Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

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Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

Dysphagia. 2014 Aug;29(4):450-8

Authors: Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV

Abstract
The implication of dysphagia for people treated nonsurgically for head and neck cancer (HNC) and its detrimental effects on functioning and quality of life has been well documented. To date, however, there has been a paucity of research on the effects of dysphagia following HNC on carers, independent of the consequences of a gastrostomy. The objective of this qualitative study was to report on the experiences of carers of people with dysphagia (non-gastrostomy dependent) following nonsurgical treatment for HNC and to identify the support needs of this group. A purposive, maximum-variation sampling technique was adopted to recruit 12 carers of people treated curatively for HNC since 2007. Each participated in an in-depth interview, detailing their experience of caring for someone with dysphagia and the associated impact on their life. Thematic analysis was adopted to search the transcripts for key phases and themes that emerged from the discussions. Analysis of the transcripts revealed four themes: (1) dysphagia disrupts daily life, (2) carers make adjustments to adapt to their partner's dysphagia, (3) the disconnect between carers' expectations and the reality of dysphagia, and (4) experiences of dysphagia-related services and informal supports. Carers generally felt ill-prepared for their role in dysphagia management. The qualitative methodology successfully described the impact of dysphagia on the everyday lives of carers, particularly in regard to meal preparation, social events, and family lifestyle. Clinicians should provide adequate and timely training and support to carers and view carers as copartners in dysphagia management.

PMID: 24844768 [PubMed - indexed for MEDLINE]

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Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo.

Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Martellucci S, Pagliuca G, de Vincentiis M, Greco A, De Virgilio A, Nobili Benedetti FM, Gallipoli C, Rosato C, Clemenzi V, Gallo A

Abstract
OBJECTIVES: To assess factors related to residual dizziness (RD) in patients who underwent successful canalith repositioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV).
STUDY DESIGN: Prospective cohort study.
SETTING: Academic center.
SUBJECTS AND METHODS: Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required ≥4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit.
RESULTS: At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P < .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdomain score of the DHI questionnaire.
CONCLUSION: RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs.

PMID: 26861236 [PubMed - as supplied by publisher]

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Novel Anatomic Characteristics of the Laryngeal Framework: A Computed Tomography Evaluation.

Novel Anatomic Characteristics of the Laryngeal Framework: A Computed Tomography Evaluation.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Sagiv D, Eyal A, Mansour J, Nakache G, Wolf M, Primov-Fever A

Abstract
OBJECTIVE: The thyroid cartilage (TC) in men has a more prominent thyroid notch and a narrower interlaminae angle (ILA) as compared with women. Anatomy textbooks classically stipulate that the ILA is 90° in men and 120° in women. Our observation, based on thyroid chondroplasty operations, of a much narrower angle led to the current investigation.
STUDY DESIGN: Cohort imaging study.
SETTING: Tertiary academic referral center.
SUBJECTS AND METHODS: Computed tomography angiography neck images of adult patients were studied. The ILA was measured on 2 axial planes: at the level of the vocal processes (and the upper portion of thyroarytenoid muscles) and 5 mm superior and parallel to the former. The anterior projection of the TC and the vertical dimensions of the midline cricothyroid membrane (CTM) were also measured.
RESULTS: A total of 126 patients were included in the study. The average ILAs were 63.5°±20.6° and 93.3°±16.6° for men and women, respectively (P < 10(-14)), and were significantly narrower at the upper level in comparison with the vocal process level (P < 10(-7) for men, P = .004 for women). The anterior projection of the TC in men was more prominent as compared with women (P = .0003) and significantly correlated with the ILA (P = .0159). The length of the midline CTM was 11.1±2.3 mm in men and 10.3±1.7 mm in women (P = .0355).
CONCLUSIONS: The ILA is narrower than that reported in the classic anatomy textbooks. In male patients, the upper part of the TC becomes narrower and projects anteriorly like a "jug's spout." The mean vertical dimension of the midline CTM was 10 to 11 mm.

PMID: 26861235 [PubMed - as supplied by publisher]

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Mucoepidermoid Carcinoma at the Mandibular Edentulous Ridge Mucosa: An Infrequent Location.

Mucoepidermoid Carcinoma at the Mandibular Edentulous Ridge Mucosa: An Infrequent Location.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Alberto PL

PMID: 26861234 [PubMed - as supplied by publisher]

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Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap.

Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Damrose EJ, Beswick DM

Abstract
Posterior glottic stenosis is a difficult clinical problem that frequently results in bilateral vocal fold immobility, dyspnea, and tracheostomy dependence. Charts were reviewed of all patients undergoing a modified endoscopic postcricoid advancement flap procedure for posterior glottic stenosis between October 1, 2003, and June 30, 2015. Age, sex, operative findings, complications, and outcomes were noted. Follow-up was available in 10 of 11 patients, 10 of whom were successfully decannulated. There were no complications. Regular diet was maintained in all patients. In patients with bilateral vocal fold immobility secondary to posterior glottis stenosis, endoscopic repair via endoscopic postcricoid advancement flap can restore full vocal fold motion and allow decannulation. In select patients with posterior glottic stenosis, repair via endoscopic postcricoid advancement flap should be considered in lieu of ablative methods, such as cordotomy, cordectomy, or arytenoidectomy.

PMID: 26861233 [PubMed - as supplied by publisher]

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Application of Lean Sigma to the Audiology Clinic at a Large Academic Center.

Application of Lean Sigma to the Audiology Clinic at a Large Academic Center.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Huddle MG, Tirabassi A, Turner L, Lee E, Ries K, Lin SY

Abstract
OBJECTIVE: To apply Lean Sigma-a quality improvement strategy to eliminate waste and reduce variation and defects-to improve audiology scheduling and utilization in a large tertiary care referral center. The project goals included an increase in utilization rates of audiology block time and a reduction in appointment lead time.
STUDY DESIGN: Prospective quality improvement study.
SETTING: Academic tertiary care center.
SUBJECTS: All patients scheduling audiology clinic visits July 2013 to July 2014.
METHODS: Value stream mapping was performed for the audiology scheduling process, and wasteful steps were identified for elimination. Interventions included a 2-week block release, audiology template revision, and reduction of underutilized blocks. Schedule utilization and lead time for new patient diagnostic audiogram were measured for 5 months postintervention and compared with 5 months preintervention. Overall, 2995 preintervention and 3714 postintervention booked appointments were analyzed.
RESULTS: Block utilization increased from 77% to 90% after intervention (P < .0001). Utilization of joint-with-provider visits increased from 39% to 67% (P < .0001). Booked appointments increased from 2995 to 3714, with joint-with-provider booked appointments increasing from 317 to 1193. Appointment lead time averaged 24 days postintervention, compared with 29 days preintervention (P = .06). Average monthly relative value units measured 13,321 preintervention and 14,778 postintervention (P = .09).
CONCLUSION: Lean Sigma techniques were successfully used to increase appointment block utilization and streamline scheduling practices.

PMID: 26861232 [PubMed - as supplied by publisher]

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Definitive Surgical Therapy after Open Neck Biopsy for HPV-Related Oropharyngeal Cancer.

Definitive Surgical Therapy after Open Neck Biopsy for HPV-Related Oropharyngeal Cancer.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Zenga J, Graboyes EM, Haughey BH, Paniello RC, Mehrad M, Lewis JS, Thorstad WL, Nussenbaum B, Rich JT

Abstract
OBJECTIVE: To determine the impact of prior open neck biopsy on the prognosis of patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) who are subsequently treated with a definitive surgical paradigm, including adjuvant therapy when indicated.
STUDY DESIGN: Retrospective cohort.
SETTING: Tertiary care university hospital.
SUBJECTS AND METHODS: Patients with open neck biopsies who were treated with definitive surgery, with or without adjuvant therapy, for HPV-related OPSCC between 1998 and 2012 were compared with a matched control group who did not undergo open neck biopsy. Outcomes were disease-free survival, overall survival, disease-specific survival, incidence of tumor deposit in dermal scar, patterns of recurrence, and neck dissection complications.
RESULTS: Forty-five patients who underwent open neck biopsy were compared with 90 matched controls. Tumor deposits in dermal scars from the prior open neck biopsy were found in 3 patients (7%) during completion neck dissection. Overall complications of the neck dissection were not significantly increased in the open biopsy group over matched controls (20% vs 12%, respectively; P > .05). Five-year Kaplan-Meier estimates for disease-free survival, overall survival, and disease-specific survival were not significantly different between the open biopsy and control groups (93% vs 91%, 98% vs 97%, 98% vs 99%, respectively; all P > .05). Recurrence rates were also not significantly different between groups.
CONCLUSIONS: Patients with HPV-related OPSCC who have undergone a prior open neck biopsy can be successfully treated with a definitive surgical paradigm. Although needle biopsy is preferable to establish a diagnosis, previous open neck biopsy does not affect prognosis in these patients.

PMID: 26861231 [PubMed - as supplied by publisher]

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Head and Neck Paragangliomas: An Update on Evaluation and Management.

Head and Neck Paragangliomas: An Update on Evaluation and Management.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Moore MG, Netterville JL, Mendenhall WM, Isaacson B, Nussenbaum B

Abstract
OBJECTIVE: Head and neck paragangliomas are a group of slow-growing hypervascular tumors associated with the paraganglion system. The approach to evaluate and treat these lesions has evolved over the last 2 decades. While radical surgery had been the traditional approach, improvements in diagnostic imaging as well as radiation therapy techniques have led to an emphasis on observation and nonsurgical therapy in many patients. This article reviews the contemporary approach to the workup and management of head and neck paragangliomas.
DATA SOURCE: Articles were identified from PubMed.
REVIEW METHODS: PubMed searches with the following keywords were performed: carotid body paraganglioma management, vagal paraganglioma management, jugulotympanic paraganglioma management, imaging of head and neck paragangliomas, head and neck paraganglioma embolization, paraganglioma radiation, head and neck paraganglioma management, observation of head and neck paragangliomas, bilateral carotid body paragangliomas, and genetics of paragangliomas. Review and original research articles available in the English language and published during or after 2009 were selected on the basis of their clinical relevance and scientific strength. Certain articles published prior to 2009 were also included if they provided background information that was relevant.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Workup and treatment of head and neck paragangliomas are changing. With more now known regarding the longitudinal behavior of these tumors, observation and nonsurgical therapy are indicated in many instances. For patients where surgery is the most appropriate option, improved diagnostic and perioperative techniques are allowing patients to tolerate resection, often with reduced morbidity.

PMID: 26861230 [PubMed - as supplied by publisher]

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Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management.

Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Pang W, Hu L, Wang H, Sha Y, Ma N, Wang S, Liu Q, Sun X, Wang D

Abstract
OBJECTIVE: To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary medical center.
SUBJECTS AND METHODS: Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities.
RESULTS: This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred.
CONCLUSIONS: OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.

PMID: 26861229 [PubMed - as supplied by publisher]

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Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy.

Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Rosato C, Pagliuca G, Martellucci S, de Vincentiis M, Greco A, Fusconi M, De Virgilio A, Gallipoli C, Simonelli M, Gallo A

Abstract
OBJECTIVE: To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored.
STUDY DESIGN: Prospective, single-group, pretest-posttest design.
SETTING: Academic tertiary care medical center.
SUBJECTS AND METHODS: This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility.
RESULTS: Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up.
CONCLUSIONS: The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.

PMID: 26861228 [PubMed - as supplied by publisher]

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Readability and Understandability of Online Vocal Cord Paralysis Materials.

Readability and Understandability of Online Vocal Cord Paralysis Materials.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Balakrishnan V, Chandy Z, Hseih A, Bui TL, Verma SP

Abstract
OBJECTIVE: Patients use several online resources to learn about vocal cord paralysis (VCP). The objective of this study was to assess the readability and understandability of online VCP patient education materials (PEMs), with readability assessments and the Patient Education Materials Evaluation Tool (PEMAT), respectively. The relationship between readability and understandability was then analyzed.
STUDY DESIGN AND SETTING: Descriptive and correlational design.
METHOD: Online PEMs were identified by performing a Google search with the term "vocal cord paralysis." After scientific webpages, news articles, and information for medical professionals were excluded, 29 articles from the first 50 search results were considered. Readability analysis was performed with 6 formulas. Four individuals with different educational backgrounds conducted understandability analysis with the PEMAT. Fleiss's Kappa interrater reliability analysis determined consistency among raters. Correlation between readability and understandability was determined with Pearson's correlation test.
RESULTS: The reading level of the reviewed articles ranged from grades 9 to 17. Understandability ranged from 29% to 82%. Correlation analysis demonstrated a strong negative correlation between materials' readability and understandability (r = -0.462, P < .05).
CONCLUSION: Online PEMs pertaining to VCP are written above the recommended reading levels. Overall, materials written at lower grade levels are more understandable. However, articles of identical grade levels had varying levels of understandability. The PEMAT may provide a more critical evaluation of the quality of a PEM when compared with readability formulas. Both readability and understandability should be used to evaluate PEMs.

PMID: 26861227 [PubMed - as supplied by publisher]

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Book review.

Book review.

Int J Audiol. 2016 Mar;55(3):196

Authors: Gilbert J

PMID: 26862923 [PubMed - as supplied by publisher]

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Book Review.

Book Review.

Int J Audiol. 2016 Mar;55(3):195

Authors: Marc B

PMID: 26862922 [PubMed - as supplied by publisher]

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Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients.

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Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients.

Otol Neurotol. 2015 Aug;36(7):1238-44

Authors: Piker EG, Baloh RW, Witsell DL, Garrison DB, Lee WT

Abstract
OBJECTIVES: To assess whether patient age or sex was predictive of a bilaterally absent cervical or ocular vestibular evoked myogenic potential (cVEMP or oVEMP).
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary center.
PATIENTS: Patients presenting with normal vestibular tests (i.e. normal caloric and rotational chair) who underwent cVEMP and/or oVEMP testing. Patients with conductive hearing loss were excluded as were those with unilaterally abnormal VEMP results because they presented with evidence of a possible unilateral vestibular impairment. A total of 895 patients met criteria for cVEMPs and 297 for oVEMPs.
MAIN OUTCOME MEASURES: The presence or absence of cVEMP and oVEMP responses elicited with a 500-Hz 125-dB pSPL air conduction stimulus.
RESULTS: A logistic regression was performed including odd ratios and confidence intervals. Compared with adults in their 20s, the odds of bilaterally absent cVEMP responses are 6 times greater for patients in their 50s and 60s and over 22 times greater for patients in their 70s and 80s. A bilaterally absent oVEMP response is 6 times more likely for patients in their 40s, 50s, and 60 and 13 times greater for patients in their 70s.
CONCLUSIONS: VEMPs in response to air conduction stimuli are bilaterally absent in a large percentage of older patients complaining of dizziness who otherwise have normal vestibular and auditory testing for their age. In combination with other abnormal vestibular findings, an absence of VEMP responses may be of value. However, the functional consequence of an isolated bilaterally absent VEMP is not known and may provide minimal information to an older patient's diagnostic picture. In cases where the response is bilaterally absent, a more intense AC stimulus should be used or bone conducted vibration should be considered.

PMID: 26111076 [PubMed - indexed for MEDLINE]

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Early stage squamous cell carcinoma of the lower lip: predictive factors for recurrence.

Early stage squamous cell carcinoma of the lower lip: predictive factors for recurrence.

J Laryngol Otol. 2016 Feb 10;:1-4

Authors: Ozkul Y, Songu M, Imre A, Tunc E, Ozkul Z, Arslanoglu S, Pinar E, Onal K

Abstract
OBJECTIVE: This study aimed to evaluate the effect of tumour thickness on other clinicopathological parameters in early stage lower lip squamous cell carcinoma.
METHODS: Forty-six consecutive patients with lower lip squamous cell carcinoma were included in the study. Demographic, clinical and pathological data were retrospectively collected.
RESULTS: The mean follow-up period for all patients was 32.0 ± 18.9 months. Forty-four tumours were staged as T1 and two were T2. Twelve patients underwent neck dissection. Two patients presented with neck metastasis in the follow-up period. Four patients (8.7 per cent) had local recurrence. Correlation analysis revealed a significant relationship between microscopic tumour thickness and local tumour recurrence (r = 0.328, p = 0.045).
CONCLUSION: Surgical margin control is important to prevent local recurrence, especially in thicker tumours. In addition, neck metastasis is rare in early stage lower lip squamous cell carcinoma. A 'wait and see' policy might be preferred in early stage T1 lower lip squamous cell carcinoma cases.

PMID: 26860988 [PubMed - as supplied by publisher]

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Sialendoscopy-assisted transfacial surgery for the removal of an iatrogenic foreign body in Stensen's duct: a stone and broken wire basket.

Sialendoscopy-assisted transfacial surgery for the removal of an iatrogenic foreign body in Stensen's duct: a stone and broken wire basket.

J Laryngol Otol. 2016 Feb 10;:1-5

Authors: Capaccio P, Gaffuri M, Torretta S, Pignataro L

Abstract
BACKGROUND: A foreign body is a rare cause of parotid gland obstructive sialadenitis; intra-oral penetration via Stensen's duct is unusual. The relatively recent introduction of interventional sialendoscopy to treat obstructive sialadenitis has allowed surgeons to adopt a gland-sparing approach by means of miniaturised endoscopes and instruments. However, unusual anatomy or pathological conditions can give rise to a risk of intraductal rupture that may lead to a subsequent iatrogenic foreign body.
CASE REPORT: This paper describes the case of a patient with a 4 mm stone engaged by a broken wire basket stuck in a secondary branch of Stensen's duct.
RESULTS: The iatrogenic foreign body was successfully retrieved by means of sialendoscopy-assisted transfacial surgery.
CONCLUSION: This is the first reported case of an intraductal rupture of a miniaturised device during interventional sialendoscopy successfully resolved by means of combined endoscopy and external surgery. This proved to be an effective method of rescuing a foreign body stuck in Stensen's duct.

PMID: 26860868 [PubMed - as supplied by publisher]

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[Problems breathing through the nose and diplopic images].

[Problems breathing through the nose and diplopic images].

HNO. 2016 Feb 9;

Authors: Rödig H, Guntinas-Lichius O, Bitter T

PMID: 26861634 [PubMed - as supplied by publisher]

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Carotid Artery Compression Caused by the Cochlea.

Related Articles

Carotid Artery Compression Caused by the Cochlea.

Otol Neurotol. 2015 Aug;36(7):1275-8

Authors: Giese D, Rask-Andersen H

Abstract
HYPOTHESIS: We investigated the possible interference between the human internal carotid artery and the cochlea.
BACKGROUND: The cochlea and the internal carotid artery (ICA) are anatomically closely related in the human temporal bone. The intimacy may even result in functional interferences.
METHODS: Here, we analyzed 324 human plastic inner ear corrosion casts including the ICA canal and jugular bulb.
RESULTS: Results showed that in 23% (14 cases), the cochlea caused physical impression in the carotid canal (CA) with luminal restriction. In one case, there was no separation between the CC and the basal turn of the cochlea. The distance between the CC and the cochlea varied between 0 and 1 mm among these 14 specimens. The lumen restriction of the CC in the pyramid-axial projection varied between 39% and 79%.
CONCLUSION: We speculate that the reduction in ICA canal lumen size caused by the cochlea may form a predilection site for intratemporal ICA plaque formation and therefore be clinically relevant.

PMID: 26075676 [PubMed - indexed for MEDLINE]

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Does Coupling and Positioning in Vibroplasty Matter? A Prospective Cohort Study.

Related Articles

Does Coupling and Positioning in Vibroplasty Matter? A Prospective Cohort Study.

Otol Neurotol. 2015 Aug;36(7):1223-30

Authors: Marino R, Lampacher P, Dittrich G, Tavora-Vieira D, Kuthubutheen J, Rajan GP

Abstract
OBJECTIVE: Vibroplasty has offered a new modality of hearing rehabilitation in patients with mixed, conductive, and sensorineural hearing loss who cannot wear hearing aids. Potentially, the positioning of the floating mass transducer (FMT) in vibroplasty surgery has a critical effect on hearing outputs. In this study, the impact on hearing outputs and coupling efficiency are evaluated by comparing various vibroplasty applications in the middle ear. No other study to date has examined the coupling efficiency of round window (RW) versus an ossicular vibroplasty application.
STUDY DESIGN: Prospective cohort study of patients with underlying ear pathologies who were not able to wear hearing aids.
METHODS: This is an ongoing prospective study of 16 patients. All patients had a standard audiological test battery. Direct drive transfer function analysis results were correlated with bone conduction thresholds to assess the efficiency of the FMT coupling. Speech perception in quiet and quality of life measure questionnaires were used to assess outcomes. Nine patients had round window vibroplasty, six patients had stapes vibroplasty, and one patient had traditional incus vibroplasty.
RESULTS: Patients with a soft tissue coupler between the FMT and the RW had significantly reduced coupling efficiency. Patients who had direct RW contact had significantly improved coupling efficiency. Patients who underwent stapes or incus vibroplasty had the greatest coupling efficiency.
CONCLUSION: This study demonstrates that attachment to the stapes or incus provides the best coupling when compared to round window vibroplasty. When applicable, stapes or incus coupling should be the first choice when implementing vibroplasty.

PMID: 26075675 [PubMed - indexed for MEDLINE]

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Acute vocal fold hemorrhage after phonosurgery.

Related Articles

Acute vocal fold hemorrhage after phonosurgery.

Ear Nose Throat J. 2014 Jul;93(7):E33

Authors: Portnoy JE, Capo C, Sataloff RT

PMID: 25025420 [PubMed - indexed for MEDLINE]

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Multiple mandibular fractures. Treatment outlines.

Multiple mandibular fractures. Treatment outlines.

Minerva Stomatol. 2016 Feb;65(1):54-63

Authors: Elia G, Franco E, Clauser LC

Abstract
Multiple mandibular comminuted fractures usually occur in high energy traumas. The authors describe the management and treatment of multiple mandibular fractures in a young patient after a suicide attempt.

PMID: 26862697 [PubMed - as supplied by publisher]

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Reliability and efficacy of palifermin in prevention and management of oral mucositis in patients with acute lymphoblastic leukemia: a randomized, double-blind controlled clinical trial.

Reliability and efficacy of palifermin in prevention and management of oral mucositis in patients with acute lymphoblastic leukemia: a randomized, double-blind controlled clinical trial.

Minerva Stomatol. 2016 Feb;65(1):43-53

Authors: Lucchese A, Matarese G, Manuelli M, Ciuffreda C, Bassani L, Isola G, Cordasco G, Gherlone E

Abstract
BACKGROUND: Myeloablative and hematopoietic stem cells transplantation therapy (HSCT) often acts as side-effect to oral mucositis (OM) with no effective treatment. This randomized-controlled trial analyzed the efficacy of palifermin, administered as a dose during HSCT therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia (ALL).
METHODS: In this study forty-six patients (9-15 years) with B-cell acute lymphoblastic leukemia (B-ALL) were analyzed. The patients underwent allogenic HSCT conditioned by myeloablative regimen. Subsequently to randomization, patients in the palifermin group were assigned to receive palifermin, 60 mg/kg, intravenously as a single dose 3 days before and after transplant conditioning regimen cycle. The patients in the Control group received only a placebo treatment. Maximum severity of OM, incidence and duration of ulcerative OM, incidence and duration of severe OM limitations were evaluated.
RESULTS: A statistically significant reduction in the incidence of OM up to grade 3 in the palifermin group compared to the control group was discovered. There was also a reduction, confirmed at 60 days, in the degree of severity of mucositis in the palifermin group, with an average of 1.54 grade in the palifermin group, and of 2.16 in the Control group and in the use of opioid analgesics.
CONCLUSIONS: This study indicates that a single dose of palifermin used as primary prophylaxis during HSTC therapy can prevent severe OM in pediatric patients with ALL and used as secondary prophylaxis can prevent the recurrence of severe OM in high-risk patients with previous mucosal injury and improves the quality of life in pediatric patients with ALL.

PMID: 26862696 [PubMed - as supplied by publisher]

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Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers.

Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers.

Minerva Stomatol. 2016 Feb;65(1):39-42

Authors: Dequanter D, Zouaoui Boudjeltia K, Shahla M, Aubert C, Lothaire P

Abstract
BACKGROUND: In the current study, the utility of lymph node ratio (LNR) was evaluated as an alternative method for predicting locoregional failure in patients with advanced head and neck cancer.
METHODS: Fifty-six patients with oral and (pharyngo)laryngeal squamous cell carcinoma were included. Among those, 48 were males and 8 females, with a mean age of 58 years. The primary tumor was located in the oral cavity in 16 cases, involved the larynx in 17 cases and the hypopharynx in 23 cases. All the tumors were staged T4. We carried out 112 neck dissections. All the lymph nodes harvested from the neck dissection were carefully examined, with LNR calculated as the ratio of positive lymph nodes to total lymph nodes removed. All the patients received adjuvant (chemo)radiotherapy.
RESULTS: Receiver operating characteristic curve analysis showed LNR was significantly associated with locoregional failure. LNR >0.09 (as the cutoff point) could predict locoregional failure after surgery for oral and (pharyngo)laryngeal cancers with a sensibility of 93% and specificity of 100%.
CONCLUSIONS: After surgery, pathologic evaluation of the neck using LNR was found to reliably predict the risk of locoregional recurrence in patients with advanced head and neck cancers.

PMID: 26862695 [PubMed - as supplied by publisher]

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Retrospective review of 78 rehabilitated head and neck postoncological patients: a new classification method.

Retrospective review of 78 rehabilitated head and neck postoncological patients: a new classification method.

Minerva Stomatol. 2016 Feb;65(1):17-38

Authors: Brauner E, Valentini V, Jamshir S, Guarino G, Battisti A, Fadda MT, Pompa G

Abstract
BACKGROUND: Numerous studies have been published about the prosthetic rehabilitation of the postoncological maxillo-facial patient, but the guidelines that emerge lack a correlation between the anatomical classification of the treated site, which generally is preparatory upon surgery, and the type of prosthetic rehabilitation appropriate to the new anatomical and functional condition. With this correlation, it would be possible to obtain a multidisciplinary and predictable therapeutic process, able to identify from the beginning the best type of prosthetic rehabilitation.
METHODS: The authors analyzed a sample of 78 patients treated in the Maxillofacial Surgery Unit of "Sapienza" University of Rome for a tumor of the head and neck area, and at a later stage prosthetically rehabilitated in the years from 2010 to 2013 in the Prosthetic Rehabilitation Unit of the same University because of the consequences of the ablative surgery. After having analyzed data concerning the treatment of the maxillofacial tumor, Authors classified the kind of prosthetic rehabilitation. Removable prosthesis was chosen in 18 cases, while implant (or teeth)-supported rehabilitation was performed in 60 cases.
RESULTS: Authors correlated the kind of surgical reconstruction to the prosthetic rehabilitation performed. In the maxilla removable prosthesis was chosen in 8 cases, while implant supported rehabilitation was performed in 18 cases. In the mandible 10 cases were rehabilitated through a removable prosthesis and 42 through a teeth or implant supported prosthesis.
CONCLUSIONS: It is evident the need to perform a careful evaluation of the patient, in order to identify the best possible prosthetic rehabilitation.

PMID: 26862694 [PubMed - as supplied by publisher]

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Comparative CBCT evaluation of the efficacy of Nd:YAG laser and K3 rotary system in non-surgical root canal retreatment.

Comparative CBCT evaluation of the efficacy of Nd:YAG laser and K3 rotary system in non-surgical root canal retreatment.

Minerva Stomatol. 2016 Feb;65(1):11-16

Authors: Samiei M, Ghasemi N, Torab A, Rahimi S, Niknami M, Rikhtegaran S, Purnaghi Azar F, Mehdi Vahid Pakdel S

Abstract
BACKGROUND: The aim of the present study was to compare the efficacy of Nd:YAG laser and K3 rotary system in the non-surgical root canal retreatment.
METHODS: Sixty-one rooted human teeth were divided into two groups of 30 after root canal therapy. In groups 1 and 2 root canal retreatments were carried out using K3 rotary system and Nd:YAG laser, respectively. CBCT images were used to evaluate canal transportation and root canal debridement at coronal, middle and apical canal cross-sections. In addition, the time necessary for canal debridement and the temperature on the external root surface were calculated. Mann-Whitney U test was used for statistical analysis of data with SPSS 17 after means ± SD were calculated. Shapiro-Wilk test was used to evaluate normal distribution of data. Statistical significance was defined at P<0.05.
RESULTS: The mean time necessary for the debridement of root canals in the laser group was significantly shorter than that in the K3 group (P=0.001). However, there were no significant differences in external root surface temperatures between the two groups (P=0.17). The coronal third of the canals was cleaner in the laser group significantly (p=0.01). Less canal transportation was seen in the laser group compared to the K3 group, significantly (P=0.04).
CONCLUSIONS: Nd:YAG is superior to K3 rotary system in the non-surgical root canal retreatment because it is faster and results in less canal transportation in the middle and apical thirds of the canals.

PMID: 26862693 [PubMed - as supplied by publisher]

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Bone regeneration in rat femoral defects after osteotomy with surgical ultrasound.

Bone regeneration in rat femoral defects after osteotomy with surgical ultrasound.

Minerva Stomatol. 2016 Feb;65(1):1-10

Authors: Bergonse Pereira Pedriali MB, Trevisan W, Goulart DE Andrade F, Menck Sangiorgio JP, Ricardo Pires W, DE Paula Ramos S

Abstract
To evaluate bone healing after osteotomy by surgical drill (D) and piezoelectric ultrasound (U), Wistar rats were submitted to femoral osteotomy and submitted to histological analysis. After 60 h, slight (83.3%) and moderate (3.4%) inflammatory areas were frequent in the U defects whereas D group presented moderate (33.3%) and severe (16.6%) inflammatory infiltrate (P<0.001). There was few intramedullary hemorrhaging in U (80%) than D group (100%, P<0.05). On the 7th day, inflammatory areas was less frequent in U (30%) than D osteotomies (93.4%) (P<0.005) and D osteotomies presented larger areas of ossification (median: 47%, quartile: 37-64%) than U group (30%, 18.5-38%; P<0.005). After 30 days, ossification was larger in the U defects (65.9±10.1%) than D group (57±14.5%, P<0.05). There was complete bone remodeling in both groups after 60 days. Piezoelectric ultrasound evokes less postoperative inflammatory response, but delay initial bone ossification.

PMID: 26862692 [PubMed - as supplied by publisher]

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Book Review: Endonasal Endoscopic Surgery of Skull Base Tumors: An Interdisciplinary Approach.

Book Review: Endonasal Endoscopic Surgery of Skull Base Tumors: An Interdisciplinary Approach.

Ann Otol Rhinol Laryngol. 2016 Feb 9;

Authors: Abuzeid WM

PMID: 26862058 [PubMed - as supplied by publisher]

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Arachnoid cyst of the Fallopian canal and geniculate ganglion area: our experience of 9 cases.

Arachnoid cyst of the Fallopian canal and geniculate ganglion area: our experience of 9 cases.

Clin Otolaryngol. 2016 Feb 10;

Authors: Sagardoy T, De Mones E, Bonnard D, Darrouzet V, Franco-Vidal V

Abstract
Arachnoid cyst of the Fallopian canal should be suspected and sought in all cases of CSF leak or bacterial meningitis (especially Streptococcus pneumonia, Haemophilus influenzae) in overweight middle-aged women without any osteo-meningeal breach identified on the tegmen tympani. A combination of CT scan and MRI allows the diagnosis of arachnoid cyst of the Fallopian canal, can be used to rule out other confounding diagnoses and provides all essential pre-operative information. No systematic surgery is needed for arachnoid cysts of the Fallopian canal that have no CSF leak. When a leak from an arachnoid cyst is identified or when it is associated to a history of meningitis, surgery is needed; a middle ear approach allows minimal invasion with good long-term results. The idiopathic intracranial hypertension syndrome should be sought in cases of arachnoid cyst of the Fallopian canal by performing ophthalmological examination and cerebral MRI. This article is protected by copyright. All rights reserved.

PMID: 26860697 [PubMed - as supplied by publisher]

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Hyaluronic acid liposomal gel sustains delivery of a corticoid to the inner ear.

Hyaluronic acid liposomal gel sustains delivery of a corticoid to the inner ear.

J Control Release. 2016 Feb 6;

Authors: El Kechai N, Mamelle E, Nguyen Y, Huang N, Nicolas V, Chaminade P, Yen-Nicolaÿ S, Gueutin C, Granger B, Ferrary E, Agnely F, Bochot A

Abstract
The inner ear is one of the most challenging organs for drug delivery, mainly because of the blood-perilymph barrier. Therefore, local rather than systemic drug delivery methods are being developed for inner ear therapy. In this work, we have evaluated the benefit of a hyaluronic acid liposomal gel for sustained delivery of a corticoid to the inner ear after local injection into the middle ear in a guinea pig model. The liposomal gel was easily injectable as a result of the shear-thinning behavior of hyaluronic acid. A prolonged residence time at the site of injection as well as in the round window was achieved without any negative effect on the hearing thresholds of the animals. The presence of liposomes in the formulation resulted in sustained release of the drug in the perilymph for 30days and promoted the conversion of the prodrug loaded within the liposomes (dexamethasone phosphate) into its active form (dexamethasone). In this way, therapeutic doses were attained in the perilymph. A small amount of intact liposomes was visualized in the perilymph, whereas the main proportion of liposomes seemed to be trapped in the round window resulting in a reservoir effect. Thus, the administration of hyaluronic acid liposomal gel to the middle ear is an efficient strategy for delivering corticoids to the inner ear in a sustained manner.

PMID: 26860286 [PubMed - as supplied by publisher]

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Neuroendocrine carcinoma of the larynx with metastasis to the eyelid.

Neuroendocrine carcinoma of the larynx with metastasis to the eyelid.

J Community Support Oncol. 2015 Oct;13(10):378-380

Authors: Assi HA, Patel R, Mehdi S

Abstract
Neuroendocrine tumors are a rare type of neoplasms that comprise only 0.5% of all malignancies.¹ They usually arise from the gastrointestinal tract and the lung.¹,² Neuroendocrine carcinoma of the head and neck is a relatively rare malignancy described in the literature. The larynx is the most commonly affected region of the head and neck.³,⁴ Nevertheless, small-cell carcinoma comprises only 0.5% of all laryngeal cancers.⁵ Neuroendocrine carcinoma of the larynx carries variable prognosis depending on the histological subtype.⁶ Typical carcinoid rarely metastasizes, but atypical carcinoid and small-cell carcinoma have high rates of metastasis, usually in the lung and liver.² Cutaneous metastasis from neuroendocrine carcinoma is an extremely rare entity, with only few cases reported in the English literature.⁷,⁸ We report the case of an elderly man with recurrent laryngeal neuroendocrine carcinoma with metastasis to the eyelid.

PMID: 26862914 [PubMed - as supplied by publisher]

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Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers.

Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers.

Minerva Stomatol. 2016 Feb;65(1):39-42

Authors: Dequanter D, Zouaoui Boudjeltia K, Shahla M, Aubert C, Lothaire P

Abstract
BACKGROUND: In the current study, the utility of lymph node ratio (LNR) was evaluated as an alternative method for predicting locoregional failure in patients with advanced head and neck cancer.
METHODS: Fifty-six patients with oral and (pharyngo)laryngeal squamous cell carcinoma were included. Among those, 48 were males and 8 females, with a mean age of 58 years. The primary tumor was located in the oral cavity in 16 cases, involved the larynx in 17 cases and the hypopharynx in 23 cases. All the tumors were staged T4. We carried out 112 neck dissections. All the lymph nodes harvested from the neck dissection were carefully examined, with LNR calculated as the ratio of positive lymph nodes to total lymph nodes removed. All the patients received adjuvant (chemo)radiotherapy.
RESULTS: Receiver operating characteristic curve analysis showed LNR was significantly associated with locoregional failure. LNR >0.09 (as the cutoff point) could predict locoregional failure after surgery for oral and (pharyngo)laryngeal cancers with a sensibility of 93% and specificity of 100%.
CONCLUSIONS: After surgery, pathologic evaluation of the neck using LNR was found to reliably predict the risk of locoregional recurrence in patients with advanced head and neck cancers.

PMID: 26862695 [PubMed - as supplied by publisher]

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Factors predicting early diagnosis of pediatric laryngotracheobronchial foreign bodies.

Factors predicting early diagnosis of pediatric laryngotracheobronchial foreign bodies.

Otolaryngol Pol. 2015 Dec 31;69(6):45-52

Authors: Nirmal NS, Parida P, Gopalakrishnan S, Saxena SK

Abstract
OBJECTIVE: To study the clinical and radiological findings to make early diagnosis of foreign body (FB) aspiration in children Methods: This prospective study was conducted on 45 children below 12 years of age with a clinical diagnosis of FB aspiration undergone rigid bronchoscopy from September 2008 to may 2010.
RESULTS: Bronchoscopy was positive for FB in 37 children. The results of these 37 children (15 female and 22 male) were analyzed. 81% of children were in age group of 1-3 years. Penetration syndrome (sudden onset coughing, choking and gagging when the child is having something in the mouth) (89.2%) and decreased breath sounds (86.5%) were the most common clinical features. Cough, respiratory difficulty and fever were present in 83.8%, 78.4% and 27% respectively. Tachypnoea, tachycardia, chest retractions, decreased chest movements and wheeze were present in 83.3%, 83.3%, 83.3%, 51.4% and 43.2% respectively. Unilateral hyperinflation (64.9%), mediastinal shift (45.9%), and collapse (21.6%) were common radiological sign on chest radiograph and in 13.5% patients the chest X-rays were normal. Sites of FB lodgments were larynx, trachea, right main bronchus, left main bronchus and bilateral bronchi in 10.8%, 10.8%, 35.1%, 37.8 and 5.5% respectively. Food related FBs were present in 30 cases (peanut in 54.1%) and inorganic FBs were present in 7 cases. FBs were removed successfully by rigid bronchoscopy in all cases without any mortality.
CONCLUSIONS: Penetration syndrome, localized decreased breath sounds, unilateral hyperinflation and/or mediastinal shift on radiology are predictors for early diagnosis of FB aspiration.

PMID: 26860607 [PubMed - in process]

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Intralesional cidofovir injection for recurrent respiratory papillomatosis in Japan.

Intralesional cidofovir injection for recurrent respiratory papillomatosis in Japan.

Auris Nasus Larynx. 2016 Feb 6;

Authors: Murono S, Nakanishi Y, Tsuji A, Endo K, Kondo S, Wakisaka N, Yoshizaki T

Abstract
OBJECTIVE: The treatment of recurrent respiratory papillomatosis (RRP) continues to be difficult. Adjuvant pharmacological treatment is increasingly being used, and intralesional cidofovir injection remains the leading option. Almost all papers regarding the treatment come from the United States and Europe. The present study demonstrated it for the first time from Asia.
METHODS: Ten patients with RRP were treated with intralesional cidofovir injection. The severity of papillomatosis and adverse events including blood leukocytes, blood neutrophils, and serum creatinine were evaluated before and after the completion of treatment.
RESULTS: Human papillomavirus (HPV) type 6 was detected in nine patients, and no types of HPV were detected in a remaining patient. Severity scores significantly improved after treatment (p=0.005). However, complete resolution was achieved in only one patient. No significant differences were observed between before and after treatment with respect to adverse events (p=0.866 for blood leukocytes, p=0.866 for blood neutrophils, and p=0.933 for serum creatinine). Squamous cell carcinoma occurred three and half years after the completion of treatment in a patient without HPV detection. However, the link between cidofovir and the occurrence of carcinoma in the case remains questionable.
CONCLUSION: This initial report of intralesional cidofovir injection for RRP from Asia demonstrated acceptable efficacy without obvious adverse events. However, the uncontrolled spread of this treatment should be avoided, and eighteen statements approved by the task force of the United States should be referred to while planning this treatment.

PMID: 26860235 [PubMed - as supplied by publisher]

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Cavernous sinus thrombosis secondary to aspergillus granuloma: A case report and review of the literature.

Cavernous sinus thrombosis secondary to aspergillus granuloma: A case report and review of the literature.

Auris Nasus Larynx. 2016 Feb 6;

Authors: Brenet E, Boulagnon-Rombi C, N'guyen Y, Litré CF

Abstract
Cavernous sinus thrombosis is a rare but serious complication of sphenoid aspergillosis. The rarity of this pathology makes its diagnostic very difficult on a clinical, biological and radiological sense. The authors present a case of cavernous sinus thrombosis with ipsilateral internal carotid artery thrombosis secondary to a non-invasive sphenoid aspergillosis in an immunocompetent host, responsible of a cavernous syndrome associated to a Claude Bernard Horner syndrome. One year after surgery, the patient is still asymptomatic without recurrence. Diagnostic modalities are detailed and several management of this pathology are compared. Surgery is essential in a diagnostic and therapeutic sense. There is no evidence of the interest of adjuvant therapies such as antibiotic and anticoagulation. Concerning the antifungal treatment, the attitude towards a non-invasive sphenoid aspergillosis in an immunocompetent host is unclear.

PMID: 26860234 [PubMed - as supplied by publisher]

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True Vertigo Patients in Emergency Department; an Epidemiologic Study.

True Vertigo Patients in Emergency Department; an Epidemiologic Study.

Emerg (Tehran). 2016;4(1):25-8

Authors: Shahrami A, Norouzi M, Kariman H, Hatamabadi HR, Arhami Dolatabadi A

Abstract
INTRODUCTION: Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient's quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED).
METHODS: In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined.
RESULTS: 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86) were enrolled (58.13% female). There was no sex difference in vertigo incidence (p = 0.756). A significant correlation existed between older age and increase in frequency of central cases (p < 0.001). No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72). There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist's final opinion (p < 0.001). In the end, 361 (95.3%) patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported.
CONCLUSION: Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99) and 99 (95% CI: 97-99), respectively.

PMID: 26862546 [PubMed]

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Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo.

Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo.

Otolaryngol Head Neck Surg. 2016 Feb 9;

Authors: Martellucci S, Pagliuca G, de Vincentiis M, Greco A, De Virgilio A, Nobili Benedetti FM, Gallipoli C, Rosato C, Clemenzi V, Gallo A

Abstract
OBJECTIVES: To assess factors related to residual dizziness (RD) in patients who underwent successful canalith repositioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV).
STUDY DESIGN: Prospective cohort study.
SETTING: Academic center.
SUBJECTS AND METHODS: Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required ≥4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit.
RESULTS: At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P < .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdomain score of the DHI questionnaire.
CONCLUSION: RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs.

PMID: 26861236 [PubMed - as supplied by publisher]

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Diagnostic Value of Clinical Cervical Spine Tests in Patients With Cervicogenic Somatic Tinnitus.

Related Articles

Diagnostic Value of Clinical Cervical Spine Tests in Patients With Cervicogenic Somatic Tinnitus.

Phys Ther. 2015 Nov;95(11):1529-35

Authors: Michiels S, Van de Heyning P, Truijen S, De Hertogh W

Abstract
BACKGROUND: Tinnitus can be related to many different etiologies, such as hearing loss or a noise trauma, but it also can be related to the somatosensory system of the cervical spine. The diagnosis of cervicogenic somatic tinnitus (CST) is made when the predominant feature is the temporal coincidence of appearance or increase of both neck pain and tinnitus.
OBJECTIVE: The aim of this study was to assess the diagnostic value of clinical cervical spine tests in people with CST.
DESIGN: A cross-sectional study was conducted.
SETTING: The study was conducted at a tertiary referral center.
PATIENTS: Consecutive adult patients with chronic subjective nonpulsatile tinnitus were included. Exclusion criteria were vertigo, Ménière disease, middle ear pathology, intracranial pathology, cervical spine surgery, whiplash trauma, and temporomandibular dysfunction.
MEASUREMENTS: A full ear, nose, and throat examination was conducted to classify patients into CST and non-CST groups. The physical therapist examination included completion of the Neck Bournemouth Questionnaire (NBQ) and the following clinical cervical spine tests: manual rotation test, adapted Spurling test (AST), trigger point tests, and tests for strength and endurance of the deep neck flexors.
RESULTS: Eighty-seven patients with tinnitus were included, of whom 37 (43%) were diagnosed with CST. The diagnosis of CST becomes less likely with NBQ scores of <14 points (sensitivity of 80%, likelihood ratio [LR] of 0.3, and posttest probability of 19%). Absence of trigger points corresponded to an LR of 0.3, a sensitivity of 82%, and a posttest probability of 22%. A positive manual rotation test and AST indicate a higher probability of CST (LR of 5, specificity of 90%, and posttest probability of 78%).
LIMITATIONS: A limited number of clinical cervical spine tests were used in this study. Although tests with good validity and reliability were included, additional tests could provide more information on cervical spine dysfunction in patients with CST.
CONCLUSIONS: Clinical cervical spine tests can support the diagnostic process for CST. An NBQ score of <14 points and the absence of trigger points can help to exclude CST. In contrast, a positive manual rotation test and AST can help to include CST. In future studies, these tests should be included in a multidisciplinary assessment of patients with suspected CST.

PMID: 26045606 [PubMed - indexed for MEDLINE]

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Are emergency physicians and paramedics providing canalith repositioning manoeuvre for benign paroxysmal positional vertigo?

Related Articles

Are emergency physicians and paramedics providing canalith repositioning manoeuvre for benign paroxysmal positional vertigo?

Emerg Med Australas. 2015 Apr;27(2):179-80

Authors: Bashir K, Qotb MA, Alkahky S, Fathi AM, Mohamed MA, Cameron PA

PMID: 25651159 [PubMed - indexed for MEDLINE]

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