A case-control study of medical, psychological and socio-economic factors influencing the severity of chronic rhinosinusitis.

A case-control study of medical, psychological and socio-economic factors influencing the severity of chronic rhinosinusitis.

Rhinology. 2016 May 12;

Authors: Philpott C, Erskine S, Hopkins C, Coombes E, Kara N, Sunkareneni V, Anari S, Salam M, Farboud A

Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) is a common and debilitating disorder. Little is known about the epidemiology of this disease. The aims of the study were to identify differences in socio-economic variables and quality of life between patients with chronic rhinosinusitis and healthy controls, to identify any significant associations between CRS and other medical co-morbidities, psychiatric disease or environmental exposure and to explore the experience of CRS from the perspective of CRS sufferers.
METHODS: Participants were recruited from ENT clinics from 30 centres across the UK. They completed a study-specific questionnaire considering environmental, medical and socio-economic factors, and SF-36 and SNOT-22 scores. All participants with CRS were diagnosed by a clinician and categorised as having CRS (with polyposis, without polyposis or allergic fungal rhinosinusitis (AFRS)). Controls included family and friends of those attending ENT outpatient clinics and hospital staff who had no diagnosis of nose or sinus problems and had not been admitted to hospital in the previous 12 months.
RESULTS: A total of 1470 study participants (1249 patients and 221 controls) were included in the final analysis. Highly significant differences were seen in generic and disease-specific quality of life scores between CRS sufferers and controls; mean SNOT-22 score 45.0 for CRS compared with 12.1 amongst controls. There were no clear differences in socioeconomic variables including social class, index of multiple deprivation and educational attainment between cases and controls. Common comorbidities with a clear association included respiratory and psychiatric disorders, with a higher frequency of reported upper respiratory tract infections.
CONCLUSIONS: CRS is associated with significant impairment in quality of life and with certain medical co-morbidities. In contrast to other common ENT disorders, no socioeconomic differences were found between patients and controls in this study.

PMID: 27172454 [PubMed - as supplied by publisher]

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Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan.

Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan.

Odontology. 2016 May 11;

Authors: Yonenaga K, Majima HJ, Oyama S, Ishibashi K, Tanno H

Abstract
Japan has entered an era of a super-aging population, and given the importance of oral nutrition, the need to evaluate swallowing function has increased. Herein, we contribute to continued developments in evaluating eating and swallowing functions by describing current videoendoscopy (VE) usage and trends to evaluate and diagnose causes of dysphagia. In all, 100 patients (58 men and 42 women; mean age: 79 years) with suspected dysphagia were enrolled; 15 of these were re-examinations. Examinations were conducted according to the Japanese Society of Dysphagia Rehabilitation VE examination guidelines for swallowing. In this study, several patients (77.8 %) with poor vocalization and a saliva reservoir were unable to eat. While evaluating the relationship between aspiration and pharyngeal or laryngeal influx, we found that when pharyngeal and laryngeal influx were present, the risk of aspiration was high. Some patients (38.9 %) were able to eat despite lacking a cough reflex; thus, the absence of a cough reflex does not necessarily equate to an inability to eat, even in patients unable to ingest nutrition orally. One case could ingest nutrition, even with no cough reflex. The 6-month survival rate after the examination of patients on nil per os status was 57.1 %, specifically in patients unable to ingest nutrition orally. These results suggest that decreased eating and swallowing functions indicate a poor prognosis for the patient's quality of life, as eating and swallowing require smooth passage in the oral phase. Therefore, actively requesting a dental intervention and oral rehabilitation is important for a patient presenting these issues.

PMID: 27167386 [PubMed - as supplied by publisher]

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Skull Base; +23 new citations

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

Skull Base

These pubmed results were generated on 2016/05/14

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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In response to Spontaneous middle cranial fossa cerebrospinal fluid otorrhea in adults.

In response to Spontaneous middle cranial fossa cerebrospinal fluid otorrhea in adults.

Laryngoscope. 2016 May 12;

Authors: Rao N, Redleaf M

PMID: 27172003 [PubMed - as supplied by publisher]

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Endoscopic Endonasal Reconstruction of Skull Base: Repair Protocol.

Endoscopic Endonasal Reconstruction of Skull Base: Repair Protocol.

J Neurol Surg B Skull Base. 2016 Jun;77(3):271-8

Authors: Dehdashti AR, Stofko D, Okun J, Obourn C, Kennedy T

Abstract
Background Endoscopic endonasal skull base reconstructions have been associated with postoperative cerebrospinal fluid (CSF) leaks. Objective A repair protocol for endoscopic endonasal skull base reconstruction is presented with the objective of decreasing the overall leak rate. Methods A total of 180 endoscopic endonasal skull base reconstructions were reviewed. Reconstructions were classified I to IV according to the reconstruction method, determined by severity of intraoperatively encountered CSF leaks for types I to III, and planned preoperatively for type IVs, which required nasoseptal flap. Results A total of 11 patients(6%) had postoperative leaks: 0 in type I (0%), 2 in type II (5%), 7 in type III (18%), and 2 (4%) in type IV reconstruction. Type III leak rate was higher than all other reconstructions. Total 31 intraoperative and 16 postoperative lumbar drains were placed. More patients had lumbar drains placed postoperatively for type III and intraoperatively for type IV than all other groups. There were significant overall differences in postoperative CSF leaks and lumbar drain placement between the four reconstruction types. No patient with type III reconstruction and intraoperative lumbar drain had postoperative CSF leak. Conclusions A repair protocol for endoscopic endonasal reconstructions determined by intraoperative CSF leak and preoperative planning minimizes unnecessary repair materials and additional morbidity. Our experience leads to a routine prophylactic lumbar drain placement in all type III leak and reconstructions. We also favor the type III reconstruction for minor intraoperative leaks, and a more generous use of type IV reconstructions in expectation of significant intraoperative CSF leak. The option of rescue flap technique in type III leaks should be strongly considered.

PMID: 27175324 [PubMed]

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Consistent Efficacy of Wendan Decoction for the Treatment of Digestive Reflux Disorders.

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Consistent Efficacy of Wendan Decoction for the Treatment of Digestive Reflux Disorders.

Am J Chin Med. 2015;43(5):893-913

Authors: Ling W, Huang Y, Xu JH, Li Y, Huang YM, Ling HB, Sui Y, Zhao HL

Abstract
Gastroesophageal reflux disease (GERD) and bile reflux gastritis (BRG) are common gastrointestinal (GI) disorders with unmet medical needs. Traditional Chinese medicine has long been used for the treatment of GERD and BRG whereas the ginger-containing formula Wendan decoction (WDD) targets homeostatic disturbances characterized by "reflux" and "gut-juice exposure" problems. Here we used WDD as a therapeutic tool to unravel the common pathogenesis of GI reflux disorders. Control clinical trials reporting the WDD-treated patients with GERD and BRG were included in this systematic review and meta-analysis. Outcome measurements were clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology. Eventually, 33 studies involved 3253 participants (1351 vs. 1035 of the BRG in 20 publications, 449 vs. 418 of the GERD in 13 studies, and 194 vs. 159 of relapse rate in 6 trials). Pooled data showed a consistent therapeutic efficacy of WDD on BRG (OR = 6.00, 95%C = 4.68-7.69) and GERD (OR = 4.39, 95%CI = 2.72-7.07). The relapse rate was 12.4% for WDD, significantly lower than 44.0% for conventional therapies (OR = 0.14, 95%CI = 0.08-0.26). The consistent therapeutic efficacy of the single TCM formula on GERD and BRD indirectly indicates reflux as a common pathogenesis in reflux-associated GI disorders.

PMID: 26243580 [PubMed - indexed for MEDLINE]

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Pediatric Sudden Sensorineural Hearing Loss.

Pediatric Sudden Sensorineural Hearing Loss.

J Craniofac Surg. 2016 May 11;

Authors: Kizilay A, Koca ÇF

Abstract
Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied.

PMID: 27171971 [PubMed - as supplied by publisher]

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Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo.

Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo.

Braz J Otorhinolaryngol. 2016 Apr 22;

Authors: Evren C, Demirbilek N, Elbistanlı MS, Köktürk F, Çelik M

Abstract
INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. The Dix-Hallpike and Roll maneuvers are used to diagnose BPPV.
OBJECTIVE: This study aims to investigate the diagnostic value of repeated Dix-Hallpike and Roll maneuvers in BPPV.
METHODS: We performed Dix-Hallpike and roll maneuvers in patients who admitted with peripheral vertigo anamnesis and met our criteria. The present study consists of 207 patients ranging in age from 16 to 70 (52.67±10.67). We conducted the same maneuvers sequentially one more time in patients with negative results. We detected patients who had negative results in first maneuver and later developed symptom and nystagmus. We evaluated post-treatment success and patient satisfaction by performing Dizziness Handicap Inventory (DHI) at first admittance and two weeks after treatment in all patients with BPPV.
RESULTS: Of a total of 207 patients, we diagnosed 139 in first maneuver. We diagnosed 28 more patients in sequentially performed maneuvers. The remaining 40 patients were referred to imaging. There was a significant difference between pre- and post-treatment DHI scores in patients with BPPV (p<0.001).
CONCLUSION: Performing the diagnostic maneuvers only one more time in vertigo patients in the first clinical evaluation increases the diagnosis success in BPPV. Canalith repositioning maneuvers are effective and satisfactory treatment methods in BPPV.

PMID: 27170347 [PubMed - as supplied by publisher]

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Meniere's disease.

Meniere's disease.

Nat Rev Dis Primers. 2016;2:16028

Authors: Nakashima T, Pyykkö I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, Megerian CA, Naganawa S, Young YH

Abstract
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.

PMID: 27170253 [PubMed - in process]

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Prognostic implications of and audiometric evidence for hearing fluctuation in Meniere's disease.

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Prognostic implications of and audiometric evidence for hearing fluctuation in Meniere's disease.

Laryngoscope. 2015 Dec;125 Suppl 12:S1-12

Authors: Hoa M, Friedman RA, Fisher LM, Derebery MJ

Abstract
OBJECTIVES/HYPOTHESIS: 1) To establish criteria for significant hearing fluctuation by assessing the range and occurrence of hearing fluctuations over the course of Meniere's disease; 2) to determine if audiometric evidence exists to support the notion that Meniere's disease is a pathophysiologic process involving the whole cochlea; and 3) to suggest prognostic implications for initial hearing fluctuation in patients with Meniere's disease.
STUDY DESIGN: Retrospective case series review.
METHODS: A total of 488 patients diagnosed by 1995 American Academy of Otolaryngology-Head and Neck Surgery Meniere's disease criteria for whom audiometric data were prospectively collected (2 cohorts: 341 and 146 patients initially seen between April 2002 to July 2003 and between January to December 2010, respectively). Based on several definitions for significant hearing fluctuation, change in hearing was categorized as "same," "worse," or "better" between any two consecutive evaluations. The relationship of initial hearing fluctuation to future hearing fluctuation and future hearing loss was evaluated.
RESULTS: Hearing fluctuation was evident in Meniere's disease patients with heterogeneous audiometric follow-up; and the characteristics of these hearing fluctuations, including the mean incidence, is described. Audiometric data suggests that there is a high congruence in Meniere's disease between changes in low- and high-frequency thresholds. Initial hearing fluctuation is associated with the occurrence of future and more frequent hearing fluctuations.
CONCLUSION: Understanding the range of hearing fluctuations establishes a basis for determining audiometric thresholds used in evaluating future therapeutic trials aimed at the prevention of hearing loss in Meniere's disease. This knowledge will also inform the counseling directed toward patients diagnosed with Meniere's disease.

PMID: 26343803 [PubMed - indexed for MEDLINE]

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Contralateral cochlear implantation prior to vestibular nerve section for 'drop attacks' in the only hearing ear.

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Contralateral cochlear implantation prior to vestibular nerve section for 'drop attacks' in the only hearing ear.

J Laryngol Otol. 2015 Jul;129 Suppl 3:S58-60

Authors: Shi J, Kertesz T

Abstract
BACKGROUND: A dilemma occurs in the treatment of second-sided Ménière's disease in the only hearing ear, particularly in patients with severe symptoms such as 'drop attacks'. This paper describes a patient treated with contralateral cochlear implantation prior to vestibular nerve section of the symptomatic ear.
CASE REPORT: A 53-year-old man, with second-sided Ménière's disease and drop attacks in the only serviceable right ear, underwent successful left cochlear implantation 30 years after hearing loss, followed by right vestibular nerve section. The patient achieved control of Ménière's attacks and improved hearing. Although the patient experienced oscillopsia post-operatively, he was satisfied with his improved everyday functioning.
CONCLUSION: Patients with severe second-sided Ménière's disease in the only hearing ear are a small but difficult treatment group. In those that are suitable for cochlear implantation in the non-serviceable ear, it is suggested that this be employed prior to surgical treatment of the Ménière's symptoms, even if the implanted ear has had no auditory stimulation for many years.

PMID: 25809739 [PubMed - indexed for MEDLINE]

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Classification, diagnostic criteria and management of benign paroxysmal positional vertigo.

Classification, diagnostic criteria and management of benign paroxysmal positional vertigo.

Auris Nasus Larynx. 2016 May 9;

Authors: Imai T, Takeda N, Ikezono T, Shigeno K, Asai M, Watanabe Y, Suzuki M, Suzuki on behalf of Committee for Standards in Diagnosis of Japan Society for Equilibrium Research

Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo and the posterior and/or lateral semicircular canals are usually affected. BPPV is characterized by brief attacks of rotatory vertigo associated with positional and/or positioning nystagmus, which are elicited by specific head positions or changes in head position relative to gravity. In patients with the posterior-canal-type of BPPV, torsional nystagmus is induced by the Dix-Hallpike maneuver. In patients with the lateral-canal-type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The pathophysiology of BPPV is canalolithiasis comprising free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The observation of positional and/or positioning nystagmus is essential for the diagnosis of BPPV. BPPV is treated with the canalith repositioning procedure (CRP). Through a series of head position changes, the CRP moves otoconial debris from the affected semicircular canal to the utricle. In this review, we provide the classification, diagnostic criteria, and examinations for the diagnosis, and specific and non-specific treatments of BPPV in accordance with the Japanese practical guidelines on BPPV published by the Japan Society for Equilibrium Research.

PMID: 27174206 [PubMed - as supplied by publisher]

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A genome-wide association study of non-HPV-related head and neck squamous cell carcinoma identifies prognostic genetic sequence variants in the MAP-kinase and hormone pathways.

A genome-wide association study of non-HPV-related head and neck squamous cell carcinoma identifies prognostic genetic sequence variants in the MAP-kinase and hormone pathways.

Cancer Epidemiol. 2016 May 9;42:173-180

Authors: Azad AK, Bairati I, Qiu X, Girgis H, Cheng L, Waggott D, Cheng D, Mirshams M, Ho J, Fortin A, Vigneault E, Huang SH, O'Sullivan B, Waldron J, Boutros PC, Goldstein D, Meyer F, Xu W, Liu G

Abstract
BACKGROUND: Carcinomas of the oral cavity, pharynx and larynx are referred to as head and neck cancers (HNC); together they account for 2-3% of all newly diagnosed cancers in North America. Between 40-50% of HNC are early diagnosed at stages I-II. The 5-year and 10-year relative survival rates are 61% and 50%, respectively. Germline genetic sequence variants (GSV) have become increasingly found to have prognostic implications in a variety of cancers. Identifying these variants may have important clinical and biological implications.
METHODS: We conducted a genome-wide association study (GWAS) in 531 Stage I-II radiation-treated HNC patients (originally recruited for α-tocopherol/β-carotene placebo-controlled secondary prevention study) and used a replication cohort of 566 HNC patients of all stages, of mostly non-HPV-related cancers. Survival rates were estimated by the Kaplan-Meier method. Cox proportional hazards models adjusted for potential clinical factors and principal components were used to test for associations between the GSV and overall survival (OS) in these tumors.
RESULTS: The median follow-up time for OS was 9.21 years (GWAS cohort) and 2.37 years (replication cohort). In both cohorts, CACNA2D1:rs2299187, ESRRG:rs946465 and ESRRG:rs1416612 were each individually significantly associated with survival. In silico analysis of ESRRG:rs946465 identifies that it produces a splice variant in ESRRG. Variant alleles of CACNA2D1:rs2299187 and ESRRG:rs946465 were associated with higher expression of the corresponding protein.
CONCLUSIONS: Putatively functional polymorphisms in the MAP-Kinase and estrogen pathways, identified through GWAS and replicated in an independent dataset were associated with the survival of HNC patients.

PMID: 27173062 [PubMed - as supplied by publisher]

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Double primary malignant fibrous histiocytoma and squamous cell carcinoma of the larynx treated with laser laryngeal conservation surgery.

Double primary malignant fibrous histiocytoma and squamous cell carcinoma of the larynx treated with laser laryngeal conservation surgery.

Ecancermedicalscience. 2016;10:636

Authors: Karkos PD, Dova S, Sotiriou S, Markou K, Kostopoulos I

Abstract
ΒACKGROUND: Synchronous multiple malignancies of the larynx are rare. We present a case here of synchronous primary laryngeal squamous cell carcinoma (SCC) and malignant fibrous histiocytoma (MFH) in a patient with hoarseness though with no history of exposure to radiation. Clinical, intraoperative, and histopathological findings in this patient are discussed.
METHODS: Wide laser excision of the left supraglottic lesion and laser cordectomy of the right true vocal cord were performed.
RESULTS: The patient presented with a recurrence of the ÎFH alone (with no recurrence of the SCC) two months after the first operation and was managed with an extended second look laser cordectomy. The patient is under regular follow-up and remained disease-free nine months from diagnosis.
CONCLUSIONS: Our results show that early-stage simultaneous tumours of the larynx and particularly MFH and SCC can be treated efficiently with endoscopic laryngeal surgery alone. Close follow-up is of paramount importance because of the aggressive nature of MFH.

PMID: 27170836 [PubMed]

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Mixed Neuroendocrine-Nonneuroendocrine Neoplasms (MiNENs): Unifying the Concept of a Heterogeneous Group of Neoplasms.

Mixed Neuroendocrine-Nonneuroendocrine Neoplasms (MiNENs): Unifying the Concept of a Heterogeneous Group of Neoplasms.

Endocr Pathol. 2016 May 12;

Authors: La Rosa S, Sessa F, Uccella S

Abstract
The wide application of immunohistochemistry to the study of tumors has led to the recognition that epithelial neoplasms composed of both a neuroendocrine and nonneuroendocrine component are not as rare as traditionally believed. It has been recommended that mixed neuroendocrine-nonneuroendocrine epithelial neoplasms are classified as only those in which either component represents at least 30 % of the lesion but this cutoff has not been universally accepted. Moreover, since their pathogenetic and clinical features are still unclear, mixed neuroendocrine-nonneuroendocrine epithelial neoplasms are not included as a separate clinicopathological entity in most WHO classifications, although they have been observed in virtually all organs. In the WHO classification of digestive tumors, mixed neuroendocrine-nonneuroendocrine neoplasm is considered a specific type and is defined as mixed adenoneuroendocrine carcinoma, a definition that has not been accepted for other organs. In fact, this term does not adequately convey the morphological and biological heterogeneity of digestive mixed neoplasms and has created some misunderstanding among both pathologists and clinicians. In the present study, we have reviewed the literature on mixed neuroendocrine-nonneuroendocrine epithelial neoplasms reported in the pituitary, thyroid, nasal cavity, larynx, lung, digestive system, urinary system, male and female genital organs, and skin to give the reader an overview of the most important clinicopathological features and morphological criteria for diagnosing each entity. We also propose to use the term "mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN)" to define and to unify the concept of this heterogeneous group of neoplasms, which show different characteristics mainly depending on the type of neuroendocrine and nonneuroendocrine components.

PMID: 27169712 [PubMed - as supplied by publisher]

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Laryngeal penetration on videofluoroscopic swallowing study is associated with increased pneumonia in children.

Related Articles

Laryngeal penetration on videofluoroscopic swallowing study is associated with increased pneumonia in children.

Int J Pediatr Otorhinolaryngol. 2015 Nov;79(11):1827-30

Authors: Gurberg J, Birnbaum R, Daniel SJ

Abstract
OBJECTIVES: To determine whether children with laryngeal penetration on videofluoroscopic swallowing study are at higher risk for pneumonia than those with normal findings.
METHODS: We reviewed the charts of 235 pediatric patients presenting to our Swallowing and Dysphagia clinic for videofluoroscopic swallowing study over a 3-year period. Patients with unsuccessful swallowing studies, incomplete charts, extra-laryngeal etiologies for recurrent pneumonia, or who were lost to follow up were excluded. Out of the 165 patients remaining, 58 had normal findings, 59 had laryngeal penetration, and 48 had tracheobronchial aspiration. The number of cases of pneumonia, aspiration events, and demographic data were recorded for all patients.
RESULTS: Children with laryngeal penetration on videofluoroscopic swallowing study had significantly (P=0.032) more pneumonia than patients with neither penetration nor aspiration (median 2 vs. 0; mean 2.22 vs. 1.60). Furthermore, analysis revealed that glottic abnormalities (e.g. laryngeal cleft) represented a significant independent risk factor (P=0.004) for pneumonia and aspiration, while being diagnosed with a syndrome did not (P=0.343).
CONCLUSION: To our knowledge, this is the first study to demonstrate that laryngeal penetration on videofluoroscopic swallowing study is associated with significantly more cases of pneumonia in children. While this remains a retrospective study demonstrating a weak association, the results suggest a need for future prospective studies to evaluate this important clinical question in children.

PMID: 26381290 [PubMed - indexed for MEDLINE]

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Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.

Related Articles

Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.

Laryngoscope. 2015 Dec;125 Suppl 11:S1-15

Authors: Zur KB, Carroll LM

Abstract
OBJECTIVES/HYPOTHESIS: To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation.
STUDY DESIGN: Retrospective case-series chart review.
METHODS: Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time.
RESULTS: Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis.
CONCLUSIONS: This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP.

PMID: 26257068 [PubMed - indexed for MEDLINE]

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Comparison of Enk Fibreoptic Atomizer with translaryngeal injection for topical anaesthesia for awake fibreoptic intubation in patients at risk of secondary cervical injury: A randomised controlled trial.

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Comparison of Enk Fibreoptic Atomizer with translaryngeal injection for topical anaesthesia for awake fibreoptic intubation in patients at risk of secondary cervical injury: A randomised controlled trial.

Eur J Anaesthesiol. 2015 Sep;32(9):615-23

Authors: Malcharek MJ, Bartz M, Rogos B, Günther L, Sablotzki A, Gille J, Schneider G

Abstract
BACKGROUND: Two methods of topical anaesthesia for awake fibreoptic intubation (FOI) in patients at risk of secondary cervical injury were compared: the translaryngeal injection (TLI) technique and the Enk Fibreoptic Atomizer.
OBJECTIVE: The objective of this study was to determine which system of topical anaesthesia provides the fastest and most comfortable awake FOI, using the oral approach.
DESIGN: A randomised controlled study.
SETTING: A single centre trial between 2009 and 2011.
PATIENTS: One hundred and twenty patients (63 women, 57 men) who underwent neurosurgery of the spine at Klinikum St. Georg Leipzig were randomly allocated into two groups (group TLI, 61 patients; group ENK-ATOMIZER, 59 patients). Inclusion criteria were an American Society of Anesthesiology (ASA) physical status of 1 to 3, age 18 to 80 years, and those who met any one of three indications for FOI - cervical instability, predicted difficult airway, a BMI greater than 40 kg m(-2), and who gave written informed consent.Exclusion criteria were emergency awake FOI, mental disability/delirium, polytrauma and contraindication to TLI.
INTERVENTIONS: Two anaesthesiologists experienced in both techniques performed all anaesthesia procedures within the study.
MAIN OUTCOME MEASURES: The primary outcome was the timing sequence of awake FOI. The incidence of coughing/gagging, ease of tracheal tube placement, mucosal bleeding, cardiopulmonary stability and postoperative outcomes were also investigated.
RESULTS: Awake FOI was significantly faster using the TLI technique (mean, 191 s; range, 123 to 447 s; SD, 83.5) than the Enk Fibreoptic Atomizer [mean, 430 s; range, 275 to 773 s; SD, 124.9; (P = 0.0001)]. Patients in group TLI exhibited significantly less gagging (P = 0.047) but more mucosal bleeding (P <â .001).
CONCLUSION: Awake FOI using the TLI technique was faster and provided better topical anaesthesia with less gagging during endoscopic intubation. However, the TLI technique was also more invasive.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00948350.

PMID: 26086284 [PubMed - indexed for MEDLINE]

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Blind intubation of anaesthetised children with supraglottic airway devices AmbuAura-i and Air-Q cannot be recommended: A randomised controlled trial.

Related Articles

Blind intubation of anaesthetised children with supraglottic airway devices AmbuAura-i and Air-Q cannot be recommended: A randomised controlled trial.

Eur J Anaesthesiol. 2015 Sep;32(9):631-9

Authors: Kleine-Brueggeney M, Nicolet A, Nabecker S, Seiler S, Stucki F, Greif R, Theiler L

Abstract
BACKGROUND: Paediatric supraglottic airway devices AmbuAura-i and Air-Q were designed as conduits for tracheal intubation. Although fibreoptic-guided intubation has proved successful, blind intubation as a rescue technique has never been evaluated.
OBJECTIVE: Evaluation of blind intubation through AmbuAura-i and Air-Q. On the basis of fibreoptic view data, we hypothesised that the success rate with the AmbuAura-i would be higher than with the Air-Q.
DESIGN: A randomised controlled trial.
SETTING: University Childrens' Hospital; September 2012 to July 2014.
PATIENTS: Eighty children, American Society of Anesthesiologists (ASA) class I to III, weight 5 to 50 kg.
INTERVENTIONS: Tracheal intubation was performed through the randomised device with the tip of a fibrescope placed inside and proximal to the tip of the tracheal tube. This permitted sight of tube advancement, but without fibreoptic guidance (visualised blind intubation).
MAIN OUTCOME MEASURES: Primary outcome was successfully visualised blind intubation; secondary outcomes included supraglottic airway device success, insertion times, airway leak pressure, fibreoptic view and adverse events.
RESULTS: Personal data did not differ between groups. In contrast to our hypothesis, blind intubation was possible in 15% with the Air-Q and in 3% with the AmbuAura-i [95% confidence interval (95% CI) 6 to 31 vs. 0 to 13%; P = 0.057]. First attempt supraglottic airway device insertion success rates were 95% (Air-Q) and 100% (AmbuAura-i; 95% CI 83 to 99 vs. 91 to 100; P = 0.49). Median leak pressures were 18 cmH2O (Air-Q) and 17 cmH2O [AmbuAura-i; interquartile range (IQR) 14 to 18 vs. 14 to 19 cmH2O; P = 0.66]. Air-Q insertion was slower (27 vs. 19 s, P < 0.001). There was no difference in fibreoptic view, or adverse events (P > 0.05). In one child (Air-Q size 1.5, tube size 3.5), the tube dislocated during device removal.
CONCLUSION: Ventilation with both devices is reliable, but success of blind intubation is unacceptably low and cannot be recommended for elective or rescue purposes. If intubation through a paediatric supraglottic airway device is desired, we suggest that fibreoptic guidance is used.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01692522.

PMID: 26061874 [PubMed - indexed for MEDLINE]

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Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin.

Related Articles

Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin.

Neurol Sci. 2015 Sep;36(9):1679-82

Authors: Esposito M, Dubbioso R, Apisa P, Allocca R, Santoro L, Cesari U

Abstract
Spasmodic dysphonia (SD) is a focal dystonia of laryngeal muscles seriously impairing quality of voice. Adductor SD (ADSD) is the most common presentation of this disorder that can be identified by specialized phoniatricians and neurologists firstly on a clinical evaluation and then confirmed by videolaryngoscopy (VL). Botulinum toxin (BTX) injection with electromyographic guidance in muscles around vocal cords is the most effective treatment. Voice Handicap Index (VHI) questionnaire is the main tool to assess dysphonia and response to treatment. Objective of this study is to perform VL and voice spectrography (VS) to confirm the efficacy of BTX injections over time. 13 patients with ADSD were studied with VHI, VL and VS before and after 4 consecutive treatment with onobotulinumtoxin-A. For each treatment vocal improvement was proved by a significant reduction of VHI score and increase of maximum time phonation and harmonic-to-noise ratio while VL showed the absence of spasm in most of patients. No change of the response to BTX was found between injections. This study supports the efficacy of the treatment of SD with BTX with objective measurements and suggests that the efficacy of recurring treatments is stable over time.

PMID: 25966878 [PubMed - indexed for MEDLINE]

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Distal airways are protected from goblet cell metaplasia by diminished expression of IL-13 signalling components.

Related Articles

Distal airways are protected from goblet cell metaplasia by diminished expression of IL-13 signalling components.

Clin Exp Allergy. 2015 Sep;45(9):1447-58

Authors: Vock C, Yildirim AÃ, Wagner C, Schlick S, Lunding LP, Lee CG, Elias JA, Fehrenbach H, Wegmann M

Abstract
BACKGROUND: Increased mucus production is a critical factor impairing lung function in patients suffering from bronchial asthma, the most common chronic inflammatory lung disease worldwide.
OBJECTIVE: This study aimed at investigating whether goblet cell (GC) metaplasia and mucus production are differentially regulated in proximal and distal airways.
METHODS: Female Balb/c mice were sensitized to ovalbumin (OVA) and challenged with an OVA-aerosol on two consecutive days for 1 week (acute) or 12 weeks (chronic). Real-time RT-PCR analysis was applied on microdissected airways.
RESULTS: In acutely and chronically OVA-challenged mice, GC metaplasia and mucus production were observed in proximal but not in distal airways. In contrast, inflammation reflected by the infiltration of eosinophils and expression of the TH2-type cytokines IL-4 and IL-13 was increased in both proximal and distal airways. Abundance of IL-13Rα1 was lower in distal airways of healthy control mice. Under acute and chronic OVA-exposure, activation of IL-13Rα1-dependent signalling cascade, reflected by Spdef and Foxo3A transcription factors, was attenuated in distal compared to proximal airways.
CONCLUSION AND CLINICAL RELEVANCE: These data indicate that distal airways might be less sensitive to IL-13-induced GC metaplasia and mucus production through lower expression of IL-13Rα1 and attenuated activation of downstream signalling. This might represent a protective strategy to prevent mucus plugging of distal airways and thus impaired ventilation of attached alveoli.

PMID: 25772331 [PubMed - indexed for MEDLINE]

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[Significance of Secondary Mucosal Primaries in Patients with a Cervical CUP-Syndrome].

[Significance of Secondary Mucosal Primaries in Patients with a Cervical CUP-Syndrome].

Laryngorhinootologie. 2016 May 12;

Authors: Franzen AM, Lieder A, Buchali A

Abstract
Background: We discuss the significance of an occult primary in the prognosis of cervical carcinoma with unknown primary (CUP) after completion of diagnostic and treatment. Patients/Methods: A series of 36 patients diagnosed between 2001 and 2009 underwent staging including panendoscopy, mapping and tonsillectomy, ultrasound and CT/MRI of the neck, thorax and abdomen. The patients recieved neck surgery followed by adjuvant radio-(chemo-)therapy of cervical fields as well as limited mucosal irradiation (IMRT, GHD 50 Gy). The results of tumor control and therapy-related toxicity were ascertained. Results: A secondary primary of the cervical metastases was not detected during follow-up. 6 patients died from distant metastases and 1 from chemotherapy; 4 patients died from a different secondary tumour, 2 patients died intercurrently. We did not observe late toxicity but 8% of patients had Grade 3 dysphagia. Discussion: Efficacy of diagnostic procedure and therapy are important in treating occult primary tumours in CUP. Our results show that omitting PET-CT, which was not available in diagnostic workup of the study-patients, did not impact negatively on the manifestation rate of mucosal primaries and/or was compensated for by intensive therapy. Distant metastases and infraclavicular secondary primaries had a negative impact for the survival. Elective therapy of a presumed occult primary tumour in CUP should be included into the therapeutic discussion considering its efficacy and toxicity.

PMID: 27172108 [PubMed - as supplied by publisher]

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[Mass of the External Auditory Canal of Uncertain Etiology].

[Mass of the External Auditory Canal of Uncertain Etiology].

Laryngorhinootologie. 2016 May 12;

Authors: Patrick B, Torsten M

PMID: 27172107 [PubMed - as supplied by publisher]

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[Voice Self-Concept (FESS) in Medical Students].

[Voice Self-Concept (FESS) in Medical Students].

Laryngorhinootologie. 2016 May 12;

Authors: Lehnert B

PMID: 27172106 [PubMed - as supplied by publisher]

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Clinical and Radiographic Factors Predicting Hearing Preservation Rates in Large Vestibular Schwannomas.

Clinical and Radiographic Factors Predicting Hearing Preservation Rates in Large Vestibular Schwannomas.

J Neurol Surg B Skull Base. 2016 Jun;77(3):193-8

Authors: Mendelsohn D, Westerberg BD, Dong C, Akagami R

Abstract
Objectives Postoperative hearing preservation rates for patients with large vestibular schwannomas range from 0 to 43%. The clinical and radiographic factors predicting hearing preservation in smaller vestibular schwannomas are well described; however, their importance in larger tumors is unclear. We investigated factors predicting hearing preservation in large vestibular schwannomas. Design Retrospective review. Setting Quaternary care academic center. Participants A total of 85 patients with unilateral vestibular schwannomas > 3 cm underwent retrosigmoid resections. Main Outcomes Measures Preoperative and postoperative serviceable hearing rates. Methods Clinical and radiographic data including preoperative and postoperative audiograms, preoperative symptoms, magnetic resonance imaging features, and postoperative facial weakness were analyzed. Results Hearing was preserved in 41% of patients (17 of 42) with preoperative serviceable hearing. Hypertension and diabetes increased the likelihood of preoperative hearing loss. Preoperative tinnitus predicted a lower likelihood of hearing preservation. No radiographic factors predicted hearing preservation; however, larger tumor size, smaller fourth ventricular width, and the presence of a cerebrospinal fluid cleft surrounding the tumor predicted postoperative facial weakness. Conclusion Systemic comorbidities may influence hearing loss preoperatively in patients with large vestibular schwannomas. The absence of tinnitus may reflect hearing reserve and propensity for hearing preservation. Preoperative radiographic features did not predict hearing preservation despite some associations with postoperative facial weakness.

PMID: 27175312 [PubMed]

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Specific immediate early gene expression induced by high doses of salicylate in the cochlear nucleus and inferior colliculus of the rat.

Specific immediate early gene expression induced by high doses of salicylate in the cochlear nucleus and inferior colliculus of the rat.

Braz J Otorhinolaryngol. 2016 Apr 25;

Authors: Santos P, da Silva LE, Leão RM

Abstract
INTRODUCTION: Salicylate at high doses induces tinnitus in humans and experimental animals. However, the mechanisms and loci of action of salicylate in inducing tinnitus are still not well known. The expression of Immediate Early Genes (IEG) is traditionally associated with long-term neuronal modifications but it is still not clear how and where IEGs are activated in animal models of tinnitus.
OBJECTIVES: Here we investigated the expression of c-fos and Egr-1, two IEGs, in the Dorsal Cochlear Nucleus (DCN), the Inferior Colliculus (IC), and the Posterior Ventral Cochlear Nucleus (pVCN) of rats.
METHODS: Rats were treated with doses known to induce tinnitus in rats (300mg/kg i.p. daily, for 3 days), and c-fos and Egr-1 protein expressions were analyzed using western blot and immunocytochemistry.
RESULTS: After administration of salicylate, c-fos protein expression increased significantly in the DCN, pVCN and IC when assayed by western blot. Immunohistochemistry staining showed a more intense labeling of c-fos in the DCN, pVCN and IC and a significant increase in c-fos positive nuclei in the pVCN and IC. We did not detect increased Egr-1 expression in any of these areas.
CONCLUSION: Our data show that a high dose of salicylate activates neurons in the DCN, pVCN and IC. The expression of these genes by high doses of salicylate strongly suggests that plastic changes in these areas are involved in the genesis of tinnitus.

PMID: 27174774 [PubMed - as supplied by publisher]

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Pediatric Sudden Sensorineural Hearing Loss.

Pediatric Sudden Sensorineural Hearing Loss.

J Craniofac Surg. 2016 May 11;

Authors: Kizilay A, Koca ÇF

Abstract
Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied.

PMID: 27171971 [PubMed - as supplied by publisher]

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Meniere's disease.

Meniere's disease.

Nat Rev Dis Primers. 2016;2:16028

Authors: Nakashima T, Pyykkö I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, Megerian CA, Naganawa S, Young YH

Abstract
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.

PMID: 27170253 [PubMed - in process]

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This issue of The Journal of Laryngology & Otology Australian Supplement presents two practical reviews. Introduction.

Related Articles

This issue of The Journal of Laryngology & Otology Australian Supplement presents two practical reviews. Introduction.

J Laryngol Otol. 2015 Jul;129 Suppl 3:S1

Authors: Harvey RJ

PMID: 26245671 [PubMed - indexed for MEDLINE]

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"Finding a Voice": Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis.

"Finding a Voice": Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis.

AJNR Am J Neuroradiol. 2016 May 12;

Authors: Vachha BA, Ginat DT, Mallur P, Cunnane M, Moonis G

Abstract
Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis.

PMID: 27173367 [PubMed - as supplied by publisher]

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C2-3 Anterior Cervical Fusion: Technical Report.

C2-3 Anterior Cervical Fusion: Technical Report.

Clin Spine Surg. 2016 May 11;

Authors: Finn MA, MacDonald JD

Abstract
STUDY DESIGN: Retrospective review of patients at a university hospital OBJECTIVE:: To describe the anterior approach for cervical discectomy and fusion (ACDF) at C2-3 level and evaluate its suitability for treatment of instability and degenerative disease in this region.
SUMMARY OF BACKGROUND DATA: The anterior approach is commonly used for ACDF in the lower cervical spine but is used less often in the high cervical spine.
METHODS: We retrospectively reviewed a database of consecutive cervical spine surgeries performed at our institution to identify patients who underwent ACDF at the C2-3 level during a 10-year period. Demographic data, clinical indications, surgical technique, complications, and immediate results were evaluated.
RESULTS: Of the 11 patients (7 female, 4 male; mean age 46 y) identified, 7 were treated for traumatic fractures and 4 for degenerative disc disease. Three patients treated for myelopathy showed improvement in mean Nurick grade from 3.6 to 1.3. Pain was significantly improved in all patients who had preoperative pain. Solid bony fusion was achieved in 5 of 7 patients at 3-month follow-up. Complications included dysphagia in 4 patients (which resolved in 3), aspiration pneumonia, mild persistent dysphonia, and construct failure at C2 requiring posterior fusion. One patient died of a pulmonary embolism 2 weeks postoperatively.
CONCLUSIONS: ACDF at the C2-3 level is an option for the treatment of high cervical disease or trauma but is associated with a higher rate of approach-related morbidity. Familiarity with local anatomy may help to reduce complications. ACDF at C2-3 appears to have a fusion rate similar to ACDF performed at other levels.

PMID: 27171665 [PubMed - as supplied by publisher]

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Wireless and acoustic hearing with bone-anchored hearing devices.

Wireless and acoustic hearing with bone-anchored hearing devices.

Int J Audiol. 2016 May 13;:1-6

Authors: Bosman AJ, Mylanus EA, Hol MK, Snik AF

Abstract
OBJECTIVE: The efficacy of wireless connectivity in bone-anchored hearing was studied by comparing the wireless and acoustic performance of the Ponto Plus sound processor from Oticon Medical relative to the acoustic performance of its predecessor, the Ponto Pro.
STUDY SAMPLE: Nineteen subjects with more than two years' experience with a bone-anchored hearing device were included. Thirteen subjects were fitted unilaterally and six bilaterally.
DESIGN: Subjects served as their own control. First, subjects were tested with the Ponto Pro processor. After a four-week acclimatization period performance the Ponto Plus processor was measured. In the laboratory wireless and acoustic input levels were made equal. In daily life equal settings of wireless and acoustic input were used when watching TV, however when using the telephone the acoustic input was reduced by 9 dB relative to the wireless input.
RESULTS: Speech scores for microphone with Ponto Pro and for both input modes of the Ponto Plus processor were essentially equal when equal input levels of wireless and microphone inputs were used. Only the TV-condition showed a statistically significant (p <5%) lower speech reception threshold for wireless relative to microphone input. In real life, evaluation of speech quality, speech intelligibility in quiet and noise, and annoyance by ambient noise, when using landline phone, mobile telephone, and watching TV showed a clear preference (p <1%) for the Ponto Plus system with streamer over the microphone input. Due to the small number of respondents with landline phone (N = 7) the result for noise annoyance was only significant at the 5% level.
CONCLUSION: Equal input levels for acoustic and wireless inputs results in equal speech scores, showing a (near) equivalence for acoustic and wireless sound transmission with Ponto Pro and Ponto Plus. The default 9-dB difference between microphone and wireless input when using the telephone results in a substantial wireless benefit when using the telephone. The preference of wirelessly transmitted audio when watching TV can be attributed to the relatively poor sound quality of backward facing loudspeakers in flat screen TVs. The ratio of wireless and acoustic input can be easily set to the user's preference with the streamer's volume control.

PMID: 27176657 [PubMed - as supplied by publisher]

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Sensory Impairment, Functional Balance and Physical Activity with All-Cause Mortality.

Sensory Impairment, Functional Balance and Physical Activity with All-Cause Mortality.

J Phys Act Health. 2016 May 11;

Authors: Loprinzi PD, Crush E

Abstract
OBJECTIVE: No study has comprehensively examined the independent and combined effects of sensory impairment, physical activity and balance on mortality risk, which was this study's purpose.
METHODS: Data from the population-based 2003-2004 National Health and Nutrition Examination Survey was used, with follow-up through 2011. Physical activity was assessed via accelerometry. Balance was assessed via the Romberg test. Peripheral neuropathy was assessed objectively using a standard monofilament. Visual impairment was objectively assessed using an autorefractor. Hearing impairment was assessed via self-report. A 5-level index variable (higher score is worse) was calculated based on the participant's degree of sensory impairment, dysfunctional balance and physical inactivity.
RESULTS: Among the 1,658 participants (40-85 yrs), 228 died during the median follow-up period of 92 months. Hearing (HR=1.18; P=0.40), vision (HR=1.17; P=0.58) and peripheral neuropathy (HR=1.06; P=0.71) were not independently associated with all-cause mortality, but physical activity (HR=0.97; P=0.01) and functional balance (HR=0.59; P=0.03) were. Compared to those with an index score of 0, the Hazard Ratios (95% CI) for those with an index score of 1-3, respectively, were 1.20 (0.46-3.13), 2.63 (1.08-6.40) and 2.88 (1.36-6.06).
CONCLUSIONS: Physical activity and functional balance are independent contributors to survival.

PMID: 27172618 [PubMed - as supplied by publisher]

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Meniere's disease.

Meniere's disease.

Nat Rev Dis Primers. 2016;2:16028

Authors: Nakashima T, Pyykkö I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, Megerian CA, Naganawa S, Young YH

Abstract
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.

PMID: 27170253 [PubMed - in process]

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Dancing Jaw and Dancing Eyes.

Related Articles

Dancing Jaw and Dancing Eyes.

JAMA Neurol. 2016 Jan;73(1):122

Authors: Kalla R, Meichtry J, Schumacher R, Cazzoli D, Wiest R, Seifert E, Müri R

PMID: 26619272 [PubMed - indexed for MEDLINE]

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Wireless and acoustic hearing with bone-anchored hearing devices.

Wireless and acoustic hearing with bone-anchored hearing devices.

Int J Audiol. 2016 May 13;:1-6

Authors: Bosman AJ, Mylanus EA, Hol MK, Snik AF

Abstract
OBJECTIVE: The efficacy of wireless connectivity in bone-anchored hearing was studied by comparing the wireless and acoustic performance of the Ponto Plus sound processor from Oticon Medical relative to the acoustic performance of its predecessor, the Ponto Pro.
STUDY SAMPLE: Nineteen subjects with more than two years' experience with a bone-anchored hearing device were included. Thirteen subjects were fitted unilaterally and six bilaterally.
DESIGN: Subjects served as their own control. First, subjects were tested with the Ponto Pro processor. After a four-week acclimatization period performance the Ponto Plus processor was measured. In the laboratory wireless and acoustic input levels were made equal. In daily life equal settings of wireless and acoustic input were used when watching TV, however when using the telephone the acoustic input was reduced by 9 dB relative to the wireless input.
RESULTS: Speech scores for microphone with Ponto Pro and for both input modes of the Ponto Plus processor were essentially equal when equal input levels of wireless and microphone inputs were used. Only the TV-condition showed a statistically significant (p <5%) lower speech reception threshold for wireless relative to microphone input. In real life, evaluation of speech quality, speech intelligibility in quiet and noise, and annoyance by ambient noise, when using landline phone, mobile telephone, and watching TV showed a clear preference (p <1%) for the Ponto Plus system with streamer over the microphone input. Due to the small number of respondents with landline phone (N = 7) the result for noise annoyance was only significant at the 5% level.
CONCLUSION: Equal input levels for acoustic and wireless inputs results in equal speech scores, showing a (near) equivalence for acoustic and wireless sound transmission with Ponto Pro and Ponto Plus. The default 9-dB difference between microphone and wireless input when using the telephone results in a substantial wireless benefit when using the telephone. The preference of wirelessly transmitted audio when watching TV can be attributed to the relatively poor sound quality of backward facing loudspeakers in flat screen TVs. The ratio of wireless and acoustic input can be easily set to the user's preference with the streamer's volume control.

PMID: 27176657 [PubMed - as supplied by publisher]

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Role of cervical vestibular evoked myogenic potentials (cVEMP) and auditory brainstem response (ABR) in the evaluation of vestibular schwannoma.

Role of cervical vestibular evoked myogenic potentials (cVEMP) and auditory brainstem response (ABR) in the evaluation of vestibular schwannoma.

Braz J Otorhinolaryngol. 2016 Apr 28;

Authors: Valame DA, Gore GB

Abstract
INTRODUCTION: Cervical vestibular evoked myogenic potentials (cVEMP) can assess the integrity of the inferior vestibular nerve thereby promising to be a useful tool in the audiological test battery to diagnose vestibular schwannoma.
OBJECTIVE: To ascertain the utility of cVEMP in diagnosis of vestibular schwannoma in conjunction with the ABR and to evaluate whether the size of lesion has any effect on the cVEMP measures.
METHODS: Case-files of 15 known cases of vestibular schwannoma whose pure tone audiometry, auditory brainstem response (ABR), cVEMP and radiological investigation findings were available, were included in the study. Patients were categorised as large or small tumours based on the size. The absolute and inter-peak latencies of ABR, amplitudes of waves V and I, and inter-aural latency difference of wave V of ABR; and latency of P1 and N1 of cVEMP and amplitude of P1-N1 complex were considered in the study.
RESULTS: There were eight large and nine small tumours. All the patients with large tumours showed significant severity of hearing loss whereas only three out of nine patients with small tumours showed severe to profound deafness in the affected ear. The rest showed hearing status ranging from normal hearing sensitivity to moderate hearing loss. Most of the patients with large tumours showed complete absence of ABR in the affected ears with no identifiable wave-peaks. ABR in small tumours exhibited delayed III-I and delayed V-I interpeak latency interval (IPL). Four out of five patients with large unilateral tumours revealed contralateral effects of reduced amplitude or absence of cVEMP. On the contrary, six out of eight unilateral small tumours showed a normal cVEMP response in the contralateral ear. Both the patients with NF2 in the present study demonstrated cVEMP abnormalities.
CONCLUSION: ABR and cVEMP, when used in combination, can be of immense use in identification of neuro-otologic conditions such as vestibular schwannoma and bilateral tumours in NF2. In the evaluation of unilateral vestibular schwannoma, abnormal contralateral findings of cVEMP and ABR are strongly indicative of the tumour size >2.5cm. In unilateral severe to profound loss wherein ABR in poorer ear cannot give information of site-of-lesion, cVEMP can help in the differentiation.

PMID: 27174775 [PubMed - as supplied by publisher]

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Parent-rated measures of bilingual children's speech accuracy: Implications for a universal speech screen.

Parent-rated measures of bilingual children's speech accuracy: Implications for a universal speech screen.

Int J Speech Lang Pathol. 2016 Apr;18(2):202-11

Authors: Kim JH, Ballard E, McCann CM

Abstract
PURPOSE: This study investigated whether parents were reliable in judging their bilingual children's speech and whether parent-rated measure of children's speech could be used as a tool for a universal speech screen to identify children with speech sound disorder (SSD).
METHOD: Single word samples from 33 Korean-English bilingual (KEB) pre-school children were analysed for percentage of consonants correct (PCC). Their parents completed the Intelligibility in Context Scale and a similarly constructed scale devised by Stertzbach and Gildersleeve-Neumann. Spearman rank correlations were used to examine the association between the PCC scores and the parent-rated measures.
RESULT: A number of factors influenced parents' reliability in judging their bilingual children's speech, including language dominance and the nature of the questions that were asked. The perception of strangers on a child's speech problems, as judged by the parents, could be significant in identifying children with SSD. When the cut-off ICS mean score derived from a previous monolingual research was applied to KEB children, over 40% of the sample was identified as requiring a comprehensive clinical assessment.
CONCLUSION: Implementation of a universal speech screen utilising parent-rated measures of children's speech cannot be introduced without further research.

PMID: 27172854 [PubMed - in process]

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The role of language proficiency, cognate status and word frequency in the assessment of Spanish-English bilinguals' verbal fluency.

The role of language proficiency, cognate status and word frequency in the assessment of Spanish-English bilinguals' verbal fluency.

Int J Speech Lang Pathol. 2016 Apr;18(2):190-201

Authors: Blumenfeld HK, Bobb SC, Marian V

Abstract
PURPOSE: Assessment tools are needed to accurately index performance in bilingual populations. This study examines the verbal fluency task to further establish the relative sensitivities of letter and category fluency in assessing bilingual language skills in Spanish-English bilinguals.
METHOD: English monolinguals and Spanish-English bilinguals had 1 minute to name words belonging to a category (e.g. animals) or starting with a letter (e.g. A). Number of words retrieved, proficiency, cognate and frequency effects were examined.
RESULT: In their dominant language (English), bilinguals and monolinguals showed similar fluency patterns, generating more words in category than letter tasks. This category advantage disappeared for bilinguals tested in their non-dominant language (Spanish). Further, bilinguals retrieved a higher percentage of cognates (e.g. lagoon-laguna) than monolinguals across tasks and languages. In particular, as proficiency increased in their non-dominant language, bilinguals were more likely to produce cognates (including cognates with lower word frequencies).
CONCLUSION: While bilinguals and monolinguals performed largely the same, bilinguals showed fine-grained differences from monolinguals in both their dominant and non-dominant languages. Based on these results, it is recommended that clinicians evaluate findings from bilinguals' verbal fluency tasks with attention to language proficiency, cognate words produced and relative to normative data that match their clients' language histories.

PMID: 27172853 [PubMed - in process]

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A descriptive study of lexical organisation in bilingual children with language impairment: Developmental changes.

A descriptive study of lexical organisation in bilingual children with language impairment: Developmental changes.

Int J Speech Lang Pathol. 2016 Apr;18(2):178-89

Authors: Holmström K, Salameh EK, Nettelbladt U, Dahlgren Sandberg A

Abstract
PURPOSE: This study aimed to describe the development of Arabic and Swedish lexical organisation in bilingual children with language impairment (BLI).
METHOD: Lexical organisation was assessed through word associations in 10 BLI and 10 bilingual children with typical development (BTD), aged 6;2-8;0 years, matched for age and gender. The participants were assessed twice, with a 1-year interval. Word associations were coded as paradigmatic, syntagmatic, phonological, other and no answer. This study reports analyses of the semantically-related syntagmatic and paradigmatic associations. Using repeated measures ANOVA, main and interaction effects of Group, Time and Language were examined for paradigmatic and syntagmatic associations separately.
RESULT: The interaction between Group and Time was significant for both associations. The BLI group increased syntagmatic associations from time 1 to time 2, while the BTD group increased paradigmatic associations. Results showed a significant main effect of Language for both types of associations, with better performance in Swedish. Significant Group by Language interactions resulted from lower Arabic than Swedish syntagmatic and paradigmatic scores for the BLI and BTD groups, respectively.
CONCLUSION: Differing developmental trajectories indicate that bilingual children with LI develop lexical organisation at a slower pace than bilingual peers with typical language development.

PMID: 27172852 [PubMed - in process]

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Interlocutor differential effects on the expressive language skills of Spanish-speaking English learners.

Interlocutor differential effects on the expressive language skills of Spanish-speaking English learners.

Int J Speech Lang Pathol. 2016 Apr;18(2):166-77

Authors: Rojas R, Iglesias A, Bunta F, Goldstein B, Goldenberg C, Reese L

Abstract
PURPOSE: The primary objective of this study was to investigate the relationship between language use with different interlocutors, maternal education level and the expressive language skills of US English learners (ELs) in Spanish and English.
METHOD: Two hundred and twenty-four Spanish-speaking ELs in kindergarten provided narrative language samples in Spanish and English. Parents completed a questionnaire of maternal education level and language use with parents, older siblings and peers.
RESULT: Multiple linear regression analyses demonstrated that language used with different interlocutors and maternal education level had unique effects on participants' expressive language skills. ELs' expressive language skills in English were predicted by interactions with older siblings, peers and maternal education level; Spanish expressive language skills were predicted by interactions with older siblings.
CONCLUSION: The findings from this study suggest that the determination of language experience of school-age bilingual children should examine differential language use with multiple interlocutors, particularly interactions with older siblings and peers.

PMID: 27172851 [PubMed - in process]

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Phonology in Swedish-speaking 5-year-olds born with unilateral cleft lip and palate and the relationship with consonant production at 3 years of age.

Phonology in Swedish-speaking 5-year-olds born with unilateral cleft lip and palate and the relationship with consonant production at 3 years of age.

Int J Speech Lang Pathol. 2016 Apr;18(2):147-56

Authors: Klintö K, Salameh EK, Lohmander A

Abstract
PURPOSE: At ∼3 years of age ∼50% of the children born with cleft palate present with phonological/articulatory difficulties. Differences between children with and without cleft palate have been reported to decline with age; however, the phonology in children with cleft palate at pre-school age/early school age has rarely been explored. The purpose of this study was to assess phonology in children with unilateral cleft lip and palate (UCLP) at age 5 and its relationship with performances at 3 years of age.
METHOD: The study included 29 children with UCLP and 20 without UCLP. Percentage correct consonants adjusted for age (PCC-A) and number of consistent phonological simplification processes were assessed from phonetic transcriptions. In addition, a descriptive analysis of phonological/articulatory processes was performed.
RESULT: The children with UCLP displayed significantly lower PCC-A and more phonological processes at age 5 years than peers without UCLP. The correlations between the outcomes at 3 and 5 years of age were significant.
CONCLUSION: Still at 5 years of age many children with cleft palate have phonological problems and it is possible to identify children at risk for impaired phonology at earlier age.

PMID: 27172850 [PubMed - in process]

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Redefining 'Chinese' L1 in SLP: Considerations for the assessment of Chinese bilingual/bidialectal language skills.

Redefining 'Chinese' L1 in SLP: Considerations for the assessment of Chinese bilingual/bidialectal language skills.

Int J Speech Lang Pathol. 2016 Apr;18(2):135-46

Authors: Han W, Brebner C, McAllister S

Abstract
PURPOSE: Language assessment of bilingual/bidialectal children can be complex. This is particularly true for speakers from China, who are likely to be bilingual and bidialectal at the same time. There has been, however, a lack of understanding of the diversity of Chinese languages as well as data on bidialectal children's L1 syntactic development and the development of L1 bidialectal children's L2 acquisition.
METHOD: This paper provides information on the complexity of the language system for people from China. It will present illustrative examples of the expressive language outputs of bilingual and bidialectal children from the perspective of bilingual, bidialectal linguists and speech-language pathologists. Then it will outline why appropriate assessment tools and practices for identification of language impairment in bilingual Chinese children need to be developed.
RESULT: Considerations include that Chinese bilingual children may differ in L2 performance because of lack of exposure in the target language or because of their varied L1 dialectal backgrounds, but not necessarily because of language impairment.
CONCLUSION: When evaluating morphosyntactic performance of bilingual children, a series of reliable threshold indicators for possible language impairment is urgently needed for SLPs to facilitate accurate diagnosis of language impairment.

PMID: 27172849 [PubMed - in process]

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Consonants, vowels and tones across Vietnamese dialects.

Consonants, vowels and tones across Vietnamese dialects.

Int J Speech Lang Pathol. 2016 Apr;18(2):122-34

Authors: PhȦm B, McLeod S

Abstract
PURPOSE: Vietnamese is spoken by over 89 million people in Vietnam and it is one of the most commonly spoken languages other than English in the US, Canada and Australia. This study defines between one and nine different dialects of Vietnamese spoken in Vietnam. In Vietnamese schools, children learn Standard Vietnamese which is based on the northern dialect; however, if they live in other regions they may speak a different dialect at home.
METHOD: This paper describes the differences between the consonants, semivowels, vowels, diphthongs and tones for four dialects: Standard, northern, central and southern Vietnamese.
RESULT: The number and type of initial consonants differs per dialect (i.e. Standard = 23, northern = 20, central = 23, southern = 21). For example, the letter "r" is pronounced in the Standard and central dialects as the retroflex /ʐ/, northern dialect as the voiced alveolar fricative /z/ or the trilled /r/ and in the southern dialect as the voiced velar fricative /ɣ/. Additionally, the letter "v" is pronounced in the Standard, northern and central dialects as the voiced bilabial fricative /v/, the southern dialect as the voiced palatal approximant /j/ and in the lower northern dialect (Ninh Binh) as the voiceless bilabial fricative /f/. Similarly, the number of final consonants differs per dialect (i.e. Standard = 6, northern = 10, central = 10, southern = 8). Finally, the number and type of tones differs per dialect (i.e. Standard = 6, northern = 6, central = 5, southern = 5).
CONCLUSION: Understanding differences between Vietnamese dialects is important so that speech-language pathologists and educators provide appropriate services to people who speak Vietnamese.

PMID: 27172848 [PubMed - in process]

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Cultural and linguistic diversity in speech-language pathology.

Cultural and linguistic diversity in speech-language pathology.

Int J Speech Lang Pathol. 2016 Apr;18(2):109-10

Authors: Verdon S, Blake HL, Hopf SC, Phạm B, McLeod S

PMID: 27172847 [PubMed - in process]

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Shoulder morbidity after pectoralis major flap reconstruction.

Shoulder morbidity after pectoralis major flap reconstruction.

Head Neck. 2016 May 13;

Authors: Refos JW, Witte BI, de Goede CJ, de Bree R

Abstract
BACKGROUND: Donor site morbidity of pectoralis major pedicled flap (PMPF) is scarcely studied.
METHODS: A cross-sectional study on patients who underwent reconstructive surgery with a PMPF at least 6 months before was performed. Patients with a similar type neck dissection on both sides and PMPF on one side (n = 9) were assigned to group 1; patients with neck dissection and PMPF (n = 26) were assigned to group 2; and neck dissection only (n = 47) were assigned to group 3. All 3 groups filled out a shoulder disability questionnaire and underwent shoulder function tests. Pain of the shoulder was rated on a visual analog scale (VAS). Patients were also asked if they had experienced stiffness of the shoulder during the previous week. Range of motion (ROM) of the shoulder was examined by one single examiner using an inclinometer, in accord with a standardized protocol. Radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND) sides were separately analyzed.
RESULTS: In group 2, shoulder morbidity was experienced more often (p = .065) than in group 3, particularly at the sides where an SND was performed (p = .010). Significant differences in prevalence of shoulder stiffness between PMPF and neck dissection sides and neck dissection only sides were found in the RND (p = .001) and MRND (p = .004) groups, but not in the SND group. A lower ROM of abduction (p = .026) was found in group 2 as compared to group 3.
CONCLUSION: Patients frequently have additional shoulder morbidity after PMPF harvest, particularly after SND. PMPF harvest adds to impairment of abduction. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27172858 [PubMed - as supplied by publisher]

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Validation of the secretion severity rating scale.

Validation of the secretion severity rating scale.

Eur Arch Otorhinolaryngol. 2016 May 12;

Authors: Pluschinski P, Zaretsky E, Stöver T, Murray J, Sader R, Hey C

Abstract
Accumulation of secretions within the hypopharynx, aditus laryngis, and trachea is one characteristic of severe dysphagia and is of high clinical and therapeutic relevance. For the graduation of the secretion severity level, a secretion scale was provided by Murray et al. in 1996. The purpose of the study presented here is the validation of this scale by analyzing the intra-rater and inter-rater reliability as well as concurrent validity. For examination of reliability and validity, a reference standard was defined by two expert clinicians who reviewed 40 video recordings of fiberendoscopic swallowing evaluations, with 10 videos for each severity grade. These videos were rated and rerated independently and blinded by 4 ENT-residents with an interval of 4 weeks. Both the intra-rater (Kendall's τ > 0.847***) and inter-rater reliability (Kendall's W > 0.951***) were highly significant and can be considered good or very good. Correlation of the median of all ratings with the reference standard was close to the highest possible value 1 (τ = 0.984***). The scale was proved to be a reliable and valid instrument for graduation of one of the principal symptoms of oropharyngeal dysphagia and is recommended as an evidence-based instrument for standardized fiberoptic endoscopic evaluation of swallowing.

PMID: 27173156 [PubMed - as supplied by publisher]

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Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach.

Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach.

Eur Arch Otorhinolaryngol. 2016 May 12;

Authors: Crott R, Lawson G, Nollevaux MC, Castiaux A, Krug B

Abstract
Head and neck cancer (HNC) is predominantly a locoregional disease. Sentinel lymph node (SLN) biopsy offers a minimally invasive means of accurately staging the neck. Value in healthcare is determined by both outcomes and the costs associated with achieving them. Time-driven activity-based costing (TDABC) may offer more precise estimates of the true cost. Process maps were developed for nuclear medicine, operating room and pathology care phases. TDABC estimates the costs by combining information about the process with the unit cost of each resource used. Resource utilization is based on observation of care and staff interviews. Unit costs are calculated as a capacity cost rate, measured as a Euros/min (2014), for each resource consumed. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost for each phase of care. Three time equations with six different scenarios were modeled based on the type of camera, the number of SLN and the type of staining used. Total times for different SLN scenarios vary between 284 and 307 min, respectively, with a total cost between 2794 and 3541€. The unit costs vary between 788€/h for the intraoperative evaluation with a gamma-probe and 889€/h for a preoperative imaging with a SPECT/CT. The unit costs for the lymphadenectomy and the pathological examination are, respectively, 560 and 713€/h. A 10 % increase of time per individual activity generates only 1 % change in the total cost. TDABC evaluates the cost of SLN in HNC. The total costs across all phases which varied between 2761 and 3744€ per standard case.

PMID: 27170361 [PubMed - as supplied by publisher]

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Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction.

Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction.

Eur Arch Otorhinolaryngol. 2016 May 11;

Authors: Giordano L, Di Santo D, Occhini A, Galli A, Bertino G, Benazzo M, Bussi M

Abstract
Over the last 20 years, free flaps have represented the gold standard for moderate to large head and neck reconstruction. However, regional flaps continue to evolve and still play an important role in a reconstructive surgeon's armamentarium, especially for the more delicate patients who would certainly benefit from simpler surgical procedures. The supraclavicular artery island flap (SCAIF) is a pedicled flap that has recently gained great popularity for reconstruction of most head and neck sites, because of its unusual versatility and wide arc of rotation. SCAIF is a fasciocutaneous flap that is very reliable and both easy and quick to harvest. It is pedicled on the supraclavicular artery, which is a branch of the transverse cervical artery. Between October 2012 and July 2015, at Ospedale San Raffaele (Milan, Italy) and Policlinico San Matteo (Pavia, Italy), we used the SCAIF procedure on 14 patients with cervical and facial skin, oral cavity, oropharyngeal, and hypopharyngeal defects after oncologic surgery or as revision surgery after free-flap failure. The presence of the supraclavicular artery was demonstrated preoperatively by computed tomography angiography. Harvesting time never exceeded 50 min. Functional outcomes were excellent, and the donor site was always closed. We reported only one case of tip desquamation, which was treated conservatively, and two cases of partial flap necrosis, which required revision surgery. In our opinion, SCAIF should be considered to be a valid alternative to free-flap reconstruction, especially for facial and cervical skin, floor-of-mouth, and hypopharyngeal defects; oropharyngeal defects may be harder to reconstruct.

PMID: 27170317 [PubMed - as supplied by publisher]

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