Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation.

Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation.

Acta Otorrinolaringol Esp. 2016 Mar 15;

Authors: Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M

Abstract
INTRODUCTION AND OBJECTIVE: Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA).
METHOD: A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared.
RESULT: The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques.
CONCLUSION: In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.

PMID: 26992775 [PubMed - as supplied by publisher]

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Aging and Hearing Health: The Life-course Approach.

Aging and Hearing Health: The Life-course Approach.

Gerontologist. 2016 Apr;56(Suppl 2):S256-S267

Authors: Davis A, McMahon CM, Pichora-Fuller KM, Russ S, Lin F, Olusanya BO, Chadha S, Tremblay KL

Abstract
Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of "hearing health," how to achieve it, and implications for policy and practice.

PMID: 26994265 [PubMed - as supplied by publisher]

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A Genomic Alternative to Preoperatively Identify Medullary Thyroid Cancer in Thyroid Nodules with Indeterminate Cytology.

A Genomic Alternative to Preoperatively Identify Medullary Thyroid Cancer in Thyroid Nodules with Indeterminate Cytology.

Thyroid. 2016 Mar 18;

Authors: Kloos RT, Monroe RJ, Traweek ST, Lanman RB, Kennedy GC

Abstract
BACKGROUND: The use of calcitonin screening for the rare medullary thyroid cancer (MTC) is controversial due to questions of efficacy, accuracy, and cost-effectiveness. We report the results of a large prospective validation using a machine-trained algorithm (MTC Classifier) to pre-operatively identify MTC in fine-needle aspiration biopsies in lieu of calcitonin measurements.
METHODS: Cytology analysis on a prospective consecutive series of 50,430 thyroid nodule biopsies yielded a total of 7,815 indeterminate (Bethesda categories III/IV) cases which were tested with the MTC classifier. A prospective, consecutively submitted series of 2,673 Bethesda III-VI cases with cytology determined locally was also evaluated. RNA was isolated and tested for the MTC Classifier using microarrays.
RESULTS: Forty-three cases were positive by the MTC Classifier among 10,488 tested nodules (0.4%), consistent with the low prevalence of MTC. Of these, all but one was histologically or biochemically confirmed as MTC, yielding a positive predictive value (PPV) of 98%. Of the positive cases, only 19 (44%) had been specifically suspected of MTC by cytology, highlighting the limitations of light microscopy to detect this disease. Three surgically confirmed MTC cases that were detected by the MTC Classifier had low basal serum calcitonin values, indicating these would have been missed by traditional calcitonin screening methods. A pooled analysis of 3 independent validation sets demonstrates high test sensitivity (97.9%), specificity (99.8%), PPV (97.9%), and negative predictive value (99.8%).
CONCLUSIONS: We propose a clinical paradigm whereby cytologically indeterminate thyroid nodules being tested for common malignancies using gene expression can be simultaneously tested for MTC using the same genomic assay, at no added cost.

PMID: 26992356 [PubMed - as supplied by publisher]

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Middle ear capillary haemangioma: Review of literature and appraisal of management options.

Middle ear capillary haemangioma: Review of literature and appraisal of management options.

Auris Nasus Larynx. 2016 Mar 15;

Authors: Salamat AA, Casselden E, Theaker J, Batty V, Thomas S

Abstract
Infantile middle ear capillary haemangiomas (MECH) are a rare entity with only five reported cases in the literature. At present there is no consensus regarding the management of such lesions. Extra-cutaneous haemangiomas have been successfully managed with oral propranolol but not yet reported in MECH. We present a further case and appraise the management options. At present oral propranolol has not been used in the treatment of MECH. The literature suggests that infantile MECH have a higher propensity to spontaneously involute and a greater likelihood of response to propranolol. Surgical excision is the best option in older children and adults.

PMID: 26992272 [PubMed - as supplied by publisher]

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Randomized trial of standard pain control with or without gabapentin for pain related to radiation-induced mucositis in head and neck cancer.

Randomized trial of standard pain control with or without gabapentin for pain related to radiation-induced mucositis in head and neck cancer.

Auris Nasus Larynx. 2016 Mar 15;

Authors: Kataoka T, Kiyota N, Shimada T, Funakoshi Y, Chayahara N, Toyoda M, Fujiwara Y, Nibu KI, Komori T, Sasaki R, Mukohara T, Minami H

Abstract
OBJECTIVE: Radiation-induced mucositis (RIM) in chemoradiotherapy (CRT) for head and neck cancer (HNC) causes severe pain and worsens CRT compliance, QOL and outcome. Following retrospective reports, we conducted a randomized trial of the safety and efficacy of gabapentin for RIM-associated pain during CRT.
METHODS: HNC patients (pts) receiving CRT were randomized to standard pain control (SPC) with acetaminophen and opioids, or SPC plus gabapentin (SPC+G). Gabapentin was maintained at 900mg/day for 4 weeks after CRT. Primary endpoint was maximum visual analogue scale (VAS) score during CRT, and secondary endpoints were total opioid dose, changes in QOL (EORTC QLQ-C30 and QLQ-HN 35) from baseline to 4 weeks after CRT, and adverse events.
RESULTS: Twenty-two eligible Stage III or IV pts were randomly assigned to SPC or SPC+G (n=11 each). Twelve were treated in a locally advanced setting and 10 in a postoperative setting. Median maximum VAS scores, median total dose of opioids at maximum VAS and total dose of opioids at 4 weeks after CRT tended to be higher in the SPC+G arm (47 in SPC vs. 74 in SPC+G, p=0.517; 215mg vs. 745.3mg, p=0.880; and 1260mg vs. 1537.5mg, p=0.9438, respectively), without significance. QOL analysis showed significantly worse scores in the SPC+G arm for weight gain (p=0.005). Adverse events related to gabapentin were manageable.
CONCLUSIONS: This pilot study is the first prospective randomized trial of gabapentin for RIM-related pain. Gabapentin had no apparent beneficial effect. Further research into agents for RIM-related pain is warranted.

PMID: 26992271 [PubMed - as supplied by publisher]

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Treatment in elderly patients with head and neck cancer : A challenging dilemma.

Treatment in elderly patients with head and neck cancer : A challenging dilemma.

HNO. 2016 Mar 18;

Authors: Teymoortash A, Ferlito A, Halmos GB

Abstract
Despite the increasing number of elderly patients requiring treatment for head and neck cancer, there is insufficient available evidence about the oncological results of treatment and its tolerability in such patients. Owing to comorbidities, elderly patients often need complex evaluation and pretreatment management, which often results in their exclusion from clinical trials. The question of which patients constitute the highest-risk groups regarding treatment-related morbidity and mortality, and who can tolerate and benefit from aggressive treatment, has not been adequately studied. Biologic rather than chronologic age should be a more important factor in treatment protocols. Age-specific prospective clinical studies are needed on the treatment of head and neck cancer in elderly patients.

PMID: 26992385 [PubMed - as supplied by publisher]

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[Hydropic inner ear disease of the vestibular type].

[Hydropic inner ear disease of the vestibular type].

HNO. 2016 Mar 18;

Authors: Volgger V, Krause E, Ertl-Wagner B, Gürkov R

Abstract
We report the case of a patient with episodic rotational vertigo for years. Ear symptoms were negated. The clinical diagnosis was not clear - Menière's disease, vestibular migraine and recurrent vertigo after vestibular neuritis all qualified for differential diagnoses. A locally enhanced inner-ear MRI established clarity by showing an endolymphatic hydrops in the vestibulum. Besides the classical triad of Menière's disease there are other clinical appearances of endolymphatic hydrops, which can be visualized with inner-ear MRI.

PMID: 26992384 [PubMed - as supplied by publisher]

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[Is (chemo)radiotherapy really the future standard in the treatment of oropharyngeal carcinoma?]

[Is (chemo)radiotherapy really the future standard in the treatment of oropharyngeal carcinoma?]

HNO. 2016 Mar 18;

Authors: Knecht R, Bussmann L, Möckelmann N, Lörincz BB

Abstract
Treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC) requires interdisciplinary collaboration. Besides oncologic control, organ and function preservation are important priorities. One treatment option is primary concomitant chemoradiotherapy (CRT), particularly for locally advanced head and neck cancer. Another option is sequential CRT, where induction chemotherapy may be followed either by radiation alone or by CRT. An important aspect of these modalities is the development of functional sequelae with regards to swallowing as a direct consequence of radiogenic fibrosis, as well as tissue ctoxicity associated with cisplatin-based chemotherapy. Conventional open surgical approaches are being increasingly replaced by transoral surgical modalities with less treatment-related morbidity. As a further, equally important goal of appropriately indicated surgery, adjuvant (C)RT may be omitted or the dose significantly reduced. The advantages of primary surgery over primary CRT may be less obvious in cases still requiring adjuvant treatment, although not necessarily completely eliminated. For patients with human papillomavirus (HPV)-driven OPSCC, it is important to note that primary surgery may provide comparable or even increased survival benefit. To date, there is no evidence for a clear advantage of primary CRT over primary surgery in this group. In these cases, a de-escalated treatment package may be the preferred option. Here, the application of radioimmunotherapy as well as a reduced radiation dose may minimize long-term treatment-related morbidities.

PMID: 26992383 [PubMed - as supplied by publisher]

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[Malignant intraorbital tumor: Primary tumor or metastasis?]

[Malignant intraorbital tumor: Primary tumor or metastasis?]

HNO. 2016 Mar 18;

Authors: Pausch NC, Sterker I, Bauer U

PMID: 26992382 [PubMed - as supplied by publisher]

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Optimisation of the round window opening in cochlear implant surgery in wet and dry conditions: impact on intracochlear pressure changes.

Optimisation of the round window opening in cochlear implant surgery in wet and dry conditions: impact on intracochlear pressure changes.

Eur Arch Otorhinolaryngol. 2016 Mar 18;

Authors: Mittmann P, Ernst A, Mittmann M, Todt I

Abstract
To preserve residual hearing in cochlear implant candidates, the atraumatic insertion of the cochlea electrode has become a focus of cochlea implant research. In a previous study, intracochlear pressure changes during the opening of the round window membrane were investigated. In the current study, intracochlear pressure changes during opening of the round window membrane under dry and transfluid conditions were investigated. Round window openings were performed in an artificial cochlear model. Intracochlear pressure changes were measured using a micro-optical pressure sensor, which was placed in the apex. Openings of the round window membrane were performed under dry and wet conditions using a cannula and a diode laser. Statistically significant differences in the intracochlear pressure changes were seen between the different methods used for opening of the round window membrane. Lower pressure changes were seen by opening the round window membrane with the diode laser than with the cannula. A significant difference was seen between the dry and wet conditions. The atraumatic approach to the cochlea is assumed to be essential for the preservation of residual hearing. Opening of the round window under wet conditions produce a significant advantage on intracochlear pressure changes in comparison to dry conditions by limiting negative outward pressure.

PMID: 26993657 [PubMed - as supplied by publisher]

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Clinical impact of malnutrition on complication rate and length of stay in elective ENT patients: a prospective cohort study.

Clinical impact of malnutrition on complication rate and length of stay in elective ENT patients: a prospective cohort study.

Eur Arch Otorhinolaryngol. 2016 Mar 18;

Authors: Kisser U, Kufeldt J, Adderson-Kisser C, Becker S, Baumeister P, Reiter M, Harréus U, Thomas MN, Rittler P

Abstract
Malnutrition is considered as an independent risk factor for morbidity, mortality and a prolonged hospital stay for in-hospital patients. While most available data on the impact of malnutrition on health-related and financial implications refer to gastroenterologic or abdominal surgery patients, little is known about the impact of malnutrition on Ear Nose Throat (ENT)/head and neck surgery patients. The objective of this study was to investigate the impact of malnutrition on morbidity and length of hospital stay in an elective ENT/head and neck surgery patient cohort. The study was performed as a single-center, prospective cohort study at a tertiary referral centre. Nutritional risk at admission was assessed using the NRS-2002 screening tool. Multivariate regression models were used to determine independent risk factors for complications and a prolonged hospitalization. Three hundred fifty one participants were included in the study. A malignant disease was found in 62 participants (17.7 %). 62 patients (17.7 %) were at a moderate to severe risk of malnutrition. A bad general health condition and complications during hospital stay could be identified as independent risk factors for a prolonged hospitalization. Patients with a malignant tumor showed a more than fourfold higher risk of developing at least one complication. Malnutrition, however, was not statistically associated with a higher complication rate or a prolonged hospital stay. Our data suggests that malnutrition does not seem to play such an important role as a risk factor for complications and a prolonged hospital stay in ENT patients as it does in other disciplines like abdominal surgery or gastroenterology.

PMID: 26993656 [PubMed - as supplied by publisher]

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Expansion sphincter pharyngoplasty for obstructive sleep apnea: an update to the recent meta-analysis.

Expansion sphincter pharyngoplasty for obstructive sleep apnea: an update to the recent meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Mar 18;

Authors: Camacho M, Zaghi S, Piccin O, Certal V

PMID: 26993655 [PubMed - as supplied by publisher]

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