The Rhinitis Control Scoring System: Development and validation.

The Rhinitis Control Scoring System: Development and validation.

Am J Rhinol Allergy. 2016 Jan;30(1):54-9

Authors: Boulay ME, Boulet LP

Abstract
BACKGROUND: Allergic rhinitis is a common health problem that requires regular monitoring of symptoms to provide adequate treatment. There is a need to develop rhinitis control assessment tools that are meaningful and easy to interpret by both the patient and the practitioner.
OBJECTIVE: To develop a simple, easy-to-interpret instrument, the Rhinitis Control Scoring System (RCSS), for the assessment of rhinitis control, as a companion tool to the Asthma Control Scoring System previously validated.
METHODS: After a literature review and based on the Allergic Rhinitis and its Impact on Asthma guidelines, allergic rhinitis control parameters were identified. The draft items were subjected to cognitive debriefing regarding instructions, wordings, and response options. The second version of the draft was then pretested and modified according to the results. The final draft of the RCSS, based on the intensity and frequency of symptoms, was then pilot tested with 50 subjects who had allergic rhinitis for validation of some psychometric properties. Each subject completed the RCSS in addition to other rhinitis instruments. They also had nasal peak inspiratory flow measurements.
RESULTS: The RCSS showed good internal consistency (Cronbach α = 0.84). There was strong criterion validity between the RCSS scores and the other instruments. The discriminant validity demonstrated as mean RCSS scores differed significantly across groups of patients with different Total Nasal Symptom Score severity (F = 58.8, p < 0.0001).
CONCLUSIONS: This pilot study showed that the RCSS is a simple tool to assess and quantify rhinitis control by using a percentage score. This questionnaire allows the quantification of rhinitis control and, therefore, may help guide therapeutic interventions. Combined with the Asthma Control Scoring System, it can provide a global assessment of rhinitis and asthma control. Clinical Trial number NCT00967967.

PMID: 26867531 [PubMed - in process]

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The role of allergen immunotherapy in the management of allergic rhinitis.

The role of allergen immunotherapy in the management of allergic rhinitis.

Am J Rhinol Allergy. 2016 Jan;30(1):48-53

Authors: Cox L

Abstract
PURPOSE: To evaluate the role of allergen immunotherapy (AIT) in the treatment of allergic rhinitis (AR).
METHOD: Individual studies, systematic reviews, and practice guidelines that included information on sublingual AIT (SLIT) and subcutaneous AIT (SCIT) in the treatment of AR were considered.
RESULTS: AIT via the SLIT or SCIT route has been shown to be effective in treating AR symptoms with resultant improvements in overall quality of life, comorbid illnesses, and medication requirements. Persistent clinical benefits have been demonstrated years after AIT treatment discontinuation. AIT may prevent the progression of AR to asthma. In addition, studies that evaluated the pharmacoeconomics of AR treatment indicate that AIT may be more cost effective than pharmacotherapy. The AIT cost savings are likely underestimated in that few cost comparison studies considered AIT's long-term benefits or preventive effects.
CONCLUSION: Multiple individual studies and systematic reviews provide strong evidence for the clinical effectiveness of AIT in the treatment of AR. Cost-effectiveness and disease modification are additional advantages of AIT compared with standard drug treatment in the management of AR.

PMID: 26867530 [PubMed - in process]

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Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis.

Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis.

Am J Rhinol Allergy. 2016 Jan;30(1):44-7

Authors: Rosati MG, Peters AT

Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) is a common disease in the United States. There are a significant number of patients with CRS who are refractory to standard medical and surgical therapy. Many of these patients also have comorbid allergic rhinitis (AR) and asthma, although the underlying pathophysiology that connects these three conditions remains unclear.
OBJECTIVE: The goal of this article is to review the relationships among CRS, AR and asthma.
METHODS: Scientific literature that addresses the prevalence of AR and asthma in CRS populations, the effect of AR and asthma on CRS disease severity, and whether treatment of AR and asthma can affect CRS outcomes was reviewed.
RESULTS: The literature supports the relationship between AR and CRS, but there is no direct evidence of causality the between the two conditions. There is a high prevalence of CRS in patients with asthma and the presence of CRS is associated with worse asthma outcomes. There is weak evidence that treatment of CRS may improve asthma outcomes. Targeting type 2 inflammation via biologics is being investigated in the treatment of asthma and CRS.
CONCLUSION: AR, asthma, and CRS are closed related and understanding the associations among these comorbid diseases will have significant clinical implication.

PMID: 26867529 [PubMed - in process]

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The bacterial microbiome in chronic rhinosinusitis: Richness, diversity, postoperative changes, and patient outcomes.

The bacterial microbiome in chronic rhinosinusitis: Richness, diversity, postoperative changes, and patient outcomes.

Am J Rhinol Allergy. 2016 Jan;30(1):37-43

Authors: Cleland EJ, Bassiouni A, Vreugde S, Wormald PJ

Abstract
BACKGROUND: The bacterial microbiome in chronic rhinosinusitis (CRS) remains poorly understood. Microorganisms are believed to be important contributors to the inflammatory response seen in these patients.
OBJECTIVE: To examine the bacterial CRS microbiome by using a pyrosequencing technique and determine the diversity, richness, prevalence, and abundance of bacterial species in these patients. Furthermore, the postoperative changes that occur in the microbiome and correlations with patient outcomes are assessed.
METHODS: Swabs were collected from 23 patients with CRS and 11 controls during surgery. Further postoperative swabs were collected in the CRS group. Bacterial DNA was extracted from the swabs and then sequenced by using 16S ribosomal DNA bacterial tag-encoded FLX amplicon pyrosequencing.
RESULTS: A total of 456 unique bacterial species were detected. No difference was seen for richness or diversity between the study groups (p > 0.05). Diversity declined after surgery in the CRS group (p = 0.01). Propionibacterium acnes and Staphylococcus epidermidis were the most prevalent species. Several significant differences were determined for prevalence and mean relative abundance (MRA) between the study groups. In particular, Acinetobacter johnsonii was more prevalent and had a higher MRA in the controls. Furthermore, the MRA of this species increased after surgery and was associated with improved quality of life.
CONCLUSION: This study characterized the sinonasal microbiome in a group of controls and patients with CRS. Important differences in diversity, prevalence, abundance, and temporal changes were described. Of great interest is the potential association between A. johnsonii and health. These findings provide new insights into the interplay between the microbiome and health in the paranasal sinuses.

PMID: 26867528 [PubMed - in process]

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Characterizing airflow profile in the postoperative maxillary sinus by using computational fluid dynamics modeling: A pilot study.

Characterizing airflow profile in the postoperative maxillary sinus by using computational fluid dynamics modeling: A pilot study.

Am J Rhinol Allergy. 2016 Jan;30(1):29-36

Authors: Choi KJ, Jang DW, Ellison MD, Frank-Ito DO

Abstract
BACKGROUND: Maxillary antrostomy is commonly performed during endoscopic sinus surgery. Little is known about the association surrounding recalcitrant maxillary sinusitis, antrostomy size, and intranasal airflow changes. Furthermore, the interaction between sinus mucosa and airflow is poorly understood. This study used computational fluid dynamics (CFD) modeling to investigate postoperative airflow characteristics between diseased and nondiseased maxillary sinuses in subjects with recurrent disease.
METHODS: A retrospective review of patients from a tertiary-level academic rhinology practice was performed. Seven subjects with endoscopic evidence of postoperative maxillary sinus disease that presented as chronic unilateral crusting at least 1 year after bilateral maxillary antrostomies were selected. A three-dimensional model of each subject's sinonasal cavity was created from postoperative computed tomographies and used for CFD analysis.
RESULTS: Although the variables investigated between diseased and nondiseased sides were not statistically significant, the diseased side in six subjects had a smaller antrostomy, and five of these subjects had both reduced nasal unilateral airflow and increased unilateral nasal resistance on the diseased side. The ratio of posterior wall shear stress (WSS) of the maxillary sinus to the total WSS was higher on the diseased side in six subjects. Results also showed strong correlations between antrostomy and CFD variables on the diseased side than on the nondiseased side.
CONCLUSION: This pilot study showed that the majority of the simulated sinonasal models exhibited common characteristics on the side with persistent disease, such as smaller antrostomy, reduced nasal airflow, increased nasal resistance, and increased posterior WSS. Although statistical significance was not established, this study provided preliminary insight into variables to consider in a larger cohort study.

PMID: 26867527 [PubMed - in process]

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The relationship between serum vitamin D and chronic rhinosinusitis: A systematic review.

The relationship between serum vitamin D and chronic rhinosinusitis: A systematic review.

Am J Rhinol Allergy. 2016 Jan;30(1):23-8

Authors: Stokes PJ, Rimmer J

Abstract
BACKGROUND: An exciting development in upper respiratory tract disease is the pathophysiology of vitamin D (VD3). There now is substantial literature to indicate that VD3 acts as an immunomodulator of adaptive and innate immunity locally within the respiratory epithelium. Chronic rhinosinusitis (CRS) places a relatively large socioeconomic burden on developed nations, yet remains a difficult disease to treat. VD3, therefore, has become an area of clinical interest because it may provide an adjunctive drug therapy option in CRS, thereby potentially improving the quality of life of these patients.
OBJECTIVE: A systematic review of the relationship among serum VD3 levels, CRS phenotype, and disease severity by using outcome assessments.
METHODS: A systematic search was performed by using the PubMed, MEDLINE, and EMBASE databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured serum VD3 levels and correlated the measurements to any subtype of CRS (with or without nasal polyps) were included for qualitative analysis.
RESULTS: Seven articles were included (four prospective and three retrospective studies), with a total of 539 patients. There were significantly lower VD3 levels in the polypoid phenotypes of CRS compared with controls. Low VD3 levels were often associated with an increased degree of inflammation.
CONCLUSION: The available evidence indicated that there is a significant relationship between low VD3 levels and polypoid CRS phenotypes. The association between VD3 levels and disease severity and VD3 potential for drug therapy remains unclear, which warrants further research in the area.

PMID: 26867526 [PubMed - in process]

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Microbiome of the paranasal sinuses: Update and literature review.

Microbiome of the paranasal sinuses: Update and literature review.

Am J Rhinol Allergy. 2016 Jan;30(1):3-16

Authors: Lee JT, Frank DN, Ramakrishnan V

Abstract
BACKGROUND: Our understanding of the resident microbiome of the paranasal sinuses has changed considerably in recent years. Once presumed to be sterile, healthy sinus cavities are now known to harbor a diverse assemblage of microorganisms, and, it is hypothesized that alterations in the kinds and quantities of these microbes may play a role in the pathogenesis of chronic rhinosinusitis (CRS).
OBJECTIVES: To review the current literature regarding the sinus microbiome and collate research findings from relevant studies published to date.
METHODS: A systematic literature review was performed on all molecular studies that investigated the microbial communities of the paranasal sinuses. Methods of detection, microbiome composition, and comparative profiling between patients with and without CRS were explored.
RESULTS: A complex consortium of microorganisms has been demonstrated in the sinuses of both patients with and without CRS. However, the latter generally have been characterized by reduced biodiversity compared with controls, with selective enrichment of particular microbes (e.g., Staphylococcus aureus). Such disruptions in the resident microbiome may contribute to disease pathogenesis by enhancing the virulence of potential pathogens and adversely modulating immune responses.
CONCLUSION: The advent of culture-independent molecular approaches has led to a greater appreciation of the intricate microbial ecology of the paranasal sinuses. Microbiota composition, distribution, and abundance impact mucosal health and influence pathogen growth and function. A deeper understanding of the host-microbiome relationship and its constituents may encourage development of new treatment paradigms for CRS, which target restoration of microbiome homeostasis and cultivation of optimal microbial communities.

PMID: 26867525 [PubMed - in process]

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Editorial: The microbiome of the sinuses and its relevance in health and disease.

Editorial: The microbiome of the sinuses and its relevance in health and disease.

Am J Rhinol Allergy. 2016 Jan;30(1):1-2

Authors: Carney AS

PMID: 26867524 [PubMed - in process]

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Epidermal growth factor receptor inhibitor AG1478 inhibits mucus hypersecretion in airway epithelium.

Epidermal growth factor receptor inhibitor AG1478 inhibits mucus hypersecretion in airway epithelium.

Am J Rhinol Allergy. 2016 Jan;30(1):1-6

Authors: Takezawa K, Ogawa T, Shimizu S, Shimizu T

Abstract
BACKGROUND: Mucus hypersecretion and neutrophil infiltration are important characteristics of airway inflammation. Epidermal growth factor receptor (EGFR) transactivation induces mucus and inflammatory cytokine secretion from airway epithelial cells. To elucidate the roles of EGFR in airway inflammation, the in vitro effects on mucin production and interleukin (IL) 8 secretion from cultured airway epithelial cells and the in vivo effects on mucus hypersecretion and neutrophil infiltration in rat nasal mucosa of the EGFR tyrosine kinase inhibitor AG1478 were examined.
METHODS: The in vitro effects of AG1478 treatment of cultured NCI-H292 cells on lipopolysaccharide (LPS) induced or tumor necrosis factor (TNF) α induced MUC5AC mucin and IL-8 secretion were evaluated. Hypertrophic and metaplastic changes of goblet cells, mucus production and neutrophil infiltration in rat nasal epithelium were induced by intranasal instillation of LPS in vivo, and the inhibitory effects of AG1478 by intraperitoneal injection or intranasal instillation were examined.
RESULTS: AG1478 (1-1000 nM) significantly inhibited both LPS-induced and TNF-α-induced secretion of MUC5AC and IL-8 from cultured NCI-H292 cells in a dose-dependent manner. The expression of MUC5AC and IL-8 messenger RNAs was also significantly inhibited. Intranasal instillation of AG1478 one hour after intranasal LPS instillation significantly inhibited LPS-induced goblet cell metaplasia, mucus production, and neutrophil infiltration in rat nasal epithelium, as did intraperitoneal injection of AG1478 one hour before LPS instillation.
CONCLUSIONS: These results indicated that EGFR transactivation plays an important role in mucin and IL-8 secretion from airway epithelial cells. Intranasal instillation of an EGFR tyrosine kinase inhibitor may be a new therapeutic approach for the treatment of upper airway inflammation.

PMID: 26867523 [PubMed - in process]

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Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

J Neurosurg. 2016 Feb 12;:1-7

Authors: Chung LK, Ung N, Spasic M, Nagasawa DT, Pelargos PE, Thill K, Voth B, Hirt D, Gopen Q, Yang I

Abstract
OBJECTIVE Superior semicircular canal dehiscence (SSCD) is a rare disorder characterized by the formation of a third opening in the inner ear between the superior semicircular canal and the middle cranial fossa. Aberrant communication through this opening causes a syndrome of hearing loss, pulsatile tinnitus, disequilibrium, and autophony. This study analyzed the clinical outcomes of a single-institution series of patients with SSCD undergoing surgical repair by the same otolaryngologist and neurosurgeon. METHODS All patients who underwent SSCD repair at the University of California, Los Angeles, between March 2011 and November 2014 were included. All patients had their SSCD repaired via middle fossa craniotomy by the same otolaryngologist and neurosurgeon. Outcomes were analyzed with Fisher's exact test. RESULTS A total of 18 patients with a mean age of 56.2 years (range 27-84 years) and an average follow-up of 5.0 months (range 0.2-21.8 months) underwent 21 cases of SSCD repair. Following treatment, all patients (100%) reported resolution in ≥ 1 symptom associated with SSCD. Autophony (p = 0.0005), tinnitus (p = 0.0059), and sound- and/or pressure-induced dizziness (p = 0.0437) showed significant symptomatic resolution. Following treatment, 29% (2/7) of patients developed imbalance, 20% (1/5) of patients developed sound- and/or pressure-induced dizziness, and 18% (2/11) of patients developed aural fullness. Among patients with improved symptoms following surgical repair, none reported recurrence of symptoms at subsequent follow-up visits. CONCLUSIONS SSCD remains an underdiagnosed and undertreated condition. Surgical repair of SSCD using a middle fossa craniotomy is associated with a high rate of symptom resolution. Continued investigation using a larger patient cohort and longer-term follow-up could further demonstrate the effectiveness of using middle fossa craniotomy for SSCD repair.

PMID: 26871374 [PubMed - as supplied by publisher]

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Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review.

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Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review.

Otolaryngol Head Neck Surg. 2015 Nov;153(5):721-30

Authors: Aron M, Lea J, Nakku D, Westerberg BD

Abstract
OBJECTIVE: To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head trauma.
DATA SOURCES: Systematic review of the literature was performed using Medline, EMBASE, and Cochrane databases. English and French articles meeting inclusion criteria and published between 1946 and October 2014 were included.
REVIEW METHODS: Data were independently extracted from the articles by 2 reviewers using data collection forms developed a priori. Inclusion and exclusion criteria were decided a priori. Studies were included if they reported on at least 1 case of posttraumatic BPPV (t-BPPV), reported on outcomes of all patients with t-BPPV, had a clearly defined inception point, and provided a clear diagnosis of BPPV (defined a priori by reviewers).
RESULTS: A total of 3017 titles, 362 abstracts, and 67 articles were reviewed, from which 16 articles met inclusion criteria and underwent data extraction. There were a total of 207 patients with posttraumatic BPPV identified. Among the 207 patients, 151 (73%) had resolution of symptoms. The T-BPPV patients may have more multi-canal involvement and may require more repositioning maneuvers for resolution compared to patients with nontraumatic BPPV.
CONCLUSIONS: Available evidence does not support the notion that symptom resolution rates in patients with posttraumatic BPPV are worse than those with nontraumatic BPPV. However, well-designed studies with adequate cohorts are lacking. Additional well-executed studies are needed to confirm this lack of difference in resolution rates.

PMID: 26183524 [PubMed - indexed for MEDLINE]

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Caloric test as a predictor tool of postural control in CI users.

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Caloric test as a predictor tool of postural control in CI users.

Acta Otolaryngol. 2015 Jul;135(7):685-91

Authors: Abramides PA, Bittar RS, Tsuji RK, Bento RF

Abstract
CONCLUSIONS: Balance was improved at 365 days after CI in all patients. Caloric test findings were important determinants of balance outcomes over a year after CI. Pre-operative vestibular assessment findings should be documented because postural recovery over time depends on this information.
OBJECTIVE: To verify the importance of the caloric test as a pre-operative predictor tool of postural control after CI surgery.
METHODS: Prospective observational study made with 24 post-lingual deafness patients who underwent unilateral CI surgery. Vestibular assessments: questionnaire assessing vertigo, caloric tests, rotary chair (RC) testing, and computerized dynamic posturography (CDP), were sequentially performed for all patients before and 60, 120, 180, and 365 days after CI.
RESULTS: Thirteen patients (54.2%) reported dizziness before CI. At the end of the study, dizziness remained unchanged in one (7.7%) patient, ameliorated in 11 (84.6%), and worsened in one (7.7%). Baseline caloric tests identified 29.2% patients with normal reflexes, 33.3% with unilateral areflexia or hyporeflexia, 12.5% with bilateral hyporeflexia, and 25% with bilateral vestibular loss (BVL). Most patients exhibited objective improvements in postural stability. At 365 days, the CDP condition (particularly C5) and CS were higher for caloric tests responders at baseline than for those with BVL at baseline.

PMID: 25812584 [PubMed - indexed for MEDLINE]

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Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable Meniere's disease.

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Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable Meniere's disease.

Acta Otolaryngol. 2015 Jul;135(7):667-72

Authors: Sakagami M, Kitahara T, Ito T, Ota I, Nishimura T, Nishimura A, Otsuka S, Yamanaka T

Abstract
CONCLUSIONS: At the second postoperative year, there were no significant differences between results for vertigo and hearing after endolymphatic sac drainage with steroid instillation surgery (EDSS) and EDSS with posterior tympanotomy with steroids at the round window (EDRW). In particular, as regards hearing recovery to the preoperative level, the periods after EDRW were shorter than those after the second EDSS.
OBJECTIVES: Patients sometimes faces recurrent problems years after EDSS due to endolymphatic sac closure and/or disease progression. In the present study, we examined the effects of EDRW on vertigo and hearing after revision surgery for intractable relapsed Meniere's disease.
METHODS: Sixteen patients with Meniere's disease had revision surgery due to intractable recurrence of disease, and were followed up regularly at least for 2 years. As revision surgery, EDSS was performed repeated in eight cases and EDRW was performed in the other eight. There were no significant differences between the patients' backgrounds in the two groups.
RESULTS: Periods of hearing recovery to the preoperative level were 11.5 ± 4.4 months after the first EDSS, although it took 16.4 ± 2.6 months longer after revision surgery with the second EDSS (p = 0.038 < 0.05: first EDSS vs second EDSS) and was 10.0 ± 3.3 months shorter after revision surgery with EDRW (p = 0.010 < 0.05: second EDSS vs EDRW).

PMID: 25762028 [PubMed - indexed for MEDLINE]

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[Benign paroxysmal positional vertigo: frequent misdiagnosis].

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[Benign paroxysmal positional vertigo: frequent misdiagnosis].

Laryngorhinootologie. 2014 Dec;93(12):816-7

Authors: Hegemann S, Helling K

PMID: 25594096 [PubMed - indexed for MEDLINE]

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Speech Practice Effects on Bilingual Children's Fast Mapping Performance.

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Speech Practice Effects on Bilingual Children's Fast Mapping Performance.

Semin Speech Lang. 2015 May;36(2):109-19

Authors: Kan PF, Sadagopan N

Abstract
Learning a new word involves many subsystems and their interactions. The purpose of this study was to examine whether speech practice facilitates the subsequent fast mapping performance of bilingual preschool children. Participants were 18 typically developing preschoolers who learned Cantonese (L1) as a home language and English (L2) as a second language. Each participant was asked to repeat each of the four novel words after an auditory model (speech practice) before he or she was exposed to the novel word-objects in the subsequent fast mapping task. Significant speech practice and language effects on fast mapping production scores were found. These findings suggest a complex relationship between speech learning, fast mapping, and L1-L2 language skills. Our results suggest that clinical methods that facilitate bilingual children's production skills (e.g., repeat after a model) hold promise as a means of improving the initial stage of word learning in both languages.

PMID: 25922996 [PubMed - indexed for MEDLINE]

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Phonological development in young bilinguals: clinical implications.

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Phonological development in young bilinguals: clinical implications.

Semin Speech Lang. 2015 May;36(2):100-8

Authors: Core C, Scarpelli C

Abstract
This article reviews recent research on bilingual phonological development and describes the nature of bilingual phonology, focusing on characteristics of cross-linguistic influence on bilingual phonological abilities. There is evidence of positive and negative transfer (acceleration and deceleration) on children's phonological abilities. Several methodological issues limit the ability to generalize findings from previous research to larger groups of bilingual children (e.g., small sample size, lack of consideration of age of acquisition of each language, and language abilities of the participants). Sources of heterogeneity in language development are presented and discussed. Phonological abilities are related to language abilities in bilingual first language learners of English and Spanish. Empirical evidence from research in our laboratory supports this claim. We discuss implications of research findings and limitations for future research and clinical practice. We provide specific recommendations for bilingual research and for clinical assessment of young bilingual children.

PMID: 25922995 [PubMed - indexed for MEDLINE]

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Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms.

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Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms.

Acta Otolaryngol. 2015 Jul;135(7):635-9

Authors: Hägg M, Tibbling L, Franzén T

Abstract
CONCLUSION: Misdirected swallowing can be triggered by esophageal retention and hiatal incompetence. The results show that oral IQoro(R) screen (IQS) training improves misdirected swallowing, hoarseness, cough, esophageal retention, and globus symptoms in patients with hiatal hernia.
OBJECTIVES: The present study investigated whether muscle training with an IQS influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia.
METHODS: A total of 28 adult patients with hiatal hernia suffering from misdirected swallowing and esophageal retention symptoms for more than 1 year before entry to the study were evaluated before and after training with an IQS. The patients had to fill out a questionnaire regarding symptoms of misdirected swallowing, hoarseness, cough, esophageal retention, and suprasternal globus, which were scored from 0-3, and a VAS on the ability to swallow food. The effect of IQS traction on diaphragmatic hiatus (DH) pressure was recorded in 12 patients with hiatal hernia using high resolution manometry (HRM).
RESULTS: Upon entry into the study, misdirected swallowing, globus sensation, and esophageal retention symptoms were present in all 28 patients, hoarseness in 79%, and cough in 86%. Significant improvement was found for all symptoms after oral IQS training (p < 0.001). Traction with an IQS resulted in a 65 mmHg increase in the mean HRM pressure of the DH.

PMID: 25963055 [PubMed - indexed for MEDLINE]

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World gastroenterology organisation global guidelines: dysphagia--global guidelines and cascades update September 2014.

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World gastroenterology organisation global guidelines: dysphagia--global guidelines and cascades update September 2014.

J Clin Gastroenterol. 2015 May-Jun;49(5):370-8

Authors: Malagelada JR, Bazzoli F, Boeckxstaens G, De Looze D, Fried M, Kahrilas P, Lindberg G, Malfertheiner P, Salis G, Sharma P, Sifrim D, Vakil N, Le Mair A

PMID: 25853874 [PubMed - indexed for MEDLINE]

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Changing trends in the incidence of juvenile nasopharyngeal angiofibroma: seven decades of experience at King George's Medical University, Lucknow, India.

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Changing trends in the incidence of juvenile nasopharyngeal angiofibroma: seven decades of experience at King George's Medical University, Lucknow, India.

J Laryngol Otol. 2016 Feb 11;:1-6

Authors: Mishra A, Mishra SC

Abstract
BACKGROUND: The occurrence of juvenile nasopharyngeal angiofibroma is reportedly higher in India than in some other parts of the world, and our centre has seen a four-fold increase in its occurrence across seven decades.
METHODS: This paper reports a retrospective archival analysis of 701 juvenile nasopharyngeal angiofibroma cases from 1958 to 2013, and considers probable environmental factors in an Indian context that may affect its biology and the global distribution, as reported in the literature.
RESULTS: A continuously progressive increase in occurrence was evident, but the rapid rise observed in the current decade was alarming. The world map of juvenile nasopharyngeal angiofibroma incidence does not reflect true global distribution given the paucity of reporting. Our centre has dealt with approximately 400 cases in the last 24 years.
CONCLUSION: With the alarming increase in juvenile nasopharyngeal angiofibroma incidence, there is a need for a registry to define its epidemiology. The world literature needs to reflect the status of juvenile nasopharyngeal angiofibroma incidence in the third world as well. Environmental factors known for hormone disruptive actions may influence its occurrence. Such aspects need to be considered to plan specific prevention policies.

PMID: 26864451 [PubMed - as supplied by publisher]

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Vestibular pathology in children with enlarged vestibular aqueduct.

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Vestibular pathology in children with enlarged vestibular aqueduct.

Laryngoscope. 2016 Feb 10;

Authors: Yang CJ, Lavender V, Meinzen-Derr JK, Cohen AP, Youssif M, Castiglione M, Manickam V, Bachmann KR, Greinwald JH

Abstract
OBJECTIVES/HYPOTHESIS: To establish the prevalence of abnormal vestibular test findings in children with enlarged vestibular aqueduct (EVA) and determine if these findings correlate with clinical symptoms, radiographic findings (EVA size and laterality), audiometric findings, and genetic testing in these patients.
STUDY DESIGN: Prospective cohort.
METHODS: Patients 3 to 12 years of age with hearing loss and imaging findings consistent with EVA treated at our tertiary care institution were sequentially enrolled from 2009 to 2011. The following six outcome measurements were analyzed: audiometric findings, EVA laterality, temporal bone measurements, genetic testing, vestibular testing (cervical-evoked myogenic potentials, posturography, rotational chair, and calorics), and vestibular symptoms.
RESULTS: Twenty-seven patients with EVA (mean age 9.2 years, 48% female) were enrolled in and completed the study. Vertigo was reported in six patients. Twenty-four of 27 (89%) had at least one abnormal vestibular test result. Midpoint and operculum size correlated with directional preponderance (P = .042 and P = .032, respectively). Also, high-frequency pure tone average (HFPTA) correlated with unilateral weakness (P = .002). Walking at a later age correlated with abnormal posturography results. There was no correlation between EVA laterality and vestibular test findings.
CONCLUSION: We found a high rate of vestibular pathology in children with EVA; however, the prevalence of abnormal vestibular test findings in this patient population was not correlated with vestibular symptoms. Enlarged vestibular aqueduct size, HFPTA, and walking at a later age were correlated with abnormal vestibular test findings. In view of these results, it may be prudent to consider vestibular testing in children with these clinical characteristics.
LEVEL OF EVIDENCE: 2b. Laryngoscope, 2015.

PMID: 26864825 [PubMed - as supplied by publisher]

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Acute hearing loss in patients with hematological disorders.

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Acute hearing loss in patients with hematological disorders.

Acta Otolaryngol. 2015 Jul;135(7):673-80

Authors: Lin CT, Chiang CW, Young YH

Abstract
OBJECTIVE: This study adopted an inner ear test battery to investigate the causes of acute sensorineural hearing loss in patients with hematological disorders.
METHODS: During the past 20 years, the authors have experienced 14 patients with hematological disorders, i.e. leukemia or aplastic anemia, having acute sensorineural hearing loss. An inner ear test battery comprising audiometry and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP), and caloric tests was performed.
RESULTS: Diagnoses comprised of sudden sensorineural hearing loss in 12 patients and endolymphatic hydrops in four patients (two patients had one ear with sudden sensorineural hearing loss while the other ear had endolymphatic hydrops). Percentages of recruitment phenomenon showed a significant difference between endolymphatic hydrops and sudden sensorineural hearing loss. Abnormal percentages for mean hearing level (86%), cVEMP test (71%), oVEMP test (25%), and caloric test (14%) exhibited a significant sequential decline in these patients.
CONCLUSION: Acute sensorineural hearing loss in a patient with leukemia or aplastic anemia may be related to either sudden sensorineural hearing loss or endolymphatic hydrops. A significant sequential decline in the function of the cochlea, saccule, utricle, and semicircular canals indicates that the pars inferior is more vulnerable to blood insult than the pars superior.

PMID: 25772410 [PubMed - indexed for MEDLINE]

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Superior canal dehiscence reveals concomitant unilateral utricular loss (UUL).

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Superior canal dehiscence reveals concomitant unilateral utricular loss (UUL).

Acta Otolaryngol. 2015 Jun;135(6):557-64

Authors: Manzari L, Burgess AM, MacDougall HG, Curthoys IS

Abstract
CONCLUSION: We report enhanced symmetrical cervical vestibular evoked myogenic potential (cVEMP) but asymmetrical ocular VEMP (oVEMP) responses in a patient with CT-verified bilateral superior semicircular canal dehiscence (SCD) but with acute vestibular syndrome. This implies that absence of unilateral utricular macula function alone is sufficient to cause symptoms of acute vertigo. Acute vertigo should not automatically be presumed to originate from semicircular canal dysfunction.
OBJECTIVES: To identify the cause of an acute vertigo attack in a patient with bilateral SCD.
METHODS: The functional state of all peripheral vestibular sense organs was tested using the video head impulse test (vHIT) for all semicircular canals and VEMPs to air-conducted sound (ACS) or bone-conducted vibration (BCV) to test all otolith organs. The cVEMP tested mainly saccular function and the oVEMP mainly utricular function.
RESULTS: All semicircular canals showed normal function. The cVEMPs showed enhanced, but symmetrical saccular function. In contrast, oVEMPs showed an enhanced but asymmetric n10 component - it was greatly reduced beneath the left eye, implying decreased function in the right utricular macula. That result was confirmed using very high frequency stimuli which are effective in SCD: 4000 Hz BCV stimuli showed that oVEMP n10 was present beneath the right eye but absent beneath the left eye.

PMID: 25719967 [PubMed - indexed for MEDLINE]

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Time Course and Predictors of Structural Disease Progression in Pulmonary Metastases Arising from Follicular Cell-Derived Thyroid Cancer.

Time Course and Predictors of Structural Disease Progression in Pulmonary Metastases Arising from Follicular Cell-Derived Thyroid Cancer.

Thyroid. 2016 Feb 12;

Authors: Sabra MM, Ghossein R, Tuttle RM

Abstract
BACKGROUND: With the advent of molecular targeted therapy for the management of radioactive iodine (RAI) refractory, progressive metastatic thyroid cancer, it becomes important to define the time course and risk factors for structural disease progression in follicular cell-derived thyroid cancer (FCDTC) patients. This will help in defining the optimal time to start these therapies and better define their impact on structural disease progression.
OBJECTIVES: This retrospective review of 199 consecutive patients with FCDTC presenting with lung metastasis examined the progression-free survival (PFS) in thyroid cancer patients with lung metastasis treated with surgery and RAI, and who had not received molecular targeted therapy or chemotherapy.
RESULTS: The median overall survival (OS) was 10.45 years, while the median PFS was 3.65 years. A strong correlation was found between OS and PFS. PFS is shorter in patients with RAI refractory disease, poorly differentiated/Hürthle cell histologies, male sex, fluorodeoxyglucose-avid metastatic foci, older age (>45 years), and pulmonary metastases >1 cm. At final follow-up (a median of 6.9 years from lung metastasis diagnosis), 68% of the patients had progressed and 46% had died.
CONCLUSIONS: With the exception of younger patients with low disease burden, most patients presenting with lung metastasis from FCDTC (RAI avid and RAI refractory) using standard-of-care approaches will have disease progression on long-term follow-up. Additional studies are needed to identify novel therapies that would improve the PFS of such patients.

PMID: 26872102 [PubMed - as supplied by publisher]

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Characteristics of antithyroid drug-induced agranulocytosis in patients with hyperthyroidism: A retrospective analysis of 114 cases in a single institution in China involving 9690 patients referred for radioiodine treatment over 15 years.

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Characteristics of antithyroid drug-induced agranulocytosis in patients with hyperthyroidism: A retrospective analysis of 114 cases in a single institution in China involving 9690 patients referred for radioiodine treatment over 15 years.

Thyroid. 2016 Feb 11;

Authors: Yang J, Zhu YJ, Zhong J, Zhang J, Weng WW, Liu Z, Xu Q, Dong M

Abstract
BACKGROUND: Antithyroid drug (ATD)-induced agranulocytosis is a rare but life-threatening disease. Clinical features of ATD-induced agranulocytosis and outcomes remain incompletely understood.
METHOD: We retrospectively studied patients with clinically diagnosed ATD-induced agranulocytosis involving 9690 patients who were referred for radioiodine treatment during a 15-year period (2000-2015) in China. Finally, there were 114 cases of agranulocytosis attributable to ATD included and their clinical characteristics and therapy outcomes were analyzed.
RESULTS: The female to male ratio of ATD-induced agranulocytosis was 10.4:1. The mean age of the patients with ATD-induced agranulocytosis was 41.7 ± 12.3 years (mean ± standard deviation). The methimazole (MMI) and propylthiouracil (PTU) dose given at the onset were 22.9 ± 8.0 mg/day and 253.6 ± 177.5 mg/day, respectively. ATD-induced agranulocytosis occurred in 45.1%, 74.3% and 88.5% of patients within 4, 8, and 12 weeks of the onset of ATD therapy, respectively. Fever (78.9%) and sore throat (72.8%) were the most common symptoms when agranulocytosis was diagnosed. The mean recovery time of agranulocytosis was 13.41 ± 7.14 days. Recovery time in the G-CSF-treated group (12.7 ± 6.0 days) did not differ from that in the group not treated with G-CSF (16.4 ± 10.6 days) (p = 0.144). Treatment of 131I was successful in 87 out of the 98 patients (88.8%). The success rate of 131I was equivalent (p = 1.000) between the groups receiving MMI (88.2%, 75/85) and PTU (92.3%, 12/13).
CONCLUSIONS: This largest single institution study in China shows that ATD-induced agranulocytosis tends to occur within the first 12 weeks after the onset of ATD therapy. For patient with ATD-induced agranulocytosis, G-CSF does not improve recovery time of agranulocytosis and 131I is an optimal treatment approach.

PMID: 26867063 [PubMed - as supplied by publisher]

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Lingual Thyroid Ectopia: Diagnostic SPECT/CT imaging and Radioactive Iodine Treatment.

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Lingual Thyroid Ectopia: Diagnostic SPECT/CT imaging and Radioactive Iodine Treatment.

Thyroid. 2016 Feb 11;

Authors: Gandhi A, Wong KK, Gross M, Avram A

Abstract
BACKGROUND: Lingual thyroid is a rare abnormality of thyroid development that is usually treated conservatively with levothyroxine replacement. Rarely, it becomes large enough to cause obstructive symptoms in the oral cavity, requiring definitive treatment.
PATIENT FINDINGS: We report 3 patients with lingual thyroid treated with radioactive iodine-131 (¹³¹I) with successful radioablation of their ectopic thyroid tissues. Measurement of 24 hour radioactive iodine uptake (RAIU) within thyroidal tissues and hybrid SPECT/CT imaging using either iodine-123 (¹²³I) or technetium-99m pertechnetate (^99mTc) scans were performed in all patients demonstrating the location and size of lingual thyroid and absence of an orthotopic thyroid gland.
SUMMARY: The aim of this study is to describe non-surgical management of obstructive lingual thyroid tissue with ¹³¹I therapy for lingual thyroid radioablation. Patients were prepared with a low iodine diet and levothyroxine (L-T4) withdrawal prior to radioablation for optimizing ¹³¹I uptake in ectopic thyroid tissues. Hybrid SPECT/CT measurement of anatomic size of lingual thyroid tissue and RAIU guided selection of therapeutic doses, resulting in administration of 10.7, 17.5, and 15.4 mCi of ¹³¹I respectively. There were no post-therapy complications, and clinical follow-up demonstrated resolution of obstructive oropharyngeal symptoms.
CONCLUSIONS: Ectopic lingual thyroid tissue is rarely associated with obstructive oropharyngeal symptoms due to progressive enlargement. Radioiodine therapy with ¹³¹I is an effective treatment modality for ablation of ectopic thyroid tissue as an alternative to surgery.

PMID: 26864253 [PubMed - as supplied by publisher]

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Prevention of laryngospasm with rocuronium in cats: a dose-finding study.

Prevention of laryngospasm with rocuronium in cats: a dose-finding study.

Vet Anaesth Analg. 2016 Feb 12;

Authors: Martin-Flores M, Sakai DM, Portela DA, Borlle L, Campoy L, Gleed RD

Abstract
OBJECTIVE: To identify the dose of rocuronium that will prevent a laryngeal response to water spraying of the glottis in anesthetized cats.
STUDY DESIGN: Randomized crossover study.
ANIMALS: Eight healthy, adult, short-haired cats, aged 1-4 years, weighing 3.2-6.0 kg.
METHODS: Each cat was anesthetized four times and administered one of four doses of rocuronium (0.1, 0.2, 0.3 and 0.6 mg kg(-1) ) in random order. The larynx was observed with a video-endoscope inserted through a laryngeal mask airway. Video-clips of the laryngeal response to a sterile water spray (0.2 mL) were obtained at baseline (without rocuronium) and at maximal effect of each treatment. Glottal closure score (0-2), duration of glottal closure, and number of adductive arytenoid movements were obtained from video-clips of laryngeal responses (reproduced in slow motion) at baseline and after treatment. Two observers blinded to treatment allocation scored the vigor of the laryngeal response on a visual analog scale (VAS). The duration of apnea (up to 5 minutes) was recorded for each treatment.
RESULTS: Compared with baseline, rocuronium 0.3 mg kg(-1) and 0.6 mg kg(-1) significantly decreased all glottal scores obtained from the videos (all p < 0.03). Both observers gave lower VAS scores after 0.3 mg kg(-1) (both p = 0.015). Apnea lasting ≥ 5 minutes occurred in none, one, three and seven of eight cats administered doses of rocuronium 0.1, 0.2, 0.3 and 0.6 mg kg(-1) , respectively.
CONCLUSIONS AND CLINICAL RELEVANCE: Rocuronium 0.3 mg kg(-1) and 0.6 mg kg(-1) consistently decreased the completeness and duration of the laryngeal response to water spray, and reduced the number of arytenoid adductive movements in response to that stimulus. However, a laryngeal response was never completely prevented. Rocuronium 0.3 mg kg(-1) may be useful for facilitating tracheal intubation. Positive pressure ventilation must be available for cats administered rocuronium.

PMID: 26872141 [PubMed - as supplied by publisher]

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Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry.

Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry.

Ann Otol Rhinol Laryngol. 2016 Feb 11;

Authors: Lippert D, Hoffman MR, Britt CJ, Jones CA, Hernandez J, Ciucci MR, McCulloch TM

Abstract
INTRODUCTION: Understanding of swallowing pressures after total laryngectomy (TL) and what constitutes a "functional" swallow are limited. Mobile structures are altered or removed after TL, with consequent effects on pressure profiles. High-resolution manometry (HRM) can characterize these pressures.
METHODS: Six TL subjects without dysphagia and 6 controls underwent pharyngeal HRM. Timing and pressure variables for the velopharynx, mesopharynx, and upper esophageal sphincter (UES) were compared. Changes in variables due to bolus volume were evaluated in TL subjects.
RESULTS: The TL subjects had increased duration of velopharyngeal pressure (P = .012). Maximum mesopharyngeal pressure was lower versus controls (P = .003). Maximal and total pre-opening (P = .002, P = .002) and post-closure (P = .001, P = .002) UES pressures were lower. Maximum mesopharyngeal pressure (P = .032) decreased with increasing bolus volume.
CONCLUSIONS: Increased velopharyngeal pressure duration and total swallow duration reflect separation of the pharynx into distinct conduits for air and food, thus ensuring successful bolus passage without the need for respiration. Decreased UES pressure highlights the effects of disrupting the cricopharyngeal and rostral esophageal muscle fibers from their attachments to the larynx and performing a cricopharyngeal myotomy. Additional studies including subjects with dysphagia could further characterize the functional TL swallow and identify aspects susceptible to dysfunction.

PMID: 26868604 [PubMed - as supplied by publisher]

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Cranio-facial remodeling in domestic dogs is associated with changes in larynx position.

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Cranio-facial remodeling in domestic dogs is associated with changes in larynx position.

J Anat. 2016 Feb 11;

Authors: Plotsky K, Rendall D, Chase K, Riede T

Abstract
The hyo-laryngeal complex is a multi-segmented structure integrating the oral and pharyngeal cavities and thus a variety of critical functions related to airway control, feeding, and vocal communication. Currently, we lack a complete understanding of how the hyoid complex, and the functions it mediates, can also be affected by changes in surrounding cranio-facial dimensions. Here, we explore these relationships in a breed of domestic dog, the Portuguese Water Dog, which is characterized by strong cranio-facial variation. We used radiographic images of the upper body and head of 55 adult males and 51 adult females to obtain detailed measures of cranio-facial variation and hyoid anatomy. Principal components analysis revealed multiple orthogonal dimensions of cranio-facial variation, some of which were associated with significant differences in larynx position: the larynx occupied a more descended position in individuals with shorter, broader faces than in those with longer, narrower faces. We then tested the possibility that caudal displacement of the larynx in brachycephalic individuals might reflect a degree of tongue crowding resulting from facial shortening and reduction of oral and pharyngeal spaces. A cadaver sample was used to obtain detailed measurements of constituent bones of the hyoid skeleton and of the tongue body, and their relationships to cranio-facial size and shape and overall body size supported the tongue-crowding hypothesis. Considering the presence of descended larynges in numerous mammalian taxa, our findings establish an important precedent for the possibility that laryngeal descent can be initiated, and even sustained, in part in response to remodeling of the face and cranium for selective pressures unrelated to vocal production. These integrated changes could also have been involved in hominin evolution, where the different laryngeal positions in modern humans compared with nonhuman primates have been traditionally linked to the evolution of speech but which are likely to be multifactorial.

PMID: 26863925 [PubMed - as supplied by publisher]

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Trends in Utilization of Vocal Fold Injection Procedures.

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Trends in Utilization of Vocal Fold Injection Procedures.

Otolaryngol Head Neck Surg. 2015 Nov;153(5):812-4

Authors: Rosow DE

Abstract
Office-based vocal fold injections have become increasingly popular over the past 15 years. Examination of trends in procedure coding for vocal fold injections in the United States from 2000 to 2012 was undertaken to see if they reflect this shift. The US Part B Medicare claims database was queried from 2000 through 2012 for multiple Current Procedural Terminology codes. Over the period studied, the number of nonoperative laryngoscopic injections (31513, 31570) and operative medialization laryngoplasties (31588) remained constant. Operative vocal fold injection (31571) demonstrated marked linear growth over the 12-year study period, from 744 procedures in 2000 to 4788 in 2012-an increase >640%. The dramatic increased incidence in the use of code 31571 reflects an increasing share of vocal fold injections being performed in the operating room and not in an office setting, running counter to the prevailing trend toward awake, office-based injection procedures.

PMID: 26220059 [PubMed - indexed for MEDLINE]

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A diagnostic model for impending death in cancer patients: Preliminary report.

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A diagnostic model for impending death in cancer patients: Preliminary report.

Cancer. 2015 Nov 1;121(21):3914-21

Authors: Hui D, Hess K, dos Santos R, Chisholm G, Bruera E

Abstract
BACKGROUND: Several highly specific bedside physical signs associated with impending death within 3 days for patients with advanced cancer were recently identified. A diagnostic model for impending death based on these physical signs was developed and assessed.
METHODS: Sixty-two physical signs were systematically documented every 12 hours from admission to death or discharge for 357 patients with advanced cancer who were admitted to acute palliative care units (APCUs) at 2 tertiary care cancer centers. Recursive partitioning analysis was used to develop a prediction model for impending death within 3 days with admission data. The model was validated with 5 iterations of 10-fold cross-validation, and the model was also applied to APCU days 2 to 6.
RESULTS: For the 322 of 357 patients (90%) with complete data for all signs, the 3-day mortality rate was 24% on admission. The final model was based on 2 variables (Palliative Performance Scale [PPS] and drooping of nasolabial folds) and had 4 terminal leaves: PPS score ≤ 20% and drooping of nasolabial folds present, PPS score ≤ 20% and drooping of nasolabial folds absent, PPS score of 30% to 60%, and PPS score ≥ 70%. The 3-day mortality rates were 94%, 42%, 16%, and 3%, respectively. The diagnostic accuracy was 81% for the original tree, 80% for cross-validation, and 79% to 84% for subsequent APCU days.
CONCLUSIONS: Based on 2 objective bedside physical signs, a diagnostic model was developed for impending death within 3 days. This model was applicable to both APCU admission and subsequent days. Upon further external validation, this model may help clinicians to formulate the diagnosis of impending death.

PMID: 26218612 [PubMed - indexed for MEDLINE]

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Improvement in glottic visualisation by using the C-MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study.

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Improvement in glottic visualisation by using the C-MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study.

Eur J Anaesthesiol. 2015 Jun;32(6):425-31

Authors: Hossfeld B, Frey K, Doerges V, Lampl L, Helm M

Abstract
BACKGROUND: Out-of-hospital tracheal intubation is associated with life-threatening complications. To date, no study has compared direct and video laryngoscopic views simultaneously in the same patients in an out-of-hospital setting.
OBJECTIVES: The aim of this study was to determine the effect of C-MAC PM video laryngoscope on laryngeal view, compared with direct laryngoscopy, and to estimate possible consequences for patient safety.
DESIGN: An observational, single-centre study.
SETTING: Helicopter Emergency Medical Service (HEMS) 'CHRISTOPH 22', Ulm, Germany.
PATIENTS: Two-hundrend and twenty-eight emergency patients undergoing airway management out of hospital.
INTERVENTIONS: Laryngoscopy and tracheal intubation using C-MAC PM video laryngoscope. For all intubations, the HEMS physician used CMAC PM as the first-line device and performed an initial direct laryngoscopy followed by a video laryngoscopy, without changing the laryngoscope blade.
MAIN OUTCOME MEASURES: The difference in laryngeal view was recorded as well as the number of intubation attempts along with the success rate and difficulties in airway management. Improvement in glottic visualisation from Cormack and Lehane grade III/IV to I/II was rated as being clinically relevant.
RESULTS: During a 20-month study period, a total of 228 out-of-hospital emergency patients requiring tracheal intubation were included. The overall success rate in securing the airway was 100%. For 226 patients (99.1%), tracheal intubation was successful with two or fewer attempts. For comparison of direct and indirect laryngoscopic views, five patients were excluded because of the use of an indirect laryngoscope blade. Of 223 patients, 120 had a glottic view rated as Cormack and Lehane grade II to IV with direct laryngoscopy; in these patients, visualisation of the glottis was significantly improved with the C-MAC PM video laryngoscope (P < 0.001). In 56 patients (25.1%), improvement of glottic visualisation was clinically relevant (P < 0.001).
CONCLUSION: Use of the C-MAC PM video laryngoscope is associated with improved visualisation of the glottis according to the Cormack and Lehane grading system and an excellent success rate for out-of-hospital tracheal intubation. These results suggest that the use of C-MAC PM as a first-line device for tracheal intubation by out-of-hospital emergency medical services is a safe procedure.

PMID: 25886716 [PubMed - indexed for MEDLINE]

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Preventive effects of bortezomib on denervation-induced atrophy of the intrinsic laryngeal muscles: an experimental study in the rat.

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Preventive effects of bortezomib on denervation-induced atrophy of the intrinsic laryngeal muscles: an experimental study in the rat.

Acta Otolaryngol. 2015 Jul;135(7):713-7

Authors: Sei H, Taguchi A, Nishida N, Hato N, Gyo K

Abstract
CONCLUSION: Bortezomib was effective in attenuating atrophy of the posterior cricoarytenoid (PCA) muscle, but not the thyroarytenoid (TA) muscle. This was probably due to differences in the fiber composition of the two muscles. The PCA muscle is composed of a combination of fast- and slow-twitch fibers, and therefore is more resistant to atrophy than the TA muscle, which is composed solely of fast-twitch fibers.
OBJECTIVES: To investigate the preventive effects of bortezomib on denervation-induced atrophy of the TA and PCA muscles in the rat.
METHODS: Following transection of the left recurrent laryngeal nerve, bortezomib (100 μg/kg) was administered subcutaneously on post-denervation days 1 and 4, followed by a 10-day rest period every 14 days; each 2-week period constituted a single treatment cycle. In controls, saline was administered instead. Animals were killed for histological examination at 4 (n = 6), 8 (n = 7), and 12 (n = 7) weeks post-denervation. Muscle atrophy was assessed using three indices: wet muscle weight, muscle fiber cross-sectional area, and the number of muscle fibers/mm(2). The effects of bortezomib were evaluated by comparing the left (L) and right (R) muscles, with sequential changes in the L/R ratio assessed.
RESULTS: In saline-administered animals, atrophy of the left-sided TA and PCA muscles progressed rapidly during the first 4 weeks post-denervation, following which progression slowed. Atrophy was greater in the TA compared with the PCA muscle, although this difference was not statistically significant. In bortezomib-administered animals, atrophy of the PCA muscle was attenuated significantly at post-denervation weeks 8 and 12; no such reduction in atrophy was observed for the TA muscle.

PMID: 25813911 [PubMed - indexed for MEDLINE]

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Dietary squid ink polysaccharide induces goblet cells to protect small intestine from chemotherapy induced injury.

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Dietary squid ink polysaccharide induces goblet cells to protect small intestine from chemotherapy induced injury.

Food Funct. 2015 Mar;6(3):981-6

Authors: Zuo T, Cao L, Xue C, Tang QJ

Abstract
Gastrointestinal mucositis induced by chemotherapy is associated with alterations of intestinal barrier function due to the potential damage induced by anti-cancer drugs on the epithelial cells. Goblet cells, an important epithelial lining in the intestine, contribute to innate immunity by secreting mucin glycoproteins. Employing a mouse model of chemotherapy induced intestinal mucosal immunity injury by cyclophosphamide, we demonstrated for the first time that polysaccharide from the ink of Ommastrephes bartramii (OBP) enhanced Cyto18, which is a mucin expression in goblet cells. The up-regulation of mucins by OBP relied on the augmented quantity of goblet cells, but not on the changes in the ultrastructure of endoplasmic reticulum (ER). Our results may have important implications for enhanced immunopotentiation function of functional OBP on intestinal mucosal immunity against intestinal disorders involving inflammation and infection.

PMID: 25671677 [PubMed - indexed for MEDLINE]

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A complication of the laryngeal mask airway: Pharyngolaryngeal rupture and pneumomediastinum.

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A complication of the laryngeal mask airway: Pharyngolaryngeal rupture and pneumomediastinum.

Eur J Anaesthesiol. 2015 Jun;32(6):439-40

Authors: Atalay YO, Kaya C, Aktas S, Toker K

PMID: 25485882 [PubMed - indexed for MEDLINE]

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Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis-a commentary.

Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis-a commentary.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):341

Authors: Chakravarthy PK, Pai KM, Kumar S

PMID: 26868471 [PubMed - in process]

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Validation of cone beam computed tomography-based tooth printing using different three-dimensional printing technologies.

Validation of cone beam computed tomography-based tooth printing using different three-dimensional printing technologies.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):307-15

Authors: Khalil W, EzEldeen M, Van De Casteele E, Shaheen E, Sun Y, Shahbazian M, Olszewski R, Politis C, Jacobs R

Abstract
OBJECTIVE: Our aim was to determine the accuracy of 3-dimensional reconstructed models of teeth compared with the natural teeth by using 4 different 3-dimensional printers.
STUDY DESIGN: This in vitro study was carried out using 2 intact, dry adult human mandibles, which were scanned with cone beam computed tomography. Premolars were selected for this study. Dimensional differences between natural teeth and the printed models were evaluated directly by using volumetric differences and indirectly through optical scanning. Analysis of variance, Pearson correlation, and Bland Altman plots were applied for statistical analysis.
RESULTS: Volumetric measurements from natural teeth and fabricated models, either by the direct method (the Archimedes principle) or by the indirect method (optical scanning), showed no statistical differences. The mean volume difference ranged between 3.1 mm(3) (0.7%) and 4.4 mm(3) (1.9%) for the direct measurement, and between -1.3 mm(3) (-0.6%) and 11.9 mm(3) (+5.9%) for the optical scan. A surface part comparison analysis showed that 90% of the values revealed a distance deviation within the interval 0 to 0.25 mm.
CONCLUSIONS: Current results showed a high accuracy of all printed models of teeth compared with natural teeth. This outcome opens perspectives for clinical use of cost-effective 3-dimensional printed teeth for surgical procedures, such as tooth autotransplantation.

PMID: 26868470 [PubMed - in process]

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Low-level laser therapy versus 5% amlexanox: a comparison of treatment effects in a cohort of patients with minor aphthous ulcers.

Low-level laser therapy versus 5% amlexanox: a comparison of treatment effects in a cohort of patients with minor aphthous ulcers.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):269-73

Authors: Jijin MJ, Rakaraddi M, Pai J, Jaishankar HP, Krupashankar R, Kavitha AP, Anjana R, Shobha R

Abstract
OBJECTIVE: The aim of the study was to compare the treatment effects of 5% amlexanox and low-level laser therapy (LLLT) in a cohort of patients who experienced minor aphthous stomatitis.
STUDY DESIGN: A clinical trial was performed between 2012 and 2014 on 50 participants having minor aphthous ulcers. Group A participants were treated with amlexanox oral paste (lexanox 5% oral paste), and group B participants were treated with LLLT. Pain scores and sizes of ulcers were measured on the first, third, and seventh days of treatment in both groups. Data were analyzed using paired t test and independent t test.
RESULTS: No significant difference was observed between the two groups with respect to pain level on the first and seventh days of treatment.
CONCLUSIONS: Both amlexanox and LLLT were equally effective in relieving pain associated with minor aphthous stomatitis. Both groups showed significant reduction in ulcer sizes and in pain scores.

PMID: 26868469 [PubMed - in process]

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Compromised salivary parameters of children with juvenile idiopathic arthritis.

Compromised salivary parameters of children with juvenile idiopathic arthritis.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):262-8

Authors: de Oliveira Perestrelo B, Feres de Melo AR, de Sant'Anna GR, Leite MF

Abstract
OBJECTIVE: To evaluate the salivary parameters of individuals with juvenile idiopathic arthritis (JIA) and determine if there is a correlation with the simplified oral hygiene index (OHI-S).
STUDY DESIGN: Stimulated whole saliva was collected from children, aged 6 to 12 years, with JIA (n = 36) and compared with saliva from a control group (CG) composed of healthy children matched by demographic characteristics (n = 36). Salivary parameters evaluated were amylase and peroxidase activities, calcium, phosphate, and total sialic acid concentration. Data were compared by two-tailed Student's t test, and salivary parameters were evaluated for correlations with OHI-S by Spearman's correlation.
RESULTS: The JIA group had a statistically significant reduction in all salivary parameters: α-amylase (20%) (CG, 9.84 ± 4.23; JIA 4.80 ± 3.10) and peroxidase (55%) (CG, 35.05 ± 14.97; JIA, 15.78 ± 6.44) activities, total sialic acid (25%) (CG, 0.024 ± 0.01; JIA, 0.010 ± 0.04), calcium (13%) (CG, 6.26 ± 2.26; JIA, 5.44 ± 2.26) and phosphate (50%) (CG, 10.88 ± 1.49; JIA, 5.45 ± 0.88) concentration compared with the CG (P ≤ .05). There were no significant correlations between the salivary parameters and OHI-S in either group.
CONCLUSION: JIA patients showed a reduction of different salivary parameters involved in maintaining oral health.

PMID: 26868468 [PubMed - in process]

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Characterization of pain originating from oral mucosal lesions.

Characterization of pain originating from oral mucosal lesions.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):255-61

Authors: Abdalla-Aslan R, Benoliel R, Sharav Y, Czerninski R

Abstract
OBJECTIVE: The aim of the study was to characterize pain associated with oral mucosal lesions.
STUDY DESIGN: A cross-sectional study was performed in patients diagnosed with localized mucosal pain originating from acute ulcers (AUs), herpes infections (HIs), and immune-mediated chronic diseases (IMCDs). Pain-related features, including intensity (VAS-I), perceived unpleasantness (VAS-U), functional impairment (VAS-F), and effect on quality of life (VAS-Q), were recorded using a 10-cm visual analogue scale (VAS). Waking from sleep, provoking, and alleviating factors were assessed by questionnaires.
RESULTS: Sixty-three patients aged 19 to 82 years (47.22 ± 17.20 years) were examined over the study period. These included 18 patients with AUs, 21 with HIs, and 24 with IMCDs. At rest, VAS-U was significantly higher than VAS-I for all groups, and VAS-F was higher for lesions located on the tongue or lips. Up to 80% of patients described the pain as "burning." Differences between groups were not observed for all other parameters measured. Pain woke the patients from sleep in almost half of cases. VAS-I and VAS-U were not related to size or number of lesions.
CONCLUSIONS: Mucosal pain is generally burning in quality, with a higher level of pain-related unpleasantness than pain intensity. In about half of the cases, pain awakens the person from sleep, a feature that correlated to female gender and pain intensity. Pain intensity or unpleasantness was not related to the size or number of lesions.

PMID: 26868467 [PubMed - in process]

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

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

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):248-54

Authors: Petruzzi M, De Benedittis M

Abstract
OBJECTIVE: Increased use of smartphone and related software applications has created a new era in clinical data exchange among patients and clinicians. This study describes use of the smartphone-based application WhatsApp to share clinical oral medicine information.
STUDY DESIGN: Clinical images and related questions were submitted by general dentists, physicians, dental hygienists, and patients to the authors via WhatsApp. For each submission, a clinical impression was made and categorized as traumatic, infective, neoplastic, autoimmune, or unclassified. Submissions were summarized by sender type, number of photographs per sender, and category of question. Patients were invited to undergo a clinical examination with biopsy, when indicated. The telemedicine impression was compared to the clinicopathologic diagnosis.
RESULTS: Three hundred and thirty-nine images were received for 96 patients; 92 (95.8%) patients underwent clinicopathologic examination, and 45 (49%) received a biopsy. General dentists (62%) and dental hygienists (26%) were the most frequent senders. The most common question was related to diagnosis (56%). The telemedicine impression agreed with the clinicopathologic assessment for 82% of cases.
CONCLUSIONS: Telemedicine applications, such as WhatsApp, can support communication about oral conditions among clinicians and patients. Telemedicine consultation reduced geographic barriers to initial clinical consultation and encouraged the significant majority of patients to pursue expert clinical examination.

PMID: 26868466 [PubMed - in process]

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Patient support and advocacy organizations: partners in promoting awareness and improving the lives of patients with oral and maxillofacial disease.

Patient support and advocacy organizations: partners in promoting awareness and improving the lives of patients with oral and maxillofacial disease.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):203-4

Authors: Edwards PC

PMID: 26868465 [PubMed - in process]

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[Vascular lesions of vocal folds--part 1: horizontal vascular lesions].

Related Articles

[Vascular lesions of vocal folds--part 1: horizontal vascular lesions].

Laryngorhinootologie. 2014 Dec;93(12):819-30

Authors: Voigt-Zimmermann S, Arens C

Abstract
BACKGROUND: In recent decades, the endoscopic methods and technologies for laryngeal examination have improved so much that not only epithelial changes, but also vascular changes are recognizable at earlier stages. When comparing newer and older literature, the associated increasingly differentiated descriptions of such visible vascular changes of the vocal folds lead to terminological blurring and shifts of meaning. This complicates the technical-scientific discourse. The aim of the present work is a theoretical and conceptual clarification of early vascular changes of vocal folds.
RESULTS: Horizontal changes of benigne vascular diseases, e. g. vessel ectasia, meander, increasing number and branching of vessels, change of direction may develop in to manifest vascular lesions, like varicosis, polyps and in case of ruptures to haemorrhages of vocal folds. These beginning and reversible vascular changes, when early detected and discussed basing on etiological knowledge, may lead to more differentiated prognostic statements and adequate therapeutic decisions, e. g. phonosurgery, functional voice therapy, voice hygiene and voice rest. Vertical vascular changes, like vessel loops, occur primarily in laryngeal papilloma, pre-cancerous and cancerous changes of the vocal folds. Already in small cancerous lesions of the vocal folds the vascular architecture is completely destroyed.

PMID: 25437624 [PubMed - indexed for MEDLINE]

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Endoscopic resection of a vocal cord polyp with a bipolar snare in a patient with cervical disc herniation.

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Endoscopic resection of a vocal cord polyp with a bipolar snare in a patient with cervical disc herniation.

Clin J Gastroenterol. 2014 Apr;7(2):136-9

Authors: Minamino H, Nagami Y, Tominaga K, Matsushita N, Sugimori S, Shiba M, Watanabe T, Iguchi H, Fujiwara Y, Arakawa T

Abstract
A 55-year-old male with progressively worsening hoarseness was found to have a vocal cord polyp of >10 mm in diameter on the right true cord. It was necessary to remove the polyp in order to prevent airway obstruction by prolapse. However, the patient was a poor candidate for resection by standard otolaryngologic procedures because of the large size of the polyp and because he had a symptomatic cervical disc herniation. Therefore, endoscopic resection under general anesthesia using a bipolar electrocautery snare was selected. This case was our first attempt to treat a vocal cord polyp using this technique, and we found that polypectomy with the bipolar snare was an efficient and safe method for the treatment of this lesion.

PMID: 26183629 [PubMed - indexed for MEDLINE]

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Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

J Neurosurg. 2016 Feb 12;:1-7

Authors: Chung LK, Ung N, Spasic M, Nagasawa DT, Pelargos PE, Thill K, Voth B, Hirt D, Gopen Q, Yang I

Abstract
OBJECTIVE Superior semicircular canal dehiscence (SSCD) is a rare disorder characterized by the formation of a third opening in the inner ear between the superior semicircular canal and the middle cranial fossa. Aberrant communication through this opening causes a syndrome of hearing loss, pulsatile tinnitus, disequilibrium, and autophony. This study analyzed the clinical outcomes of a single-institution series of patients with SSCD undergoing surgical repair by the same otolaryngologist and neurosurgeon. METHODS All patients who underwent SSCD repair at the University of California, Los Angeles, between March 2011 and November 2014 were included. All patients had their SSCD repaired via middle fossa craniotomy by the same otolaryngologist and neurosurgeon. Outcomes were analyzed with Fisher's exact test. RESULTS A total of 18 patients with a mean age of 56.2 years (range 27-84 years) and an average follow-up of 5.0 months (range 0.2-21.8 months) underwent 21 cases of SSCD repair. Following treatment, all patients (100%) reported resolution in ≥ 1 symptom associated with SSCD. Autophony (p = 0.0005), tinnitus (p = 0.0059), and sound- and/or pressure-induced dizziness (p = 0.0437) showed significant symptomatic resolution. Following treatment, 29% (2/7) of patients developed imbalance, 20% (1/5) of patients developed sound- and/or pressure-induced dizziness, and 18% (2/11) of patients developed aural fullness. Among patients with improved symptoms following surgical repair, none reported recurrence of symptoms at subsequent follow-up visits. CONCLUSIONS SSCD remains an underdiagnosed and undertreated condition. Surgical repair of SSCD using a middle fossa craniotomy is associated with a high rate of symptom resolution. Continued investigation using a larger patient cohort and longer-term follow-up could further demonstrate the effectiveness of using middle fossa craniotomy for SSCD repair.

PMID: 26871374 [PubMed - as supplied by publisher]

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Manual Therapy and Exercise for a Patient With Neck-Tongue Syndrome: A Case Report.

Manual Therapy and Exercise for a Patient With Neck-Tongue Syndrome: A Case Report.

J Orthop Sports Phys Ther. 2016 Feb 11;:1-30

Authors: Niethamer L, Myers R

Abstract
Study Design Case report. Background Neck-tongue syndrome (NTS) is defined as neck and/or head pain accompanied by ipsilateral dysesthesia of the tongue with sudden rotation of the head. Proposed causes include compression or irritation of the C2 nerve root as it courses behind the atlantoaxial joint or hypertrophy of the inferior oblique muscle. The primary purpose of this case report is to describe the conservative physical therapy treatment of a patient with uncomplicated NTS. Case Description The patient was a 13-year-old girl who reported insidious onset of sharp pain in the neck, numbness/tingling of the ipsilateral tongue/face, and tinnitus with cervical rotation. Symptoms occurred several times a week for approximately 10 seconds. Examination revealed impaired function, increased forward head posture, decreased cervical range of motion, and positive neurodynamic assessment. The patient's treatment included manual therapy and exercise for postural stabilization. Outcomes Following 8 visits, pain of the neck and tongue numbness had resolved. Score on the Patient Specific Functional Scale (PSFS), cervical range of motion (ROM), and posture had also improved. At 22 month follow-up, infrequent, momentary symptoms in the neck and dysesthesia of the tongue were reported. THE PSFS remained the same. Objective measures were normal. Discussion This case report describes the physical therapy management of an individual with NTS. The management strategy followed a protocol similar to that used for cervicogenic headaches (CH) due to the involvement of the upper cervical spine with both NTS and CH and the lack of evidence for the treatment of NTS. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther, Epub 11 Jan 2016. doi:10.2519/jospt.2016.6195.

PMID: 26868897 [PubMed - as supplied by publisher]

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Maladaptive plasticity in tinnitus - triggers, mechanisms and treatment.

Maladaptive plasticity in tinnitus - triggers, mechanisms and treatment.

Nat Rev Neurol. 2016 Feb 12;

Authors: Shore SE, Roberts LE, Langguth B

Abstract
Tinnitus is a phantom auditory sensation that reduces quality of life for millions of people worldwide, and for which there is no medical cure. Most cases of tinnitus are associated with hearing loss caused by ageing or noise exposure. Exposure to loud recreational sound is common among the young, and this group are at increasing risk of developing tinnitus. Head or neck injuries can also trigger the development of tinnitus, as altered somatosensory input can affect auditory pathways and lead to tinnitus or modulate its intensity. Emotional and attentional state could be involved in the development and maintenance of tinnitus via top-down mechanisms. Thus, military personnel in combat are particularly at risk owing to combined risk factors (hearing loss, somatosensory system disturbances and emotional stress). Animal model studies have identified tinnitus-associated neural changes that commence at the cochlear nucleus and extend to the auditory cortex and other brain regions. Maladaptive neural plasticity seems to underlie these changes: it results in increased spontaneous firing rates and synchrony among neurons in central auditory structures, possibly generating the phantom percept. This Review highlights the links between animal and human studies, and discusses several therapeutic approaches that have been developed to target the neuroplastic changes underlying tinnitus.

PMID: 26868680 [PubMed - as supplied by publisher]

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Long-Lasting Sound-Evoked Afterdischarge in the Auditory Midbrain.

Long-Lasting Sound-Evoked Afterdischarge in the Auditory Midbrain.

Sci Rep. 2016;6:20757

Authors: Ono M, Bishop DC, Oliver DL

Abstract
Different forms of plasticity are known to play a critical role in the processing of information about sound. Here, we report a novel neural plastic response in the inferior colliculus, an auditory center in the midbrain of the auditory pathway. A vigorous, long-lasting sound-evoked afterdischarge (LSA) is seen in a subpopulation of both glutamatergic and GABAergic neurons in the central nucleus of the inferior colliculus of normal hearing mice. These neurons were identified with single unit recordings and optogenetics in vivo. The LSA can continue for up to several minutes after the offset of the sound. LSA is induced by long-lasting, or repetitive short-duration, innocuous sounds. Neurons with LSA showed less adaptation than the neurons without LSA. The mechanisms that cause this neural behavior are unknown but may be a function of intrinsic mechanisms or the microcircuitry of the inferior colliculus. Since LSA produces long-lasting firing in the absence of sound, it may be relevant to temporary or chronic tinnitus or to some other aftereffect of long-duration sound.

PMID: 26867811 [PubMed - in process]

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Internet-Delivered Cognitive-Behavior Therapy for Tinnitus: A Randomized Controlled Trial.

Related Articles

Internet-Delivered Cognitive-Behavior Therapy for Tinnitus: A Randomized Controlled Trial.

Psychosom Med. 2016 Feb 9;

Authors: Weise C, Kleinstäuber M, Andersson G

Abstract
OBJECTIVES: Tinnitus has a substantially negative impact on quality of life in up to 5% of the general population. Internet-based cognitive-behavioral treatment (iCBT) has been shown to be effective in a few trials. The aim of our study was to investigate iCBT for tinnitus by using a randomized controlled trial.
METHODS: Patients with severe tinnitus-related distress were randomly assigned to therapist-guided iCBT (n = 62) or to a moderated online discussion forum (n = 62). Standardized self-report measures for tinnitus-related distress (Tinnitus Handicap Inventory, Mini-Tinnitus Questionnaire) and associated symptoms (tinnitus acceptance, anxiety, depression, and insomnia) were assessed at pretreatment and posttreatment, 6-month-, and 1-year follow-up. Clinical significance was assessed with the Reliable Change Index.
RESULTS: Multivariate analyses of variance revealed significant main effects for time, group, and interaction in favor of the iCBT group. With regard to tinnitus-related distress, the significant univariate interaction effects (time by group) were supported by large effect sizes (Tinnitus Handicap Inventory: g = 0.83, 95% confidence interval = 0.47-1.20; Mini-Tinnitus Questionnaire: g = 1.08, 95% confidence interval = 0.71-1.64). For the secondary outcomes, significant interactions with small to medium effect sizes were found. Within-group effects for the iCBT, from pretreatment to follow-up, were substantial in regard to tinnitus-related distress (1.38 ≤ d ≤ 1.81) and small to large for secondary outcomes (0.39 ≤ d ≤ 1.04).
CONCLUSIONS: Using a randomized controlled trial design, we replicated prior findings regarding positive effects of Internet-delivered CBT on tinnitus-related distress and associated symptoms. Implementing iCBT for tinnitus into regular health care will be an important next step to increase access to treatment for patients with tinnitus.
TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT01205919.

PMID: 26867083 [PubMed - as supplied by publisher]

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Increased Synchrony and Bursting of Dorsal Cochlear Nucleus Fusiform Cells Correlate with Tinnitus.

Related Articles

Increased Synchrony and Bursting of Dorsal Cochlear Nucleus Fusiform Cells Correlate with Tinnitus.

J Neurosci. 2016 Feb 10;36(6):2068-73

Authors: Wu C, Martel DT, Shore SE

Abstract
UNLABELLED: Tinnitus, the perception of phantom sounds, is thought to arise from increased neural synchrony, which facilitates perceptual binding and creates salient sensory features in the absence of physical stimuli. In the auditory cortex, increased spontaneous cross-unit synchrony and single-unit bursting are de facto physiological correlates of tinnitus. However, it is unknown whether neurons in the dorsal cochlear nucleus (DCN), the putative tinnitus-induction site, exhibit increased synchrony. Using a temporary-threshold shift model and gap-prepulse inhibition of the acoustic startle to assess tinnitus, we recorded spontaneous activity from fusiform cells, the principle neurons of the DCN, in normal hearing, tinnitus, and non-tinnitus guinea pigs. Synchrony and bursting, as well as spontaneous firing rate (SFR), correlated with behavioral evidence of tinnitus, and increased synchrony and bursting were associated with SFR elevation. The presence of increased synchrony and bursting in DCN fusiform cells suggests that a neural code for phantom sounds emerges in this brainstem location and likely contributes to the formation of the tinnitus percept.
SIGNIFICANCE STATEMENT: Tinnitus, a phantom auditory percept, is encoded by pathological changes in the neural synchrony code of perceptual processing. Increased cross-unit synchrony and bursting have been linked to tinnitus in several higher auditory stations but not in fusiform cells of the dorsal cochlear nucleus (DCN), key brainstem neurons in tinnitus generation. Here, we demonstrate increased synchrony and bursting of fusiform cell spontaneous firing, which correlate with frequency-specific behavioral measures of tinnitus. Thus, the neural representation of tinnitus emerges early in auditory processing and likely drives its pathophysiology in higher structures.

PMID: 26865628 [PubMed - in process]

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Streptococcus pyogenes: Basic Biology to Clinical Manifestations

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Streptococcus pyogenes: Basic Biology to Clinical Manifestations

Book. 2016

Authors: Ferretti JJ, Stevens DL, Fischetti VA

Abstract
Despite being in existence for hundreds of years, Streptococcus pyogenes (group A streptococci) remains a significant cause of global morbidity and mortality, with a particular impact in resource-limited settings. The vast majority of cases of acute rheumatic fever (ARF), rheumatic heart disease (RHD), acute post-streptococcal glomerulonephritis (APSGN), and invasive S. pyogenes cases occur in low-resource settings (Carapetis, 2005) (Figure 1). Accurate estimates of the global disease burden are important in planning for disease control, allocating resources, advocating for interventions, and prioritizing new strategies and research. This is particularly relevant in light of the potential to invest in the development of a vaccine to control S. pyogenes disease (Moreland, et al., 2014) (for more information, see the chapter on vaccine development in this book). However, overall disease burden estimates are difficult, mainly because of the scarcity of comprehensive disease registries, the reliance on passive surveillance systems, and the underreporting of both acute and chronic cases. This is true in all regions, and particularly in countries where S. pyogenes diseases occur most frequently (Marijon, Mirabel, Celermajer, & Jouven, 2012). Clinical manifestations of S. pyogenes are among the most diverse of any human pathogen (Ralph & Carapetis, 2013). S. pyogenes has a varied presentation that ranges from seemingly benign pharyngitis and skin infections to more severe glomerulonephritis and sepsis, as well as devastating rheumatic heart disease (RHD), toxic shock syndrome, and necrotizing fasciitis. In 2005, a review of the global burden of group A streptococcal diseases was published, using conservative methodologies that were deliberately designed to under-estimate the burden (Carapetis, 2005; Carapetis, Steer, Mulholland, & Weber, 2005b). At that time, it was estimated that a minimum of 18.1 million people were suffering from invasive S. pyogenes diseases, with an additional 1.78 million incident cases occurring each year. These estimates did not include over 111 million cases of streptococcal pyoderma and 616 million cases of S. pyogenes pharyngitis each year (Carapetis, Steer, Mulholland, & Weber, 2005b). A subsequent review published in 2008 provided updated data on the RHD burden from Asia, which estimated between 1.96 and 2.21 million cases of RHD in Asian children 5 to 14 years of age (Carapetis, 2008). These studies also highlighted the dramatic gaps in reliable recent disease burden data from many regions, particularly Asia, Eastern Europe, and Latin America. In this chapter, we will build on the 2005 review by including the considerable amount of studies that have been performed since that review. Improved capacity for case detection that includes the use of echocardiography, as well as an increase in notification, have been associated with increases in reported rates of S. pyogenes–related diseases in low-resource settings.

PMID: 26866218

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