Non-epithelial tumors of the larynx: a single institution review.

Non-epithelial tumors of the larynx: a single institution review.

Am J Otolaryngol. 2016 May-Jun;37(3):279-85

Authors: Karatayli-Ozgursoy S, Bishop JA, Hillel AT, Akst LM, Best SR

Abstract
AIM: Non-epithelial tumors of the larynx are rare and encompass a wide range of pathology. We present the decade-long experience of a single institution to define clinical presentations and outcomes.
MATERIAL AND METHODS: This is a ten year retrospective chart review of a tertiary head and neck cancer center. Index patients were identified from a review of a pathology database, and patient demographics, presenting signs and symptoms, treatment modalities, and clinical outcomes were extracted from electronic medical records. Epithelial tumors (squamous cell carcinoma, spindle cell carcinoma, and salivary tumors), granulomas, sarcoidosis, papilloma, and amyloidosis were all excluded.
RESULTS: Twenty-four patients with ages ranging from 2months-old to 84years were identified. Malignant lesions (11) included chondrosarcoma (6), Kaposi's sarcoma (2), metastatic melanoma, synovial cell sarcoma, and T cell neoplasm. Six were operated upon endolaryngeally, but four required either upfront or salvage total laryngectomy. Two received adjuvant therapy. Benign lesions (13) included hemangioma (4), granular cell tumor (3), myofibroblastic tumor (2), schwannoma (2), chondroma, and ossifying fibromyxoid tumor. Nine underwent endolaryngeal operations, and four were managed medically or with observation. None have required aggressive open resection or total laryngectomy.
CONCLUSION: Treatment approach of non-epithelial tumors of the larynx depends on the site and extent of the tumor, histology, and sensitivity of adjuvant therapy. Benign tumors can be managed without need for aggressive resection thereby sparing laryngeal function.

PMID: 27178524 [PubMed - in process]

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The price of robustness; impact of worst-case optimization on organ-at-risk dose and complication probability in intensity-modulated proton therapy for oropharyngeal cancer patients.

The price of robustness; impact of worst-case optimization on organ-at-risk dose and complication probability in intensity-modulated proton therapy for oropharyngeal cancer patients.

Radiother Oncol. 2016 May 10;

Authors: van de Water S, van Dam I, Schaart DR, Al-Mamgani A, Heijmen BJ, Hoogeman MS

Abstract
PURPOSE: To quantify the impact of the degree of robustness against setup errors and range errors on organ-at-risk (OAR) dose and normal tissue complication probabilities (NTCPs) in intensity-modulated proton therapy for oropharyngeal cancer patients.
MATERIAL AND METHODS: For 20 oropharyngeal cases (10 unilateral and 10 bilateral), robust treatment plans were generated using 'minimax' worst-case optimization. We varied the robustness against setup errors ('setup robustness') from 1 to 7mm and the robustness against range errors ('range robustness') from 1% to 7% (+1mm). We evaluated OAR doses and NTCP-values for xerostomia, dysphagia and larynx edema.
RESULTS: Varying the degree of setup robustness was found to have a considerably larger impact than varying the range robustness. Increasing setup robustness from 1mm to 3, 5, and 7mm resulted in average NTCP-values to increase by 1.9, 4.4 and 7.5 percentage point, whereas they increased by only 0.4, 0.8 and 1.2 percentage point when increasing range robustness from 1% to 3%, 5% and 7%. The degree of setup robustness was observed to have a clinically significant impact in bilateral cases in particular.
CONCLUSIONS: For oropharyngeal cancer patients, minimizing setup errors should be given a higher priority than minimizing range errors.

PMID: 27178142 [PubMed - as supplied by publisher]

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Phase II randomized trial of radiation therapy, cetuximab and pemetrexed with or without bevacizumab in patients with locoregionally-advanced head and neck cancer.

Phase II randomized trial of radiation therapy, cetuximab and pemetrexed with or without bevacizumab in patients with locoregionally-advanced head and neck cancer.

Ann Oncol. 2016 May 13;

Authors: Argiris A, Bauman JE, Ohr J, Gooding WE, Heron DE, Duvvuri U, Kubicek GJ, Posluszny DM, Vassilakopoulo M, Kim S, Grandis JR, Johnson JT, Gibson MK, Clump DA, Flaherty JT, Chiosea SI, Branstetter B, Ferris RL

Abstract
BACKGROUND: We previously reported the safety of concurrent cetuximab, an antibody against epidermal growth factor receptor (EGFR), pemetrexed and radiation therapy (RT) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). In this non-comparative phase II randomized trial, we evaluated this non-platinum combination with or without bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF).
PATIENTS AND METHODS: Patients with previously untreated stage III-IVB SCCHN were randomized to receive: conventionally fractionated radiation (70Gy), concurrent cetuximab, and concurrent pemetrexed (arm A); or the identical regimen plus concurrent bevacizumab followed by bevacizumab maintenance for 24 weeks (arm B). The primary endpoint was 2-year progression-free survival (PFS), with each arm compared to historical control. Exploratory analyses included the relationship of established prognostic factors to PFS and quality of life (QOL).
RESULTS: Seventy-eight patients were randomized: 66 oropharynx (42 HPV-positive, 15 HPV-negative, 9 unknown) and 12 larynx; 38 (49%) had heavy tobacco exposure. Two-year PFS was 79% (90% CI 0.69 - 0.92; p<0.0001) for arm A and 75% (90% CI 0.64 - 0.88; p<0.0001) for arm B, both higher than historical control. No differences in PFS were observed for stage, tobacco history, HPV status, or type of center (community versus academic). A significantly increased rate of hemorrhage occurred in arm B. SCCHN-specific QOL declined acutely, with marked improvement but residual symptom burden one year post-treatment.
CONCLUSIONS: RT with a concurrent non-platinum regimen of cetuximab and pemetrexed is feasible in academic and community settings, demonstrating expected toxicities and promising efficacy. Adding bevacizumab increased toxicity without apparent improvement in efficacy, countering the hypothesis that dual EGFR-VEGF targeting would overcome radiation resistance and enhance clinical benefit. Further development of cetuximab, pemetrexed and RT will require additional prospective study in defined, high-risk populations where treatment intensification is justified.

PMID: 27177865 [PubMed - as supplied by publisher]

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Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Eur Arch Otorhinolaryngol. 2016 May 13;

Authors: Gökcan MK, Günaydinoğlu E, Kurtuluş DF

Abstract
Glottic obstruction is a major cause of dyspnea. Without understanding the normal function of the glottis in breathing, treating dyspnea does not restore normal physiology. Therefore, we designed a computational fluid dynamics (CFD) model that tested the respiratory cycle in larynges with normal glottis and congenital glottic web (CGW). A CGW case and a control subject (CC) were selected from the computed tomography (CT) archive. 3D computational models of the larynges with structured boundary layer were constructed from axial CT images after mesh refinement study. CFD analyses were based on the Reynolds-averaged Navier-Stokes approach. Incompressible flow solver (pressure-based) and SST k-w turbulence model were chosen for this study. To simulate a real-time breathing process, time varying flow rate boundary condition was derived from the spirometer of a healthy, non-smoking woman. Glottic areas were measured as 51.64 and 125.43 mm(2) for the CGW patient and CC, respectively. Time-dependent velocity contours and streamlines for the CC and CGW patient were drawn. The CC showed uniform flow, all through the inspiration and expiration phases. However, the CGW patient showed separation of flow at the glottis level, which caused areas of stagnation in the supraglottis (during expiration) and the subglottis and trachea (during inspiration). Specialized geometry of the normal larynx maintained uniform flow with low shear stress values on the wall even at high mass flow rates. Distortion of this geometry may cause obstruction of flow at multiple levels and, therefore, should be evaluated at multiple levels.

PMID: 27177730 [PubMed - as supplied by publisher]

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Laryngeal amyloidosis presenting as false vocal fold bulging: clinical and therapeutic aspects.

Related Articles

Laryngeal amyloidosis presenting as false vocal fold bulging: clinical and therapeutic aspects.

Braz J Otorhinolaryngol. 2015 Mar-Apr;81(2):219-21

Authors: Caporrino Neto J, Alves NS, Gondra Lde A

PMID: 25731952 [PubMed - indexed for MEDLINE]

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Validation of the Home Hearing Test™.

Validation of the Home Hearing Test™.

J Am Acad Audiol. 2016 May;27(5):416-420

Authors: Margolis RH, Killion MC, Bratt GW, Saly GL

Abstract
BACKGROUND: The Home Hearing Test™ (HHT) is an automated pure-tone threshold test that obtains an air-conduction audiogram at five test frequencies. It was developed to provide increased access to hearing testing and support home telehealth programs.
PURPOSE: The study was conducted as part of an audiology telehealth trial based at the U.S. Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Air-conduction audiograms obtained by the HHT were compared to results obtained in the clinic.
RESEARCH DESIGN: Prospective, repeated measures.
STUDY SAMPLE: Twenty-eight participants, aged 44-88 yr (mean = 65) were recruited from the Nashville U.S. Department of Veterans Affairs audiology clinic. Participants were required to have a Windows personal computer in the home and were self-reported to be comfortable with using computers. Two participants had normal hearing and 26 had hearing loss of various severities and configurations.
DATA COLLECTION AND ANALYSIS: Audiograms were obtained in the audiology clinic by experienced audiologists following standard clinical protocols. Participants were provided with a kit for installing HHT on their home computers. The HHT air-conduction audiogram is obtained with Automated Method for Testing Auditory Sensitivity (AMTAS(®)), described in previous publications. Threshold pairs (clinic versus HHT) were analyzed by determining distributions of threshold differences and absolute differences. These were compared to distributions of differences between manual threshold pairs obtained by two audiologists and AMTAS(®) versus manual threshold pairs obtained under laboratory conditions.
RESULTS: Threshold differences (clinic versus HHT) were slightly larger than differences between thresholds obtained by two audiologists and AMTAS(®) versus manual threshold differences obtained under laboratory conditions. The differences were not statistically significant.
CONCLUSIONS: HHT air-conduction audiograms agree well with audiograms obtained in the clinic. HHT is well suited to home telehealth applications and personal use.

PMID: 27179261 [PubMed - as supplied by publisher]

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Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

J Am Acad Audiol. 2016 May;27(5):406-415

Authors: Bardy F, Sjahalam-King J, Van Dun B, Dillon H

Abstract
PURPOSE: To determine if one-octave multitone (MT) stimuli increase the amplitude of cortical auditory-evoked potentials (CAEPs) in individuals with a hearing loss when compared to standard pure-tone (PT) stimuli and narrow-band noise (NBN).
RESEARCH DESIGN: CAEPs were obtained from 16 hearing-impaired adults in response to PT and MT auditory stimuli centered around 0.5, 1, 2, and 4 kHz and NBN centered around 1 and 2 kHz. Hearing impairment ranged from a mild to a moderate hearing loss in both ears. Auditory stimuli were monaurally delivered through insert earphones at 10 and 20 dB above threshold. The root mean square amplitude of the CAEP and the detectability of the responses using Hotelling's T² were calculated and analyzed.
RESULTS: CAEP amplitudes elicited with MT stimuli were on average 29% larger than PT stimuli for frequencies centered around 1, 2, and 4 kHz. No significant difference was found for responses to 0.5-kHz stimuli. Significantly higher objective detection scores were found for MT when compared to PT. For the 1- and 2-kHz stimuli, the CAEP amplitudes to NBN were not significantly different to those evoked by PT but a significant difference was found between MT stimuli and both NBN and PT. The mean detection sensitivity of MT for the four frequencies was 80% at 10 dB SL and 95% at 20 dB SL, and was comparable with detection sensitivities observed in normal-hearing participants.
CONCLUSIONS: Using MT stimuli when testing CAEPs in adults with hearing impairment showed larger amplitudes and a higher objective detection sensitivity compared to using traditional PT stimuli for frequencies centered around 1, 2, and 4 kHz. These findings suggest that MT stimuli are a clinically useful tool to increase the efficiency of frequency-specific CAEP testing in adults with hearing impairment.

PMID: 27179260 [PubMed - as supplied by publisher]

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Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

J Am Acad Audiol. 2016 May;27(5):395-405

Authors: Sidiras C, Iliadou VV, Chermak GD, Nimatoudis I

Abstract
BACKGROUND: Including speech recognition in noise testing in audiological evaluations may reveal functional hearing deficits that may otherwise remain undetected.
PURPOSE: The current study explored the potential utility of the Speech-in-Babble (SinB) test in the assessment of central auditory processing disorder (CAPD) in young children for whom diagnosis is challenging.
RESEARCH DESIGN: A cross-sectional analysis.
STUDY SAMPLE: Forty-one Greek children 4-13 yr of age diagnosed with CAPD and exhibiting listening and academic problems (clinical group) and 20 age-matched controls with no listening or academic problems participated in the study.
DATA COLLECTION AND ANALYSIS: All participants' auditory processing was assessed using the same tests and instrumentation in a sound-treated room. Two equivalent lists of the SinB test, developed at the Psychoacoustic Laboratory of the Aristotle University of Thessaloniki, were administered monaurally in a counterbalanced order. SinB consists of lists of 50 phonetically balanced disyllabic words presented in background multitalker babble. Five signal-to-noise ratios (SNRs) were used in a fixed order. The children were instructed to repeat the word after each presentation. The SNR at which the child achieved 50% correct word identification served as the dependent variable or outcome measure, with higher SinB scores (measured in SNR dB) corresponding to poorer performance.
RESULTS: SinB performance was better (lower SNR) for the normal control group versus the clinical group [F(1,35) = 43.03, p < 0.0001]. SinB inversely correlated with age for both CAPD and control groups (r = -0.648, p << 0.001 and r = -0.658, p < 0.005, respectively). Regression analysis revealed that linear models better explained the variance in the data than a quadratic model for both the control and CAPD groups. The slope (beta value of the linear model) was steeper for the clinical group compared to the control group (beta = -0.306 versus beta = -0.130, respectively). An analysis of covariance run with age as the covariate to assess the potential effect of comorbidity on SinB performance in children with CAPD with and without comorbid conditions revealed no significant differences between groups [F(1,38) = 0.149, p > 0.05].
CONCLUSIONS: This study offers the first detailed presentation of the performance of Greek children on a Greek language SinB test. The main finding is that SinB scores improved as a function of age in a constant manner as represented by the slope of the linear regression line for both CAPD and control groups. Results suggest that this speech recognition in competition test holds promise for differentiating typically developing Greek children from those children with CAPD across the age range studied here (4-13 yr). The SinB seemed rather immune to the presence of comorbid conditions presented by some of the children in this study, suggesting its potential utility as a valid measure of central auditory processing. While there are many speech-in-noise or competition tests in English, there are fewer in other languages. Tests like the SinB should be developed in other languages to ensure that children demonstrating "listening" problems can be properly evaluated.

PMID: 27179259 [PubMed - as supplied by publisher]

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Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

J Am Acad Audiol. 2016 May;27(5):388-394

Authors: Duke MM, Wolfe J, Schafer E

Abstract
BACKGROUND: Cochlear implant (CI) recipients often experience difficulty understanding speech in noise and speech that originates from a distance. Many CI recipients also experience difficulty understanding speech originating from a television. Use of hearing assistance technology (HAT) may improve speech recognition in noise and for signals that originate from more than a few feet from the listener; however, there are no published studies evaluating the potential benefits of a wireless HAT designed to deliver audio signals from a television directly to a CI sound processor.
PURPOSE: The objective of this study was to compare speech recognition in quiet and in noise of CI recipients with the use of their CI alone and with the use of their CI and a wireless HAT (Cochlear Wireless TV Streamer).
RESEARCH DESIGN: A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in competing noise (65 dBA) with the CI sound processor alone and with the sound processor coupled to the Cochlear Wireless TV Streamer.
STUDY SAMPLE: Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study.
DATA COLLECTION AND ANALYSIS: Participants were evaluated in four conditions including use of the sound processor alone and use of the sound processor with the wireless streamer in quiet and in the presence of competing noise at 65 dBA. Speech recognition was evaluated in each condition with two full lists of Computer-Assisted Speech Perception Testing and Training Sentence-Level Test sentences presented from a light-emitting diode television.
RESULTS: Speech recognition in noise was significantly better with use of the wireless streamer compared to participants' performance with their CI sound processor alone. There was also a nonsignificant trend toward better performance in quiet with use of the TV Streamer. Performance was significantly poorer when evaluated in noise compared to performance in quiet when the TV Streamer was not used.
CONCLUSIONS: Use of the Cochlear Wireless TV Streamer designed to stream audio from a television directly to a CI sound processor provides better speech recognition in quiet and in noise when compared to performance obtained with use of the CI sound processor alone.

PMID: 27179258 [PubMed - as supplied by publisher]

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Ex vivo ovine model for head and neck surgical simulation.

Ex vivo ovine model for head and neck surgical simulation.

Am J Otolaryngol. 2016 May-Jun;37(3):272-8

Authors: Ianacone DC, Gnadt BJ, Isaacson G

Abstract
OBJECTIVE: To evaluate a fresh, ovine/sheep head and neck tissue model to teach otolaryngology-head and neck surgical techniques.
STUDY DESIGN: Observational animal study.
SETTING: A university animal resource facility.
METHODS: Tissue was collected from pre-pubescent sheep (n=10; mean age: 4months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated and stored at 5°C for 1-5days. The tissues were tested in a variety of simulated procedures by a medical student and four fellowship-trained otolaryngology faculty. Practicality and similarity to human surgeries were assessed.
RESULTS: While ovine head and neck structures are proportionally different, the consistencies of skin, subcutaneous tissues and bone are remarkably similar to that seen in human dissection. Particularly useful were the eyelids and orbits, facial nerve and parotid gland, mandible, anterior neck and submandibular triangle. Surgeries performed included blepharoplasty, ptosis repair, orbital floor exploration, facial nerve dissection and repair, mandibular plating, tracheotomy, laryngofissure, tracheal resection and laryngectomy. The model was also useful for flexible and microsuspension laryngoscopy.
CONCLUSION: Fresh, ovine tissue provides a readily available, anatomically compatible, affordable, model for training in otolaryngology-head and neck surgery. The use of sheep tissues carries a low risk for disease transmission and is ethically defensible. Structural variations in the sheep temporal bone, paranasal sinuses and skull base anatomy limit the usefulness of the model for surgical training in these areas.

PMID: 27178523 [PubMed - in process]

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Atypical culture-negative skull base osteomyelitis masquerading as advanced nasopharyngeal carcinoma.

Atypical culture-negative skull base osteomyelitis masquerading as advanced nasopharyngeal carcinoma.

Am J Otolaryngol. 2016 May-Jun;37(3):236-9

Authors: See A, Tan TY, Gan EC

Abstract
Skull base osteomyelitis typically arises as a complication of otogenic or sinonasal infections in immunocompromised patients. A much rarer entity, atypical skull base osteomyelitis is not associated with an obvious infective source. Atypical and culture-negative skull base osteomyelitis is even rarer and hampers diagnosis, as its clinical presentation is remarkably similar to skull base neoplasms. We report a case of extensive skull base osteomyelitis with orbital apex syndrome and multiple lower cranial nerve palsies which initially masqueraded as possible advanced nasopharyngeal carcinoma. Extensive investigations and consult with an infectious diseases specialist aided in elucidation of the correct diagnosis. Through this article, we emphasize that skull base osteomyelitis must be considered in the setting of headache, cranial neuropathies, elevated inflammatory markers and abnormal imaging findings. Early tissue sampling for histology, stainings and cultures and prompt appropriate treatment may prevent or arrest further complications.

PMID: 27178515 [PubMed - in process]

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Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Am J Otolaryngol. 2016 May-Jun;37(3):225-30

Authors: Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F

Abstract
PURPOSE: The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD).
MATERIALS AND METHODS: Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method.
RESULTS: Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups.
CONCLUSIONS: Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.

PMID: 27178513 [PubMed - in process]

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PET/CT in giant cell arteritis: High (18)F-FDG uptake in the temporal, occipital and vertebral arteries.

PET/CT in giant cell arteritis: High (18)F-FDG uptake in the temporal, occipital and vertebral arteries.

Rev Esp Med Nucl Imagen Mol. 2016 May 10;

Authors: Rehak Z, Vasina J, Ptacek J, Kazda T, Fojtik Z, Nemec P

Abstract
(18)F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High (18)F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high (18)F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).

PMID: 27177856 [PubMed - as supplied by publisher]

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Cytopathologic characteristics of SMARCB1 (INI-1) deficient sinonasal carcinoma: A potential diagnostic pitfall.

Cytopathologic characteristics of SMARCB1 (INI-1) deficient sinonasal carcinoma: A potential diagnostic pitfall.

Diagn Cytopathol. 2016 May 14;

Authors: Allison DB, Bishop JA, Ali SZ

Abstract
Tumors of the head and neck are extremely diverse and a subset are poorly differentiated and difficult to classify. Recently, a new entity has been described with rhabdoid and/or plasmacytoid cytologic features and a characteristic genetic signature-inactivation of the SMARCB1 (INI-1) tumor suppressor gene. To date, only 16 cases of SMARCB1 (INI-1) deficient sinonasal carcinoma have been described, and there are currently no reports of the cytopathologic features by fine needle aspiration (FNA) cytology. A case of a 77-year-old man who presented with a posterior ethmoid sinus lesion with invasion into the skull base and bone was reported. FNA cytology of a right retropharyngeal lymph node revealed relatively monomorphic, loosely cohesive clusters of plasmacytoid cells with occasional nucleoli, rare intranuclear cytoplasmic inclusions, and mitotic figures in a background of necrosis and absence of overt squamous or glandular differentiation. A diagnosis of metastatic myoepithelial carcinoma was made; however, retrospectively, the surgical excision showed loss of the SMARCB1 (INI-1) tumor suppressor gene by immunohistochemistry. In summary, the cytomorphologic features of SMARCB1 (INI-1) deficient sinonasal carcinoma are relatively nonspecific and overlap with other regional tumors, including myoepithelial neoplasms. As a result, this entity should be considered in the differential diagnosis for a plasmacytoid tumor arising in the sinonasal tract by FNA cytology. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.

PMID: 27177850 [PubMed - as supplied by publisher]

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Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Am J Otolaryngol. 2016 May-Jun;37(3):225-30

Authors: Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F

Abstract
PURPOSE: The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD).
MATERIALS AND METHODS: Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method.
RESULTS: Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups.
CONCLUSIONS: Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.

PMID: 27178513 [PubMed - in process]

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Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Eur Arch Otorhinolaryngol. 2016 May 13;

Authors: Gökcan MK, Günaydinoğlu E, Kurtuluş DF

Abstract
Glottic obstruction is a major cause of dyspnea. Without understanding the normal function of the glottis in breathing, treating dyspnea does not restore normal physiology. Therefore, we designed a computational fluid dynamics (CFD) model that tested the respiratory cycle in larynges with normal glottis and congenital glottic web (CGW). A CGW case and a control subject (CC) were selected from the computed tomography (CT) archive. 3D computational models of the larynges with structured boundary layer were constructed from axial CT images after mesh refinement study. CFD analyses were based on the Reynolds-averaged Navier-Stokes approach. Incompressible flow solver (pressure-based) and SST k-w turbulence model were chosen for this study. To simulate a real-time breathing process, time varying flow rate boundary condition was derived from the spirometer of a healthy, non-smoking woman. Glottic areas were measured as 51.64 and 125.43 mm(2) for the CGW patient and CC, respectively. Time-dependent velocity contours and streamlines for the CC and CGW patient were drawn. The CC showed uniform flow, all through the inspiration and expiration phases. However, the CGW patient showed separation of flow at the glottis level, which caused areas of stagnation in the supraglottis (during expiration) and the subglottis and trachea (during inspiration). Specialized geometry of the normal larynx maintained uniform flow with low shear stress values on the wall even at high mass flow rates. Distortion of this geometry may cause obstruction of flow at multiple levels and, therefore, should be evaluated at multiple levels.

PMID: 27177730 [PubMed - as supplied by publisher]

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Distinct Disease and Functional Characteristics of Thyroid-Surgery-Related Vocal Fold Palsy.

Distinct Disease and Functional Characteristics of Thyroid-Surgery-Related Vocal Fold Palsy.

Thyroid. 2016 May 13;

Authors: Tseng WC, Pei YC, Wong AM, Li HY, Fang TJ

Abstract
BACKGROUND: Iatrogenic trauma induced by thyroid surgery is the most common etiology of unilateral vocal fold paralysis (UVFP). UVFP after thyroid surgery may lead to profound physical and psychosocial distress. In this study, we comprehensively evaluated UVFP caused by thyroid surgery, and compared the results with those caused by other surgical trauma.
STUDY DESIGN: Retrospective case series study.
METHODS: Patients with surgery-related UVFP were evaluated using quantitative laryngeal electromyography (LEMG), videolaryngostroboscopy, voice acoustic analysis, Voice Outcome Survey, and Short Form-36 quality-of-life questionnaire. Patients with thyroid surgery and other surgeries were compared.
RESULTS: A total of 105 patients were recruited, among whom 52 and 53 were assigned to the thyroid surgery and the other surgery group, respectively. Patients in the thyroid surgery group had a higher proportion of external branch of superior laryngeal nerve (eSLN) involvement, longer duration from disease onset to the first LEMG examination, lower jitter, higher harmonic-to-noise ratio, and better quality of life compared with the other surgery group. Specifically for patients in the thyroid surgery group, those with eSLN involvement tended to have more pronounced impairment in jitter and shimmer compared with patients without eSLN involvement.
CONCLUSION: UVFP caused by thyroid surgery has a distinct clinical presentation with relatively high involvement in the eSLN, better voice acoustics, longer waiting time before asking for evaluation, and less impact on quality of life. The involvement of eSLN in these patients further impaired their voice. Early referral is suggested for these patients especially with suspected eSLN injury.

PMID: 27177593 [PubMed - as supplied by publisher]

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Vestibular evoked myogenic potentials and motion sickness medications.

Vestibular evoked myogenic potentials and motion sickness medications.

Clin Neurophysiol. 2016 Jun;127(6):2350-4

Authors: Tal D, Shemy S, Kaminski-Graif G, Wiener G, Hershkovitz D

Abstract
OBJECTIVE: Seasickness is a widespread problem among naval crew, and has a major impact on their performance at sea. The three pharmacological agents most commonly employed in the treatment of seasickness are dimenhydrinate, cinnarizine, and scopolamine. At present, the effectiveness of anti-seasickness drugs is tested by a process of "trial and error", while sailing and exposed to sea conditions. A physiological test to evaluate the action of a drug might save crew members long periods of suffering, as well as simplifying the procedure of selecting the appropriate treatment for each individual. The cervical vestibular evoked myogenic potentials (cVEMP) test has come to be recognized as a reliable procedure for the objective evaluation of saccular function. It was the hypothesis of the present study that cVEMP otolith responses may be affected by anti-motion sickness drugs, which might thus make cVEMP a useful clinical neurophysiological tool for the assessment of drug absorption and efficacy.
METHODS: Thirty male sailors who regularly took medication for the treatment of seasickness participated in the study. Participants underwent the cVEMP test pre- and 1h post-drug administration.
RESULTS: A statistically significant decrease in p13 latency was found after administration of scopolamine compared with baseline (14.46ms vs. 15.09ms, p=0.0049), with significant prolongation of the binaural average inter-latency in this group. No differences were found in the dimenhydrinate and cinnarizine study groups.
CONCLUSIONS: This study demonstrated that scopolamine absorption can be verified by changes in cVEMP latencies.
SIGNIFICANCE: The potential of the cVEMP test for predicting action of scopolamine on the vestibular system.

PMID: 27178852 [PubMed - in process]

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Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Hear Res. 2016 May 10;

Authors: Veugen LC, Hendrikse MM, van Wanrooij MM, Agterberg MJ, Chalupper J, Mens LH, Snik AF, John van Opstal A

Abstract
Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds.. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.

PMID: 27178443 [PubMed - as supplied by publisher]

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