Dysfunctional long term habituation to exogeneous tinnitus-matched sounds in patients with high tinnitus distress.

Dysfunctional long term habituation to exogeneous tinnitus-matched sounds in patients with high tinnitus distress.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:1967-1970

Authors: Lehser C, Hannemann R, Corona-Strauss FI, Strauss DJ, Haab L, Seidler-Fallbohmer B, Seidler H

Abstract
During the last years, the demand of accurate diagnostic tools for individualized tinnitus treatment gradually increased. Today several different psychometric instruments for the estimation of the patients degree of decompensation with clinical relevance have emerged. All of these tools are questionnaires for a subjective self-assessment and have deficits in comparability due to severe differences in their factor structure in the anamnesis. Those questionnaires thus they are only of limited value in the design of an individualized therapeutic approach. Objective diagnostic tools for the categorization of the patients' distress level are lacking in clinical routine. Scientific approaches yet demonstrated the feasibility of individual distress assessment by objective markers in the EEG. In this article we present the preliminary results of our study of a use of habituation correlates as objective indicator for the decompensation degree in high-distress tinnitus patients.

PMID: 26736670 [PubMed - as supplied by publisher]

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Quiet transcranial magnetic stimulation: Status and future directions.

Quiet transcranial magnetic stimulation: Status and future directions.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:226-229

Authors: Peterchev AV, Murphy DL, Goetz SM

Abstract
A significant limitation of transcranial magnetic stimulation (TMS) is that the magnetic pulse delivery is associated with a loud clicking sound as high as 140 dB resulting from electromagnetic forces. The loud noise significantly impedes both basic research and clinical applications of TMS. It effectively makes TMS less focal since every click activates auditory cortex, brainstem, and other connected regions, synchronously with the magnetic pulse. The repetitive clicking sound can induce neuromodulation that can interfere with and confound the intended effects at the TMS target. As well, there are known concerns regarding blinding of TMS studies, hearing loss, induction of tinnitus, as well as tolerability. Addressing this need, we are developing a quiet TMS (qTMS) device that incorporates two key concepts: First, the dominant frequency components of the TMS pulse sound (typically 2-5 kHz) are shifted to higher frequencies that are above the human hearing upper threshold of about 20 kHz. Second, the TMS coil is designed electrically and mechanically to generate suprathreshold electric field pulses while minimizing the sound emitted at audible frequencies (<; 20 kHz). The enhanced acoustic properties of the coil are accomplished with a novel, layered coil design. We summarize a proof-of-concept qTMS prototype demonstrating noise loudness reduction by 19 dB(A) with ultrabrief pulses at conventional amplitudes. Further, we outline next steps to accomplish further sound reduction and suprathreshold pulse amplitudes.

PMID: 26736241 [PubMed - as supplied by publisher]

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Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing.

Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing.

Clujul Med. 2015;88(4):500-12

Authors: Stamate MC, Todor N, Cosgarea M

Abstract
BACKGROUND AND AIM: The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but to what extent they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The aim of the study was to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches.
METHODS: The study included 105 adult subjects with normal hearing and hearing loss who underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developed to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves and to estimate the areas under the curves in order to compare different multivariate analyses.
RESULTS: We compared the performance of each otoacoustic emission (transient, distorsion product) using three different multivariate analyses for each ear, when multi-frequency gold standards were used. We demonstrated that all multivariate analyses provided high values of the area under the curve proving the performance of the otoacoustic emissions. Each otoacoustic emission test presented high values of area under the curve, suggesting that implementing a multivariate approach to evaluate the performances of each otoacoustic emission test would serve to increase the accuracy in identifying the normal and impaired ears. We encountered the highest area under the curve value for the combined multivariate analysis suggesting that both otoacoustic emission tests should be used in assessing hearing status. Our multivariate analyses revealed that age is a constant predictor factor of the auditory status for both ears, but the presence of tinnitus was the most important predictor for the hearing level, only for the left ear. Age presented similar coefficients, but tinnitus coefficients, by their high value, produced the highest variations of the logistic scores, only for the left ear group, thus increasing the risk of hearing loss. We did not find gender differences between ears for any otoacoustic emission tests, but studies still debate this question as the results are contradictory. Neither gender, nor environment origin had any predictive value for the hearing status, according to the results of our study.
CONCLUSION: Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies.

PMID: 26733749 [PubMed]

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Objective pulsatile tinnitus.

Objective pulsatile tinnitus.

Clin Case Rep. 2015 Dec;3(12):1058-9

Authors: Yacovino DA, Casas P

Abstract
Tinnitus is the usually unwanted perception of sound, in most cases there is no genuine physical source of sound. Less than 10% of tinnitus patients suffer from pulsatile tinnitus. Objective Pulsatile tinnitus can also be the first indication of dural arteriovenous fistula, so examination for such vascular origin must be performed.

PMID: 26733223 [PubMed]

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A biorobotic model of the human larynx.

A biorobotic model of the human larynx.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:3623-3626

Authors: Manti M, Cianchetti M, Nacci A, Ursino F, Laschi C

Abstract
This work focuses on a physical model of the human larynx that replicates its main components and functions. The prototype reproduces the multilayer vocal folds and the ab/adduction movements. In particular, the vocal folds prototype is made with soft materials whose mechanical properties have been obtained to be similar to the natural tissue in terms of viscoelasticity. A computational model was used to study fluid-structure interaction between vocal folds and the airflow. This tool allowed us to make a comparison between theoretical and experimental results. Measurements were performed with this prototype in an experimental platform comprising a controlled air flow, pressure sensors and a high-speed camera for measuring vocal fold vibrations. Data included oscillation frequency at the onset pressure and glottal width. Results show that the combination between vocal fold geometry, mechanical properties and dimensions exhibits an oscillation frequency close to that of the human vocal fold. Moreover, computational results show a high correlation with the experimental one.

PMID: 26737077 [PubMed - as supplied by publisher]

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Voice quality in patients suffering from bipolar disease.

Voice quality in patients suffering from bipolar disease.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:6106-6109

Authors: Guidi A, Schoentgen J, Bertschy G, Gentili C, Landini L, Scilingo EP, Vanello N

Abstract
People suffering from bipolar disease are more and more common. Such pathology can severely affect patients' lifestyle by wide, and sometimes extreme, mood swings. Biosignals can be very useful to understand this disease. Specifically, speech-related features have been seen to vary in depressed people with respect to healthy subjects. Usually prosodic, spectral and energy-related features are studied. Some further information, instead, can be provided studying voice quality. According to Laver's model, voice quality is sensitive and depends on both anatomic/physiologic issues and long-term muscular adjustments of the larynx or the supraglottal vocal tract. A pilot study on both bipolar patients and healthy control subjects, performed by means of the Long-Term Average Spectrum (LTAS) is presented. The effects on LTAS estimation of a F0-correction procedure are discussed. Pairwise statistical comparisons between subjects in euthymic and depressed states and euthymic and hypomanic states were performed. Significant differences were found in some frequency intervals in both cases. The F0-correction procedure modified the values of the significant frequency intervals in the euthymic/depressed comparison, that also was characterized by a change of F0. Noticeably, no statistically significant differences were found in control subjects acquired in the same mood state. Though the number of subjects is small, the results are encouraging given their coherence across patients and the lack of differences in the control group. Finally, this work suggests that particular vocal settings might be involved in different mood states.

PMID: 26737685 [PubMed - as supplied by publisher]

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Voice pathology classification based on High-Speed Videoendoscopy.

Voice pathology classification based on High-Speed Videoendoscopy.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:735-738

Authors: Panek D, Skalski A, Zielinski T, Deliyski DD

Abstract
This work presents a method for automatical and objective classification of patients with healthy and pathological vocal fold vibration impairments using High-Speed Videoendoscopy of the larynx. We used an image segmentation and extraction of a novel set of numerical parameters describing the spatio-temporal dynamics of vocal folds to classification according to the normal and pathological cases and achieved 73,3% cross-validation classification accuracy. This approach is promising to develop an automatic diagnosis tool of voice disorders.

PMID: 26736367 [PubMed - as supplied by publisher]

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Large Cell Neuroendocrine Carcinoma of the Head and Neck: A Clinicopathologic Series of 10 Cases With an Emphasis on HPV Status.

Large Cell Neuroendocrine Carcinoma of the Head and Neck: A Clinicopathologic Series of 10 Cases With an Emphasis on HPV Status.

Am J Surg Pathol. 2016 Jan 5;

Authors: Thompson ED, Stelow EB, Mills SE, Westra WH, Bishop JA

Abstract
Large cell neuroendocrine carcinoma (LCNEC) is a high-grade neuroendocrine neoplasm first described in the lung and subsequently well documented in many other anatomic sites. It has only recently been recognized that LCNEC can also occasionally arise in the head and neck. The role of human papillomavirus (HPV), which is associated with some small cell carcinomas of the head and neck, has not been investigated for LCNEC. We sought to further characterize the histologic, immunophenotypic, and clinical features of LCNEC and also investigate the role of HPV in this newly described group of tumors. The surgical pathology archives of 2 large academic institutions were searched for cases of LCNEC arising in the head and neck. p16 immunohistochemistry and HPV in situ hybridization were performed, and clinical information was obtained from electronic medical records. Ten cases of head and neck LCNEC were identified. The tumors arose in 6 men and 4 women ranging in age from 14 to 70 years (median, 63.5 y). The primary tumor sites were the oropharynx (n=4), the sinonasal tract (n=3), and the larynx (n=3). The LCNECs consisted of nests and trabeculae of medium-large cells with abundant cytoplasm, coarse chromatin, and prominent nucleoli with very high mitotic rates. The tumor nests were often associated with necrosis, peripheral palisading, and rosette formations. The LCNECs were positive for pan-cytokeratin and at least 1 neuroendocrine marker (most often synaptophysin) and were largely negative for p63 (focal staining in 2/10) and CK5/6 (staining in 1/10). The LCNECs demonstrated aggressive clinical behavior: 8 of 10 presented with advanced disease, 5 of 10 died, with 4 more living but with persistent tumor. Three of 10 LCNECs were HPV-related (HPV-LCNEC); they arose in the oropharynx (n=2) and sinonasal tract (n=1). The HPV-LCNECs did not differ from the HPV-negative tumors in histologic appearance or behavior: 2 patients with HPV-LCNEC have died because of their disease and 1 remains alive but with widespread metastases. LCNEC is a rare but distinct form of head and neck carcinoma that exhibits aggressive clinical behavior. A subset of oropharyngeal and sinonasal LCNEC is HPV related, but the presence of HPV may not impart a more favorable prognosis. Because of its aggressive behavior, LCNEC should be distinguished from moderately differentiated neuroendocrine carcinoma and squamous cell carcinoma. The morphology of LCNEC overlaps considerably with the nonkeratinizing appearance of HPV-related squamous cell carcinoma, and as a result a high index of suspicion is needed to identify LCNEC. Immunohistochemical studies for synaptophysin and p63 are helpful tools for making this distinction.

PMID: 26735857 [PubMed - as supplied by publisher]

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Secondhand Smoking and the Risk of Esophageal Squamous Cell Carcinoma in a High Incidence Region, Kashmir, India: A Case-control-observational Study.

Secondhand Smoking and the Risk of Esophageal Squamous Cell Carcinoma in a High Incidence Region, Kashmir, India: A Case-control-observational Study.

Medicine (Baltimore). 2016 Jan;95(1):e2340

Authors: Rafiq R, Shah IA, Bhat GA, Lone MM, Islami F, Boffetta P, Dar NA

Abstract
Studies have associated secondhand smoking (SHS) with cancers of the lung, larynx, and pharynx. Only a few studies have examined the association between SHS and esophageal squamous cell carcinoma (ESCC) and the findings are inconclusive. We aimed to investigate the association between SHS and risk of ESCC in a case-control study in Kashmir, where the incidence of ESCC is high.We recruited 703 histopathologically confirmed ESCC cases and 1664 hospital-based controls individually matched to the cases for age, sex, and district of residence. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using conditional logistic regression models.Among never-tobacco users, the ORs for the association between SHS and ESCC risk were above unity with ever exposure to SHS (OR = 1.32; 95% CI, 0.43-4.02) and exposure to SHS for >14 h/wk (median value) (OR = 2.69; 95% CI, 0.75-20.65). In the analysis of data from all participants, the OR (95% CI) for the association between SHS and ESCC was (OR = 1.02; 95% CI, 0.53-1.93) for SHS ≤14 h/wk and (OR = 1.91; 95% CI, 0.75-4.89) for SHS >14 h/wk in the models adjusted for tobacco use and several other potential confounding factors.We found an indication of increased risk of ESCC associated with exposure to SHS. Studies with larger numbers of SHS-exposed never tobacco users are required to further examine this association.

PMID: 26735535 [PubMed - as supplied by publisher]

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The Role of the Paratrigeminal Nucleus in Vagal Afferent Evoked Respiratory Reflexes: A Neuroanatomical and Functional Study in Guinea Pigs.

The Role of the Paratrigeminal Nucleus in Vagal Afferent Evoked Respiratory Reflexes: A Neuroanatomical and Functional Study in Guinea Pigs.

Front Physiol. 2015;6:378

Authors: Driessen AK, Farrell MJ, Mazzone SB, McGovern AE

Abstract
The respiratory tree receives sensory innervation from the jugular and nodose vagal sensory ganglia. Neurons of these ganglia are derived from embryologically distinct origins and as such demonstrate differing molecular, neurochemical and physiological phenotypes. Furthermore, whereas nodose afferent neurons project to the nucleus of the solitary tract (nTS), recent neuroanatomical studies in rats suggest that jugular neurons have their central terminations in the paratrigeminal nucleus (Pa5). In the present study we confirm that guinea pigs demonstrate a comparable distinction between the brainstem terminations of nodose and jugular ganglia afferents. Thus, microinjection of fluorescently conjugated cholera toxin B (CT-B) neural tracers into the caudal nTS and Pa5 resulted in highly specific retrograde labeling of neurons in the nodose and jugular ganglia, respectively. Whereas, nodose neurons more often expressed 160 KD neurofilament proteins and the alpha3 subunit of Na(+)/K(+) ATPase, significantly more jugular neurons expressed the neuropeptides substance P (SP) and, especially, Calcitonin Gene-Related Peptide (CGRP). Indeed, terminal fibers in the Pa5 compared to the nTS were characterized by their significantly greater expression of CGRP, further supporting the notion that jugular afferents project to trigeminal-related brainstem regions. Electrical stimulation of the guinea pig larynx following selective surgical denervation of the nodose afferent innervation to the larynx (leaving intact the jugular innervation) resulted in stimulus dependent respiratory slowing and eventual apnea. This jugular ganglia neuron mediated response was unaffected by bilateral microinjections of the GABAA agonist muscimol into the nTS, but was abolished by muscimol injected into the Pa5. Taken together these data confirm that jugular and nodose vagal ganglia afferent neurons innervate distinct central circuits and support the notion that multiple peripheral and central pathways mediate sensory responses associated with airway irritations.

PMID: 26733874 [PubMed]

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Aberrant laryngeal location of Onchocerca lupi in a dog.

Aberrant laryngeal location of Onchocerca lupi in a dog.

Parasitol Int. 2015 Dec 27;

Authors: Alho AM, Cruz L, Coelho A, Martinho F, Mansinho M, Annoscia G, Lia RP, Giannelli A, Otranto D, de Carvalho LM

Abstract
Onchocerca lupi (Spirurida, Onchocercidae) is an emerging vector-borne helminth that causes nodular lesions associated with acute or chronic ocular disease in dogs and cats. Since its first description in dogs in 1991, this zoonotic filarioid has been increasingly reported in Europe and the United States. An 8-year-old outdoor mixed-breed female dog from the Algarve (southern Portugal) was presented with a history of severe dyspnoea. Cervical and thoracic radiographs revealed a slight reduction in the diameter of the cervical trachea and a moderate increase in radiopacity of the laryngeal soft tissue. An exploratory laryngoscopy was performed, revealing filiform worms associated with stenosis of the thyroid cartilage and a purulent necrotic tissue in the larynx lumen. A single sessile nodule, protruding from the dorsal wall of the laryngeal lumen caused a severe reduction of the glottis and tracheal diameter. Fragments of the worms were morphologically and molecularly identified as O. lupi. Histological examination of the nodule showed a granulomatous reaction with sections of coiled gravid female nematodes. Following laryngoscopy, a tracheostomy tube was inserted to relieve dyspnoea and ivermectin (300 μg/kg, once a week, for 8 weeks) combined with prednisolone were prescribed. The dog showed a complete recovery. Although O. lupi has been isolated in human patients from the spinal cord, this is the first report of an aberrant migration of O. lupi in a dog. The veterinary medical community should pay attention to aberrant location of O. lupi and consider onchocercosis as a differential diagnosis for airway obstruction in dogs.

PMID: 26732654 [PubMed - as supplied by publisher]

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Different spectral hounsfield unit curve and high-energy virtual monochromatic image characteristics of squamous cell carcinoma compared with nonossified thyroid cartilage.

Related Articles

Different spectral hounsfield unit curve and high-energy virtual monochromatic image characteristics of squamous cell carcinoma compared with nonossified thyroid cartilage.

AJNR Am J Neuroradiol. 2015 Jun;36(6):1194-200

Authors: Forghani R, Levental M, Gupta R, Lam S, Dadfar N, Curtin HD

Abstract
BACKGROUND AND PURPOSE: The attenuation of normal nonossified thyroid cartilage can be similar to that of head and neck squamous cell carcinoma on CT. We compared dual-energy CT spectral Hounsfield unit attenuation characteristics of nonossified thyroid cartilage with that of squamous cell carcinoma to determine the optimal virtual monochromatic image reconstruction energy levels for distinguishing tumor from normal nonossified thyroid cartilage.
MATERIALS AND METHODS: Dual-energy CT scans from 30 patients with histopathology-proved squamous cell carcinoma at different primary sites (laryngeal and nonlaryngeal) and 10 healthy patients were evaluated. Patients were scanned with a 64-section single-source scanner with fast-kilovolt (peak) switching, and scans were reconstructed at different virtual monochromatic energy levels ranging from 40 to 140 keV. Spectral attenuation curves of tumor and nonossified thyroid cartilage were quantitatively evaluated and compared. Any part of the tumor invading the cartilage, when present, was excluded from ROI analysis to avoid cross-contamination from areas where there could be a mixture of cartilage and invading tumor.
RESULTS: Normal nonossified thyroid cartilage had a characteristic, predictable spectral attenuation curve that was different from that of tumors. The greatest difference in attenuation of nonossified cartilage compared with tumor was on virtual monochromatic images of ≥95 keV (P < .0001), with sharp contrast between the relatively high attenuation of nonossified cartilage compared with that of tumor.
CONCLUSIONS: Head and neck squamous cell carcinoma has significantly different attenuation on virtual monochromatic images of ≥95 keV, compared with nonossified thyroid cartilage.

PMID: 25742986 [PubMed - indexed for MEDLINE]

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Package architecture and component design for an implanted neural stimulator with closed loop control.

Package architecture and component design for an implanted neural stimulator with closed loop control.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:7825-7830

Authors: Bjune CK, Marinis TF, Brady JM, Moran J, Wheeler J, Sriram TS, Parks PD, Widge AS, Dougherty DD, Eskandar EN

Abstract
An implanted neural stimulator with closed loop control requires electrodes for stimulation pulses and recording neuron activity. Our system features arrays of 64 electrodes. Each electrode can be addressed through a cross bar switch, to enable it to be used for stimulation or recording. This electrode switch, a bank of low noise amplifiers with an integrated analog to digital converter, power conditioning electronics, and a communications and control gate array are co-located with the electrode array in a 14 millimeter diameter satellite package that is designed to be flush mounted in a skull burr hole. Our system features five satellite packages connected to a central hub processor-controller via ten conductor cables that terminate in a custom designed, miniaturized connector. The connector incorporates features of high reliability, military grade devices and utilizes three distinct seals to isolate the contacts from fluid permeation. The hub system is comprised of a connector header, hermetic electronics package, and rechargeable battery pack, which are mounted on and electrically interconnected by a flexible circuit board. The assembly is over molded with a compliant silicone rubber. The electronics package contains two antennas, a large coil, used for recharging the battery and a high bandwidth antenna that is used to download data and update software. The package is assembled from two machined alumina pieces, a flat base with brazed in, electrical feed through pins and a rectangular cover with rounded corners. Titanium seal rings are brazed onto these two pieces so that they can be sealed by laser welding. A third system antenna is incorporated in the flexible circuit board. It is used to communicate with an externally worn control package, which monitors the health of the system and allows both the user and clinician to control or modify various system function parameters.

PMID: 26738106 [PubMed - as supplied by publisher]

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Updates in anterior skull base reconstruction.

Updates in anterior skull base reconstruction.

Curr Opin Otolaryngol Head Neck Surg. 2016 Feb;24(1):75-82

Authors: Zuniga MG, Turner JH, Chandra RK

Abstract
PURPOSE OF REVIEW: This article summarizes the indications and surgical techniques for the reconstructions of anterior skull base defects.
RECENT FINDINGS: There is increasing popularity of the vascularized pedicled flaps in endoscopic skull base surgery for the successful reconstruction of anterior skull base defects, compared with the use of free-tissue grafts. The location and size of the defect as well as the rate of cerebrospinal fluid (CSF) flow are important considerations for selection of the most appropriate reconstructive approach. Recent literature provides evidence suggesting that pedicled flaps may be more effective for clival defects and high-flow CSF leaks, potentially reducing the incidence of postoperative CSF leaks. Although the nasoseptal flap (NSF) continues to be the mainstay of endoscopic skull base reconstruction, alternative vascularized flaps exist when the NSF is impractical or unavailable, and new surgical approaches continue to evolve.
SUMMARY: Vascularized pedicled flaps, and especially the NSF, have greatly reduced complications associated with endoscopic skull base surgery. Multiple considerations should be taken into account during closure of skull base defects, and several options are available to accommodate different needs.

PMID: 26735312 [PubMed - as supplied by publisher]

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Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

World Neurosurg. 2015 Dec 27;

Authors: Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ

Abstract
OBJECTIVE: Patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal approach (ETN-TSA) surgery. We modified this technique by bypassing the nasal mucosa and approaching through the septum bilaterally. In this study, we analyze whether these technical modifications, which we have termed the endoscopic modified transseptal transsphenoidal approach (EMTS-TSA), decrease postoperative sinonasal morbidity after endoscopic TSA.
METHODS: We retrospectively reviewed a prospectively collected database. Patients who underwent endoscopic TSA from Dec 2012 to Jun 2014 were included. Thirty patients underwent ETN-TSA and 51 underwent EMTS-TSA. Sino-Nasal Outcome Test (SNOT)-20, anterior skull base (ASK) nasal inventory, and visual analogue scale (VAS) for subjective olfaction were evaluated before and 1 and 3 months after surgery. Cross Cultural Smell Identification Test (CC-SIT) was also measured before and 3 months after surgery.
RESULTS: There was a significant difference between the preoperative and 3 month VAS for olfaction in the ETN-TSA group (92.5 to 81.3; P = 0.002) but not the EMTS-TSA group (from 90.6 to 88.8; P = 0.403). There was no statistical difference in SNOT-20 or CC-SIT scores between two groups during follow-up. The EMTS-TSA group scored better than the ETN-TSA group in the ASK nasal inventory subdomain ("nasal discharge", "urge to blow" and "trouble breading) 1 month postoperatively.
CONCLUSIONS: EMTS-TSA could preserve almost all nasal mucosa, including the septum and turbinates. EMTS-TSA may be useful for preserving early postoperative olfactory function and some sinonasal quality of life. We believe that EMTS-TSA is a good endoscopic pituitary surgery option.

PMID: 26732950 [PubMed - as supplied by publisher]

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[Epistaxis following skull trauma].

[Epistaxis following skull trauma].

Ned Tijdschr Geneeskd. 2015;159:A9352

Authors: Nooij RP, van Dijk JM, Groen RJ, Uyttenboogaart M, Eshghi OS, Kosten-Meijer AG

Abstract
BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition.
CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus. The aneurysm was treated endovascularly by placing a coil in the aneurism and a stent in the artery. On the basis of this case study we describe the diagnostics and treatment of patients with posttraumatic posterior epistaxis.
CONCLUSION: In cases if delayed epistaxis following head injury the physician should be alert for the possibility of trauma to the ICA. This is a potentially life-threatening situation that requires prompt treatment.

PMID: 26732210 [PubMed - in process]

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A brain-lesion pattern based algorithm for the diagnosis of posttraumatic olfactory loss.

A brain-lesion pattern based algorithm for the diagnosis of posttraumatic olfactory loss.

Rhinology. 2015 Dec 1;53(4):365-370

Authors: Lő Tsch J, Reither N, Bogdanov V, Hähner A, Ultsch A, Hill K, Hummel T

Abstract
BACKGROUND: Brain areas processing olfactory information exhibit functionally relevant morphological dynamics. This suggests the exploitation of anatomical information in the diagnosis of an olfactory dysfunction. Following previous identifications of olfactory eloquent areas such as the olfactory bulbs and tracts, we focused at a brain-morphology based algorithm for establishing the diagnosis of olfactory loss following brain injury.
METHODOLOGY: Forty-one patients with a history of head trauma dated back 40 ± 39 months, and additional 23 patients without head trauma, were assessed for damages in 11 olfaction-relevant brain areas using magnetic resonance imaging (MRI). Olfactory function was derived from the use of a standardized, reliable and validated olfactory test. An olfactory diagnostic algorithm was derived following classification and regression tree analysis of the brain lesion pattern.
RESULTS: Subjects were assigned to olfactory diagnoses of anosmia, hyposmia or normosmia. These diagnoses were predictable at an accuracy of 62.3 % from the degree of damage in the olfactory bulb and in the left temporal lobe pole. The main diagnosis algorithm addressed the presence of anosmia, which could be predicted from the degree of damage in these brain areas at an accuracy of 81.3 %.
CONCLUSIONS: We independently reproduced previously identified brain regions in which morphological damage is associated with olfactory loss. Based on this reproduction, an algorithm was developed for the diagnosis of anosmia from central-nervous damage. Thus, we introduce a morphological component to the olfactory diagnosis that specifically addresses clinical cases of olfactory loss following head trauma.

PMID: 26735133 [PubMed - as supplied by publisher]

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Follow-up of Thalidomide treatment in patients with Hereditary Haemorrhagic Telangiectasia.

Follow-up of Thalidomide treatment in patients with Hereditary Haemorrhagic Telangiectasia.

Rhinology. 2015 Dec 1;53(4):340-344

Authors: Hosman A, Westermann CJ, Snijder R, Disch F, Mummery CL, Mager JJ

Abstract
BACKGROUND: Patients with a hereditary vascular disorder called Rendu-Osler-Weber syndrome (Hereditary Haemorrhagic Telangiectasia, HHT) haemorrhage easily due to weak-walled vessels. Haemorrhage in lungs or brain can be fatal but patients suffer most from chronic and prolonged nosebleeds (epistaxis), the frequency and intensity of which increases with age. Several years ago, it was discovered serendipitously that the drug Thalidomide had beneficial effects on the disease symptoms in several of a small group of HHT patients: epistaxis and the incidence of anaemia were reduced and patients required fewer blood transfusions. In addition, they reported a better quality of life. However, Thalidomide has significant negative side effects, including neuropathy and fatigue.
METHODS: We followed up all HHT patients in the Netherlands who had been taking Thalidomide at the time the original study was completed to find out (i) how many had continued taking Thalidomide and for how long (ii) the nature and severity of any side-effects and (iii) whether side-effects had influenced their decision to continue taking Thalidomide.
RESULTS: Only a minority of patients had continued taking the drug despite its beneficial effects on their symptoms and that the side effects were the primary reason to stop.
CONCLUSION: Despite symptom reduction, alternative treatments are still necessary for epistaxis in HHT patients and a large-scale clinical trial is not justified although incidental use in the most severely affected patients can be considered.

PMID: 26735132 [PubMed - as supplied by publisher]

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A time-frequency respiration tracking system using non-contact bed sensors with harmonic artifact rejection.

A time-frequency respiration tracking system using non-contact bed sensors with harmonic artifact rejection.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:8111-8114

Authors: Beattie ZT, Jacobs PG, Riley TC, Hagen CC

Abstract
Sleep apnea is a breathing disorder that affects many individuals and has been associated with serious health conditions such as cardiovascular disease. Clinical diagnosis of sleep apnea requires that a patient spend the night in a sleep clinic while being wired up to numerous obtrusive sensors. We are developing a system that utilizes respiration rate and breathing amplitude inferred from non-contact bed sensors (i.e. load cells placed under bed supports) to detect sleep apnea. Multi-harmonic artifacts generated either biologically or as a result of the impulse response of the bed have made it challenging to track respiration rate and amplitude with high resolution in time. In this paper, we present an algorithm that can accurately track respiration on a second-by-second basis while removing noise harmonics. The algorithm is tested using data collected from 5 patients during overnight sleep studies. Respiration rate is compared with polysomnography estimations of respiration rate estimated by a technician following clinical standards. Results indicate that certain subjects exhibit a large harmonic component of their breathing signal that can be removed by our algorithm. When compared with technician transcribed respiration rates using polysomnography signals, we demonstrate improved accuracy of respiration rate tracking using harmonic artifact rejection (mean error: 0.18 breaths/minute) over tracking not using harmonic artifact rejection (mean error: -2.74 breaths/minute).

PMID: 26738176 [PubMed - as supplied by publisher]

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Horner syndrome in glandular fever: a case report.

Horner syndrome in glandular fever: a case report.

J Laryngol Otol. 2016 Jan 6;:1-3

Authors: West EV, Sheerin F, Bates JE

Abstract
OBJECTIVE: This study aimed to present and discuss the case of a patient with known glandular fever who presented with Horner syndrome.
CASE REPORT: A 35-year-old patient with known glandular fever developed acute unilateral Horner syndrome, a previously undescribed complication of this common illness. Magnetic resonance imaging and magnetic resonance angiography showed that enlarged intra-carotid sheath lymphoid tissue was likely to be the underlying cause of sympathetic nerve disruption. The case is described, the anatomy of the sympathetic chain is discussed and possible alternative pathophysiological mechanisms are reviewed.
CONCLUSION: This is the first report in the worldwide literature of Horner syndrome arising as a result of compression from enlarged lymph nodes in glandular fever.

PMID: 26732343 [PubMed - as supplied by publisher]

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Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

Eur Arch Otorhinolaryngol. 2016 Jan 5;

Authors: Longari F, Dehgani Mobaraki P, Ricci AL, Lapenna R, Cagini C, Ricci G

Abstract
The objective of this study is to assess different outcomes between endoscopic dacryocystorhinostomy (En-DCR) with and without silicone intubation. We retrospectively analyzed 84 patients (89 procedures), suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction, treated with En-DCR and divided into two groups depending on silicone stent intubation. The surgical outcomes were evaluated at 7 post-operative controls using Munk's score criteria. Functional success was defined as absence of epiphora, no further episodes of dacryocystitis, and a patent ostium after fluorescein irrigation. 45 En-DCR with stent and 44 En-DCR without stent were performed. Success rate after 18 months follow-up were, respectively, 82.2 % in the stent group and 88.6 % in the non-stent group (OR 0.59) with no statistical differences. The ostial size reduction has been reported in higher percentage in the stent group, mainly due to peristomal granuloma (OR 3.64), scar tissue formation (OR 2.25), and turbinoseptal synaechia (OR 1.76). The benefits of non-intubation are less patient discomfort, reduced surgical time and costs, simpler follow-up regimen and less intubation-associated complications. En-DCR without silicone stent intubation should be the first choice of procedure, stent intubation should be reserved in selected cases with poor local conditions pre and intra-operatively assessed.

PMID: 26732693 [PubMed - as supplied by publisher]

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