Lemierre's syndrome from odontogenic infection: Review of the literature and case description.

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Lemierre's syndrome from odontogenic infection: Review of the literature and case description.

Ann Maxillofac Surg. 2015 Jul-Dec;5(2):219-25

Authors: Noy D, Rachmiel A, Levy-Faber D, Emodi O

Abstract
Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: "Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival." We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.

PMID: 26981474 [PubMed]

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Retrospective analysis of etiology and comorbid diseases associated with Ludwig's Angina.

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Retrospective analysis of etiology and comorbid diseases associated with Ludwig's Angina.

Ann Maxillofac Surg. 2015 Jul-Dec;5(2):168-73

Authors: Botha A, Jacobs F, Postma C

Abstract
INTRODUCTION: Ludwig's angina (LA) still presents regularly at our tertiary academic hospital. Various etiologies and comorbid diseases are documented worldwide, but the South African population has not been studied.
AIM: To establish whether LA cases presenting to the department are different from international reports regarding etiology and comorbidities.
SETTINGS AND DESIGN: Retrospective analysis of patients presenting with LA to a tertiary hospital.
MATERIALS AND METHODS: 93 patients were included over a 5-year period. Archived files were analyzed for data including age, gender, comorbid diseases, etiology, airway management, and season on admission.
STATISTICAL ANALYSIS: Descriptive statistics with the inclusion of frequency distributions.
RESULTS: 93 patients were included; 65 (69.9%) male and 28 (30.1%) female; age - minimum 20 years, maximum 75 years, mean 40.366.
ETIOLOGY: 68 (73.1%) odontogenic, 13 (14%) nonodontogenic, and 12 (12.9%) unknown cause. Comorbid diseases: 21 (22.6%) diabetes mellitus (DM), 19 (20.4%) hypertension, and 18 (19.4%) human immunodeficiency virus (HIV). Airway management: 61 (65.6%) tracheostomy and 32 (34.4%) nonsurgical.
COMPLICATIONS: 11 (11.8%) deaths, 8 (8.60%) descending mediastinitis, and 7 (7.53%) necrotizing fasciitis. Seasonal occurrence: 30 (32.3%) spring, 24 (25.8%) winter, 22 (23.7%) summer, and 17 (18.3%) autumn.
CONCLUSION: A 2.32:1 ratio male: female presentation mirrors previous statistics. DM patients had increased risks of complications, which resulted in multiple deaths. HIV patients showed increased risks for complications with more intense, longer hospital stays, but lower percentages of deaths compared to patients with DM and complications who died. There was no statistically significant finding regarding seasonal tendency.

PMID: 26981465 [PubMed]

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Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.

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Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.

World J Gastroenterol. 2015 Jun 28;21(24):7558-62

Authors: Hägg M, Tibbling L, Franzén T

Abstract
AIM: To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms.
METHODS: A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (≥ 15 N), velopharyngeal closure test (≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry.
RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7 (0-3) vs 0.5 (0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71 (30-100) vs 22 (0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N (12-80 N) vs 54 N (27-116), P < 0.001] and velopharyngeal closure test values [28 s (5-74 s) vs 34 s (13-80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mmHg at rest (range: 0-0 mmHG) to 65 mmHg (range: 20-100 mmHg).
CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

PMID: 26140003 [PubMed - indexed for MEDLINE]

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Genomic alterations of anaplastic thyroid carcinoma detected by targeted massive parallel sequencing in a BRAFV600E mutation-prevalent area.

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Genomic alterations of anaplastic thyroid carcinoma detected by targeted massive parallel sequencing in a BRAFV600E mutation-prevalent area.

Thyroid. 2016 Mar 16;

Authors: Jeon M, Chun SM, Kim D, Kwon H, Jang EK, Kim TY, Kim WB, Shong Y, Jang SJ, Song DE, Kim WG

Abstract
BACKGROUND: Anaplastic thyroid carcinoma (ATC), the most aggressive type of thyroid cancer, has no effective therapy. Due to its dismal prognosis, it is vital to understand the genetic alterations of ATC and identify effective molecular targets. We performed targeted next-generation sequencing to investigate the mutational profile of ATC using a massive parallel sequencing approach.
METHODS: DNA from formalin-fixed, paraffin-embedded archival samples of 11 ATCs and normal matched pairs were used. We identified 48 genetic alterations by targeted exome sequencing. These alterations were validated by mass spectrometric genotyping and direct Sanger sequencing.
RESULTS: The most commonly mutated gene was BRAF, identified in 10 samples (91%), all showing the V600E point mutation. A KRAS point mutation was observed in the one sample (9%) without the BRAF V600E mutation. All 11 ATCs harbored BRAF or RAS mutations, reflecting the possibility that differentiated thyroid carcinomas progress to ATCs after the accumulation of mutations. A loss of function mutation of TP53 was observed in eight samples (73%), a PIK3CA mutation was observed in two samples (18%), and a frameshift mutation of PTEN was observed in one sample (9%). We found 28 novel mutated genes that had not previously been associated with ATC. Of these, loss of function mutations of NF2, KMT2D, and PKHD1 were repeatedly seen in three samples (27%), two samples (18%) and two samples (18%), respectively. Using direct Sanger sequencing, we also found two samples (18%) with a RASAL1 mutation. KMT2D and RASAL1 mutations were significantly associated with shorter ATC patient survival.
CONCLUSIONS: This comprehensive analysis of ATCs using targeted massive parallel sequencing identified several novel mutations in ATCs, such as loss of function mutations of NF2 or KMT2D. Future studies are needed to confirm the role of these novel mutations as independent drivers of ATC development.

PMID: 26980298 [PubMed - as supplied by publisher]

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Acta Oto-laryngologica Prize 2015.

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Acta Oto-laryngologica Prize 2015.

Acta Otolaryngol. 2016 Mar 16;:1

Authors: Anniko M

PMID: 26982284 [PubMed - as supplied by publisher]

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Superparamagnetic nanoparticles as vectors for inner ear treatments: driving and toxicity evaluation.

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Superparamagnetic nanoparticles as vectors for inner ear treatments: driving and toxicity evaluation.

Acta Otolaryngol. 2016 Mar 16;:1-7

Authors: Nguyen Y, Celerier C, Pszczolinski R, Claver J, Blank U, Ferrary E, Sterkers O

Abstract
Conclusion Super paramagnetic nanoparticles (MNP) are a promising vector to achieve controlled drug delivery into the cochlea. Objective The goal of the study was to evaluate the toxicological risk of MNP upon the inner ear. Methods Fe3O4-MNP displacement was studied in various catheter materials, shape, and solvent with a local magnetic field. EC5V cells (derived from the inner ear) were cultured with MNP (100 and 500 nm) at various concentrations or without MNP. Cell survival was assessed with a flow cytometry analysis. Localization of MNP within the cells was studied with confocal microscopy. In vivo, a single intra-cochlear administration of 200 nm MNP (3 × 10(10)MNP/mL, n = 8; 1.5 × 10(12) MNP/mL, n = 6) or saline (n = 14) was performed in guinea pigs. Hearing thresholds were assessed with auditory brainstem responses at Day 7. Results MNP could be concentrated at different locations of the catheter with sequential activation of solenoids. MNP were internalized in the cytoplasm, but not in the nuclei nor in endosomes at 48 h. After 48 h of incubation, no difference for cell survival between the groups was observed, whatever the MNP concentration. A size effect was observed with less survival in the 100 nm group. In guinea pigs at day 7, hearing threshold shift was not different in the three groups.

PMID: 26982172 [PubMed - as supplied by publisher]

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The expression and prognostic relevance of indoleamine 2,3-dioxygenase in tongue squamous cell carcinoma.

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The expression and prognostic relevance of indoleamine 2,3-dioxygenase in tongue squamous cell carcinoma.

Acta Otolaryngol. 2016 Mar 16;:1-7

Authors: Seppälä M, Halme E, Tiilikainen L, Luukkainen A, Laranne J, Rautiainen M, Huhtala H, Paavonen T, Toppila-Salmi S

Abstract
Conclusion IDO might be useful for predicting progression of primary tumor stage T2 and T3 in tongue squamous cell carcinoma (TSCC), but does not seem like a specific biomarker for diagnosing TSCC and predicting patient survival. Objectives Indoleamine 2,3-dioxygenase (IDO) is expressed in many cells and it catabolises the essential amino acid tryptophan to kynurenine. IDO acts as an immune modulator through suppression of T-cell immunity and other pathways. In cancer cells, IDO has been proposed to promote tumor progression by enabling malignant cells to escape from the immune system. The aim of this study was to evaluate the association and prognostic relevance of IDO expression in TSCC. Method One hundred and eight retrospective tongue and lymph node specimens were stained immunohistochemically with monoclonal antibody anti-indoleamine 2,3-dioxygenase. The relative abundance of IDO positive epithelial cells, IDO staining intensity, and inflammation were assessed semi-quantitatively with light microscopy. Results IDO was expressed stronger in tongue hyperplasia than in TSCC. However, IDO expression associated with poor survival in the sub-groups with primary tumor stage T2-T4 and in the sub-group with strong inflammation in tumors' invasive front.

PMID: 26982018 [PubMed - as supplied by publisher]

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The auditory characteristics of children with inner auditory canal stenosis.

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The auditory characteristics of children with inner auditory canal stenosis.

Acta Otolaryngol. 2016 Mar 16;:1-5

Authors: Ai Y, Xu L, Li L, Li J, Luo J, Wang M, Fan Z, Wang H

Abstract
Conclusions This study shows that the prevalence of auditory neuropathy spectrum disorder (ANSD) in the children with inner auditory canal (IAC) stenosis is much higher than those without IAC stenosis, regardless of whether they have other inner ear anomalies. In addition, the auditory characteristics of ANSD with IAC stenosis are significantly different from those of ANSD without any middle and inner ear malformations. Objectives To describe the auditory characteristics in children with IAC stenosis as well as to examine whether the narrow inner auditory canal is associated with ANSD. Method A total of 21 children, with inner auditory canal stenosis, participated in this study. A series of auditory tests were measured. Meanwhile, a comparative study was conducted on the auditory characteristics of ANSD, based on whether the children were associated with isolated IAC stenosis. Results Wave V in the ABR was not observed in all the patients, while cochlear microphonic (CM) response was detected in 81.1% ears with stenotic IAC. Sixteen of 19 (84.2%) ears with isolated IAC stenosis had CM response present on auditory brainstem responses (ABR) waveforms. There was no significant difference in ANSD characteristics between the children with and without isolated IAC stenosis.

PMID: 26981851 [PubMed - as supplied by publisher]

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Comparative outcomes of active and passive hearing devices by transcutaneous bone conduction.

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Comparative outcomes of active and passive hearing devices by transcutaneous bone conduction.

Acta Otolaryngol. 2016 Mar 16;:1-3

Authors: Zernotti ME, Di Gregorio MF, Galeazzi P, Tabernero P

Abstract
Conclusion Bonebridge (BB) and Sophono (SP) devices improved hearing; with the BB implant showing a better performance at medium and high frequencies. Furthermore, the BB, as an active implant, showed higher functional gain and increased time of use, when compared to the SP, a passive system. Objectives This study aims to compare surgical and audiological outcomes of SP and BB devices in order to assess and further differentiate the indication criteria. Methods Fourteen patients with conductive and mixed hearing loss were evaluated pre- and post-operatively (BB or SP) (period 2013-2014). Age, gender, surgical history, cause and type of hearing loss, implant use per day, levels of bone and air conduction, and functional gain were recorded. Data was analysed by Wilcoxon singed-rank and Wilcoxon rank-sum tests. Results Fourteen patients (BB; n = 10 and SP; n = 4) with an average age = 25.42 years (CI95 = 12.41-38.43) were evaluated. The gender relation was equal (1:1), with pre-implantation osseous thresholds of 20.42 dB (CI95 = 11.15-29.69), and pre-implantation aerial thresholds of 70.83 dB (CI95 = 62.52-79.14). The SP wearing time was significantly lower than that of the BB (SP = 7-10 h/day, BB = 8-12 h/day; p = 0.0323). The functional gain did not differ significantly between the two devices (BB = 40.00 ± 13.19 dB, SP = 34.06 ± 15.63 dB; p = 0.3434), but a significant improvement from pre- to post-implantation was observed (p < 0.05). BB and SP decreased auditory thresholds at 1 and 2 kHz (< 0.01), respectively. The BB even significantly decreased thresholds at 0.5 kHz (p = 0.0140) and 4 kHz (p < 0.0001). No relevant surgical complications were found.

PMID: 26981711 [PubMed - as supplied by publisher]

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"Am J Rhinol Allergy"[jour]; +21 new citations

21 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Am J Rhinol Allergy"[jour]

These pubmed results were generated on 2016/03/17

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch.

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Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch.

Case Rep Med. 2016;2016:9809017

Authors: Correia I, Marques IB, Ferreira R, Cordeiro M, Sousa L

Abstract
Spontaneous intracranial hypotension (SIH) is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF) leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.

PMID: 26981128 [PubMed]

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"Otolaryngol Head Neck Surg"[jour]; +18 new citations

18 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Otolaryngol Head Neck Surg"[jour]

These pubmed results were generated on 2016/03/17

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Superparamagnetic nanoparticles as vectors for inner ear treatments: driving and toxicity evaluation.

Related Articles

Superparamagnetic nanoparticles as vectors for inner ear treatments: driving and toxicity evaluation.

Acta Otolaryngol. 2016 Mar 16;:1-7

Authors: Nguyen Y, Celerier C, Pszczolinski R, Claver J, Blank U, Ferrary E, Sterkers O

Abstract
Conclusion Super paramagnetic nanoparticles (MNP) are a promising vector to achieve controlled drug delivery into the cochlea. Objective The goal of the study was to evaluate the toxicological risk of MNP upon the inner ear. Methods Fe3O4-MNP displacement was studied in various catheter materials, shape, and solvent with a local magnetic field. EC5V cells (derived from the inner ear) were cultured with MNP (100 and 500 nm) at various concentrations or without MNP. Cell survival was assessed with a flow cytometry analysis. Localization of MNP within the cells was studied with confocal microscopy. In vivo, a single intra-cochlear administration of 200 nm MNP (3 × 10(10)MNP/mL, n = 8; 1.5 × 10(12) MNP/mL, n = 6) or saline (n = 14) was performed in guinea pigs. Hearing thresholds were assessed with auditory brainstem responses at Day 7. Results MNP could be concentrated at different locations of the catheter with sequential activation of solenoids. MNP were internalized in the cytoplasm, but not in the nuclei nor in endosomes at 48 h. After 48 h of incubation, no difference for cell survival between the groups was observed, whatever the MNP concentration. A size effect was observed with less survival in the 100 nm group. In guinea pigs at day 7, hearing threshold shift was not different in the three groups.

PMID: 26982172 [PubMed - as supplied by publisher]

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Impact of Nodal Level Distribution on Survival in Oral Cavity Squamous Cell Carcinoma: A Population-Based Study.

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Impact of Nodal Level Distribution on Survival in Oral Cavity Squamous Cell Carcinoma: A Population-Based Study.

Otolaryngol Head Neck Surg. 2016 Mar 15;

Authors: Marchiano E, Patel TD, Eloy JA, Baredes S, Park RC

Abstract
OBJECTIVE: Regional lymph node metastasis is an important prognostic factor in squamous cell carcinoma of the head and neck, decreasing survival by up to 50%. Oral cavity squamous cell carcinoma (OC-SCCa) most commonly spreads to levels I, II, and III.
STUDY DESIGN: Retrospective analysis of a population-based tumor registry.
SETTING: Academic medical center.
SUBJECTS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of OC-SCCa from 2004 to 2011 (22,973 cases). Resulting data including patient demographics, clinicopathological features, topographical distribution of nodal metastasis, and survival based on lymph node level involvement were analyzed.
RESULTS: In total, 8281 patients were identified with OC-SCCa who underwent neck dissection. Level I, closely followed by levels II and III, represented the most commonly involved nodal basins. The 5-year disease-specific survival (DSS) for patients with only level I, II, or III was 42.0% compared with 30.6% for the level IV group (P < .0001) and 26.4% for the level V group (P < .0001). Surgery with adjuvant radiotherapy improved 5-year DSS for patients with level I to III, level IV, and level V neck disease compared with surgery alone (50.7% vs 48.6%, P = .0109; 39.9% vs 23.2%, P < .0001; and 33.3% vs 9.1%, P = .0005, for levels I-III, IV, and V, respectively).
CONCLUSION: Oral cavity squamous cell carcinoma most commonly involves nodal levels I, II, and III. Involvement of nodal level IV or V portends a worse prognosis than patients with only level I to III disease, and multimodality therapy should be considered for these patients.

PMID: 26980921 [PubMed - as supplied by publisher]

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Reconstruction of Lateral Skull Base Defects: A Comparison of the Submental Flap to Free and Regional Flaps.

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Reconstruction of Lateral Skull Base Defects: A Comparison of the Submental Flap to Free and Regional Flaps.

Otolaryngol Head Neck Surg. 2016 Mar 15;

Authors: Howard BE, Nagel TH, Barrs DM, Donald CB, Hayden RE

Abstract
OBJECTIVES: To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary academic referral center.
SUBJECTS: Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014.
METHODS: Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes.
RESULTS: Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P = .00817) and duration of hospitalization (4.9 vs 9.8 days; P = .02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P < .00001) and free flaps (mean, 1.6; P < .00001). There was 100% flap survival.
CONCLUSION: The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.

PMID: 26980913 [PubMed - as supplied by publisher]

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Systematic review of the effectiveness of perioperative prophylactic antibiotics for skull base surgeries.

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Systematic review of the effectiveness of perioperative prophylactic antibiotics for skull base surgeries.

Am J Rhinol Allergy. 2016 Mar;30(2):10-6

Authors: Rosen SA, Getz AE, Kingdom T, Youssef AS, Ramakrishnan VR

Abstract
BACKGROUND: Perioperative antibiotics are commonly used in endoscopic skull base surgeries as prophylaxis for infectious complications, e.g., meningitis. The role of perioperative prophylactic antibiotics in endoscopic sinus surgery is unclear, and the routine use of prophylactic antibiotics in endoscopic skull base surgery is also highly debated. Currently, there is no formal recommendation for perioperative antibiotic use in skull base surgery, and regimens vary greatly from one institution to the next.
OBJECTIVE: To assess perioperative antibiotics as prophylaxis against infectious complications in patients who underwent endoscopic skull base surgery.
DATA SOURCES: PubMed, Ovid EMBASE, and the Cochrane Library.
METHODS: A systematic review that examined perioperative antibiotic use in endoscopic skull base and craniofacial surgeries was conducted. Inclusion criteria were prospective or retrospective study design and clinical trials related to the use of antibiotics within 30 days of skull base surgery. End points included infectious complications such as (1) meningitis and (2) sinusitis.
RESULTS: A total of 2543 articles were identified by the initial search, and 5 articles met inclusion criteria. The five eligible trials were all observational and involved different types of skull base surgical procedures and antibiotic regimens.
CONCLUSIONS: Despite institutional variability in antibiotic regimens, meningitis rarely occurs after skull base procedures and seems to be encountered most frequently in open craniofacial surgeries. A systematic review revealed a limited number of published studies, all observational in study design, which precluded a formal meta-analysis. A novel large-scale randomized-controlled clinical trial is needed to evaluate antibiotic selection and need in endoscopic skull base surgery.

PMID: 26980379 [PubMed - in process]

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Diode Laser Stapedotomy vs Conventional Stapedotomy in Otosclerosis: A Double-Blinded Randomized Clinical Trial.

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Diode Laser Stapedotomy vs Conventional Stapedotomy in Otosclerosis: A Double-Blinded Randomized Clinical Trial.

Otolaryngol Head Neck Surg. 2016 Mar 15;

Authors: Parida PK, Kalaiarasi R, Gopalakrishnan S

Abstract
OBJECTIVES: To assess and compare the efficacy of diode laser stapedotomy (DLS) and conventional manual stapedotomy (CMS) in the treatment of otosclerosis.
STUDY DESIGN: Randomized clinical trial.
SETTING: Tertiary health center.
SUBJECTS AND METHODS: We randomly assigned 60 patients with otosclerosis planned for primary stapedotomy to receive either DLS or CMS. Primary outcome measure was hearing gain measured by pure-tone audiometry (PTA) performed preoperatively and postoperatively. Hearing gain was compared within and between the groups. Secondary outcome measures were the incidence of intraoperative (bleeding and fractured footplate) and postoperative (vomiting, vertigo, sensorineural hearing loss, tinnitus, facial nerve paralysis, and hospital stay) morbidities.
RESULTS: Sixty primary stapedotomies (30 in the CMS group and 30 in the DLS group) done for 60 patients (male, n = 42; female, n = 18) were included in the analysis. Preoperative mean air-bone (AB) gap in the DLS and CMS groups was 38.51 ± 8.643 dB and 36.42 ± 8.678 dB, respectively. Mean AB gap at 6 month was 10.86 ± 5.383 dB and 11.05 ± 5.236 dB in the CMS and DLS groups, respectively. Air conduction was improved by 24.98 ± 5.348 dB in the DLS group and 24.08 ± 5.911 dB in the CMS group at 6 months. No statistically significant differences were found in hearing gain between the 2 groups at 6 months (P > .05). A decreased rate and severity of intraoperative bleeding, postoperative vertigo, and vomiting were observed with the diode laser (0%, 6.6%, and 10%) compared with the conventional technique (16.7%, 16.7%, and 16.7%), but these differences were not statistically significant (P > .05).
CONCLUSION: Hearing outcomes and complications of DLS were similar to CMS. These study findings confirm the efficacy of the diode laser in stapedotomy, but DLS offers no advantages over CMS for otosclerosis surgery.

PMID: 26980905 [PubMed - as supplied by publisher]

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Diode Laser Stapedotomy vs Conventional Stapedotomy in Otosclerosis: A Double-Blinded Randomized Clinical Trial.

Related Articles

Diode Laser Stapedotomy vs Conventional Stapedotomy in Otosclerosis: A Double-Blinded Randomized Clinical Trial.

Otolaryngol Head Neck Surg. 2016 Mar 15;

Authors: Parida PK, Kalaiarasi R, Gopalakrishnan S

Abstract
OBJECTIVES: To assess and compare the efficacy of diode laser stapedotomy (DLS) and conventional manual stapedotomy (CMS) in the treatment of otosclerosis.
STUDY DESIGN: Randomized clinical trial.
SETTING: Tertiary health center.
SUBJECTS AND METHODS: We randomly assigned 60 patients with otosclerosis planned for primary stapedotomy to receive either DLS or CMS. Primary outcome measure was hearing gain measured by pure-tone audiometry (PTA) performed preoperatively and postoperatively. Hearing gain was compared within and between the groups. Secondary outcome measures were the incidence of intraoperative (bleeding and fractured footplate) and postoperative (vomiting, vertigo, sensorineural hearing loss, tinnitus, facial nerve paralysis, and hospital stay) morbidities.
RESULTS: Sixty primary stapedotomies (30 in the CMS group and 30 in the DLS group) done for 60 patients (male, n = 42; female, n = 18) were included in the analysis. Preoperative mean air-bone (AB) gap in the DLS and CMS groups was 38.51 ± 8.643 dB and 36.42 ± 8.678 dB, respectively. Mean AB gap at 6 month was 10.86 ± 5.383 dB and 11.05 ± 5.236 dB in the CMS and DLS groups, respectively. Air conduction was improved by 24.98 ± 5.348 dB in the DLS group and 24.08 ± 5.911 dB in the CMS group at 6 months. No statistically significant differences were found in hearing gain between the 2 groups at 6 months (P > .05). A decreased rate and severity of intraoperative bleeding, postoperative vertigo, and vomiting were observed with the diode laser (0%, 6.6%, and 10%) compared with the conventional technique (16.7%, 16.7%, and 16.7%), but these differences were not statistically significant (P > .05).
CONCLUSION: Hearing outcomes and complications of DLS were similar to CMS. These study findings confirm the efficacy of the diode laser in stapedotomy, but DLS offers no advantages over CMS for otosclerosis surgery.

PMID: 26980905 [PubMed - as supplied by publisher]

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CORLAS group photo 2015.

Related Articles

CORLAS group photo 2015.

Acta Otolaryngol. 2016 Mar 16;:1

Authors:

PMID: 26982456 [PubMed - as supplied by publisher]

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Acta Oto-laryngologica Prize 2015.

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Acta Oto-laryngologica Prize 2015.

Acta Otolaryngol. 2016 Mar 16;:1

Authors: Anniko M

PMID: 26982284 [PubMed - as supplied by publisher]

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Superparamagnetic nanoparticles as vectors for inner ear treatments: driving and toxicity evaluation.

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Superparamagnetic nanoparticles as vectors for inner ear treatments: driving and toxicity evaluation.

Acta Otolaryngol. 2016 Mar 16;:1-7

Authors: Nguyen Y, Celerier C, Pszczolinski R, Claver J, Blank U, Ferrary E, Sterkers O

Abstract
Conclusion Super paramagnetic nanoparticles (MNP) are a promising vector to achieve controlled drug delivery into the cochlea. Objective The goal of the study was to evaluate the toxicological risk of MNP upon the inner ear. Methods Fe3O4-MNP displacement was studied in various catheter materials, shape, and solvent with a local magnetic field. EC5V cells (derived from the inner ear) were cultured with MNP (100 and 500 nm) at various concentrations or without MNP. Cell survival was assessed with a flow cytometry analysis. Localization of MNP within the cells was studied with confocal microscopy. In vivo, a single intra-cochlear administration of 200 nm MNP (3 × 10(10)MNP/mL, n = 8; 1.5 × 10(12) MNP/mL, n = 6) or saline (n = 14) was performed in guinea pigs. Hearing thresholds were assessed with auditory brainstem responses at Day 7. Results MNP could be concentrated at different locations of the catheter with sequential activation of solenoids. MNP were internalized in the cytoplasm, but not in the nuclei nor in endosomes at 48 h. After 48 h of incubation, no difference for cell survival between the groups was observed, whatever the MNP concentration. A size effect was observed with less survival in the 100 nm group. In guinea pigs at day 7, hearing threshold shift was not different in the three groups.

PMID: 26982172 [PubMed - as supplied by publisher]

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Perceptual, durational and tongue displacement measures following articulation therapy for rhotic sound errors.

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Perceptual, durational and tongue displacement measures following articulation therapy for rhotic sound errors.

Clin Linguist Phon. 2016 Mar 16;:1-18

Authors: Bressmann T, Harper S, Zhylich I, Kulkarni GV

Abstract
Outcomes of articulation therapy for rhotic errors are usually assessed perceptually. However, our understanding of associated changes of tongue movement is limited. This study described perceptual, durational and tongue displacement changes over 10 sessions of articulation therapy for /ɹ/ in six children. Four of the participants also received ultrasound biofeedback of their tongue shape. Speech and tongue movement were recorded pre-therapy, after 5 sessions, in the final session and at a one month follow-up. Perceptually, listeners perceived improvement and classified more productions as /ɹ/ in the final and follow-up assessments. The durations of VɹV syllables at the midway point of the therapy were longer. Cumulative tongue displacement increased in the final session. The average standard deviation was significantly higher in the middle and final assessments. The duration and tongue displacement measures illustrated how articulation therapy affected tongue movement and may be useful for outcomes research about articulation therapy.

PMID: 26979162 [PubMed - as supplied by publisher]

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Buccinator Myomucosal Flap for Treatment of Osteoradionecrosis of the Mandible.

Buccinator Myomucosal Flap for Treatment of Osteoradionecrosis of the Mandible.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):85-8

Authors: Woo SH

Abstract
The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.

PMID: 26976033 [PubMed]

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Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma.

Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):75-9

Authors: Choi SY, Cho JK, Moon JH, Son YI

Abstract
OBJECTIVES: This study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma.
METHODS: After reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR.
RESULTS: The MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001).
CONCLUSION: When the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.

PMID: 26976031 [PubMed]

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Voice Outcome in Patients Treated With Endoscopic Laryngopharyngeal Surgery for Superficial Hypopharyngeal Cancer.

Voice Outcome in Patients Treated With Endoscopic Laryngopharyngeal Surgery for Superficial Hypopharyngeal Cancer.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):70-4

Authors: Tateya I, Morita S, Ishikawa S, Muto M, Hirano S, Kishimoto Y, Hiwatashi N, Ito J

Abstract
OBJECTIVES: Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery that was developed to treat superficial larygo-pharyngeal cancer, in which a mucosal lesion is resected transorally while preserving deeper structures by subepithelial injection. The purpose of this retrospective study is to evaluate voice outcome in patients who underwent ELPS for superficial hypopharyngeal cancer. As important structures in producing voice, such as intrinsic laryngeal muscles, their fascia, and recurrent laryngeal nerve, are located in the medial side of the piriform sinus and the postcricoid region of the hypopharynx, we focused on patients with cancer lesions involving these regions.
METHODS: From April 2010 to March 2011, 25 consecutive patients with superficial laryngopharyngeal cancer were treated with ELPS at Kyoto University Hospital. Among the 25 patients, 11 patients with cancer lesions on the medial side of the piriform sinus or the postcricoid area were studied. Preoperative and postoperative voice functions including maximum phonation time (MPT), mean flow rate (MFR), jitter, shimmer, soft phonation index (SPI), and noise-to-harmonic ratio (NHR), were compared retrospectively.
RESULTS: Five of 11 cancer lesions had submucosal invasion and no lesion had invaded the muscular layer pathologically. T stage was classified as Tis in 5 cases, T1 in 4 cases, and T2 in 2 cases. All lesions involved the medial side of the piriform sinus and 2 also involved the postcricoid area. Vocal fold movement was normal in all cases after the surgery. Average preoperative and postoperative values for MPT, MFR, jitter, shimmer, SPI, and NHR, were 22.7 seconds and 23.4 seconds, 165 mL/sec and 150 mL/sec, 1.53% and 1.77%, 3.82% and 5.17%, 35.5 and 36.6, and 0.13% and 0.14%, respectively. There was no statistical difference between preoperative and postoperative data for all values examined.
CONCLUSION: ELPS is useful in preserving voice function in the treatment of superficial hypopharyngeal cancer. Preserving the deeper structures including intrinsic muscles and their fascia may be important for preserving voice function as long as the lesions are superficial.

PMID: 26976030 [PubMed]

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Prognostic Impact of Ultrasonography Features and (18)F-Fluorodeoxyglucose Uptake in Patients With Papillary Thyroid Microcarcinoma.

Prognostic Impact of Ultrasonography Features and (18)F-Fluorodeoxyglucose Uptake in Patients With Papillary Thyroid Microcarcinoma.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):62-9

Authors: Seo JW, Hwang SH, Cho A, Lee HS, Kim EK, Moon HJ, Yoon JH, Kwak JY

Abstract
OBJECTIVES: To evaluate the prognostic impact of ultrasonography (US) features and (18)F-fluorodeoxyglucose ((18)F-FDG) uptake in patients with papillary thyroid microcarcinoma (PTMC).
METHODS: This study included 74 patients with a single PTMC diagnosed pathologically. Patients underwent total thyroidectomy, or near-total thyroidectomy and staging thyroid US and positron emission tomography (PET) were performed prior to surgery. US features of thyroid nodules were reviewed retrospectively and the maximum standard uptake value (SUV) of nodules was semiquantitatively analyzed on (18)F-FDG PET/computed tomography (CT). Patients were followed-up for recurrence, which was defined as PTC on cytology results, elevated serum thyroglobulin (Tg) or anti-Tg antibody levels, or uptake on whole-body scintigraphy. We used univariate and multivariate analyses to evaluate whether poor prognostic outcomes were associated with US features or SUV values derived from PET/CT of nodules. In addition, subjects were divided into 2 groups for subgroup analyses: one with nodules equal to or larger than 5 mm and one with nodules smaller than 5 mm.
RESULTS: Among the 74 patients, there was no recurrence. Thus we evaluated the correlation between SUV value and US features with poor prognostic factors of PTMC which included extrathyroid extension, central and lateral lymph node (LN) metastasis. However no clinicopathologic factors were associated with extrathyroid extension, central LN metastasis, or lateral LN metastasis.
CONCLUSION: In patients with PTMC, US features and SUV values on FDG-PET were not related to extrathyroid extension or LN metastasis. However, future studies with a larger sample size and longer follow-up should be performed to verify the results of this study.

PMID: 26976029 [PubMed]

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Histological Effect of Basic Fibroblast Growth Factor on Chronic Vocal Fold Scarring in a Rat Model.

Histological Effect of Basic Fibroblast Growth Factor on Chronic Vocal Fold Scarring in a Rat Model.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):56-61

Authors: Tateya I, Tateya T, Sohn JH, Bless DM

Abstract
OBJECTIVES: Vocal fold scarring is one of the most challenging laryngeal disorders to treat and there are currently no consistently effective treatments available. Our previous studies have shown the therapeutic potential of basic fibroblast growth factor (bFGF) for vocal fold scarring. However, the histological effects of bFGF on scarred vocal fold have not been elucidated. The aim of this study was to examine the histological effects of bFGF on chronic vocal fold scarring.
METHODS: Sprague-Dawley rats were divided into phosphate buffered saline (sham) and bFGF groups. Unilateral vocal fold stripping was performed and the drug was injected into the scarred vocal fold for each group 2 months postoperatively. Injections were performed weekly for 4 weeks. Two months after the last injection, larynges were harvested and histologically analyzed.
RESULTS: A significant increase of hyaluronic acid was observed in the vocal fold of the bFGF group compared with that of the sham group. However, there was no remarkable change in collagen expression nor in vocal fold contraction.
CONCLUSION: Significant increase of hyaluronic acid by local bFGF injection was thought to contribute to the therapeutic effects on chronic vocal fold scarring.

PMID: 26976028 [PubMed]

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Improvement of Pulmonary Functions Following Septoplasty: How Are Lower Airways Affected?

Improvement of Pulmonary Functions Following Septoplasty: How Are Lower Airways Affected?

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):51-5

Authors: Tuzuner A, Bilgin G, Demirci S, Yuce GD, Acikgoz C, Samim EE

Abstract
OBJECTIVES: Nasal septal deviation is a frequent cause of increased nasal airway resistance. A narrow nasal airway would result in a decreased airflow into the lungs. The aim of the present study was to evaluate the alterations of the pulmonary functions following septoplasty using spirometry and 6 minutes walking test (6mWT). And reveal the correlation of symptom score improvement with nasal obstruction symptom score (NOSE) and sino-nasal outcome test (SNOT22) questionnaires following surgery.
METHODS: Thirty patients with obvious nasal septal deviations were enrolled in the study. All patients had a detailed otorhinolaryngologic examination, filled NOSE/SNOT22 questionnaires, performed spirometry and 6mWT preoperatively. One month after surgery, NOSE/SNOT22 questionnaires filled by subjects and spirometry with 6mWT were performed again, and the results were compared.
RESULTS: The mean total walking distance was 702.3±68.2 m preoperatively, and it improved to 753.2±72.6 m postoperatively (P<0.001). Total tour count increased from 11 (range, 10.8 to 12.0) to 12 (range, 11 to 13.3), and the difference was found statistically significant (P<0.001). When the preoperative and postoperative mean 6mWT results were compared, diastolic blood pressure increased from 70 to 80 mmHg (P=0.031), heart rate increased from 83.5±13.2 to 90.1±12.5 bpm (P=0.017), dyspnea rate decreased from 1 to 0 (P=0.002), and fatigue scores reduced from 2 to 1 (P=0.003). Evaluation on spirometry findings revealed that FIF50% (maximum inspiratory flow at 50% of forced vital capacity [FVC]) scores and peak expiratory flow (PEF) values improved significantly after surgery. Septoplasty improves the nasal breathing pattern. While reducing FEF50% (maximum expiratory flow at 50% of FVC)/FIF50%, it increases PEF and FIF50% values. In addition, as shown by 6mWT, exercise capacity improves following surgery. Postoperative NOSE and SNOT22 scores reduced markedly compared to preoperative values (P<0.001).
CONCLUSION: These findings suggest that nasal septal surgery has a positive effect on pulmonary functions, and this can be an important clue for the relationship of lung disorders and nasal obstruction.

PMID: 26976027 [PubMed]

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The Healing Effects of Autologous Mucosal Grafts in Experimentally Injured Rabbit Maxillary Sinuses.

The Healing Effects of Autologous Mucosal Grafts in Experimentally Injured Rabbit Maxillary Sinuses.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):44-50

Authors: Topdag M, Kara A, Konuk E, Demir N, Ozturk M, Calıskan S, Topdag DO, Ulubil A, Keskin IG, Iseri M

Abstract
OBJECTIVES: Healing processes of the nose and paranasal sinuses are quite complex, and poorly understood. In this study, we aimed to compare the effect of mucosal autologous grafts on the degenerated rabbit maxillary sinus mucosa with spontaneous wound healing. It is hypothesized that mucosal grafts will enhance ciliogenesis and improve the morphology of regenerated cilia.
METHODS: Ten female New Zealand rabbits were included in the study. They underwent external maxillary sinus surgery through a transcutaneous approach. A total of 20 maxillary sinuses were randomly divided into 2 groups: 'spontaneous healing group' and 'autologous graft group.' The animals were sacrificed at the 14th day after the surgery. Scanning electron microscope (SEM), and light microscope were used for the evaluation.
RESULTS: Cellular composition of the graft group is better than the spontaneous healing group. The graft group had larger areas covered with ciliary epithelium than the spontaneous healing group, and the mean length of the cilias were also longer. Additionally, there were wider cilia with abnormal morphology areas in the spontaneous healing group.
CONCLUSION: In our opinion, covering of the denuded areas with a graft improves re-epithelization, and may prevent the early complications after sinus surgeries.

PMID: 26976026 [PubMed]

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Clinical Implications of Septal Deviation in Lateralized Olfaction.

Clinical Implications of Septal Deviation in Lateralized Olfaction.

Clin Exp Otorhinolaryngol. 2016 Mar;9(1):39-43

Authors: Choi YS, Ryu YJ, Rhee J, Seok J, Han S, Jin HR, Kim DW

Abstract
OBJECTIVES: Results of butanol threshold tests (BTTs) have shown that birhinal olfaction tends to converge toward monorhinal olfaction of the dominant nostril. However, birhinal olfaction may also be worse than dominant-side monorhinal olfaction. The goal of our study was to investigate the effect of deviated nasal septum on birhinal olfaction in patients with lateralized olfaction and to examine the effect of septoplasty in these patients.
METHODS: A retrospective study with planned data collection was conducted in 518 patients who underwent BTTs. Lateralized olfaction was defined as monorhinal BTT scores that differed by >2 between sides. Underestimated birhinal olfaction was defined as a birhinal BTT score >2 lower than the dominant nostril monorhinal BTT score. Patients with lateralized olfaction were divided into 2 groups: group 1, underestimated birhinal olfaction; and group 2, without underestimated birhinal olfaction.
RESULTS: Among 518 patients, 112 with lateralized olfaction were enrolled in this study. Group 1 included 23 patients (20.5%) and group 2 included 89 patients (79.5%). The severity of septal deviation (ratio of the distance of narrower side to wider side) did not differ between the 2 groups. Septal deviation to the dominant nostril was more common in group 1 than group 2 (73.9% vs. 37.6%; P=0.002). Five patients with septal deviation to the dominant nostril with underestimated birhinal olfaction underwent septoplasty. Improved lateralized olfaction occurred in all 5 patients postoperatively (P=0.041).
CONCLUSION: Septal deviation of the dominant nostril in patients with lateralized olfaction is associated with underestimated birhinal olfaction. Septoplasty may improve olfaction by increasing airflow in the dominant olfactory side.

PMID: 26976025 [PubMed]

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