Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores.

Related Articles

Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores.

J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1685-9

Authors: Kenmuir CL, Hammer M, Jovin T, Reddy V, Wechsler L, Jadhav A

Abstract
BACKGROUND: Although National Institutes of Health Stroke Scale (NIHSS) is a known predictor of outcome in acute ischemic stroke, there are other factors like age, ambulatory status, and ability to swallow that may be predictors of outcome but are not assessed by the traditional NIHSS. The aim of this retrospective review was to identify predictors of outcome in mild ischemic stroke.
METHODS: Discharge outcomes from patients who presented to our large academic stroke center with acute ischemic stroke from 2005 to 2013 were retrospectively reviewed. Of 7189 patients reviewed, 2597 had initial NIHSS less than 5. Outcome measures were modified Rankin Scale (MRS) score 0-1 and discharge to home.
RESULTS: In all, 65% of patients with NIHSS 0-4 were discharged directly home independent of treatment. Of those patients discharged to home, 74% were able to ambulate independently and 98% passed their dysphagia screen. Of patients not discharged directly home, 66% were unable to ambulate independently and 21% did not pass their dysphagia screen. Multivariate logistic regression analysis revealed a significant effect of dysphagia screen (P = .001), ability to ambulate independently (P = .002), age (P = .016), and NIHSS (P = .005) on discharge to home but not MRS of 0-1 (P = .564).
CONCLUSIONS: In patients with mild stroke scale scores defined as NIHSS 0-4, several factors including age, NIHSS, ambulatory status, and ability to swallow may be independent predictors of functional outcome and discharge home. These data support the development of a modified grading system for assessing functional outcome in mild stroke that considers these factors.

PMID: 25944544 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1LWi1KL
via IFTTT

Sialolithiasis in an Accessory Submandibular Gland Identified by Magnetic Resonance Sialography.

Sialolithiasis in an Accessory Submandibular Gland Identified by Magnetic Resonance Sialography.

Ann Otol Rhinol Laryngol. 2016 Mar 9;

Authors: Sanchez Barrueco A, Santillan Coello J, Sobrino Guijarro B, Villacampa Aubá JM, Cenjor Español C

Abstract
BACKGROUND: Accessory submandibular gland is a very rare anatomical variant. There have been only 6 reported cases of this entity in the English literature, only 1 of which was identified using magnetic resonance imaging.
METHODS: We report the case of a 39-year-old female with symptoms of left submandibular sialoadenitis who was diagnosed of sialolithiasis within the left accessory submandibular gland by magnetic resonance sialography (MR-Si).
RESULTS: The calculus was palpated near the submandibular papilla and was extracted by an intraoral approach. One-year follow-up revealed no evidence of recurrence.
CONCLUSIONS: This is the first case reported to date in the English literature of a patient with sialolithiasis within an accessory submandibular gland diagnosed by MR-Si.

PMID: 26961009 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1LWuuhs
via IFTTT

Sudden Sensorineural Hearing Loss Associated With Intralabyrinthine Hemorrhage.

Related Articles

Sudden Sensorineural Hearing Loss Associated With Intralabyrinthine Hemorrhage.

Otol Neurotol. 2015 Sep;36(8):e134-5

Authors: Cervantes SS, Barrs DM

PMID: 24914788 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1TzObhA
via IFTTT

Pathology of advanced buccal mucosa cancer involving masticator space (T4b).

Pathology of advanced buccal mucosa cancer involving masticator space (T4b).

Indian J Cancer. 2015 Oct-Dec;52(4):611-5

Authors: Trivedi NP, Kekatpure VD, Shetkar G, Gangoli A, Kuriakose MA

Abstract
BACKGROUND: Buccal mucosa cancer involving masticator space is classified as very advanced local disease (T4b). The local recurrence rate is very high due to poor understanding of the extent of tumor spread in masticator space and technically difficult surgical clearance. The objective of this study is to understand the extent of tumor spread in masticator space to form basis for appropriate surgical resection.
MATERIALS AND METHODS: All consecutive patients with T4b-buccal cancer underwent compartment resection, with complete anatomical removal of involved soft-tissue structures. Specimens were systematically studied to understand the extent of invasion of various structures. The findings of clinical history, imaging and pathologic evaluation were compared and the results were evaluated.
RESULTS: A total of 45 patients with advanced buccal cancer (T4b) were included in this study. The skin, mandible and lymph nodes were involved in 30, 24 and 17 cases respectively. The pterygoid muscles were involved in 34 cases (medial-pterygoid in 12 and both pterygoids in 22 cases) and masseter-muscle in 32 cases. Average distance for soft-tissue margins after compartment surgery was 2 cm and the margins were positive in 3 cases. The group with involvement of medial pterygoid muscle had safest margin with compartment surgery while it was also possible to achieve negative margins for group involving lateral pterygoid muscle and plates.The involvement of pterygomaxillary fissure was area of concern and margin was positive in 2 cases with one patient developing local recurrence with intracranial extension. At 21 months median follow-up (13-35 months), 38 patients were alive without disease while two developed local recurrence at the skull base.
CONCLUSIONS: T4b buccal cancers have significant soft-tissue involvement in the masticator space. En bloc removal of all soft-tissues in masticator space is advocated to remove tumor contained within space. The compartment surgery provides an opportunity to achieve negative margins for cancers actually contained within masticator space.It is inappropriate to club all patients with masticator space involvement in one group.

PMID: 26960493 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1TzOb1a
via IFTTT

Endoscopic endonasal anterior skull base surgery: a systematic review of complications over the past 65 years.

Endoscopic endonasal anterior skull base surgery: a systematic review of complications over the past 65 years.

World Neurosurg. 2016 Mar 4;

Authors: Borg A, Kirkman MA, Choi D

Abstract
BACKGROUND: Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and CSF fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature.
METHODS: A literature search was performed using the electronic database Ovid MEDLINE (1950 to 25(th) August 2015) using the search item "((Anterior) AND Skull base surgery) AND endoscopic".
RESULTS: We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0 - 68.0%) and a mortality rate of 0.4% (0 -10.0%) was demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0 - 40.0%) with meningiomas and clival lesions having the highest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumour was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a higher rate of meningitis when compared to studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed.
CONCLUSION: The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease complication rates .

PMID: 26960277 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1MbvOaV
via IFTTT

[Epidemiology and etiology of posterior fossa tumors with particular emphasis on astrocytomas from the Małopolska and Podkarpacki regions].

Related Articles

[Epidemiology and etiology of posterior fossa tumors with particular emphasis on astrocytomas from the Małopolska and Podkarpacki regions].

Przegl Lek. 2015;72(8):435-9

Authors: Ciepiela L, Ciepiela K, Kwiatkowski S

Abstract
Brain tumors in children are rare compared with other diseases childhood. Virtually every pediatrician working at the local hospital has been in contact or brain tumor diagnosis was that more half of them recognized the posterior fossa tumor. Analysis of surveys showed difficulties in the interpretation of basic neurological symptoms. Lessons learned from these studies point to the fact that the success of the surgery affects mainly the histological type of tumor and its location. It is extremely important to analyze complaints and symptoms young patients, we should listen to the parents of children with, because usually just parents are the first to notice that their offspring something was wrong.

PMID: 26827561 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1SFe1zN
via IFTTT

An Unusually Benign Course of Extensive Posterior Circulation Occlusion.

Related Articles

An Unusually Benign Course of Extensive Posterior Circulation Occlusion.

J Stroke Cerebrovasc Dis. 2015 Jul;24(7):e165-8

Authors: Datar S, Lanzino G, Rabinstein AA

Abstract
BACKGROUND: Acute basilar artery occlusion is associated with poor outcome. In a few cases, occlusion occurs over a period allowing adequate collateral circulation to the posterior fossa. We describe a rare presentation with transient loss of consciousness (LOC) in a patient with extensive occlusion of the posterior circulation.
METHODS: Case report.
RESULTS: We describe a 70-year-old right-handed man with a history significant for atrial fibrillation and dolichoectasia of the basilar artery. Fourteen years ago, he had a small infarction in the pons resulting in right hemiparesis. Magnetic resonance angiogram at that time showed mild intracranial atherosclerosis. He was treated with warfarin for secondary stroke prevention. He presented to our emergency department after a witnessed spell of LOC after a large meal. On regaining consciousness, he had 2 episodes of emesis. Examination revealed only a spastic right hemiparesis from the old stroke in the pons. Cerebral angiogram showed absent flow in the mid and distal basilar arteries, both posterior cerebral arteries, and both posterior communicating arteries with bilateral stenoses of internal carotid arteries. His international normalized ratio in the emergency department was 1.1. He was treated with intravenous heparin and did well. Three months later, he underwent stent treatment of the worsening stenosis (90%) of the right internal carotid artery.
CONCLUSIONS: Occasionally, collateral circulation has the potential to maintain adequate perfusion to the posterior fossa in severe cases of posterior circulation occlusion and diffuse intracranial atherosclerotic disease. Careful patient selection is essential before planning any endovascular intervention.

PMID: 25881774 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1Wem5X2
via IFTTT

Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pilot study.

Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pilot study.

Noise Health. 2016 Mar-Apr;18(81):93-7

Authors: Singh C, Kawatra R, Gupta J, Awasthi V, Dungana H

Abstract
True tinnitus is a phantom auditory perception arising from a source or trigger in the cochlea, brainstem, or at higher centers and has no detectable acoustic generator. The most accepted is the famous neurophysiologic model of Jastreboff, which stresses that tinnitus, is a subcortical perception and results from the processing of weak neural activity in the periphery. The aim of this study is to determine the role of Vitamin B12 in treatment of chronic tinnitus. In this randomized, double-blind pilot study, total 40 patients were enrolled, of which 20 in Group A (cases) received intramuscular therapy of 1 ml Vitamin B12 (2500 mcg) weekly for a period of 6 weeks and Group B (20) patients received placebo isotonic saline 01 ml intramuscular. The patients were subjected to Vitamin B12 assay and audiometry pre- and post-therapy. Of the total patients of tinnitus, 17 were Vitamin B12 deficient that is 42.5% showed deficiency when the normal levels were considered to be 250 pg/ml. A paired t-test showed that in Group A, patients with Vitamin B12 deficiency showed significant improvement in mean tinnitus severity index score and visual analog scale (VAS) after Vitamin B12 therapy. This pilot study highlights the significant prevalence of Vitamin B12 deficiency in North Indian population and improvement in tinnitus severity scores and VAS in cobalamin-deficient patients receiving intramuscular Vitamin B12 weekly for 6 weeks further provides a link between cobalamin deficiency and tinnitus thereby suggestive of a therapeutic role of B12 in cobalamin-deficient patients of tinnitus.

PMID: 26960786 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1TzO9X8
via IFTTT

Efficacy of octreotide against chylothorax following lateral neck dissection for thyroid cancer: A case report.

Efficacy of octreotide against chylothorax following lateral neck dissection for thyroid cancer: A case report.

Int J Surg Case Rep. 2016 Feb 27;21:107-110

Authors: Hayashibara N, Ogawa T, Tsuji E, Ishizuna K

Abstract
INTRODUCTION: Postsurgical chylothorax is a rare complication of cervical dissection for thyroid cancer. We report that octreotide, a synthetic analog of somatostatin, is effective in treating chylothorax after thyroid carcinoma surgery.
PRESENTATION OF CASE: The patient was a 48-year-old woman who presented to our institution complaining of a left anterior cervical mass. We diagnosed this as thyroid papillary carcinoma and performed a subtotal excision of the thyroid gland with left cervical lymph node dissection. The patient developed dyspnea, and a chest X-ray revealed bilateral chylothorax on Day 4 post-surgery. Octreotide was administered since bilateral chylothorax was noted. A marked decrease in chyle effusion was noted just 3 days after starting octreotide, and after a total of 9 days of treatment, there were no further signs of chylous effusion.
DISCUSSION: Octreotide is effective against postsurgical chylothorax; however, if there are no signs of improvement, we believe surgical treatment should be considered.
CONCLUSION: Octreotide should be administered first to treat postsurgical chylothorax before surgical treatment is considered.

PMID: 26963261 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1P3w0cr
via IFTTT

Redislocation After a Failed Surgery to Treat C6/7 Fracture-Dislocation With Pedicular Fracture of the C6 Vertebra: Case Report of a Successful Revision Surgery, Analysis of the Causes, and Discussion of Revision Surgical Strategies.

Redislocation After a Failed Surgery to Treat C6/7 Fracture-Dislocation With Pedicular Fracture of the C6 Vertebra: Case Report of a Successful Revision Surgery, Analysis of the Causes, and Discussion of Revision Surgical Strategies.

Medicine (Baltimore). 2016 Mar;95(10):e3123

Authors: Yang Y, Ma L, Li T, Liu H

Abstract
Cervical spinal fracture-dislocation with pedicular fracture of the vertebra has been little reported and the management of such a patient is difficult. Considering the little knowledge of this area, we present this special case of a successful revision surgery for the treatment of redislocation after a failed surgery to treat C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra to share our experience.A 45-year-old male patient presented to our hospital with history of neck pain for 4 months. According to his medical records, he was involved in an architectural accident and diagnosed with C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra (ASIA: D). A surgery of posterior lateral mass screw fixation (bilateral in C5 and C7; left side in C6) was performed in a different institution. However, 4 months after his primary surgery, he was still troubled by serious neck pain and muscle weakness in all right side limbs. The physical examination of the patient showed hypoesthesia in the right side limbs, myodynamia of the right side limbs weakened to Grade 4. Cervical X-rays, computed tomography (CT), and magnetic resonance imaging confirmed the redislocation of C6/7. A successful revision surgery of anterior cervical corpectomy and fusion (ACCF) with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate was performed. The 3 months postoperative X-rays and CT scan showed the good position of the implant and bony fusion. The patient's neck pain was relived and the neurological function recovered to ASIA E grade at the 3rd month follow-up.ACCF with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate is effective for the treatment of redislocation after a failed surgery in patients of fracture-dislocation with pedicular fracture. The best method to avoid such a failed surgery is a combined anterior-posterior approach surgery in our opinion.

PMID: 26962843 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1TRPb17
via IFTTT

D-methionine (D-met) significantly reduces kanamycin-induced ototoxicity in pigmented guinea pigs.

D-methionine (D-met) significantly reduces kanamycin-induced ototoxicity in pigmented guinea pigs.

Int J Audiol. 2016 Mar 10;:1-6

Authors: Campbell KC, Martin SM, Meech RP, Hargrove TL, Verhulst SJ, Fox DJ

Abstract
OBJECTIVE: Test D-methionine (D-met) as an otoprotectant from kanamycin-induced ototoxicity and determine the lowest maximally protective D-met dose.
DESIGN: Auditory brainstem responses (ABR) were measured at 4, 8, 14, and 20 kHz at baseline and two, four, and six weeks after kanamycin and D-met administration initiation. ABR threshold shifts assessed auditory function. Following six-week ABR testing, animals were decapitated and cochleae collected for outer hair cell (OHC) quantification.
STUDY SAMPLE: Eight groups of 10 male pigmented guinea pigs were administered a subcutaneous kanamycin (250 mg/kg/dose) injection once per day and an intraperitoneal D-met injection (0 (saline), 120, 180, 240, 300, 360, 420, or 480 mg/kg/day) twice per day for 23 days.
RESULTS: Significant ABR threshold shift reductions and increased OHC counts (p ≤0.01) were measured at multiple D-met-dosed groups starting at two-week ABR assessments. A 300 mg/kg/day optimal otoprotective D-met dose provided 34-41 dB ABR threshold shift reductions and OHC protection. Lesser, but significant, D-met otoprotection was measured at lower and higher D-met doses.
CONCLUSIONS: D-met significantly reduced ABR threshold shifts and increased OHC percentages compared to kanamycin-treated controls. Results may be clinically significant particularly for multidrug-resistant tuberculosis patients who frequently suffer from kanamycin-induced hearing loss in developing countries.

PMID: 26963517 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1UXUEST
via IFTTT

Psychometric properties of a Mandarin version of the tinnitus questionnaire.

Psychometric properties of a Mandarin version of the tinnitus questionnaire.

Int J Audiol. 2016 Mar 10;:1-9

Authors: Meng Z, Chen Z, Xu K, Li G, Tao Y, Kwong JS

Abstract
OBJECTIVE: To develop a Mandarin version of the tinnitus questionnaire (MTQ) and determine the reliability and validity, and to assess whether it could be used clinically in the Chinese population.
DESIGN: The MTQ, short-form (36) health survey, hospital anxiety and depression scale, Mandarin (Chinese) tinnitus handicap inventory, and visual analogue scale were completed by the participants.
STUDY SAMPLE: We included 192 adults seeking treatment for primary or secondary tinnitus.
RESULTS: Five factors, namely, emotional distress, auditory perceptual difficulties, cognitive distress, sleep disturbance, and intrusiveness, were extracted from the MTQ. Thirty-seven items were included. The MTQ had high test-retest reliability (Spearman correlation coefficients: 0.87-1.00). The MTQ and its subscales had good internal consistency and reliability (total α = 0.93, subscales α = 0.71-0.86). A single measure of severity can be acquired by summing the five subscale scores. The MTQ was significantly correlated with psychological distress and tinnitus-related handicap.
CONCLUSION: Our results demonstrated that the MTQ is a reliable and valid measure of tinnitus-related psychopathological symptoms and could be used clinically to evaluate tinnitus-related psychological problems. Questionnaires designed to explore tinnitus-related depression and other symptoms not covered by the scope of the MTQ are needed.

PMID: 26963398 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/24UAzkR
via IFTTT

Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

Int J Audiol. 2016 Mar 10;:1-6

Authors: Picciotti PM, Lucidi D, De Corso E, Meucci D, Sergi B, Paludetti G

Abstract
OBJECTIVE: The aim of this study is to evaluate the correlation between clinical features of benign paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric diseases.
DESIGN: Retrospective review of medical records (chart review).
STUDY SAMPLE: A total of 475 patients aged from 14 to 87 years, affected by BPPV.
RESULTS: Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly higher in female and older patients. Comorbidities were present in 72.6% of subjects with recurrent BPPV vs. 48.9% of patients with no recurrence (p <0.01). Forty-two patients (8.8%) reported a cranial trauma as a triggering event. Post-traumatic patients showed a significantly higher persistence rate (45.2%) compared to patients affected by non-traumatic BPPV (20.5%). Recurrence rates are overlapping between the two groups.
CONCLUSION: Our results confirm the association between recurrence of BPPV and age, female sex, and presence of comorbidities. The correlation is stronger in patients affected by multiple associated diseases; the most frequently involved pathologies are psychiatric disorders, followed by neurological and vascular diseases. Collecting a complete medical history is important for prognostic stratification and detection of potential underlying pathological conditions.

PMID: 26963274 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/24UAz4h
via IFTTT

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults.

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults.

Int J Audiol. 2016 Mar 10;:1-6

Authors: Leigh JR, Moran M, Hollow R, Dowell RC

Abstract
OBJECTIVE: Adult selection criteria for cochlear implantation have been developed based on analysis of the post-operative performance of a large group of postlingually deafened adults. Original criteria published in 2004 were reviewed and amended to reflect outcomes currently being achieved by implant recipients.
DESIGN: Retrospective review of 12-month post-operative speech perception performance of adults implanted at the Eye and Ear Hospital, Melbourne, Australia.
STUDY SAMPLE: A total of 382 postlingually deafened adults, using a Freedom, Nucleus 5, or CI422 Slim Straight cochlear implant were used to create a comparative set of data.
RESULTS: Revised guidelines suggest that adults with postlingual hearing loss can now be considered cochlear implant candidates if they obtain scores of up to 55% for open-set phonemes in quiet in the ear to be implanted. Functional benefit may vary depending on the recipients' contralateral hearing.
CONCLUSIONS: This study supports the provision of cochlear implants to candidates with significant residual hearing when at least one ear meets the criterion outlined above. Patient-specific counseling is required to ensure the potential to benefit predicted by the current model is acceptable to the individual patient and their family. Counseling regarding functional benefit must take into consideration hearing in the contralateral ear.

PMID: 26963131 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1nCj72x
via IFTTT

D-methionine (D-met) significantly reduces kanamycin-induced ototoxicity in pigmented guinea pigs.

D-methionine (D-met) significantly reduces kanamycin-induced ototoxicity in pigmented guinea pigs.

Int J Audiol. 2016 Mar 10;:1-6

Authors: Campbell KC, Martin SM, Meech RP, Hargrove TL, Verhulst SJ, Fox DJ

Abstract
OBJECTIVE: Test D-methionine (D-met) as an otoprotectant from kanamycin-induced ototoxicity and determine the lowest maximally protective D-met dose.
DESIGN: Auditory brainstem responses (ABR) were measured at 4, 8, 14, and 20 kHz at baseline and two, four, and six weeks after kanamycin and D-met administration initiation. ABR threshold shifts assessed auditory function. Following six-week ABR testing, animals were decapitated and cochleae collected for outer hair cell (OHC) quantification.
STUDY SAMPLE: Eight groups of 10 male pigmented guinea pigs were administered a subcutaneous kanamycin (250 mg/kg/dose) injection once per day and an intraperitoneal D-met injection (0 (saline), 120, 180, 240, 300, 360, 420, or 480 mg/kg/day) twice per day for 23 days.
RESULTS: Significant ABR threshold shift reductions and increased OHC counts (p ≤0.01) were measured at multiple D-met-dosed groups starting at two-week ABR assessments. A 300 mg/kg/day optimal otoprotective D-met dose provided 34-41 dB ABR threshold shift reductions and OHC protection. Lesser, but significant, D-met otoprotection was measured at lower and higher D-met doses.
CONCLUSIONS: D-met significantly reduced ABR threshold shifts and increased OHC percentages compared to kanamycin-treated controls. Results may be clinically significant particularly for multidrug-resistant tuberculosis patients who frequently suffer from kanamycin-induced hearing loss in developing countries.

PMID: 26963517 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1UXUEST
via IFTTT

Psychometric properties of a Mandarin version of the tinnitus questionnaire.

Psychometric properties of a Mandarin version of the tinnitus questionnaire.

Int J Audiol. 2016 Mar 10;:1-9

Authors: Meng Z, Chen Z, Xu K, Li G, Tao Y, Kwong JS

Abstract
OBJECTIVE: To develop a Mandarin version of the tinnitus questionnaire (MTQ) and determine the reliability and validity, and to assess whether it could be used clinically in the Chinese population.
DESIGN: The MTQ, short-form (36) health survey, hospital anxiety and depression scale, Mandarin (Chinese) tinnitus handicap inventory, and visual analogue scale were completed by the participants.
STUDY SAMPLE: We included 192 adults seeking treatment for primary or secondary tinnitus.
RESULTS: Five factors, namely, emotional distress, auditory perceptual difficulties, cognitive distress, sleep disturbance, and intrusiveness, were extracted from the MTQ. Thirty-seven items were included. The MTQ had high test-retest reliability (Spearman correlation coefficients: 0.87-1.00). The MTQ and its subscales had good internal consistency and reliability (total α = 0.93, subscales α = 0.71-0.86). A single measure of severity can be acquired by summing the five subscale scores. The MTQ was significantly correlated with psychological distress and tinnitus-related handicap.
CONCLUSION: Our results demonstrated that the MTQ is a reliable and valid measure of tinnitus-related psychopathological symptoms and could be used clinically to evaluate tinnitus-related psychological problems. Questionnaires designed to explore tinnitus-related depression and other symptoms not covered by the scope of the MTQ are needed.

PMID: 26963398 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/24UAzkR
via IFTTT

Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

Int J Audiol. 2016 Mar 10;:1-6

Authors: Picciotti PM, Lucidi D, De Corso E, Meucci D, Sergi B, Paludetti G

Abstract
OBJECTIVE: The aim of this study is to evaluate the correlation between clinical features of benign paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric diseases.
DESIGN: Retrospective review of medical records (chart review).
STUDY SAMPLE: A total of 475 patients aged from 14 to 87 years, affected by BPPV.
RESULTS: Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly higher in female and older patients. Comorbidities were present in 72.6% of subjects with recurrent BPPV vs. 48.9% of patients with no recurrence (p <0.01). Forty-two patients (8.8%) reported a cranial trauma as a triggering event. Post-traumatic patients showed a significantly higher persistence rate (45.2%) compared to patients affected by non-traumatic BPPV (20.5%). Recurrence rates are overlapping between the two groups.
CONCLUSION: Our results confirm the association between recurrence of BPPV and age, female sex, and presence of comorbidities. The correlation is stronger in patients affected by multiple associated diseases; the most frequently involved pathologies are psychiatric disorders, followed by neurological and vascular diseases. Collecting a complete medical history is important for prognostic stratification and detection of potential underlying pathological conditions.

PMID: 26963274 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/24UAz4h
via IFTTT

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults.

Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults.

Int J Audiol. 2016 Mar 10;:1-6

Authors: Leigh JR, Moran M, Hollow R, Dowell RC

Abstract
OBJECTIVE: Adult selection criteria for cochlear implantation have been developed based on analysis of the post-operative performance of a large group of postlingually deafened adults. Original criteria published in 2004 were reviewed and amended to reflect outcomes currently being achieved by implant recipients.
DESIGN: Retrospective review of 12-month post-operative speech perception performance of adults implanted at the Eye and Ear Hospital, Melbourne, Australia.
STUDY SAMPLE: A total of 382 postlingually deafened adults, using a Freedom, Nucleus 5, or CI422 Slim Straight cochlear implant were used to create a comparative set of data.
RESULTS: Revised guidelines suggest that adults with postlingual hearing loss can now be considered cochlear implant candidates if they obtain scores of up to 55% for open-set phonemes in quiet in the ear to be implanted. Functional benefit may vary depending on the recipients' contralateral hearing.
CONCLUSIONS: This study supports the provision of cochlear implants to candidates with significant residual hearing when at least one ear meets the criterion outlined above. Patient-specific counseling is required to ensure the potential to benefit predicted by the current model is acceptable to the individual patient and their family. Counseling regarding functional benefit must take into consideration hearing in the contralateral ear.

PMID: 26963131 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1nCj72x
via IFTTT

A computer-guided minimally invasive technique for orthodontic forced eruption of impacted canines.

A computer-guided minimally invasive technique for orthodontic forced eruption of impacted canines.

Minerva Stomatol. 2016 Mar 10;

Authors: BERTELé M, Minniti PP, Dalessandri D, Bonetti S, Visconti L, Paganelli C

Abstract
BACKGROUND: The aim of this study was to develop a computer-guided minimally invasive protocol for the surgical application of an orthodontic traction during the forced eruption of an impacted canine.
METHODS: 3Diagnosys® software was used to evaluate impacted canines position and to plan the surgical access, taking into account soft and hard tissues thickness, orthodontic traction path and presence of possible obstacles. Geomagic® software was used for reverse engineering and RhinocerosTM software was employed as three-dimensional modeller in preparing individualized surgical guides. Surgical access was gained flapless through the use of a mucosal punch for soft tissues, followed by a trephine bur with a pre-adjusted stop for bone path creation. A diamond bur mounted on SONICflex® 2003/L handpiece was used to prepare a 2 mm deep calibrated hole into the canine enamel where a titanium screw connected with a stainless steel ligature was screwed. In-vitro pull-out tests, radiological and SEM analysis were realized in order to investigate screw stability and position.
RESULTS: In two out of ten samples the screw was removed after the application of a 1 kg pull-out force. Radiological and SEM analysis demonstrated that all the screws were inserted into the enamel without affecting dentine integrity.
CONCLUSION: This computer-guided minimally invasive technique allowed a precise and reliable positioning of screws utilized during the orthodontic traction of impacted canines.

PMID: 26963945 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/228mga0
via IFTTT

Low level laser therapy in non-surgical management of osteoradionecrosis of the jaws.

Low level laser therapy in non-surgical management of osteoradionecrosis of the jaws.

Minerva Stomatol. 2016 Mar 10;

Authors: Moreschi C, CAPPARé P, Meleti M, Vescovi P, Bonanini M, Gherlone EF, Gastaldi G

PMID: 26963944 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1Rb8fqo
via IFTTT

[A Clinical Study of the Sclerotherapy for Large Venous Malformations of the Pharyngolarynx with Airway Stenosis].

Related Articles

[A Clinical Study of the Sclerotherapy for Large Venous Malformations of the Pharyngolarynx with Airway Stenosis].

Nihon Jibiinkoka Gakkai Kaiho. 2015 Nov;118(11):1327-33

Authors: Mada Y, Koshitsuka K, Ueki Y, Konno A

Abstract
We treated four cases of airway stenosis associated with large venous malformations of the pharyngolarynx. The patients ranged in age from 33 to 53 years, and consisted of one male and three females. The venous malformation was located in the posterior wall of the oropharynx in two cases, in the hypopharynx in. one case, and in the anterior wall of the oropharynx in one case. All the patients complained of shortness of breath upon adopting the supine position. The patients were tracheotomized under general anesthesia and treated by sclerotherapy under videolaryngoscopic guidance. We used absolute ethanol, polidocanol or monoethanolamine oleate, as appropriate, depending on the case. In regard to the efficacy of the sclerotherapy, the venous malformation disappeared in one case and reduced in size in the remaining three cases, and no severe adverse events were recognized in any of the cases. All the patients were discharged from the hospital within two weeks and did not need tracheostomy. Sclerotherapy umder videolaryngoscopic guidance is effective for the treatment of large venous malformations in the pharyngolarynx.

PMID: 26827597 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1UGjDrw
via IFTTT

Intubation trauma and the head and neck surgeon: issues with a shared airway.

Related Articles

Intubation trauma and the head and neck surgeon: issues with a shared airway.

J R Soc Med. 2015 Nov;108(11):426-8

Authors: Montgomery J, Melia L, O'Donnell N, MacKenzie K

PMID: 26609095 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1ll4Arj
via IFTTT

Analysis of audio-vestibular assessment in acute low-tone hearing loss.

Analysis of audio-vestibular assessment in acute low-tone hearing loss.

Acta Otolaryngol. 2016 Mar 10;:1-6

Authors: Im GJ, Kim SK, Choi J, Song JJ, Chae SW, Jung HH

Abstract
Conclusion This study demonstrated excellent hearing recovery following the combined treatment of diuretic and oral steroid, and electrocochleography (ECoG) was significantly higher than normal side. This study reports characteristics of acute low-tone hearing loss (ALHL) that show the greater low-tone hearing loss, the higher ECoG, and excellent recovery, even-though low-tone hearing loss is worse, which can be different compared with sudden deafness. Objective To analyze ALHL without vertigo, this study compared the ALHL group with all patients exhibiting low-tone hearing loss and ear fullness. Hearing changes and vestibular functions were analyzed. Materials and methods ALHL was defined as a mean hearing loss of ≥ 30 dB at 125, 250, and 500 Hz, and ≤ 20 dB at 2, 4, and 8 kHz. From 156 cases of low-tone hearing loss of more than 10 dB without vertigo, 31 met the ALHL criteria and were subjected to audio-vestibular assessments including PTA, ECoG, vestibular evoked myogenic potential (VEMP) testing, and caloric testing. Results In ALHL, low-tone hearing loss was 42.7 ± 9.5 dB, and 83.9% of ALHL significantly recovered by more than 10 dB. The ECoG in ALHL was 0.334 ± 0.11 (higher than 0.25 ± 0.08 on the normal side) and ECoG abnormality was 35.5% (the greater low-tone hearing loss, the higher ECoG value).

PMID: 26963446 [PubMed - as supplied by publisher]

from Hearing and Balance via ola Kala on Inoreader http://ift.tt/1QJmDTp
via IFTTT

10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?

10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?

Eur Arch Otorhinolaryngol. 2016 Mar 9;

Authors: Olusesi AD, Abubakar J

Abstract
The clinician's major role in management of the dizzy patient involves determining what dizziness is vertigo, and what vertigo is of central or peripheral origin. These demand attention to details of history, otolaryngological workup including vestibular assessment, and often use of diagnostic and management algorithms. There is paucity of published reports of the management outcomes of peripheral vestibular diseases from Africa. Two tertiary care otologist-led dedicated vertigo clinics are located in Abuja, Nigeria. A prospective, non-randomized study of patients presenting with features of peripheral vestibular diseases attending the National Hospital Abuja Nigeria (between May 2005 and April 2014) and CSR Otologics Specialist Clinics (May 2010 to April 2014) was carried out. Both institutions adopted the same diagnostic and management protocols. Data extracted from anonymized databases created for this study include age, sex, vertigo duration (acute <12 weeks, chronic >12 weeks), dizziness handicap inventory score at presentation and at subsequent visits, otological and vestibular findings, ice-water caloric testing results, other investigation outcomes, treatments offered and outcomes. 561/575 (97.5 %) of the cases recorded had peripheral vestibular disease. The male-to-female ratio was 290:271. The mean age of the subjects was 44.7 years. Duration of vertigo at presentation was acute in 278 subjects and chronic in 283 subjects. Identifiable clinical diagnostic groups include BPPV (n = 200), Meniere's disease (n = 189), cervicogenic vertigo (n = 35), labyrinthitis (n = 32), Migraine-associated vertigo (MAV) (n = 32), cholesteatoma/perilymph Fistula (n = 10), climacteric vertigo (n = 8) and unclassified vertigo (n = 55). Migraine-associated vertigo recorded the highest DHI score (95 % CI 75 ± 4.3), followed by cholesteatoma/perilymph fistula (95 % CI 72 ± 6.1) and labyrinthitis (95 % CI 62 ± 1.9). Pure tone audiometry (95 % CI 67.3 ± 3.43), followed by thyroid function tests (95 % CI 66.7 ± 23.55) and ice-water caloric testing (95 % CI 59.7 ± 2.69) were investigations with the highest yields. 86.5 % of cases were treated by either vestibular suppressant medications alone (n = 285) and/or particle repositioning maneuver (n = 200) with improvement in vertigo control (95 % CI 63.63 to 74.37 % and 62.59 to 75.41 %, respectively). Peripheral vestibular diseases constitute majority of cases of self-reported vertigo seen in our setting. Migraine-associated vertigo seen in our setting all have peripheral vestibular signs. Dedicated vertigo clinics could significantly improve the diagnostic and treatment yield in a resource-constrained setting like ours. Most cases can be managed using non-operative measures.

PMID: 26961517 [PubMed - as supplied by publisher]

from Hearing and Balance via ola Kala on Inoreader http://ift.tt/1pczDHE
via IFTTT

Multiple cerebral artery occlusion due to non-bacterial thrombotic endocarditis: an autopsy case report.

Multiple cerebral artery occlusion due to non-bacterial thrombotic endocarditis: an autopsy case report.

Rinsho Shinkeigaku. 2016 Mar 8;

Authors: Nagakane Y, Takezawa H, Katsura K, Yamamoto Y

Abstract
A 60-year-old man was admitted to our hospital because of vertigo and repeated vomiting, which suddenly occurred 25 hours before admission. Neurologic examination revealed Wallenberg syndrome on the left side, and brain MRI showed acute infarcts in the left lateral medulla as well as in the left internal carotid artery (ICA) territory. MR angiography did not depict the left vertebral artery (VA) and the left ICA. Despite antithrombotic treatment, he developed bulbar palsy, and then, brain herniation due to infarct growth in the left middle cerebral artery territory. He died on day 9. Histopathlogical examination found verruca involving the mitral leaflet, which was consistent with non-bacterial thrombotic endocarditis (NBTE). Atherosclerosis was also found in the systemic arteries, and there was sclerotic stenosis with calcification at the portion of piercing dulla matter in the left VA and at the cavernous segment of the left ICA. Because the cerebral emboli in the narrowed lumen presented a histologic appearance similar to that of the verruca, the diagnosis of brain embolism due to NBTE was confirmed.

PMID: 26960272 [PubMed - as supplied by publisher]

from Hearing and Balance via ola Kala on Inoreader http://ift.tt/1Lgk7VE
via IFTTT

Insertion trauma of a cochlear implant electrode array with Nitinol inlay.

Insertion trauma of a cochlear implant electrode array with Nitinol inlay.

Eur Arch Otorhinolaryngol. 2016 Mar 9;

Authors: Rau TS, Harbach L, Pawsey N, Kluge M, Erfurt P, Lenarz T, Majdani O

Abstract
The integration of a shape memory actuator is a potential mechanism to achieve a consistent perimodiolar position after electrode insertion during cochlear implant surgery. After warming up, and therefore activation of the shape memory effect, the electrode array will change from a straight configuration into a spiral shaped one leading to a final position close to the modiolus. The aim of this study was to investigate whether the integration of an additional thin wire (referred to as an "inlay") made of Nitinol, a well-established shape memory alloy, in a conventional hearing preservation electrode array will affect the insertion behaviour in terms of increased risk of insertion trauma. Six conventional Hybrid-L electrode arrays (Cochlear Ltd., Sydney, Australia) were modified to incorporate a wire inlay made of Nitinol. The diameter of the wires was 100 µm with a tapered tip region. Electrodes were inserted into human temporal bone specimens using a standard surgical approach. After insertion and embedding in epoxy resin, histological sections were prepared to evaluate insertion trauma. Insertion was straightforward and no difficulties were observed. The addition of a shape memory wire, thin but also strong enough to curl the electrode array, does not result in histologically detectable insertion trauma. Atraumatic insertion seems possible.

PMID: 26961519 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1pczDY8
via IFTTT

Oral HPV prevalence in women positive for cervical HPV infection and their sexual partners: a German screening study.

Oral HPV prevalence in women positive for cervical HPV infection and their sexual partners: a German screening study.

Eur Arch Otorhinolaryngol. 2016 Mar 9;

Authors: Uken RB, Brummer O, von Schubert-Bayer C, Brodegger T, Teudt IU

Abstract
The incidence of human papillomavirus (HPV) associated oropharyngeal squamous cell cancer (OSCC) is on the rise. With the HPV-positive uterine cervix as a reservoir, HPV-positive OSCC is discussed as a sexually transmitted disease. Mechanisms of HPV transmission to the oral cavity are poorly understood. To gain more insight into HPV-transmission routes, cervically HPV-positive women and their sexual partners are screened for oral HPV infection. Women with cervical dysplasia underwent HPV testing of the uterine cervix and tonsillar region via brush test. In addition, sexual partners received oral HPV testing. Tonsillar brush tests of patients admitted for routine surgery served as the control group. The HPV-PCR (Roche Linear Array Kit) was used to differentiate 37 HPV types. All participants completed a risk-factor questionnaire focusing on sexual habits. 101 women were tested HPV-positive at the cervix. Only 3/101 (3 %) were tested HPV-positive in the oropharynx. In 60/101 (60 %) women the sexual partner could be tested for oral HPV infection: testing was positive in 3/60 (5 %). No oral HPV was detected in the control group. The risk-factor questionnaire revealed significant differences between the female study- and control group in terms of age at first sexual intercourse and smoking habits. The limited data suggest that among sexual partners in Germany, HPV transmission to the oropharynx by oral-genital sex or by autoinoculation is a rare and unlikely event with low HPV concordance. Another explanation for the low oral prevalence could be an independent clearance of HPV from the oropharyngeal site compared to cervix uteri or at different time intervals.

PMID: 26961518 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1Rb2nNZ
via IFTTT

10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?

10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?

Eur Arch Otorhinolaryngol. 2016 Mar 9;

Authors: Olusesi AD, Abubakar J

Abstract
The clinician's major role in management of the dizzy patient involves determining what dizziness is vertigo, and what vertigo is of central or peripheral origin. These demand attention to details of history, otolaryngological workup including vestibular assessment, and often use of diagnostic and management algorithms. There is paucity of published reports of the management outcomes of peripheral vestibular diseases from Africa. Two tertiary care otologist-led dedicated vertigo clinics are located in Abuja, Nigeria. A prospective, non-randomized study of patients presenting with features of peripheral vestibular diseases attending the National Hospital Abuja Nigeria (between May 2005 and April 2014) and CSR Otologics Specialist Clinics (May 2010 to April 2014) was carried out. Both institutions adopted the same diagnostic and management protocols. Data extracted from anonymized databases created for this study include age, sex, vertigo duration (acute <12 weeks, chronic >12 weeks), dizziness handicap inventory score at presentation and at subsequent visits, otological and vestibular findings, ice-water caloric testing results, other investigation outcomes, treatments offered and outcomes. 561/575 (97.5 %) of the cases recorded had peripheral vestibular disease. The male-to-female ratio was 290:271. The mean age of the subjects was 44.7 years. Duration of vertigo at presentation was acute in 278 subjects and chronic in 283 subjects. Identifiable clinical diagnostic groups include BPPV (n = 200), Meniere's disease (n = 189), cervicogenic vertigo (n = 35), labyrinthitis (n = 32), Migraine-associated vertigo (MAV) (n = 32), cholesteatoma/perilymph Fistula (n = 10), climacteric vertigo (n = 8) and unclassified vertigo (n = 55). Migraine-associated vertigo recorded the highest DHI score (95 % CI 75 ± 4.3), followed by cholesteatoma/perilymph fistula (95 % CI 72 ± 6.1) and labyrinthitis (95 % CI 62 ± 1.9). Pure tone audiometry (95 % CI 67.3 ± 3.43), followed by thyroid function tests (95 % CI 66.7 ± 23.55) and ice-water caloric testing (95 % CI 59.7 ± 2.69) were investigations with the highest yields. 86.5 % of cases were treated by either vestibular suppressant medications alone (n = 285) and/or particle repositioning maneuver (n = 200) with improvement in vertigo control (95 % CI 63.63 to 74.37 % and 62.59 to 75.41 %, respectively). Peripheral vestibular diseases constitute majority of cases of self-reported vertigo seen in our setting. Migraine-associated vertigo seen in our setting all have peripheral vestibular signs. Dedicated vertigo clinics could significantly improve the diagnostic and treatment yield in a resource-constrained setting like ours. Most cases can be managed using non-operative measures.

PMID: 26961517 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1pczDHE
via IFTTT

Postoperative Cerebrospinal Fluid Leakage Associated With Total En Bloc Spondylectomy.

Related Articles

Postoperative Cerebrospinal Fluid Leakage Associated With Total En Bloc Spondylectomy.

Orthopedics. 2015 Jul 1;38(7):e561-6

Authors: Yokogawa N, Murakami H, Demura S, Kato S, Yoshioka K, Hayashi H, Ishii T, Igarashi T, Fang X, Tsuchiya H

Abstract
Cerebrospinal fluid (CSF) leakage is a serious postoperative complication associated with total en bloc spondylectomy. The authors examined the risk factors for CSF leakage after this procedure. A total of 72 patients underwent total en bloc spondylectomy at the authors' institution between May 2010 and April 2013. Postoperative CSF leakage was observed in 17 of the 72 patients (23.6%). The results of univariate analysis suggested that age 54 years or older, preoperative surgical site irradiation, resection of 3 or more vertebral bodies, and dural injury were significant risk factors for postoperative CSF leakage after total en bloc spondylectomy. Multivariate analysis showed that preoperative surgical site irradiation was the only significant risk factor for postoperative CSF leakage (adjusted odds ratio, 5.22; 95% confidence interval, 1.03-26.45, P=.046). The authors also assessed the course of treatment for postoperative CSF leakage in each patient. Of 17 patients with postoperative CSF leakage, 13 recovered without further complications, but 4 required reoperation (2 for wound dehiscence, 1 for surgical site infection, and 1 for severe intracranial hypotension). All 4 patients who required reoperation had a history of surgical site irradiation. Thus, this study suggests that careful consideration should be given to postoperative CSF leakage in patients with a history of surgical site irradiation. These findings may contribute to the management of postoperative CSF leakage associated with total en bloc spondylectomy and supplement the information given to the patient in the process of obtaining informed consent.

PMID: 26186316 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1SFea67
via IFTTT