymptomatic superior semicircular canal dehiscence (SCD) have different surgical, vestibular, and audiologic outcomes when compared to CI users with normal temporal bone anatomy.
METHODS: A retrospective single institution review of CI users with either superior semicircular canal dehiscence syndrome or asymptomatic superior semicircular canal dehiscence identified eight post-lingually deafened adults with unilateral or bilateral cochlear implantation between 2006 and 2010. Preoperative and postoperative speech perception scores as well as medical and epidemiological data were recorded and analyzed.
RESULTS: One patient with superior canal dehiscence syndrome and seven patients with asymptomatic superior semicircular canal dehiscence were identified, representing 7% or 8/113 of CI patients that fulfilled selection criteria. Average dehiscence length was 3.3 mm ± 0.79 SEM. Three patients received bilateral implants and five patients received a unilateral implant. Among asymptomatic superior semicircular canal dehiscence patients, subjective rates of post-operative dizziness were similar to those seen in patients with normal temporal bone anatomy (12.5 % vs. 15.9%, respectively). Speech perception abilities after surgery were poorer in SCD patients compared to the non-SCD cohort (Consonant Nucleus Consonant 33.7 ± 7.78 SEM vs. 56.7 ± 2.15 SEM P = 0.011), although both groups improved substantially relative to pre-operative performance. We also completed detailed analyses of auditory and vestibular outcomes in one patient with SCDS who underwent CI surgery in the symptomatic ear, which demonstrated preservation of vestibular function post-operatively, improved quality-of-life measures, and reduced dizziness symptomatology.
CONCLUSIONS: Our data suggest that patients with asymptomatic superior canal dehiscence at the time of CI surgery have similar albeit decreased speech perception scores compared to non-SCD adult CI users. Subjective rate of dizziness or vertigo following CI surgery was similar in both asymptomatic SCD and non-SCD cohorts, with detailed analyses of a single symptomatic SCD patient revealing improved vestibular function and reduced SCD symptoms following CI.

PMID: 24074366 [PubMed - indexed for MEDLINE]

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Tongguan Liqiao acupuncture therapy improves dysphagia after brainstem stroke.

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Tongguan Liqiao acupuncture therapy improves dysphagia after brainstem stroke.

Neural Regen Res. 2016 Feb;11(2):285-91

Authors: Zhang CH, Bian JL, Meng ZH, Meng LN, Ren XS, Wang ZL, Guo XY, Shi XM

Abstract
Tongguan Liqiao acupuncture therapy has been shown to effectively treat dysphagia after stroke-based pseudobulbar paralysis. We presumed that this therapy would be effective for dysphagia after bulbar paralysis in patients with brainstem infarction. Sixty-four patients with dysphagia following brainstem infarction were recruited and divided into a medulla oblongata infarction group (n = 22), a midbrain and pons infarction group (n = 16), and a multiple cerebral infarction group (n = 26) according to their magnetic resonance imaging results. All patients received Tongguan Liqiao acupuncture for 28 days. The main acupoints were Neiguan (PC6), Renzhong (DU26), Sanyinjiao (SP6), Fengchi (GB20), Wangu (GB12), and Yifeng (SJ17). Furthermore, the posterior pharyngeal wall was pricked. Before and after treatment, patient swallowing functions were evaluated with the Kubota Water Test, Fujishima Ichiro Rating Scale, and the Standard Swallowing Assessment. The Barthel Index was also used to evaluate their quality of life. Results showed that after 28 days of treatment, scores on the Kubota Water Test and Standard Swallowing Assessment had decreased, but scores on the Fujishima Ichiro Rating Scale and Barthel Index had increased in each group. The total efficacy rate was 92.2% after treatment, and was most obvious in patients with medulla oblongata infarction (95.9%). These findings suggest that Tongguan Liqiao acupuncture therapy can repair the connection of upper motor neurons to the medulla oblongata motor nucleus, promote the recovery of brainstem infarction, and improve patient's swallowing ability and quality of life.

PMID: 27073382 [PubMed]

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Voice analysis before and after vocal rehabilitation in patients following open surgery on vocal cords.

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Voice analysis before and after vocal rehabilitation in patients following open surgery on vocal cords.

Vojnosanit Pregl. 2016 Feb;73(2):165-8

Authors: Bunijevac M, Petrović-Lazić M, Jovanović-Simić N, Vuković M

Abstract
BACKGROUND/AIM: The major role of larynx in speech, respiration and swallowing makes carcinomas of this region and their treatment very influential for patients' life quality. The aim of this study was to assess the importance of voice therapy in patients after open surgery on vocal cords.
METHODS: This study included 21 male patients and the control group of 19 subjects. The vowel (A) was recorded and analyzed for each examinee. All the patients were recorded twice: firstly, when they contacted the clinic and secondly, after a three-month vocal therapy, which was held twiceper week on an outpatient basis. The voice analysis was carried out in the Ear, Nose and Throat (ENT) Clinic, Clinical Hospital Center "Zvezdara" in Belgrade.
RESULTS: The values of the acoustic parameters in the patients submitted to open surgery on the vocal cords before vocal rehabilitation and the control group subjects were significantly different in all specified parameters. These results suggest that the voice of the patients was damaged before vocal rehabilitation. The results of the acoustic parameters of the vowel (A) before and after vocal rehabilitation of the patients with open surgery on vocal cords were statistically significantly different. Among the parameters--Jitter (%), Shimmer (%)--the observed difference was highly statistically significant (p < 0.01). The voice turbulence index and the noise/harmonic ratio were also notably improved, and the observed difference was statistically significant (p < 0.05). The analysis of the tremor intensity index showed no significant improvement and the observed difference was not statistically significant (p > 0.05 ). CONCLUSION. There was a significant improvement of the acoustic parameters of the vowel (A) in the study subjects three months following vocal therapy. Only one out of five representative parameters showed no significant improvement.

PMID: 27071284 [PubMed - in process]

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Ebi, a Drosophila homologue of TBL1, regulates the balance between cellular defense responses and neuronal survival.

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Ebi, a Drosophila homologue of TBL1, regulates the balance between cellular defense responses and neuronal survival.

Am J Neurodegener Dis. 2016;5(1):62-8

Authors: Lim YM, Tsuda L

Abstract
Transducin β-like 1 (TBL1), a transcriptional co-repressor complex, is a causative factor for late-onset hearing impairments. Transcriptional co-repressor complexes play pivotal roles in gene expression by making a complex with divergent transcription factors. However, it remained to be clarified how co-repressor complex regulates cellular survival. We herein demonstrated that ebi, a Drosophila homologue of TBL1, suppressed photoreceptor cell degeneration in the presence of excessive innate immune signaling. We also showed that the balance between NF-κB and AP-1 is a key component of cellular survival under stress conditions. Given that Ebi plays an important role in innate immune responses by regulating NF-κB activity and inhibition of apoptosis induced by associating with AP-1, it may be involved in the regulation of photoreceptor cell survival by modulating cross-talk between NF-κB and AP-1.

PMID: 27073743 [PubMed]

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Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study.

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Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study.

Braz J Otorhinolaryngol. 2016 Mar 28;

Authors: Burduk PK, Wierzchowska M, Grześkowiak B, Kaźmierczak W, Wawrzyniak K

Abstract
INTRODUCTION: Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs.
OBJECTIVE: The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS.
METHODS: In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy.
RESULTS: A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group.
CONCLUSION: The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

PMID: 27068885 [PubMed - as supplied by publisher]

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Expression of estrogen and progesterone receptors in angioleiomyoma of the nasal cavity of six patients.

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Expression of estrogen and progesterone receptors in angioleiomyoma of the nasal cavity of six patients.

Oncol Lett. 2016 Apr;11(4):2359-2364

Authors: Zhu G, Xiao D, Sun P

Abstract
Angioleiomyoma of the nasal cavity is extremely rare. There are only a small number of studies in the literature that demonstrate that the estrogen receptor (ER) and progesterone receptor (PR) are expressed in angioleiomyoma, and the results from these studies are inconsistent. The present study identified 6 patients with nasal angioleiomyoma that were treated between 2004 and 2013. All patients underwent endoscopic surgery and were followed-up for 1-10 years. Resected tumors were investigated for the presence of ER and PR using immunoperoxidase staining. Of the 6 patients, 4 were men and 2 were woman. The mean age of the patients was 60.5 years. The tumors of the 6 patients were identified in the nasal septum, middle turbinate, inferior turbinate, lateral wall of the nasal cavity and nasal vestibule. The clinical manifestations reported by the patients consisted of a painless mass, recurrent epistaxis and nasal obstruction. There were no specific features observed in any of the patients using computed tomography or magnetic resonance imaging. All the patients underwent tumor dissection visualized with a nasal endoscope and recovered without recurrence or malignancy of the tumor post-surgery. Hematoxylin and eosin and immunoperoxidase staining confirmed the diagnosis of angioleiomyoma in all patients. In 5 patients the nuclei of the smooth muscle tumor cells markedly expressed ER and PR. To the best of our knowledge, the present study is the first to demonstrate that ER and PR are clearly expressed in nasal angioleiomyoma. The present study suggests that the sex hormones are possibly associated with the growth of angioleiomyoma.

PMID: 27073480 [PubMed - as supplied by publisher]

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Papillary Thyroid Cancer in a Child with Progressive Transformation of Germinal Centers.

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Papillary Thyroid Cancer in a Child with Progressive Transformation of Germinal Centers.

Case Rep Otolaryngol. 2016;2016:6469073

Authors: Mohan S, DeNardo B, Stachurski D, Greene Welch J, Groblewski JC

Abstract
Objectives. To describe the presentation and management of a child with Progressive Transformation of Germinal Centers (PTGC), an uncommon condition characterized by significant persistent lymphadenopathy, who developed papillary thyroid carcinoma and to explore and review potential links between PTGC and neoplastic processes in the head and neck. Methods. Case presentation and literature review are used. Results. A 10-year-old female presented with a right parotid mass and cervical lymphadenopathy. Multiple biopsies revealed PTGC without malignancy. Two years later, she developed fatigue and weight gain, and a thyroid nodule was found. Fine needle aspiration was strongly suggestive of papillary thyroid carcinoma. The patient underwent total thyroidectomy and central neck dissection without surgical management of the longstanding right lateral neck lymphadenopathy. Final pathology confirmed papillary thyroid carcinoma. She was treated with radioactive iodine therapy postoperatively and remains free of disease at three years of follow-up. Conclusions. PTGC is considered a benign condition but has previously been associated with Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL). This is the first reported case of papillary thyroid cancer in a child with preexisting cervical PTGC and no defined risk factors for thyroid malignancy. No link has been established with thyroid carcinoma, but patients with PTGC may have a defect in immune surveillance that predisposes them to malignancy.

PMID: 27069706 [PubMed]

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Computer-assisted navigation: its role in intraoperatively accurate mandibular reconstruction.

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Computer-assisted navigation: its role in intraoperatively accurate mandibular reconstruction.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 13;

Authors: Wu J, Sun J, Shen SG, Xu B, Li J, Zhang S

Abstract
OBJECTIVE: This article presents our experiences of computer-assisted navigation in mandibular reconstruction and evaluates its effectiveness.
STUDY DESIGN: Eight patients who underwent navigation-guided mandibular reconstruction with a fibula free flap were reviewed. Under intraoperative navigation, the ideal positions of the mandibular angles and condyles were confirmed by the navigation probe. The surgical results were evaluated through postoperative panoramic radiographs, coronal computed tomography scans, and image fusion.
RESULTS: Navigation-guided mandibular reconstructions were successfully completed on the basis of preoperative planning and simulation. The surgical discrepancy in the mandibular angle between the actual surgical results and the preoperative designs was 1.92 ± 0.97 mm. Panoramic radiographs and coronal computed tomography scans illustrated that all the condyles fitted into their glenoid fossae. All patients were satisfied with their functional and aesthetic outcomes.
CONCLUSIONS: Computer-assisted navigation is a viable technology for improving surgical outcomes in mandibular reconstruction, which can assist the surgeons by providing real-time three-dimensional surgical references during the operation.

PMID: 27068681 [PubMed - as supplied by publisher]

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The use of immunohistochemistry in detection of perineural invasion in mucoepidermoid carcinoma.

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The use of immunohistochemistry in detection of perineural invasion in mucoepidermoid carcinoma.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 13;

Authors: Lanzel E, Robinson RA, Zimmerman MB, Pourian A, Hellstein JW

Abstract
OBJECTIVES: To retrospectively study the prevalence of perineural invasion (PNI) in cases of mucoepidermoid carcinoma (MEC). The study evaluated if previously assessed PNI would be increased by re-review of the original hematoxylin and eosin-stained (H&E) slides and also review of slides reacted immunohistochemically with S100 to enhance nerve visualization and whether this is associated with clinical outcome.
STUDY DESIGN: Thirty-one cases were reviewed for PNI with H&E-stained slides as well as S-100-reacted slides. These results were compared with the original pathology report's PNI status when available (13 of 31). Subject demographic characteristics and clinical outcome were collected from electronic medical records.
RESULTS: PNI was identified in 23% (3 of 13) of tumors in the original reports, 13% (4 of 31) of the authors' re-review of the slides, and 29% (9 of 31) by immunohistochemical assessment for S100. PNI and larger-diameter nerve involvement were significantly associated with death at 5-year follow-up.
CONCLUSIONS: Immunohistochemical assessment for S100 improves the accuracy of PNI determination. PNI is a significant factor in the survival outcome of cases of MEC.

PMID: 27068680 [PubMed - as supplied by publisher]

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Establishing a targeted plan for prophylactic dental extractions in patients with laryngeal cancer receiving adjuvant radiotherapy.

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Establishing a targeted plan for prophylactic dental extractions in patients with laryngeal cancer receiving adjuvant radiotherapy.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 13;

Authors: Hentz C, Diaz AZ, Borrowdale RW, Emami B, Kase M, Choi M

Abstract
OBJECTIVE: The purpose of this study was to determine dose delivered to individual mandibular tooth-bearing regions during adjuvant intensity-modulated radiotherapy for laryngeal cancers.
STUDY DESIGN: Twenty patients with laryngeal cancer treated with intensity-modulated radiotherapy were included. Individual mandibular tooth-borne areas were manually contoured. Average doses were calculated for individual teeth.
RESULTS: Doses to individual teeth increased with more posterior location. Highest dose was observed for third molar (M3) (43.1 Gy; P < .001). Doses to molars and premolars correlated with T- and N-stage (P = .007; P < .001, respectively). For ipsilateral nodal disease, there was no difference between the doses to ipsilateral teeth and contralateral teeth. Only in N2 c tumors, dose was above our threshold for extraction for M3 only (51.5 Gy).
CONCLUSIONS: T- and N-stage drive dose to individual mandibular tooth-borne areas. With the exception of the posterior molars, particularly in node-positive patients, radiation exposure falls below the threshold reported for pre-RT tooth extractions (50 Gy). We concluded that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of osteoradionecrosis in patients with laryngeal cancer receiving adjuvant RT.

PMID: 27068679 [PubMed - as supplied by publisher]

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Microvascular stent anastomosis using N-fibroin stents: feasibility, ischemia time, and complications.

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Microvascular stent anastomosis using N-fibroin stents: feasibility, ischemia time, and complications.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):e97-e103

Authors: Smeets R, Vorwig O, Wöltje M, Gaudin R, Luebke AM, Beck-Broichsitter B, Rheinnecker M, Heiland M, Grupp K, Gröbe A, Hanken H

Abstract
OBJECTIVE: To evaluate a novel microvascular anastomosis technique using N-fibroin stents.
STUDY DESIGN: Cylinder stents of 1 mm diameter and 5 mm length were fabricated using N-fibroin from silkworms. In 22 rats, aortas were dissected, and the stent was inserted into the two ends of the aorta and fixed using methylmethacrylate.
RESULTS: Stent anastomosis was successful in 21 (96%) rats. The mean ischemia time was 7.4 minutes, significantly shorter than the 15.9 minutes in the control group with conventional sutures (P < .0001). After 4 months, anastomosis was functionally patent in all cases. However, elastic fibers remained interrupted in all stent anastomosis cases, and marked host rejection was evident at the stent anastomosis sites. Around the stents, thrombi were frequent (52%).
CONCLUSIONS: Our study demonstrated the basic feasibility of stent anastomosis using N-fibroin stents and reduced ischemia time. However, thrombus formation, frequent and severe abdominal infections, and heavy host rejection remain critical issues.

PMID: 27068318 [PubMed - in process]

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Comparison of the performance of intraoral X-ray sensors using objective image quality assessment.

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Comparison of the performance of intraoral X-ray sensors using objective image quality assessment.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):e129-37

Authors: Hellén-Halme K, Johansson C, Nilsson M

Abstract
OBJECTIVES: The main aim of this study was to evaluate the performance of 10 individual sensors of the same make, using objective measures of key image quality parameters. A further aim was to compare 8 brands of sensors.
STUDY DESIGN: Ten new sensors of 8 different models from 6 manufacturers (i.e., 80 sensors) were included in the study. All sensors were exposed in a standardized way using an X-ray tube voltage of 60 kVp and different exposure times. Sensor response, noise, low-contrast resolution, spatial resolution and uniformity were measured.
RESULTS: Individual differences between sensors of the same brand were surprisingly large in some cases. There were clear differences in the characteristics of the different brands of sensors. The largest variations were found for individual sensor response for some of the brands studied. Also, noise level and low contrast resolution showed large variations between brands.
CONCLUSIONS: Sensors, even of the same brand, vary significantly in their quality. It is thus valuable to establish action levels for the acceptance of newly delivered sensors and to use objective image quality control for commissioning purposes and periodic checks to ensure high performance of individual digital sensors.

PMID: 27068317 [PubMed - in process]

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Gnathodiaphyseal dysplasia: report of a family with a novel mutation of the ANO5 gene.

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Gnathodiaphyseal dysplasia: report of a family with a novel mutation of the ANO5 gene.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):e123-8

Authors: Duong HA, Le KT, Soulema AL, Yueh RH, Scheuner MT, Holick MF, Christensen R, Tajima TL, Leung AM, Mallya SM

Abstract
Gnathodiaphyseal dysplasia (GDD) is a rare autosomal dominant disorder characterized by florid osseous dysplasia of the jaws, bone fragility, and diaphyseal cortical thickening and bowing of long bones. We present a family with previously undiagnosed GDD. The disorder was identified by the characteristic gnathic and skeletal manifestations in the father. Clinical and radiologic examination of the patient's son also revealed the characteristic features of GDD. Gene sequencing revealed a novel mutation (c. 1067 G>A, p. Cys356 Tyr) in the ANO5 gene, which is causative for GDD. This mutation was predicted to be detrimental by computational analyses and by structural modeling of the protein. The implications for recognition and management of this disease are discussed.

PMID: 27068316 [PubMed - in process]

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WhatsApp: a telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations-a commentary.

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WhatsApp: a telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations-a commentary.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):573

Authors: Pentapati KC, Smriti K, Gadicherla S

PMID: 27068315 [PubMed - in process]

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Morphometric features of the mandibular condyle and association with disk abnormalities.

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Morphometric features of the mandibular condyle and association with disk abnormalities.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):566-72

Authors: Torres MG, Crusoé-Rebello IM, Rosário M, Albuquerque MC, Campos PS

Abstract
OBJECTIVE: The aim of this study was to evaluate the relationship between the morphometric characteristics of the condyle and temporomandibular joint (TMJ) disk displacement.
STUDY DESIGN: One hundred and nine individuals who underwent magnetic resonance imaging of the TMJ were evaluated. Linear (D1: condyle width; D2: condyle thickness) and angular (A1: horizontal condylar angle; A2: anterior condylar angle; A3: medial condylar angle) measurements were made. These measurements were associated with articular disk displacement, with and without reduction.
RESULTS: There was statistically significant association between limited D1 and D2 and between A1 above and A1 below the mean and displacement of the joint disk. There was statistically significant association between A2 and anterior displacement of the disk. Furthermore, thicker condyles and/or condyles with smaller horizontal angles and/or with smaller medial angles were associated with articular disk reduction.
CONCLUSIONS: The morphometric characteristics of the bony components of the TMJ are related to articular disk displacement and with its reduction or nonreduction.

PMID: 27068314 [PubMed - in process]

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Objective and subjective image evaluation of maxillary alveolar bone based on cone beam computed tomography exposure parameters.

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Objective and subjective image evaluation of maxillary alveolar bone based on cone beam computed tomography exposure parameters.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):557-65

Authors: de Moura PM, Hallac RR, Seaward JR, Kane AA, Aguiar M, Raggio R, Gutfilen B

Abstract
OBJECTIVES: The purpose of this study was to optimize the exposure parameters for cone beam computed tomography (CBCT) for performing diagnostic imaging of maxillary alveolar bone.
STUDY DESIGN: CBCT (Promax 3 D Max) was performed on a frozen human cadaver head. Image homogeneity and the degree of alveolar bone contrast were determined by objective assessment using ImageJ software and subjective assessment by orthodontists and oral radiologists. Kruskal-Wallis tests and interrater agreement were used to compare results across groups.
RESULTS: Image homogeneity and degree of alveolar bone contrast differed significantly among all exposure protocols (P < .001). Intraclass correlation values ranged from 0.681 to 0.779, with orthodontists having higher values compared with oral radiologists. Average of image quality scores between protocols were statistically significant (P < .001) and ranged from "fair" to "good."
CONCLUSIONS: There is great potential to reduce CBCT radiation doses for maxillary alveolar bone while maintaining adequate image quality for diagnosis.

PMID: 27068313 [PubMed - in process]

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Efficacy of a cone beam computed tomography metal artifact reduction algorithm for the detection of peri-implant fenestrations and dehiscences.

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Efficacy of a cone beam computed tomography metal artifact reduction algorithm for the detection of peri-implant fenestrations and dehiscences.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):550-6

Authors: de-Azevedo-Vaz SL, Peyneau PD, Ramirez-Sotelo LR, Vasconcelos Kde F, Campos PS, Haiter-Neto F

Abstract
OBJECTIVE: To determine whether the use of a metal artifact reduction (MAR) algorithm improves the detection of peri-implant fenestrations and dehiscences on cone beam computed tomography scans.
STUDY DESIGN: One hundred titanium fixtures were implanted into bovine ribs after the creation of defects simulating fenestrations and dehiscences. Images were acquired using four different protocols, namely, A2 (MAR on, voxel 0.2 mm), A3 (MAR on, voxel 0.3 mm), B2 (MAR off, voxel 0.2 mm), and B3 (MAR off, voxel 0.3 mm). For all protocols, receiver operating characteristic (ROC) curves were determined. Values for the areas under the ROC curves (Az) were subjected to analysis of variance.
RESULTS: Az values were not statistically different among protocols regardless of the defect type (P > .05).
CONCLUSIONS: The MAR algorithm tested by us did not improve the diagnosis of peri-implant fenestrations and dehiscences with use of either the 0.2 mm or the 0.3 mm voxel sizes.

PMID: 27068312 [PubMed - in process]

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Diagnostic and prognostic utility of Mastermind-like 2 (MAML2) gene rearrangement detection by fluorescent in situ hybridization (FISH) in mucoepidermoid carcinoma of the salivary glands.

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Diagnostic and prognostic utility of Mastermind-like 2 (MAML2) gene rearrangement detection by fluorescent in situ hybridization (FISH) in mucoepidermoid carcinoma of the salivary glands.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):530-41

Authors: Luk PP, Wykes J, Selinger CI, Ekmejian R, Tay J, Gao K, Eviston TJ, Lum T, O'Toole SA, Clark JR, Gupta R

Abstract
OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy, with a proportion harboring MAML2 rearrangement. This study evaluates the diagnostic and prognostic utility of MAML2 rearrangement in MEC.
STUDY DESIGN: Salivary gland malignancies at a single institution (1989-2014) were reviewed to identify MECs. Histopathologic evaluation, immunohistochemistry, and fluorescent in situ hybridization (FISH) were performed.
RESULTS: Forty-one cases of MEC were identified, with mean age of 47 years and mean tumor size of 21 mm. Seven locoregional recurrences and five MEC-related deaths were seen over a 22-year follow-up period. Thirty-eight cases were suitable for FISH, and 31 (82%) cases were positive for MAML2 rearrangement, including the oncocytic and clear cell variants of MEC. FISH was negative in the morphologic mimics of MEC. MAML2 rearrangement was significantly associated with longer survival.
CONCLUSIONS: MAML2 rearrangement is common and specific for MEC, which makes it a useful diagnostic tool. MAML2 rearrangement also predicts a favorable prognosis.

PMID: 27068311 [PubMed - in process]

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Possible alternative therapies for oral lichen planus cases refractory to steroid therapies.

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Possible alternative therapies for oral lichen planus cases refractory to steroid therapies.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):496-509

Authors: Yang H, Wu Y, Ma H, Jiang L, Zeng X, Dan H, Zhou Y, Chen Q

Abstract
Oral lichen planus (OLP) is a chronic inflammatory disorder with a multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients' lives may be affected by pain caused by atrophic-erosive lesions. Given the obscure etiology, treatment is usually symptomatic. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. This review provides an overview of the current approaches for the management of steroid-refractory OLP. The miscellaneous treatment regimens include tacrolimus, pimecrolimus, thalidomide, low-level laser therapy, photodynamic therapy, and surgical excision. Some results obtained from these studies were promising. However, further studies, especially randomized controlled trials with strict inclusion and exclusion criteria and larger sample sizes, are required for the evaluation of the long-term safety and efficacy of these therapies.

PMID: 27068310 [PubMed - in process]

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Oral surgery in liver transplant candidates: a retrospective study on delayed bleeding and other complications.

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Oral surgery in liver transplant candidates: a retrospective study on delayed bleeding and other complications.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):490-5

Authors: Helenius-Hietala J, Åberg F, Meurman JH, Nordin A, Isoniemi H

Abstract
OBJECTIVE: Untreated dental infections pose a threat for immunocompromised liver transplant (LT) recipients. Therefore, pretransplant dental evaluations are recommended. However, risk of bleeding should be considered among patients with end-stage liver disease, and prophylactic blood transfusions may be used to prevent bleeding. We performed a retrospective study of the incidence of and risk factors for oral surgery-related bleeding in candidates for LT and hypothesized that complications may occur despite preoperative and perioperative hemostatic actions.
STUDY DESIGN: One hundred thirty-four patients who had tooth extractions performed by oral and maxillofacial surgeons before LT were studied. The primary endpoint was bleeding between 24 hours and 2 weeks after extraction. Bleeding risk was analyzed by preoperative platelet (PLT) count and international normalized ratio (INR). Invasiveness of procedures, severity of liver disease, PLT, INR, prophylactic transfusions of PLT, fresh frozen plasma, and tranexamic acid (TA) were included in univariate and multivariate logistic regression analyses to further assess risk.
RESULTS: Twelve patients exhibited minor bleeding; four despite PLT >100 × 10(9)/L and INR <1.5. Increased bleeding associated with INR and prophylactic transfusions by univariate analysis; by multivariate analyses, prophylactic TA (odds ratio [OR] = 8.0; 95% confidence interval [CI] 1.7-37.0), and PLT (OR = 8.3; 95% CI 1.1-62.7) remained significant.
CONCLUSIONS: Most extractions were safe, but prophylactic transfusions did not ensure adequate hemostasis. Local hemostatic measures and close follow-up are warranted.

PMID: 27068309 [PubMed - in process]

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Risk factors of distant metastasis in patients with squamous cell carcinoma of the oral cavity.

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Risk factors of distant metastasis in patients with squamous cell carcinoma of the oral cavity.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):474-80

Authors: Sakamoto Y, Matsushita Y, Yamada S, Yanamoto S, Shiraishi T, Asahina I, Umeda M

Abstract
OBJECTIVE: Although the locoregional control rate of oral cancer has improved recently, the number of patients developing distant metastasis (DM) has increased. The aim of this study is to investigate the clinicopathologic factors related to DM in patients with oral cancer undergoing surgery.
STUDY DESIGN: This was a retrospective study of 252 patients who underwent surgery for squamous cell carcinoma of the oral cavity. Various clinicopathologic factors were examined to determine their relationship to the development of DM.
RESULTS: DM occurred in 21 patients. Univariate analysis showed that perineural invasion, pathologically positive lymph nodes (pN+), neck metastasis level, extracapsular spread, local recurrence, neck recurrence, locoregional control, and postoperative radiotherapy were related to the occurrence of DM. According to multiple logistic analyses, pN+, involvement of neck levels 4 and 5, and local recurrence were independent risk factors for DM.
CONCLUSIONS: pN+, metastasis to the lower neck, and local recurrence were risk factors for DM in patients with oral cancer.

PMID: 27068308 [PubMed - in process]

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Infinite cornucopia: The future of education and training in oral and maxillofacial surgery.

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Infinite cornucopia: The future of education and training in oral and maxillofacial surgery.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):447-9

Authors: Bell RB

PMID: 27068307 [PubMed - in process]

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Acute Hemorrhagic Apoplectic Pituitary Adenoma: Endoscopic Management, Surgical Outcomes, and Complications.

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Acute Hemorrhagic Apoplectic Pituitary Adenoma: Endoscopic Management, Surgical Outcomes, and Complications.

J Craniofac Surg. 2015 Sep;26(6):e510-5

Authors: Zhan R, Zhao Y, Wiebe TM, Li X

Abstract
OBJECTIVE: To assess safety and effectiveness of endoscopic transsphenoidal surgery (ETS) for acute hemorrhagic apoplectic pituitary adenoma.
METHODS: Eighty nine patients with hemorrhagic apoplectic pituitary tumor undergoing endoscopic transsphenoidal surgery were included into a retrospective chart of this study. Charts were reviewed for patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications.
RESULTS: Seventy eight (87.7%) patients achieved total resection, 9 (10.1%) had subtotal resection, and 2 (2.2%) patients had partial resection; no patient experienced insufficient resection. After surgery, 65 (90.3%) of 72 patients who had visual acuity deterioration preoperatively normalized and improved significantly; the rate for remission of visual field was 87.7%. All other acute symptoms, such as severe headache, nausea, vomiting, alteration of mental status, and loss of consciousness, vanished postoperatively. Twenty eight (90.4%) of 31 patients with active secreting adenoma had hormonal remission based on endocrinological evaluation. Three (3.4%) patients incurred CSF leakage which was managed with lumbar drainage. Nine (10.1%) patients incurred transient DI postoperatively, and 2 (2.2%) of them developed permanent DI. Seven (7.9%) patients developed hypopituitarism which was treated with replacement therapy of hormone. One (1.1%) experienced craniotomy for intracranial hemorrhage and died from severe surgical complications postoperatively. There were no patients of meningitis or carotid artery injury.
CONCLUSION: Early detection and emergent endoscopic transsphenoidal surgery provided a safe and effective surgical option for hemorrhagic apoplectic pituitary tumor with a low morbidity and mortality.

PMID: 26335327 [PubMed - indexed for MEDLINE]

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