Surgical management of traumatic cerebrospinal fluid fistulas with associated lesions.

Surgical management of traumatic cerebrospinal fluid fistulas with associated lesions.

Ulus Travma Acil Cerrahi Derg. 2015 Nov;21(6):450-456

Authors: Alagöz F, Dağlıoğlu E, Korkmaz M, Yıldırım AE, Uçkun ÖM, Divanlıoğlu D, Polat Ö, Dalgıç A, Ösün A, Yılmaz F, Sönmez M, Belen AD

Abstract
BACKGROUND: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula.
METHODS: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus.
RESULTS: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases.
CONCLUSION: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.

PMID: 27054635 [PubMed - as supplied by publisher]

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Association of BMI-1 and p16 as prognostic factors for head and neck carcinomas.

Association of BMI-1 and p16 as prognostic factors for head and neck carcinomas.

Acta Otolaryngol. 2016 May;136(5):501-5

Authors: Lundberg M, Renkonen S, Haglund C, Mattila PS, Leivo I, Hagström J, Mäkitie AA

Abstract
Conclusions BMI-1 is an upstream repressor of tumor suppressor p16 and their inverse expression patterns have been linked with patient survival in OPSCC. In this material only p16 remained a relevant prognostic marker in OPSCC. Objectives HNSCC tumors carry variable phenotypes and clinical outcomes depending on their anatomical location. In OPSCC, expression of tumor suppressor p16 is used as a surrogate marker of HPV infection and has prognostic value. There are no good prognostic biomarkers for HNSCC tumors of other anatomical locations. Aim To study the expression patterns of p16 and BMI-1 in not only oropharyngeal but also oral, hypopharyngeal, and laryngeal squamous cell carcinomas and to clarify their putative connections with clinical parameters, survival, and each other. Method Hospital records on 130 patients (59 OPSCC, 18 OSCC, 20 HPSCC, and 33 LSCC) diagnosed between 1997-2008 at the Helsinki University Hospital, Finland, were reviewed. BMI-1 and p16 expressions were studied by immunohistochemistry. Results Sixty-eight per cent of OPSCC expressed p16 and expression correlated with lower age, lower T- and higher N-category, and with improved OS and DFS. BMI-1 expression was most prevalent in OPSCC and LSCC, but had no clinical correlations. No correlation between p16 and BMI-1 expression was found.

PMID: 27052966 [PubMed - in process]

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Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes.

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Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes.

BMC Anesthesiol. 2015;15:181

Authors: Lin WC, Chen CW, Wang JD, Tsai LM

Abstract
BACKGROUND: Tracheostomy is recommended for patients receiving mechanical ventilation (MV) for 14 days or more in the intensive care unit (ICU). Nevertheless, many patients undergoing prolonged MV remain intubated via the translaryngeal route. The aim of this study was to examine the influence of tracheostomy and persistent translaryngeal intubation on short-term outcomes in patients mechanically ventilated for ≥14 days.
METHODS: A retrospective study was conducted using the admissions database of a 75-bed ICU from January 1, 2012, to December 31, 2012. Patients who required prolonged MV without tracheostomy at the time of initiation of a ventilator were included. The outcomes were successful weaning, and ICU and in-hospital death. Cox models were constructed to calculate the influence of tracheostomy on the outcome measures while adjusting for other potentially confounding factors.
RESULTS: Of the 508 patients requiring prolonged MV, 164 were tracheostomized after a median 18 days of MV. Patients in whom translaryngeal intubation was maintained had significantly higher ICU (42.7% versus 17.1%, p <0.001) and in-hospital (54.1% versus 22.0%, p <0.001) mortality rates, and a significantly lower successful weaning rate (40.4% versus 68.9%, p <0.001). The results were consistent after matching for the propensity score of performing tracheostomy. Furthermore, a time-dependent covariate Cox model showed that a tracheostomy was independently associated with lower in-hospital mortality (adjusted hazard ratio [aHR], 0.26; 95% confidence interval [CI], 0.18-0.39) and higher successful weaning rate (aHR, 2.05; 95% CI, 1.56-2.68).
CONCLUSIONS: Tracheostomy is associated with lower in-hospital mortality and higher successful weaning rates in ICU patients receiving prolonged MV. However, the cost-effectiveness and long-term outcomes of tracheostomy for this cohort require further study.

PMID: 26669760 [PubMed - indexed for MEDLINE]

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Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study.

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Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study.

BMC Anesthesiol. 2015;15:167

Authors: Kang H, Kim DR, Jung YH, Baek CW, Park YH, In Oh J, Kim WJ, Choi GJ

Abstract
BACKGROUND: The Streamlined Liner of the Pharynx Airway (SLIPA), a type of supraglottic airway, has a non-inflatable cuff that softens at body temperature to fit the laryngeal structure. We investigated whether pre-warming of SLIPA to body temperature may improve insertion parameters.
METHODS: Ninety adult patients were assigned equally randomized to either Group W or Group R. Anesthesia was induced using propofol, fentanyl, and rocuronium. In Group W, the SLIPA was warmed to 37 ° C before insertion, whereas in Group R, it was inserted at room temperature. The insertion time, oropharyngeal leak pressure, postoperative throat pain, blood staining, regurgitation, number of attempts at insertion, and difficulty of insertion were compared between the two groups.
RESULTS: The insertion time was shorter in Group W than in Group R (3.60 [3.15-4.06] s vs. 6.00 [4.45-7.50] s; P < 0.001). Oropharyngeal leak pressure from the time of insertion until 3 min after insertion was significantly higher in Group W than in Group R (P < 0.05). Postoperative throat pain, measured using the visual analog scale, was lower in Group W than in Group R (0.00 [0.00-2.50] vs. 2.00 [0.00-4.50]; P = 0.006). The difficulty of insertion was lower in Group W than in Group R (P < 0.004). There were no significant differences in terms of blood staining, regurgitation, and number of attempts.
CONCLUSIONS: Pre-warming the SLIPA to body temperature has significant benefits compared to maintaining the device at room temperature. Specifically, insertion was easier, both insertion and fitting to the laryngeal structure could be performed more quickly, and the incidence of sore throat was reduced.
TRIAL REGISTRATION: Clinical Research Information Identifier NCT01209000.

PMID: 26589142 [PubMed - indexed for MEDLINE]

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IQ Motif-Containing GTPase-Activating Protein 2 (IQGAP2) Is a Novel Regulator of Colonic Inflammation in Mice.

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IQ Motif-Containing GTPase-Activating Protein 2 (IQGAP2) Is a Novel Regulator of Colonic Inflammation in Mice.

PLoS One. 2015;10(6):e0129314

Authors: Ghaleb AM, Bialkowska AB, Snider AJ, Gnatenko DV, Hannun YA, Yang VW, Schmidt VA

Abstract
IQ motif-containing GTPase-activating protein 2 (IQGAP2) is a multidomain scaffolding protein that plays a role in cytoskeleton regulation by juxtaposing Rho GTPase and Ca2+/calmodulin signals. While IQGAP2 suppresses tumorigenesis in liver, its role in pathophysiology of the gastrointestinal tract remains unexplored. Here we report that IQGAP2 is required for the inflammatory response in colon. Mice lacking Iqgap2 gene (Iqgap2-/- mice) were resistant to chemically-induced colitis. Unlike wild-type controls, Iqgap2-/- mice treated with 3% dextran sulfate sodium (DSS) in water for 13 days displayed no injury to colonic epithelium. Mechanistically, resistance to colitis was associated with suppression of colonic NF-κB signaling and IL-6 synthesis, along with diminished neutrophil and macrophage production and recruitment in Iqgap2-/- mice. Finally, alterations in IQGAP2 expression were found in colons of patients with inflammatory bowel disease (IBD). Our findings indicate that IQGAP2 promotes inflammatory response at two distinct levels; locally, in colonic epithelium through TLR4/NF-κB signaling pathway, and systemically, via control of maturation and recruitment of myeloid immune cells. This work identifies a novel mechanism of colonic inflammation mediated by signal transducing scaffolding protein IQGAP2. IQGAP2 domain-specific blocking agents may represent a conceptually novel strategy for therapy of IBD and other inflammation-associated disorders, including cancer.

PMID: 26047140 [PubMed - indexed for MEDLINE]

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Thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection: report of a survivor.

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Thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection: report of a survivor.

Am J Emerg Med. 2015 Dec;33(12):1849.e1-3

Authors: Ahn D, Choi JH, Sohn JH

Abstract
Thyrocricotracheal separation is an extremely fatal injury that has not been reported in the literature. Although timely and proper management of this injury is paramount to preserve the patient's life, airway, and voice, its rarity has resulted in a lack of consensus regarding the best management option. We report a case of thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection caused by a self-inflicted injury, which was treated with reanastomosis in conjunction with transverse laser cordotomy. The patient could achieve both decannulation and a serviceable voice and could return to a normal social life. The present case is the first report of a survivor with thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection. This findings show that appropriate management of the airway is the first step to ensure a successful outcome, and a step-by-step approach to detect and manage the associated injuries is paramount in cases showing the most severe form of laryngeal trauma.

PMID: 25976270 [PubMed - indexed for MEDLINE]

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Laser arytenoidectomy and posterior cordotomy in a patient with bilateral vocal cord paralysis due to multiple system atrophy.

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Laser arytenoidectomy and posterior cordotomy in a patient with bilateral vocal cord paralysis due to multiple system atrophy.

BMJ Case Rep. 2015;2015

Authors: Mahmud A, Strens LH, Tedla M

Abstract
Bilateral vocal cord paralysis leading to stridor is a known but rare complication of Parkinson's disease (PD) and a recognised complication of multiple system atrophy (MSA). Tracheostomy is a commonly offered treatment, leading to substantial adaptations and lifestyle changes for the patient. Patients can struggle to manage a tracheostomy due to the tremor and bradykinesia associated with their parkinsonism. We report a case of bilateral vocal cord paralysis leading to significant stridor in a patient with atypical parkinsonism (probable MSA). To avoid tracheostomy, our patient underwent successful right-sided laser arytenoidectomy and posterior cordotomy as a day-case procedure. At follow-up, he had a weaker voice but complete recovery from the shortness of breath and stridor. He was very satisfied with the outcome. We conclude that, despite resulting in a weaker voice, this procedure offers an option to the patient that improves quality of life.

PMID: 25939970 [PubMed - indexed for MEDLINE]

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Retrosigmoid Craniotomy for Auditory Brainstem Implantation in Adult Patients with Neurofibromatosis Type 2.

Retrosigmoid Craniotomy for Auditory Brainstem Implantation in Adult Patients with Neurofibromatosis Type 2.

J Neurol Surg B Skull Base. 2015 Dec;76(6):440-50

Authors: Puram SV, Herrmann B, Barker FG, Lee DJ

Abstract
Objective To report our technique and experience using a retrosigmoid craniotomy approach for auditory brainstem implantation (ABI) placement in adult neurofibromatosis type 2 (NF2) patients. Design Retrospective case series. Setting Single-center study, Boston, Massachusetts, United States. Participants All NF2 patients who underwent evaluation at Massachusetts Eye and Ear Infirmary and surgery at Massachusetts General Hospital from 2009 to 2013 were reviewed. Six cases of retrosigmoid craniotomy for ABI surgery in five adult NF2 patients were identified. The clinical history, operative course, and outcomes in these patients were reviewed. Main Outcome Measures Postoperative complications and audiological outcomes. Results Indications for ABI surgery were profound hearing loss associated with growth or treatment of bilateral vestibular schwannomas. In all cases, a retrosigmoid craniotomy was performed for tumor resection and ABI placement without complication. Electrode placement was confirmed intraoperatively using electrical-evoked auditory brainstem responses. The ABI was activated in the awake patient 4 to 6 weeks postoperatively. Audiological testing was used to evaluate sound detection and speech perception with the ABI. There were no cases of cerebrospinal fluid leak. Conclusion Retrosigmoid craniotomy is a safe and effective means to provide access to the cochlear nucleus for ABI placement following tumor resection in the adult NF2 patient. Preliminary data indicate that this approach has few complications while offering benefits for hearing. The retrosigmoid craniotomy should be considered a reasonable alternative to the traditional translabyrinthine approach for placement of the ABI in deaf patients who are not candidates for the cochlear implant.

PMID: 27054058 [PubMed]

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Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage: A Case Study for Medical Decision-Making Heuristics.

Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage: A Case Study for Medical Decision-Making Heuristics.

Neurohospitalist. 2016 Apr;6(2):76-9

Authors: Dredla B, Freeman WD

Abstract
Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient's medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis.

PMID: 27053985 [PubMed]

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Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage.

Related Articles

Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage.

J Neurosurg Spine. 2015 Dec;23(6):812-9

Authors: Ito K, Aoyama T, Horiuchi T, Hongo K

Abstract
OBJECT: The nonpenetrating titanium clip has been successfully used in peripheral arterial bypass surgery. The purpose of this study was to evaluate the leakage pressures and patterns of nonpenetrating titanium clips using a simple model that mimicked spinal surgery. In addition, the authors describe their surgical experience with these clips and the follow-up results in 31 consecutive patients.
METHODS: The authors compared nonpenetrating titanium clips and expanded polytetrafluoroethylene (ePTFE) sutures in relation to the water pressure that could be tolerated by sutured ePTFE sheets, and the leakage pressure patterns were determined. The changes in leakage pressures at 5 minutes, 30 minutes, and 12 hours were examined when the clips and sutures were used in combination with the mesh-and-glue technique in an in vitro study. Thirty-one patients underwent spinal intradural procedures using nonpenetrating titanium clips to suture the dura maters using the meshand-glue technique, involving fibrin glue and polyglycolic acid-fibrin sheets.
RESULTS: A significant difference was apparent between the ePTFE suture group and the nonpenetrating titanium clip group, with the latter showing a leakage pressure that could be sustained and was 1508% higher than that of the former (p = 0.001). In relation to leakage patterns, the nonpenetrating titanium clips did not make any suture holes in the ePTFE sheet and fluid leakage occurred between the clips, whereas fluid leakage was associated with the pressure elevation that occurred at the suture holes made by the ePTFE sutures. Of the 31 patients who underwent spinal intradural procedures using nonpenetrating titanium clips, 1 (3.2%) experienced cerebrospinal fluid (CSF) leakage postoperatively. No other complications-for example, allergic reactions, adhesions, or infections--were encountered.
CONCLUSIONS: The interrupted placement of nonpenetrating titanium clips enables dural closure without creating any holes. These clips facilitate improvements in the initial leakage pressure and reduce postoperative CSF leakage following spinal surgery. The authors conclude that it is very beneficial to suture the spinal dura mater using nonpenetrating titanium clips given the anatomical characteristics of the spinal dura mater and the fact that the clips do not create suture holes.

PMID: 26315957 [PubMed - indexed for MEDLINE]

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Adenosine-mediated immunosuppression in patients with squamous cell carcinoma of the head and neck.

Adenosine-mediated immunosuppression in patients with squamous cell carcinoma of the head and neck.

HNO. 2016 Apr 6;

Authors: Mandapathil M

Abstract
This review article describes the potential role of ectonucleotidase activity, adenosine metabolism, and the adenosinergic signaling pathway in the suppression of the host immune system in patients with head and neck cancer. Identifying such mechanisms leads to a better understanding of immunosuppressive mechanisms in this patient population. Further, potential targets for immunotherapy in an adjuvant approach to treating squamous cell carcinoma of the head and neck in the future might be identified and improve the prognosis of these patients.

PMID: 27052632 [PubMed - as supplied by publisher]

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Association of BMI-1 and p16 as prognostic factors for head and neck carcinomas.

Association of BMI-1 and p16 as prognostic factors for head and neck carcinomas.

Acta Otolaryngol. 2016 May;136(5):501-5

Authors: Lundberg M, Renkonen S, Haglund C, Mattila PS, Leivo I, Hagström J, Mäkitie AA

Abstract
Conclusions BMI-1 is an upstream repressor of tumor suppressor p16 and their inverse expression patterns have been linked with patient survival in OPSCC. In this material only p16 remained a relevant prognostic marker in OPSCC. Objectives HNSCC tumors carry variable phenotypes and clinical outcomes depending on their anatomical location. In OPSCC, expression of tumor suppressor p16 is used as a surrogate marker of HPV infection and has prognostic value. There are no good prognostic biomarkers for HNSCC tumors of other anatomical locations. Aim To study the expression patterns of p16 and BMI-1 in not only oropharyngeal but also oral, hypopharyngeal, and laryngeal squamous cell carcinomas and to clarify their putative connections with clinical parameters, survival, and each other. Method Hospital records on 130 patients (59 OPSCC, 18 OSCC, 20 HPSCC, and 33 LSCC) diagnosed between 1997-2008 at the Helsinki University Hospital, Finland, were reviewed. BMI-1 and p16 expressions were studied by immunohistochemistry. Results Sixty-eight per cent of OPSCC expressed p16 and expression correlated with lower age, lower T- and higher N-category, and with improved OS and DFS. BMI-1 expression was most prevalent in OPSCC and LSCC, but had no clinical correlations. No correlation between p16 and BMI-1 expression was found.

PMID: 27052966 [PubMed - in process]

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Th17 expression and IL-17 levels in laryngeal squamous cell carcinoma patients.

Th17 expression and IL-17 levels in laryngeal squamous cell carcinoma patients.

Acta Otolaryngol. 2016 May;136(5):484-90

Authors: Li FJ, Cai ZJ, Yang F, Zhang SD, Chen M

Abstract
Conclusion The Th17 cell frequency in peripheral blood and levels of IL-17 showed significant differences between patients with laryngeal squamous cell carcinoma and those with vocal cords polyps. Serum levels of IL-17 were correlated with laryngocarcinoma staging. Objectives To investigate associations among the frequency of Th17 cells, levels of IL-17, and laryngeal squamous cell carcinoma. Method Eighty in-patients with laryngeal squamous cell carcinoma and 114 in-patients with polypus of the vocal cord were enrolled. Th17 cell frequencies in peripheral blood and serum levels of IL-17 were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively. The tissue expression levels of IL-17 mRNA transcripts and protein were measured using quantitative RT-PCR or immunohistochemical detection, respectively. Results Th17 cell frequencies in peripheral blood and serum concentrations of IL-17 were significantly higher in patients with laryngocarcinoma compared with those in patients with polyps (p < 0.01 for both Th17 cells and IL-17 levels). Serum concentrations of IL-17 were significantly higher in patients with advanced laryngocarcinoma than in patients with early laryngocarcinoma (p < 0.01). The mRNA and protein levels of IL-17 were significantly higher in laryngocarcinoma tissues than in adjacent normal tissues (p < 0.01 for mRNA levels, p < 0.05 for protein levels).

PMID: 27052965 [PubMed - in process]

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Anatomic measurements of the posterior tympanum related to the round window vibroplasty in congenital aural atresia and stenosis patients.

Anatomic measurements of the posterior tympanum related to the round window vibroplasty in congenital aural atresia and stenosis patients.

Acta Otolaryngol. 2016 May;136(5):470-4

Authors: Chen K, Yin D, Lyu H, Yang L, Zhang T, Dai P

Abstract
Conclusions With the aggravation of the external auditory canal malformation, the size of extra-niche fossa became smaller, providing concrete data and valuable information for the better design, selecting and safer implantation of the transducer in the area of round window niche. Three-dimensional measurements and assessments before surgery might be helpful for a safer surgical approach and implantation of a vibrant soundbridge. Objectives The aim of this study was to investigate whether differences exist in the morphology of the posterior tympanum related to the round window vibroplasty among congenital aural atresia (CAA), congenital aural stenosis (CAS), and a normal control group, and to analyze its effect on the round window implantation of vibrant soundbridge. Methods CT images of 10 normal subjects (20 ears), 27 CAS patients (30 ears), and 25 CAA patients (30 ears) were analyzed. The depth and the size of outside fossa of round window niche related to the round window vibroplasty (extra-niche fossa)and the distances between the center of round window niche and extra-niche fossa were calculated based on three-dimensional reconstruction using mimics software. Finally, the data were analyzed statistically. Results The size of extra-niche fossa in the atresia group was smaller than in the stenosis group (p < 0.05); furthermore, the size of extra-niche fossa in the stenosis group was smaller than that of the control group (p < 0.05). There was no statistically significant difference of the depth of extra-niche fossa among different groups.

PMID: 27052964 [PubMed - in process]

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Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study.

Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study.

Acta Otolaryngol. 2016 May;136(5):446-50

Authors: Yen TT, Lin CH, Shiao JY, Liang KL

Abstract
Conclusion Sudden sensorineural hearing loss (SSNHL) in pregnancy is rare. It usually occurs in the third trimester. SSNHL in pregnancy does not increase risks during delivery or subsequent stroke. Objectives This study aimed to investigate the incidence and to determine the factors associated with SSNHL in pregnancy. Method Data were retrieved from Taiwan's National Health Insurance Database (NHIRD), covering the years 2000-2009. Patients admitted for SSNHL during pregnancy were enrolled. An age-matched controlled cohort was randomly selected from pregnant women without SSNHL in the NHIRD. The clinical characteristics of both cohorts were collected for further analyses. Results Thirty-three patients with SSNHL in pregnancy were enrolled. The estimated incidence of SSNHL in pregnancy in Taiwan was 2.71 per 100,000 pregnancies. The incidence of SSNHL in pregnancy was lower than that of the general female population. The incidence of SSNHL in the third trimester was higher compared to the other two. The incidence of SSNHL occurring in the 30-39 years old age group was higher than other groups. Women with better socioeconomic status had a higher incidence of SSNHL. There were no identified systemic diseases before SSNHL. Two patients had pre-eclampsia and one patient had premature delivery. Nevertheless, SSNHL in pregnancy did not increase the risk for stroke.

PMID: 27052963 [PubMed - in process]

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Treatment of idiopathic rhinitis with kinetic oscillations - a multi-centre randomized controlled study.

Treatment of idiopathic rhinitis with kinetic oscillations - a multi-centre randomized controlled study.

Acta Otolaryngol. 2016 Apr 7;:1-8

Authors: Ehnhage A, Johnsson PS, Ahlström-Emanuelsson C, Andersson M, Knutsson J, Lien J, Norlander T, Olsson P, Friis-Liby JE, Holmström M

Abstract
CONCLUSIONS: The potential effects of KOS are still uncertain regarding the most effective air pressure to be used as well as the physiological effects on the nasal mucosa. The results of the study do not support a convincing treatment effect by KOS on IR.
OBJECTIVES: Idiopathic rhinitis (IR) is a common disorder, affecting ∼10-20% of the population. A new method for treating IR, Kinetic Oscillation Stimulation (KOS), has been reported to have beneficial effects on total vasomotor symptom scores (TVRSS). The primary objective with this study was to evaluate if a mean pressure of 65 mbar, pressure amplitude of 100 mbar, and 68 Hz treatment with KOS had a positive effect on total vasomotor symptom scores (TVRSS), as compared with a mean pressure of 65 mbar, pressure amplitude of 4 mbar, and 68 Hz treatment in patients with idiopathic rhinitis.
METHODS: Two hundred and seven patients were randomized (Full Analysis Set, FAS) in the study, including five visits and lasting for ∼25 weeks. All patients had two treatment episodes, and all patients had at least one treatment, meant as active, with high amplitude pressure for 10 min in each nostril. Group 1 had two such treatments, and Group 2 had one treatment with low amplitude pressure, initially meant as placebo, on one occasion. Because of numerical improvements in these two groups, a new control group, Group 3, was introduced. They had one new control treatment where the balloon was inserted into the nose, without any air inflation and without oscillations.
RESULTS: KOS treatment with high amplitude pressure did not have significant beneficial effects as compared to low amplitude pressure on TVRSS. Numerical improvements in TVRSS and SNOT 22 were found when comparing high and low amplitude pressure treatments with uninflated balloon treatment. However, this part of the study was initially single-blinded, and these results were secondary objectives.

PMID: 27052839 [PubMed - as supplied by publisher]

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Transzygomatic Approach to Skull Base: History, Evolution, and Possibility of a Simple Modification.

Transzygomatic Approach to Skull Base: History, Evolution, and Possibility of a Simple Modification.

J Craniofac Surg. 2016 Apr 5;

Authors: Badwal JS

Abstract
The surgical approaches to anterior, middle, and lateral skull base have evolved drastically, transcending from an era of oblivion to well-defined and systematically executed, state-of-the-art, refined surgery. The transzygomatic approach, which was developed to access the nasopharynx, has been applied to versatile locations of skull base pathology, with continuous evolution and modification of the osteotomies and skin flaps involved. A simple modification is proposed which could help reach a compromise between the wide exposure provided by the hemicoronal incision and the minimally invasive preauricular approach.

PMID: 27054426 [PubMed - as supplied by publisher]

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Retrosigmoid Craniotomy for Auditory Brainstem Implantation in Adult Patients with Neurofibromatosis Type 2.

Retrosigmoid Craniotomy for Auditory Brainstem Implantation in Adult Patients with Neurofibromatosis Type 2.

J Neurol Surg B Skull Base. 2015 Dec;76(6):440-50

Authors: Puram SV, Herrmann B, Barker FG, Lee DJ

Abstract
Objective To report our technique and experience using a retrosigmoid craniotomy approach for auditory brainstem implantation (ABI) placement in adult neurofibromatosis type 2 (NF2) patients. Design Retrospective case series. Setting Single-center study, Boston, Massachusetts, United States. Participants All NF2 patients who underwent evaluation at Massachusetts Eye and Ear Infirmary and surgery at Massachusetts General Hospital from 2009 to 2013 were reviewed. Six cases of retrosigmoid craniotomy for ABI surgery in five adult NF2 patients were identified. The clinical history, operative course, and outcomes in these patients were reviewed. Main Outcome Measures Postoperative complications and audiological outcomes. Results Indications for ABI surgery were profound hearing loss associated with growth or treatment of bilateral vestibular schwannomas. In all cases, a retrosigmoid craniotomy was performed for tumor resection and ABI placement without complication. Electrode placement was confirmed intraoperatively using electrical-evoked auditory brainstem responses. The ABI was activated in the awake patient 4 to 6 weeks postoperatively. Audiological testing was used to evaluate sound detection and speech perception with the ABI. There were no cases of cerebrospinal fluid leak. Conclusion Retrosigmoid craniotomy is a safe and effective means to provide access to the cochlear nucleus for ABI placement following tumor resection in the adult NF2 patient. Preliminary data indicate that this approach has few complications while offering benefits for hearing. The retrosigmoid craniotomy should be considered a reasonable alternative to the traditional translabyrinthine approach for placement of the ABI in deaf patients who are not candidates for the cochlear implant.

PMID: 27054058 [PubMed]

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Endonasal Skull Base Tumor Removal Using Concentric Tube Continuum Robots: A Phantom Study.

Endonasal Skull Base Tumor Removal Using Concentric Tube Continuum Robots: A Phantom Study.

J Neurol Surg B Skull Base. 2015 Mar;76(2):145-9

Authors: Swaney PJ, Gilbert HB, Webster RJ, Russell PT, Weaver KD

Abstract
Objectives The purpose of this study is to experimentally evaluate the use of concentric tube continuum robots in endonasal skull base tumor removal. This new type of surgical robot offers many advantages over existing straight and rigid surgical tools including added dexterity, the ability to scale movements, and the ability to rotate the end effector while leaving the robot fixed in space. In this study, a concentric tube continuum robot was used to remove simulated pituitary tumors from a skull phantom. Design The robot was teleoperated by experienced skull base surgeons to remove a phantom pituitary tumor within a skull. Percentage resection was measured by weight. Resection duration was timed. Setting Academic research laboratory. Main Outcome Measures Percentage removal of tumor material and procedure duration. Results Average removal percentage of 79.8 ± 5.9% and average time to complete procedure of 12.5 ± 4.1 minutes (n = 20). Conclusions The robotic system presented here for use in endonasal skull base surgery shows promise in improving the dexterity, tool motion, and end effector capabilities currently available with straight and rigid tools while remaining an effective tool for resecting the tumor.

PMID: 27054057 [PubMed]

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Simultaneous Transventricular-Orbitocranial Resection of Large Suprasellar Craniopharyngioma as Inspired by Jackson's Maneuver from 1863.

Simultaneous Transventricular-Orbitocranial Resection of Large Suprasellar Craniopharyngioma as Inspired by Jackson's Maneuver from 1863.

Cureus. 2016;8(3):e517

Authors: Jean WC, Syed HR, Felbaum D, Ryan JE, Anaizi A

Abstract
Traditional skull base techniques utilizing the microscope have allowed surgeons improved safe access to deep-seated lesions. More recent technical advances with the endoscope have allowed improved visibility and access to these previously difficult-to-reach regions. Most current literature emphasizes one technique over the other. We present a unique hybrid-type approach that tackles this not-infrequent surgical dilemma. This hybrid-type surgery resulted in a new technique that is a confluence of both open microsurgery and skull base corridors with an endoscope. Furthermore, a combined ventriculoscope approach adds extended assistance with resection. We detail the utility of this technique. A patient presented with a large suprasellar lesion that was suspicious for a craniopharyngioma. Given improved survival with extent of resection, the goal of surgical intervention was maximal safe resection. The location of the tumor would have involved certain morbidity with deliberate residual if a skull base approach or endoscope-based approach was employed independently. As a result, the patient underwent a hybrid-type operation using a multi-corridor split-surgical team approach for the resection of her tumor. The patient underwent hybrid surgery via a combined open microsurgical craniotomy, endoscopic resection, and a ventriculoscope-assisted approach. The ventriculoscope access allowed for resection of the intraventricular portion of the tumor and guided the extent of resection from the microsurgical corridor. Additionally, from a separate craniotomy, the suprasellar component was resected using both standard skull base and endoscope-assisted techniques. The patient tolerated the procedure well without additional morbidity provided from the multi-corridor hybrid technique. The hybrid surgery resulted in a new multi-modality, split-surgical team approach providing maximal visualization with minimal added morbidity to resect a lesion difficult to access. This hybrid technique may be an effective piece of the surgeon's armamentarium to provide improved patient outcomes.

PMID: 27054052 [PubMed]

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Reply to comments on: Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

Reply to comments on: Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Prasad SC, Sanna M

PMID: 27052548 [PubMed - as supplied by publisher]

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A neurosurgical simulation of skull base tumors using a 3D printed rapid prototyping model containing mesh structures.

A neurosurgical simulation of skull base tumors using a 3D printed rapid prototyping model containing mesh structures.

Acta Neurochir (Wien). 2016 Apr 6;

Authors: Kondo K, Harada N, Masuda H, Sugo N, Terazono S, Okonogi S, Sakaeyama Y, Fuchinoue Y, Ando S, Fukushima D, Nomoto J, Nemoto M

Abstract
BACKGROUND: Deep regions are not visible in three-dimensional (3D) printed rapid prototyping (RP) models prepared from opaque materials, which is not the case with translucent images. The objectives of this study were to develop an RP model in which a skull base tumor was simulated using mesh, and to investigate its usefulness for surgical simulations by evaluating the visibility of its deep regions.
METHODS: A 3D printer that employs binder jetting and is mainly used to prepare plaster models was used. RP models containing a solid tumor, no tumor, and a mesh tumor were prepared based on computed tomography, magnetic resonance imaging, and angiographic data for four cases of petroclival tumor. Twelve neurosurgeons graded the three types of RP model into the following four categories: 'clearly visible,' 'visible,' 'difficult to see,' and 'invisible,' based on the visibility of the internal carotid artery, basilar artery, and brain stem through a craniotomy performed via the combined transpetrosal approach. In addition, the 3D positional relationships between these structures and the tumor were assessed.
RESULTS: The internal carotid artery, basilar artery, and brain stem and the positional relationships of these structures with the tumor were significantly more visible in the RP models with mesh tumors than in the RP models with solid or no tumors.
CONCLUSIONS: The deep regions of PR models containing mesh skull base tumors were easy to visualize. This 3D printing-based method might be applicable to various surgical simulations.

PMID: 27052513 [PubMed - as supplied by publisher]

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[Traumatic occipitocervical and atlantoaxial dislocation with clivus fracture in a child. Case report].

Related Articles

[Traumatic occipitocervical and atlantoaxial dislocation with clivus fracture in a child. Case report].

Cir Cir. 2015 Mar-Apr;83(2):135-40

Authors: Herrada-Pineda T, Loyo-Varela M, Revilla-Pacheco F, Uribe-Leitz M, Manrique-Guzmán S

Abstract
BACKGROUND: Cranieovertebral junction lesions in the paediatric population are associated with a low survival rate, which has declined in recent years. Neurological disability is a major concern due to the high economical cost it represents. Paediatric patients are more susceptible to this lesion because of hyperextension capacity, flat articulation, and increased ligamentous laxity. Survival after these kinds of injuries has been more often reported in adults, but are limited in the paediatric population.
CLINICAL CASE: A case is reported of an 8-year-old male with occipitocervical and atlantoaxial dislocation associated with clivus fracture, brain oedema, and post-traumatic subarachnoid haemorrhage (SAH). A halo vest system was placed with no traction. One month after the trauma the patient was surgically treated with C1 and C2 trans-articular screws, occipitocervical fixation with plate and screws, and C1- C2 fixation with tricortical bone graft and wires without complication. He has now returned to school and is self-sufficient.
CONCLUSIONS: With better pre-hospital medical care and with improved surgical techniques the mortality rate has declined in this kind of lesion.

PMID: 25986981 [PubMed - indexed for MEDLINE]

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Unusual extraosseous extension of jaw lesion into the temporal fossa.

Related Articles

Unusual extraosseous extension of jaw lesion into the temporal fossa.

Clin Imaging. 2015 Sep-Oct;39(5):890-2

Authors: Metkees M, Spector M, Srinivasan A

Abstract
The keratocystic odontogenic tumor (KCOT) is a relatively rare, benign neoplasm that develops in the maxilla or mandible, arising from the dental lamina or basal cells of the oral epithelium. The disease is characterized by aggressive growth and a high recurrence rate following surgical treatment. We present a case of a 55-year-old man with a giant KCOT of the mandible. The imaging features and differential diagnosis are described with discussion of the surgical management.

PMID: 25963244 [PubMed - indexed for MEDLINE]

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Association of BMI-1 and p16 as prognostic factors for head and neck carcinomas.

Association of BMI-1 and p16 as prognostic factors for head and neck carcinomas.

Acta Otolaryngol. 2016 May;136(5):501-5

Authors: Lundberg M, Renkonen S, Haglund C, Mattila PS, Leivo I, Hagström J, Mäkitie AA

Abstract
Conclusions BMI-1 is an upstream repressor of tumor suppressor p16 and their inverse expression patterns have been linked with patient survival in OPSCC. In this material only p16 remained a relevant prognostic marker in OPSCC. Objectives HNSCC tumors carry variable phenotypes and clinical outcomes depending on their anatomical location. In OPSCC, expression of tumor suppressor p16 is used as a surrogate marker of HPV infection and has prognostic value. There are no good prognostic biomarkers for HNSCC tumors of other anatomical locations. Aim To study the expression patterns of p16 and BMI-1 in not only oropharyngeal but also oral, hypopharyngeal, and laryngeal squamous cell carcinomas and to clarify their putative connections with clinical parameters, survival, and each other. Method Hospital records on 130 patients (59 OPSCC, 18 OSCC, 20 HPSCC, and 33 LSCC) diagnosed between 1997-2008 at the Helsinki University Hospital, Finland, were reviewed. BMI-1 and p16 expressions were studied by immunohistochemistry. Results Sixty-eight per cent of OPSCC expressed p16 and expression correlated with lower age, lower T- and higher N-category, and with improved OS and DFS. BMI-1 expression was most prevalent in OPSCC and LSCC, but had no clinical correlations. No correlation between p16 and BMI-1 expression was found.

PMID: 27052966 [PubMed - in process]

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Th17 expression and IL-17 levels in laryngeal squamous cell carcinoma patients.

Th17 expression and IL-17 levels in laryngeal squamous cell carcinoma patients.

Acta Otolaryngol. 2016 May;136(5):484-90

Authors: Li FJ, Cai ZJ, Yang F, Zhang SD, Chen M

Abstract
Conclusion The Th17 cell frequency in peripheral blood and levels of IL-17 showed significant differences between patients with laryngeal squamous cell carcinoma and those with vocal cords polyps. Serum levels of IL-17 were correlated with laryngocarcinoma staging. Objectives To investigate associations among the frequency of Th17 cells, levels of IL-17, and laryngeal squamous cell carcinoma. Method Eighty in-patients with laryngeal squamous cell carcinoma and 114 in-patients with polypus of the vocal cord were enrolled. Th17 cell frequencies in peripheral blood and serum levels of IL-17 were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively. The tissue expression levels of IL-17 mRNA transcripts and protein were measured using quantitative RT-PCR or immunohistochemical detection, respectively. Results Th17 cell frequencies in peripheral blood and serum concentrations of IL-17 were significantly higher in patients with laryngocarcinoma compared with those in patients with polyps (p < 0.01 for both Th17 cells and IL-17 levels). Serum concentrations of IL-17 were significantly higher in patients with advanced laryngocarcinoma than in patients with early laryngocarcinoma (p < 0.01). The mRNA and protein levels of IL-17 were significantly higher in laryngocarcinoma tissues than in adjacent normal tissues (p < 0.01 for mRNA levels, p < 0.05 for protein levels).

PMID: 27052965 [PubMed - in process]

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Anatomic measurements of the posterior tympanum related to the round window vibroplasty in congenital aural atresia and stenosis patients.

Anatomic measurements of the posterior tympanum related to the round window vibroplasty in congenital aural atresia and stenosis patients.

Acta Otolaryngol. 2016 May;136(5):470-4

Authors: Chen K, Yin D, Lyu H, Yang L, Zhang T, Dai P

Abstract
Conclusions With the aggravation of the external auditory canal malformation, the size of extra-niche fossa became smaller, providing concrete data and valuable information for the better design, selecting and safer implantation of the transducer in the area of round window niche. Three-dimensional measurements and assessments before surgery might be helpful for a safer surgical approach and implantation of a vibrant soundbridge. Objectives The aim of this study was to investigate whether differences exist in the morphology of the posterior tympanum related to the round window vibroplasty among congenital aural atresia (CAA), congenital aural stenosis (CAS), and a normal control group, and to analyze its effect on the round window implantation of vibrant soundbridge. Methods CT images of 10 normal subjects (20 ears), 27 CAS patients (30 ears), and 25 CAA patients (30 ears) were analyzed. The depth and the size of outside fossa of round window niche related to the round window vibroplasty (extra-niche fossa)and the distances between the center of round window niche and extra-niche fossa were calculated based on three-dimensional reconstruction using mimics software. Finally, the data were analyzed statistically. Results The size of extra-niche fossa in the atresia group was smaller than in the stenosis group (p < 0.05); furthermore, the size of extra-niche fossa in the stenosis group was smaller than that of the control group (p < 0.05). There was no statistically significant difference of the depth of extra-niche fossa among different groups.

PMID: 27052964 [PubMed - in process]

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Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study.

Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study.

Acta Otolaryngol. 2016 May;136(5):446-50

Authors: Yen TT, Lin CH, Shiao JY, Liang KL

Abstract
Conclusion Sudden sensorineural hearing loss (SSNHL) in pregnancy is rare. It usually occurs in the third trimester. SSNHL in pregnancy does not increase risks during delivery or subsequent stroke. Objectives This study aimed to investigate the incidence and to determine the factors associated with SSNHL in pregnancy. Method Data were retrieved from Taiwan's National Health Insurance Database (NHIRD), covering the years 2000-2009. Patients admitted for SSNHL during pregnancy were enrolled. An age-matched controlled cohort was randomly selected from pregnant women without SSNHL in the NHIRD. The clinical characteristics of both cohorts were collected for further analyses. Results Thirty-three patients with SSNHL in pregnancy were enrolled. The estimated incidence of SSNHL in pregnancy in Taiwan was 2.71 per 100,000 pregnancies. The incidence of SSNHL in pregnancy was lower than that of the general female population. The incidence of SSNHL in the third trimester was higher compared to the other two. The incidence of SSNHL occurring in the 30-39 years old age group was higher than other groups. Women with better socioeconomic status had a higher incidence of SSNHL. There were no identified systemic diseases before SSNHL. Two patients had pre-eclampsia and one patient had premature delivery. Nevertheless, SSNHL in pregnancy did not increase the risk for stroke.

PMID: 27052963 [PubMed - in process]

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Treatment of idiopathic rhinitis with kinetic oscillations - a multi-centre randomized controlled study.

Treatment of idiopathic rhinitis with kinetic oscillations - a multi-centre randomized controlled study.

Acta Otolaryngol. 2016 Apr 7;:1-8

Authors: Ehnhage A, Johnsson PS, Ahlström-Emanuelsson C, Andersson M, Knutsson J, Lien J, Norlander T, Olsson P, Friis-Liby JE, Holmström M

Abstract
CONCLUSIONS: The potential effects of KOS are still uncertain regarding the most effective air pressure to be used as well as the physiological effects on the nasal mucosa. The results of the study do not support a convincing treatment effect by KOS on IR.
OBJECTIVES: Idiopathic rhinitis (IR) is a common disorder, affecting ∼10-20% of the population. A new method for treating IR, Kinetic Oscillation Stimulation (KOS), has been reported to have beneficial effects on total vasomotor symptom scores (TVRSS). The primary objective with this study was to evaluate if a mean pressure of 65 mbar, pressure amplitude of 100 mbar, and 68 Hz treatment with KOS had a positive effect on total vasomotor symptom scores (TVRSS), as compared with a mean pressure of 65 mbar, pressure amplitude of 4 mbar, and 68 Hz treatment in patients with idiopathic rhinitis.
METHODS: Two hundred and seven patients were randomized (Full Analysis Set, FAS) in the study, including five visits and lasting for ∼25 weeks. All patients had two treatment episodes, and all patients had at least one treatment, meant as active, with high amplitude pressure for 10 min in each nostril. Group 1 had two such treatments, and Group 2 had one treatment with low amplitude pressure, initially meant as placebo, on one occasion. Because of numerical improvements in these two groups, a new control group, Group 3, was introduced. They had one new control treatment where the balloon was inserted into the nose, without any air inflation and without oscillations.
RESULTS: KOS treatment with high amplitude pressure did not have significant beneficial effects as compared to low amplitude pressure on TVRSS. Numerical improvements in TVRSS and SNOT 22 were found when comparing high and low amplitude pressure treatments with uninflated balloon treatment. However, this part of the study was initially single-blinded, and these results were secondary objectives.

PMID: 27052839 [PubMed - as supplied by publisher]

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Protective role of misoprostol against cisplatin-induced ototoxicity.

Protective role of misoprostol against cisplatin-induced ototoxicity.

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Doğan M, Polat H, Yaşar M, Kaya A, Bayram A, Şenel F, Özcan İ

Abstract
Cis-diammineedichloroplatinum (cisplatin) is a chemotherapeutic agent that is widely used in the treatment of many cancers. Nephrotoxicity, ototoxicity and neurotoxicity are dose-limiting adverse effects for cisplatin. The cellular and molecular mechanisms underlying cisplatin-induced ototoxicity aren't fully understood. It has been proposed that cisplatin primarily cause damage at the cochlea, outer hair cells in particular, leading to excessive production of free oxygen radicals in the organ of Corti, stria vascularis, spiral ligament, and spiral ganglionic cells. The cytotoxicity is associated with the generation of reactive oxygen species (ROS); thus, there is an increasing interest on antioxidants with an effort to discover the established protection against cisplatin-induced ototoxicity over time. Misoprostol (MP) has gained considerable interest as a reactive oxygen species scavenger in recent years. To best of our knowledge, there is no study about protective effect of MP, a prostaglandin E1 (PGE1) analogue, on cisplatin-induced ototoxicity. In our study, we show that protective effects of misoprostol on cisplatin-induced ototoxcity on rats.

PMID: 27052552 [PubMed - as supplied by publisher]

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Letter to the Editor of European Archives of Otorhinolaryngology about a paper "Classification of parotidectomies: a proposal of the European Salivary Gland Society" by Quer et al.

Letter to the Editor of European Archives of Otorhinolaryngology about a paper "Classification of parotidectomies: a proposal of the European Salivary Gland Society" by Quer et al.

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Wierzbicka M

PMID: 27052551 [PubMed - as supplied by publisher]

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Commentary to: 'Long-term symptom relief after septoplasty,' Doi: 10.1007/s00405-014-3406-7.

Commentary to: 'Long-term symptom relief after septoplasty,' Doi: 10.1007/s00405-014-3406-7.

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Bakshi SS

PMID: 27052550 [PubMed - as supplied by publisher]

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Comparison of old (75-79 years) to very old (80+ years) hospitalized otorhinolaryngology patients.

Comparison of old (75-79 years) to very old (80+ years) hospitalized otorhinolaryngology patients.

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Weißenborn I, Ritter J, Geißler K, Guntinas-Lichius O

Abstract
BACKGROUND: The aim was to determine the patients' characteristics, comorbidity, and inpatient treatment features of very old otorhinolaryngology patients (80+ years) compared to old patients (75-79 years).
METHODS: A single-center cohort study in a tertiary and university care center was performed with 144 old and 143 very old patients who were hospitalized in 2012. Predictors for differences between old and very old patients were analyzed univariately and multivariately using regression models.
RESULTS: Ear (30 %) and nose/paranasal sinus (23 %) diseases were the most frequent reasons for hospitalization. Baseline and disease characteristics were not different between the two groups of elderly patients. Duration of hospitalization was no longer in very old patients (p = 0.827). Mobility (p = 0.017), dietary intake (p = 0.017), and having hearing aid (p < 0.0001) were independent comorbidity predictors in very old patients compared to old patients. Polymedication was found less frequently in very old patients (p = 0.017). To take cardiovascular drugs (p = 0.009) or psychotherapeutic drugs (p = 0.045) were independent permanent medication predictors in very old patients compared to old patients. About half of the patients received a surgical treatment (52 %) and the other half a conservative treatment (48 %). The very old patients received significantly more often an antibiotic treatment (p < 0.0001). Complication rates for surgical cases and non-surgical cases were not different (p = 0.686 and p = 0.524, respectively).
CONCLUSIONS: Although comorbidity continues to increase in hospitalized very old compared to old otorhinolaryngology patients, most of the disease, treatment and treatment related complication characteristics seem not to change significantly from old to very old patients.

PMID: 27052549 [PubMed - as supplied by publisher]

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Reply to comments on: Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

Reply to comments on: Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Prasad SC, Sanna M

PMID: 27052548 [PubMed - as supplied by publisher]

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The clinical analysis of bilateral successive sudden sensorineural hearing loss.

The clinical analysis of bilateral successive sudden sensorineural hearing loss.

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Wang Y, Zhang L, Zhang J, Zhang X, Zhang W, Chen X, Tang S

Abstract
The objective of this study is to investigate the clinical characteristics of successive bilateral sudden sensorineural hearing loss (SSNHL) with an interval of more than 1 year to aid the evaluation and management of successive bilateral SSNHL (BSSNHL). 14 successive BSSNHL patients and 118 unilateral SSNHL patients with severe and profound hearing loss were reviewed retrospectively. Information about successive BSSNHL was collected included demographics, the intervals between the attacks of bilateral ears, the past medical history, inducing factors, accompanying symptoms, pure-tone tests, blood tests, b-ultrasound examinations of vertebral artery and carotid artery, and medical interventions. And the comparison of improvement rate was made between successive BSSNHL and unilateral SSNHL. SPSS 15.0 was used to analyze the data. In successive BSSNHL, there were six males and eight females; the average aged was 49.86 ± 15.45 years (20-73 years). The interval of the two attacks was 11.43 ± 12.07 years (1-50 years) on average. The onset of treatment was 18.86 ± 12.71 days. Tinnitus was seen in 100 % of the patients, followed by vertigo in 42.85 %, and ear fullness in 21.43 %. 3 of 14 patients described obvious inducing factor: tiredness. Five patients (35.71 %) had hypertension histories, three (21.43 %) had diabetes histories, two (14.29 %) had surgery histories, one (7.14 %) was with depression history, one (7.14 %) was with coronary heart disease history. 30 % (3/10) patients were with atherosclerotic plaque in carotid artery. 4 (28.57 %) patients were with high blood sugar. 8 patients (57.14 %) were with high blood lipids. Thyroid function tests were positive in 27.27 % (3/11) patients. No abnormality was found in antinuclear antibodies titer. The percentage of profound and severe hearing loss were 71.43 and 78.57 % in the recently affected ear and contralateral ear separately. The PTAs of the recently affected ear were 77.14 ± 27.12 dB before treatment and 68.84 ± 22.32 dB after treatment, the improvement rate was 28.57 %. No improvement was found in the contralateral ears. In unilateral SSNHL, the average age was 42.47 ± 14.18 years. The onset of treatment was 18.08 ± 15.84 days. The improvement rate was 57.63 %, which was much higher than that of successive BSSNHL. There was no difference in age and time of onset of treatment between successive BSSNHL and unilateral SSNHL (p > 0.05). Successive BSSNHL is rare, the hearing impairment is severe, and the outcome of treatment is poorer. It may have a completely different profile compared with the simultaneous BSSNHL and unilateral SSNHL.

PMID: 27052547 [PubMed - as supplied by publisher]

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WITHDRAWN: A biphasic sessile mass of the buccal mucosa.

WITHDRAWN: A biphasic sessile mass of the buccal mucosa.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 13;

Authors: Peters TM, Zevallos JP, Golden BA, Curran AE

PMID: 27052446 [PubMed - as supplied by publisher]

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Effectiveness of Earplugs in Preventing Recreational Noise-Induced Hearing Loss: A Randomized Clinical Trial.

Effectiveness of Earplugs in Preventing Recreational Noise-Induced Hearing Loss: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2016 Apr 7;

Authors: Ramakers GG, Kraaijenga VJ, Cattani G, van Zanten GA, Grolman W

Abstract
Importance: The incidence of hearing loss has risen in past years. Attendance at music festivals and concerts may contribute to this increasing problem.
Objective: To assess the effectiveness of earplugs in preventing temporary hearing loss immediately following music exposure.
Design, Setting, and Participants: A randomized, single-blind clinical trial was conducted on September 5, 2015, at an outdoor music festival in Amsterdam, the Netherlands. Normal-hearing adult volunteers were recruited via social media. An exclusion criterion was the participants' intention to wear earplugs. Of the 86 volunteers assessed, 51 were included in the study. All analyses were performed on an intention-to-treat basis.
Interventions: Participants were randomly assigned to a group using earplugs or an unprotected group during a 4½-hour festival visit.
Main Outcomes and Measures: The primary study outcome was a temporary threshold shift (TTS) on the audiogram, primarily for frequencies at 3 and 4 kHz. Secondary study outcomes included distortion product otoacoustic emission (DPOAE) measurements and claims of tinnitus using a questionnaire and tinnitus matching experiments.
Results: Of 51 participants included, 25 were randomized to the earplug group and 26 to the unprotected group. Nine in each group (36% and 35%, respectively) were men, and the mean (SD) ages were 27.3 (5.6) years in the earplug group and 27.0 (6.2) years in the unprotected group. Baseline demographics were similar in both groups. The time-averaged, equivalent A-weighted sound pressure level experienced was 100 dBA during the festival. A TTS over frequencies at 3 and 4 kHz after exposure was seen in 4 of 50 ears (8%) in the earplug group compared with 22 of 52 ears (42%) in the unprotected group (P < .001). The relative risk for a TTS after exposure was 5.3 (95% CI, 2.0-14.3) for the unprotected group vs the earplug group. The number needed to treat with earplugs for preventing 1 TTS was 2.9. The DPOAE amplitudes decreased significantly more over the frequencies 2 to 8 kHz in the unprotected group: the mean (SD) decrease in magnitude was 0.6 (2.8) dB in the earplug group vs 2.2 (1.9) dB in the unprotected group (P = .04). Newly induced tinnitus following sound exposure occurred in 3 of the 25 participants (12%) in the earplug group vs 10 of 25 (40%) in the unprotected group (difference, 28%; 95% CI, 3.6%-49.0%; P = .02).
Conclusions and Relevance: Earplug use is effective in preventing temporary hearing loss after loud music exposure. The present randomized clinical trial adds proof to the scarce evidence and knowledge on this topic, which is a growing global problem.
Trial Registration: trialregister.nl Identifier: NTR5401.

PMID: 27054284 [PubMed - as supplied by publisher]

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The clinical analysis of bilateral successive sudden sensorineural hearing loss.

The clinical analysis of bilateral successive sudden sensorineural hearing loss.

Eur Arch Otorhinolaryngol. 2016 Apr 6;

Authors: Wang Y, Zhang L, Zhang J, Zhang X, Zhang W, Chen X, Tang S

Abstract
The objective of this study is to investigate the clinical characteristics of successive bilateral sudden sensorineural hearing loss (SSNHL) with an interval of more than 1 year to aid the evaluation and management of successive bilateral SSNHL (BSSNHL). 14 successive BSSNHL patients and 118 unilateral SSNHL patients with severe and profound hearing loss were reviewed retrospectively. Information about successive BSSNHL was collected included demographics, the intervals between the attacks of bilateral ears, the past medical history, inducing factors, accompanying symptoms, pure-tone tests, blood tests, b-ultrasound examinations of vertebral artery and carotid artery, and medical interventions. And the comparison of improvement rate was made between successive BSSNHL and unilateral SSNHL. SPSS 15.0 was used to analyze the data. In successive BSSNHL, there were six males and eight females; the average aged was 49.86 ± 15.45 years (20-73 years). The interval of the two attacks was 11.43 ± 12.07 years (1-50 years) on average. The onset of treatment was 18.86 ± 12.71 days. Tinnitus was seen in 100 % of the patients, followed by vertigo in 42.85 %, and ear fullness in 21.43 %. 3 of 14 patients described obvious inducing factor: tiredness. Five patients (35.71 %) had hypertension histories, three (21.43 %) had diabetes histories, two (14.29 %) had surgery histories, one (7.14 %) was with depression history, one (7.14 %) was with coronary heart disease history. 30 % (3/10) patients were with atherosclerotic plaque in carotid artery. 4 (28.57 %) patients were with high blood sugar. 8 patients (57.14 %) were with high blood lipids. Thyroid function tests were positive in 27.27 % (3/11) patients. No abnormality was found in antinuclear antibodies titer. The percentage of profound and severe hearing loss were 71.43 and 78.57 % in the recently affected ear and contralateral ear separately. The PTAs of the recently affected ear were 77.14 ± 27.12 dB before treatment and 68.84 ± 22.32 dB after treatment, the improvement rate was 28.57 %. No improvement was found in the contralateral ears. In unilateral SSNHL, the average age was 42.47 ± 14.18 years. The onset of treatment was 18.08 ± 15.84 days. The improvement rate was 57.63 %, which was much higher than that of successive BSSNHL. There was no difference in age and time of onset of treatment between successive BSSNHL and unilateral SSNHL (p > 0.05). Successive BSSNHL is rare, the hearing impairment is severe, and the outcome of treatment is poorer. It may have a completely different profile compared with the simultaneous BSSNHL and unilateral SSNHL.

PMID: 27052547 [PubMed - as supplied by publisher]

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