Follicular Variant of Papillary Thyroid Carcinoma: Hybrid or Mixture.

Follicular Variant of Papillary Thyroid Carcinoma: Hybrid or Mixture.

Thyroid. 2016 May 23;

Authors: Daniels GH

PMID: 27214083 [PubMed - as supplied by publisher]

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Letter to the Editor regarding the article "I-124 PET/CT in patients with differentiated thyroid cancer: clinical and quantitative image analysis".

Letter to the Editor regarding the article "I-124 PET/CT in patients with differentiated thyroid cancer: clinical and quantitative image analysis".

Thyroid. 2016 May 23;

Authors: Kist JW, de Keizer B, Vogel WV

PMID: 27213951 [PubMed - as supplied by publisher]

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Autonomic Nervous System Trial: Control and Resolve for Sleep-Breathing Disorders.

Autonomic Nervous System Trial: Control and Resolve for Sleep-Breathing Disorders.

Compend Contin Educ Dent. 2016 May;37(5):316-321;quiz322

Authors: Rouse JS

Abstract
Conventional approaches to sleep dentistry concentrate on apneas/ hypopneas that cause periodic desaturations and fragmentations, a strategy that may be leading healthcare professionals to overlook many patients in dental practices with breathing-disturbed sleep. Recent studies have explored a new chronic "stress" paradigm rather than the apnea/hypopnea model to explain damage from sleep-breathing disorders and the progressive nature of this problem. This article will discuss the shortcomings of traditional approaches for dealing with obstructive sleep apnea and other sleep-breathing conditions and provide a protocol, which involved the autonomic nervous system trial, for improving control and management with mandibular advancement appliances. Most importantly, an algorithm for interdisciplinary resolution strategies is presented.

PMID: 27213777 [PubMed - as supplied by publisher]

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Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review.

Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review.

Anesth Essays Res. 2016 May-Aug;10(2):297-300

Authors: Goudra B, Singh PM, Gouda G, Sinha AC

Abstract
BACKGROUND: Peroral endoscopic myotomy (POEM) is a novel method of treating achalasia of the esophagus. Very little data are available to guide the anesthesia providers caring for these patients. The anesthetic challenges are primarily related to the risk of pulmonary aspiration. There is also a potential risk of pneumomediastinum, pneumoperitoneum, subcutaneous, or submucosal emphysema, as a result of carbon dioxide tracking into the soft tissues surrounding the esophagus and lower esophageal sphincter.
METHODS: In this retrospective study, electronic charts of 24 patients who underwent POEM over 18 months were reviewed. Demographic data, fasting status, relevant aspiration risks, anesthetic technique, and postoperative care measures were extracted.
RESULTS: Fasting times for both solids and liquids were variable. None of the patients underwent preprocedural esophageal emptying. Standard induction and intubation were performed in 16, rapid sequence induction (RSI) with cricoid pressure in seven, and modified rapid sequence without application of cricoid pressure in one of the patients. One of the patients aspirated at induction, and the procedure was aborted. However, the procedure was performed successfully after a few weeks, this time a RSI with cricoid pressure was chosen.
CONCLUSION: As there are no guidelines for the perioperative management of patients presenting for POEM presently, certain recommendations can be made. Preprocedural esophageal emptying should be considered in patients considered as high-risk, although cultural factors might preclude such an approach. Induction and intubation in a semi-reclining position might be useful. Although debatable, use of RSI with cricoid pressure should be strongly considered.

PMID: 27212764 [PubMed]

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The evolving role of the oculoplastic surgeon in skull base surgery.

The evolving role of the oculoplastic surgeon in skull base surgery.

Curr Opin Ophthalmol. 2016 May 20;

Authors: Allen RC

Abstract
PURPOSE OF REVIEW: Classical orbital approaches in skull base surgery have involved large incisions with extensive bone removal resulting in prolonged recovery with associated morbidity and mortality. The purpose of this review is to explore recent advances in skull base surgery that are applicable to the orbital surgeon.
RECENT FINDINGS: Transnasal endoscopic surgery provides access to the medial 180 degrees of the orbit. Access to the lateral 180 degrees may be obtained using transmaxillary and transcranial techniques. Transorbital approaches and multiport techniques further expand the reach of the skull base surgeon. These minimally invasive techniques are supplanting the classical pterional, frontotemporal, frontotemporal orbitozygomatic, frontal, and subfrontal approaches.
SUMMARY: The role of the orbital surgeon in skull base surgery is changing. Transnasal and transcranial approaches to orbital disorders using minimally invasive techniques are becoming more common. In addition, transorbital access to the skull base, paranasal sinuses, and anterior and middle cranial fossa is offering new opportunities for the orbital surgeon.

PMID: 27213927 [PubMed - as supplied by publisher]

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Endoscopic Repair of the Injured Internal Carotid Artery Utilizing Oxidized Regenerated Cellulose and a Free Fascia Lata Graft.

Endoscopic Repair of the Injured Internal Carotid Artery Utilizing Oxidized Regenerated Cellulose and a Free Fascia Lata Graft.

J Craniofac Surg. 2016 May 20;

Authors: Zhang HK, Ma N, Sun XC, Wang DH

Abstract
OBJECTIVE: To introduce appropriate surgical procedures for the endoscopic repair of the internal carotid artery (ICA) injury.
METHODS: Two patients with ICA injury during the endoscopic endonasal approach surgery were reviewed.
RESULTS: Internal carotid artery injury during the endonasal skull-base approach was a rare complication. Once ICA injury occurred, 2 large bore suctions were placed immediately for drainage and the bleeding point was located. Then, an oxidized regenerated cellulose was quickly pressed onto the bleeding point and was held there to stop the bleeding. Afterward, a free graft of fascia lata was inserted and the free fat graft was compressed for repair. Absorbable packing materials were used for nasal packing.
CONCLUSIONS: Endoscopic repair utilizing oxidized regenerated cellulose and a free fascia lata graft is a safe and feasible surgical option for ICA injury.

PMID: 27213739 [PubMed - as supplied by publisher]

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Post-traumatic anosmia in patients with mild traumatic brain injury (mTBI): A systematic and illustrated review.

Post-traumatic anosmia in patients with mild traumatic brain injury (mTBI): A systematic and illustrated review.

Surg Neurol Int. 2016;7(Suppl 10):S263-75

Authors: Proskynitopoulos PJ, Stippler M, Kasper EM

Abstract
BACKGROUND: Olfactory dysfunction (OD) is a disorder associated with traumatic brain injury (TBI), which is prevalent in up to 20% of patients suffering from TBI. Nevertheless, most studies focusing on the relationship between OD and TBIs do not differentiate between the different types of TBI (mild, medium, and severe). In this paper, we conducted a comprehensive and systematic review of the existing literature for the association between mild TBI (mTBI) and OD in order to examine their relationship, focusing on its neurosurgical management and the radiographic characteristics.
METHODS: The MEDLINE database was systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We found 66 articles, of which 10 fulfilled our criteria.
RESULTS: All except two studies reported a significant association between trauma severity and olfaction. Two studies found a negative correlation between TBI severity and olfactory bulb volume with one reporting an r value of -0.62). Three studies reported an association between the observation of radiographic intracranial hemorrhage or skull base fractures and the history of TBI.
CONCLUSION: According to our search results, we conclude that OD is a prevalent but underdiagnosed problem in mTBI. Because OD is associated with a significant decrease in quality of life, we think that neurosurgical teams need to asses olfactory function in mTBI patients when they report to clinics. To illustrate this scenario, we include two distinct cases of patients with anosmia after mTBI in this review. Finally, we suggest a treatment algorithm for patients with mTBI so that a possible OD can be diagnosed and treated as early as possible.

PMID: 27213113 [PubMed]

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Nasal cavity epithelioid hemangioendothelioma invading the anterior skull base.

Nasal cavity epithelioid hemangioendothelioma invading the anterior skull base.

Surg Neurol Int. 2016;7:53

Authors: Ogita S, Endo T, Nomura K, Ogawa T, Watanabe M, Higashi K, Katori Y, Tominaga T

Abstract
BACKGROUND: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that frequently occurs in soft tissues. Patients suffer from local recurrence and remote metastasis because of its malignant potential. Here, we present a rare case of EHE that originated from nasal cavity and invaded intracranially through the anterior skull base.
CASE DESCRIPTION: This is a 27-year-old woman who presented a local physician with intermittent epistaxis and a facial pain around her nose. Preoperative studies demonstrated that the tumor invaded into anterior skull base and the dura matter. Therefore, we performed combined skull base and transnasal surgery, which achieved complete resection of the tumor. Postoperative course of the patient was uneventful. No recurrence or distant metastasis was observed in the patient for 2 years following the radical resection.
CONCLUSIONS: To date, four cases of EHE in the nasal cavity were reported. This is the first case in which EHE demonstrated invasive potentials with intracranial extension. Radical surgical resection plays an important role for better management of invasive paranasal EHE.

PMID: 27213107 [PubMed]

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New Method of Age Estimation from Maxillary Sutures Closure in a Thai Population.

New Method of Age Estimation from Maxillary Sutures Closure in a Thai Population.

Clin Ter. 2016 Mar-Apr;167(2):33-7

Authors: Sinthubua A, Theera-Umpon N, Auephanwiriyakul S, Ruengdit S, Das S, Mahakkanukrauh P

Abstract
Age estimation is one of the major components of forensic identification. Cranial suture closure has long been used as indicator for age estimation. Maxillary sutures have been less studied for estimation of age at death because they vary in their timing of closure with age. The purpose of this study was to estimate age by examining 190 Thai skulls with age ranging between 15-93 years from Forensic Osteology Research Center, Faculty of Medicine, and Chiang Mai University. Four parts of maxillary suture (incisive, anterior, transverse, and posterior sutures) were investigated the suture obliteration of each suture by computerizing from photograph. The suture were measured by pixel counting.The prediction model which based on the support vector machine (SVM) for regression or support vector regression (SVR) was utilized for data analysis. The results showed high correlation (R2 = 0.9086) between the predicted age and actual age. Plot between actual age group and predicted age in seven groups also revealed high correlation (R2 = 0.9434). These can be implied that we are able to use this SVR model to predict age at death using maxillary suture information.The interesting issue is to further apply this model in more cases to ensure the generalization of the finding. This study is the first attempt to estimate age at death using a new method based on novel analysis which considers a characteristic of relationship between maxillary suture closures with age that are not in linear form. The present study may contribute as a basis knowledge and method for further study of age estimation in archaeological and forensic anthropological contexts, especially when only skull or base of skull are found.

PMID: 27212570 [PubMed - in process]

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Surgical Treatment of 127 Paraclinoid Aneurysms with Multifarious Strategy: Factors Related with Outcome.

Related Articles

Surgical Treatment of 127 Paraclinoid Aneurysms with Multifarious Strategy: Factors Related with Outcome.

World Neurosurg. 2016 Jan;85:169-76

Authors: Matano F, Tanikawa R, Kamiyama H, Ota N, Tsuboi T, Noda K, Miyata S, Matsukawa H, Murai Y, Morita A

Abstract
BACKGROUND: Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass.
MATERIAL AND METHODS: We retrospectively analyzed findings from 127 consecutive patients (19 males, mean age at surgery: 56.8 years, range: 19-81 years) at our hospital. The size of aneurysms ranged from 2.7-43.2 mm (mean: 6.9 mm). Extradural anterior clinoidectomy was used to clip small aneurysms. As large or giant aneurysms required a longer temporal occlusion period and often could not undergo simple clipping, high-flow bypass with anterior clinoidectomy or cervical internal carotid ligation was performed to reduce aneurysm blood flow and induce thrombosis. We reviewed a postoperative modified Rankin Scale (mRS), radiographic outcomes, cerebral infarction, and visual disturbance. In addition, we analyzed factors relating to the outcomes and complications, with focus on the aneurysm size, location, and type of surgical treatment.
RESULTS: Good outcomes were achieved in all patients, as follows: mRS 0:100, mRS 1:16, mRS 2:11, and mRS 3-6:0. Among the 127 patients, complete exclusion of aneurysm was achieved in 119 cases (93.7%). Postoperative morbidity included ischemic lesions in 11 (8.6%) and visual disturbance in 24 (18.8%). Significant statistical differences were observed between ischemic complication and aneurysm size and location (P = 0.0001) and surgical treatment (P < 0.0001).
CONCLUSION: Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.

PMID: 26344635 [PubMed - indexed for MEDLINE]

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Assessment of solid lesions of the temporal fossa with diffusion-weighted magnetic resonance imaging.

Related Articles

Assessment of solid lesions of the temporal fossa with diffusion-weighted magnetic resonance imaging.

Int J Oral Maxillofac Surg. 2015 Sep;44(9):1081-5

Authors: Abdel Razek AA

Abstract
The aim of this work was to assess solid lesions of the temporal fossa with diffusion-weighted magnetic resonance imaging (MRI). A retrospective analysis of diffusion-weighted MRI obtained for 33 patients with solid lesions of the temporal fossa was conducted. Fifteen of the patients were male and 18 were female, and their mean age was 39 years. The apparent diffusion coefficient (ADC) of solid lesions of the temporal fossa was calculated on two separate occasions by the same observer. The mean ADC values (×10(-3)mm(2)/s) of the two readings in cases of malignancy (0.98±0.17 and 0.95±0.13) were significantly different to those of benign lesions (1.32±0.24 and 1.28±0.21) (P=0.001 and 0.001), with excellent intra-observer agreement (κ=0.937). The area under the receiver operating characteristic curve was 0.855. A threshold ADC of 1.23×10(-3)mm(2)/s was found to have an accuracy of 91%, with sensitivity of 94% and specificity of 85%, for differentiating malignancy of the temporal fossa from benign lesions. It is concluded that ADC is a non-invasive imaging parameter that is able to differentiate malignancy of the temporal fossa from benign lesions.

PMID: 26072154 [PubMed - indexed for MEDLINE]

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Pediatric Longitudinal Clivus Fracture: Survival With Minimal Morbidity.

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Pediatric Longitudinal Clivus Fracture: Survival With Minimal Morbidity.

J Intensive Care Med. 2015 Oct;30(7):443-6

Authors: Samraj RS, Stalets EL

Abstract
Longitudinal clivus fractures are rare in children, with only 5 cases published in the English literature to date. Clivus fractures, particularly longitudinal type, are associated with high mortality and morbidity. We report a case of longitudinal clivus fracture in a teenager with survival and complete neurological recovery. Our case is the first pediatric case of longitudinal clivus fracture caused by frontal impact and the first described pediatric case associated with transient diabetes insipidus (DI).

PMID: 25336680 [PubMed - indexed for MEDLINE]

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Reversible hearing loss following cryptococcal meningitis: case study.

Reversible hearing loss following cryptococcal meningitis: case study.

J Laryngol Otol. 2016 May 23;:1-5

Authors: Neo WL, Durisala N, Ho EC

Abstract
BACKGROUND: Sensorineural hearing loss is a recognised complication of cryptococcal meningitis. The mechanism of hearing loss in patients with cryptococcal meningitis is different from that in bacterial meningitis.
CASE REPORT: An immune-competent man with cryptococcal meningitis presented with sudden onset, bilateral, severe to profound sensorineural hearing loss and vestibular dysfunction. He was initially evaluated for cochlear implantation. However, he had a significant recovery; he no longer required surgery and was able to cope without a hearing aid.
CONCLUSION: Typically, cochlear implantation is performed with some urgency in patients with hearing loss post-bacterial meningitis, because of the risk of labyrinthitis ossificans. However, this process has not been described in patients with cryptococcal meningitis. Furthermore, patients with hearing loss associated with cryptococcal meningitis have shown varying degrees of reversibility. In this case report, hearing loss from cryptococcal meningitis is compared with that from bacterial meningitis, and the need for cochlear implantation in patients with cryptococcal meningitis is discussed.

PMID: 27210482 [PubMed - as supplied by publisher]

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Age of onset of Ménière's disease in the Netherlands: data from a specialised dizziness clinic.

Age of onset of Ménière's disease in the Netherlands: data from a specialised dizziness clinic.

J Laryngol Otol. 2016 May 23;:1-4

Authors: Van Esch BF, Van Benthem PP, Van Der Zaag-Loonen HJ, Bruintjes TD

Abstract
OBJECTIVES: To determine the age of onset of Ménière's disease in patients who visited a specialised dizziness clinic, and to verify whether the trend of a delayed onset age of Ménière's disease as reported for the Japanese population also occurs in the Netherlands.
METHOD: A retrospective data analysis was performed of patients diagnosed with 'definite' Ménière's disease who visited our clinic between January 2000 and December 2013.
RESULTS: Mean onset age of Ménière's disease among the 296 patients was 53.0 ± 14.1 years; 209 patients (71 per cent) were diagnosed between the fifth and seventh decades of life. No trend towards a later onset of Ménière's disease was found (regression beta co-efficient for year of presentation was 0.03; 95 per cent confidence interval = -0.34-0.61; p = 0.58).
CONCLUSION: Ménière's disease has a peak incidence between 40 and 69 years of age. No shift towards a later onset age of Ménière's disease was found.

PMID: 27210249 [PubMed - as supplied by publisher]

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Does topical use of autologous serum help to reduce post-tonsillectomy morbidity? A prospective, controlled preliminary study.

Does topical use of autologous serum help to reduce post-tonsillectomy morbidity? A prospective, controlled preliminary study.

J Laryngol Otol. 2016 May 23;:1-7

Authors: Kara M, Erdoğan H, Altinişik HB, Aylanç H, Güçlü O, Dereköy FS

Abstract
BACKGROUND: To evaluate the effects of autologous serum usage on throat pain, haemorrhage and tonsillar fossa epithelisation in patients after tonsillectomy.
METHODS: Thirty-two patients (aged 4-15 years) were included in the study. Tonsillectomy was performed and autologous serum was administered topically to the right tonsillar fossa during the operation, and at 8 and 24 hours post-operatively. The left side served as the control. A visual analogue scale was used to record the patient's pain every day. Each patient's oropharynx was observed on the 5th and 10th post-operative days to examine bleeding and epithelisation.
RESULTS: The pain scores for the side administered autologous serum were significantly lower than those for the control side, on the night following the operation and on the 1st, 2nd, 5th and 6th post-operative days. Tonsillar fossa epithelisation was significantly accelerated on the study side compared with the control side on the 5th and 10th post-operative days.
CONCLUSION: In tonsillectomy patients, topically administered autologous serum contributed to throat pain relief and tonsillar fossa epithelisation during the post-operative period.

PMID: 27210022 [PubMed - as supplied by publisher]

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Anxiety among individuals with visual vertigo and vestibulopathy.

Related Articles

Anxiety among individuals with visual vertigo and vestibulopathy.

Disabil Rehabil. 2015;37(23):2197-202

Authors: Zur O, Schoen G, Dickstein R, Feldman J, Berner Y, Dannenbaum E, Fung J

Abstract
PURPOSE: Visual vertigo (VV) is a type of dizziness triggered by visual stimuli. Despite a high incidence, its relationship with anxiety is not well-defined or understood. This study evaluated anxiety levels in subjects with VV compared to vestibulopathic subjects without VV and healthy individuals.
METHODS: A cross-sectional study to evaluate anxiety among individuals with VV was conducted twice. The first study included 72 participants (66 to 83 years of age) from senior residential centers. The second included 31 participants from a vestibular rehabilitation program (age range 35-82 years). Study 1 also used the Activities-Specific Balance Confidence (ABC) scale and study 2 the Dizziness Handicap Inventory (DHI).
RESULTS: Subjects were classified as VV positive (27 in study 1, 10 in study 2) or vestibulopathic without VV (30 in study 1, 11 in study 2) based on Head Impulse or Dynamic Visual Acuity Tests and the Dizziness Questionnaire. The remaining were age-matched healthy controls. The outcome of each study demonstrated significantly higher anxiety levels (p = 0.0001) in the VV group compared to the other groups. The results of the ABC test demonstrated that subjects in the VV group had significantly lower self-confidence (p = 0.001) than those in the Vest and Cont groups and performed fewer balance-related activities of daily life. DHI results showed that VV group expressed higher (p < 0.001) mean scores for self-perceived feelings of dizziness and imbalance (54%), compared to the Vest (9%) and Cont groups (1%).
CONCLUSIONS: Anxiety related to VV requires special attention when assessing and managing vestibulopathy, regardless of patient age.
IMPLICATIONS FOR REHABILITATION: Anxiety is a characteristic of subjects with visual vertigo (VV) and vestibulopathy. Anxiety in subjects with VV is not related to age. VV should be considered when subjects with anxiety complain of imbalance. Anxiety and vestibulopathy are often interrelated and should be considered in diagnostic evaluations.

PMID: 25597835 [PubMed - indexed for MEDLINE]

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Periprocedural stroke presenting as isolated unilateral internuclear ophthalmoplegia.

Related Articles

Periprocedural stroke presenting as isolated unilateral internuclear ophthalmoplegia.

QJM. 2015 Feb;108(2):165

Authors: Saini M, Bte Idu Jion Y

PMID: 25114281 [PubMed - indexed for MEDLINE]

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Oncological and complication assessment of CO2 laser-assisted endoscopic surgery for T1-T2 glottic tumours: clinical experience.

Oncological and complication assessment of CO2 laser-assisted endoscopic surgery for T1-T2 glottic tumours: clinical experience.

Acta Otorhinolaryngol Ital. 2016 May;36(3):167-173

Authors: Galli A, Giordano L, Sarandria D, Di Santo D, Bussi M

Abstract
Several therapeutic options are used for treatment of early stage glottic carcinoma (Tis/T1/T2): open partial laryngectomy (OPL), radiotherapy and CO2 laser-assisted endoscopic surgery. Laser surgery has gradually gained approval in the management of laryngeal cancer. We present our experience in endoscopic laser surgery for early stage glottic carcinomas. This was a retrospective analysis of 72 patients with T1-T2 glottic cancer treated with laser cordectomy between 2006 and 2012. All patients had at least a 36-month follow-up period. Percentages for disease-specific survival, disease-free survival (DFS) and laryngeal preservation rates were 98.6%, 84.7% and 97.2% respectively. Considering neoplastic features that could predict long-term oncological outcome, tumoural involvement of anterior commissure and pathological staging (pT) significantly correlate with local recurrence (p = 0.021 and p = 0.035) and with a lowered DFS (p = 0.017 and p = 0.023). Other variables such as clinical staging, type of cordectomy, involvement of other structures and surgical margin status showed no significant impact on oncological endpoints. CO2 laser surgery is a reliable technique for T1-T2 glottic cancer considering oncological outcomes. The recurrence rate seems to be affected by involvement of anterior commissure and pT stage.

PMID: 27214828 [PubMed - as supplied by publisher]

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Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation.

Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation.

J Craniofac Surg. 2016 May 20;

Authors: Gökdoğan O, Koybasioglu A, Ileri F

Abstract
INTRODUCTION: Laryngeal cartilaginous framework tumors are very rare. Chondroma and chondrosarcoma are the most common types of these tumors.
PATIENT PRESENTATION: A 27-year-old man with a history of intubation presented with exercise-induced dyspnea. A computed tomography scan of larynx showed a rounded and circumscribed mass without infiltration of the adjacent structures which obstructs 75% of airway. Histopathological investigation of the mass revealed the chondroma of the larynx. The patients' history of intubation trauma with the subsequent progressive onset of clinical symptoms demonstrates the relationship between these 2 entities.
CONCLUSION: Clinicians should consider laryngeal chondroma in the differential diagnosis of dyspnea after endotracheal intubation.

PMID: 27213734 [PubMed - as supplied by publisher]

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Comparison of GlideScope video laryngoscope with Macintosh laryngoscope in adult patients undergoing elective surgical procedures.

Comparison of GlideScope video laryngoscope with Macintosh laryngoscope in adult patients undergoing elective surgical procedures.

Anesth Essays Res. 2016 May-Aug;10(2):245-9

Authors: Parasa M, Yallapragada SV, Vemuri NN, Shaik MS

Abstract
BACKGROUND: GlideScope (GS) is a video laryngoscope that allows a real-time view of the glottis and endotracheal intubation. It provides a better view of the larynx without the need for alignment of the airway axes.
AIM: This prospective randomized comparative study is designed to compare the intubation time, hemodynamic response, and complications associated with intubation using a GS or Macintosh laryngoscope (ML) in adult subjects undergoing elective surgical procedures.
MATERIALS AND METHODS: Sixty American Society of Anesthesiologists physical status 1-2 patients were included in this prospective randomized comparative study. Patients were randomized to be intubated using either a GS or an ML. The primary outcome measure was the intubation time. The secondary outcome measures were the hemodynamic response to intubation and the incidence of mucosal injury.
STATISTICAL ANALYSIS: Mean and standard deviation were calculated for different parameters under the study. The observed results were analyzed using Student's t-test for quantitative data and Z-test of proportions. P<0.05 was considered statistically significant.
RESULTS: Intubation time was longer in GS group (45.7033 ± 11.649 s) as compared to ML (27.773 ± 5.122 s) P< 0.0001 with 95% confidence interval (95% CI) -13.2794 to -22.5806. GS provided better Cormack and Lehane laryngoscopic view (P = 0.0016 for grade 1 view) with 95% CI -0.1389 to -0.5951. GS group exhibited more laryngoscopic response than ML group with more increase in blood pressure and heart rate, but the difference was not statistically significant. More cases of mucosal trauma were documented in GS group.
CONCLUSION: Use of GS to facilitate intubation led to better glottic view but took a longer time to achieve endotracheal intubation. GS was associated with more hemodynamic response to intubation and mucosal injury in comparison with an ML.

PMID: 27212755 [PubMed]

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Validation and Evaluation of the Effects of Semi-Occluded Face Mask Straw Phonation Therapy Methods on Aerodynamic Parameters in Comparison to Traditional Methods.

Validation and Evaluation of the Effects of Semi-Occluded Face Mask Straw Phonation Therapy Methods on Aerodynamic Parameters in Comparison to Traditional Methods.

J Voice. 2016 May 19;

Authors: Mills R, Hays C, Al-Ramahi J, Jiang JJ

Abstract
OBJECTIVES/HYPOTHESIS: Traditional semi-occluded vocal tract therapies have the benefit of improving vocal economy but, do not allow for connected speech during rehabilitation. In this study, we introduce a semi-occluded face mask (SOFM) as an improvement upon current methods. This novel technique allows for normal speech production, and will make the transition to everyday speech more natural. We hypothesize that use of an SOFM will lead to the same gains in vocal economy seen in traditional methods.
STUDY DESIGN: Repeated measures excised canine larynx bench experiment with each larynx subject to controls and a randomized series of experimental conditions.
METHODS: Aerodynamic data were collected for 30 excised canine larynges. The larynges were subjected to conditions including a control, two tube extensions (15 and 30 cm), and two tube diameters (6.5 and 17 mm) both with and without the SOFM. Results were compared between groups and between conditions within each group.
RESULTS: No significant differences were found between the phonation threshold pressure and phonation threshold flow measurements obtained with or without the SOFM throughout all extension and constriction levels. Significant differences in phonation threshold pressure and phonation threshold flow were observed when varying the tube diameter while the same comparison for varying the tube length at least trended toward significance.
CONCLUSIONS: This study suggests that a SOFM can be used to elicit the same gains in vocal economy as what has been seen with traditional semi-occluded vocal tract methods. Future studies should test this novel technique in human subjects to validate its use in a clinical setting.

PMID: 27210476 [PubMed - as supplied by publisher]

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Cholesterol influences potassium currents in inner hair cells isolated from guinea pig cochlea.

Cholesterol influences potassium currents in inner hair cells isolated from guinea pig cochlea.

Auris Nasus Larynx. 2016 May 19;

Authors: Kimitsuki T

Abstract
OBJECTIVE: There is a correlation between serum hyperlipidemia and hearing loss. Cholesterol is an integral component of the cell membrane and regulates the activity of ion channels in the lipid bilayer. The aim of this study was to investigate the effects of cholesterol on the potassium currents in IHCs by using the cholesterol-depleting drug, MβCD, and water-soluble cholesterol.
METHODS: IHCs were acutely isolated from a mature guinea-pig cochlea and potassium currents were recorded. MβCD and water-soluble cholesterol were applied to IHCs under pressure puff pipettes.
RESULTS: IHCs showed outwardly rectifying currents (IK,f and IK,s) in response to depolarizing voltage pulses, with only a slight inward current (IK,n) when hyperpolarized. In 10mM MβCD solutions, the amplitude of outward K currents reversely decreased; however, fast activation kinetics was preserved. In contrast, in solution of 1mM water-soluble cholesterol, the amplitude of outward K currents reversely increased. At the membrane potential of +110mV, relative conductances were 0.87±0.07 and 1.18±0.11 in MβCD solutions and cholesterol solutions, respectively.
CONCLUSION: The amplitude of K currents in isolated IHCs was reversely changed by cholesterol-depleting drug and water-soluble cholesterol. These results demonstrated the possibility of the involvement of IHC function in hyperlipidemia-induced inner ear disorders.

PMID: 27210104 [PubMed - as supplied by publisher]

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Changes in calsequestrin, TNF-α, TGF-β and MyoD levels during the progression of skeletal muscle dystrophy in mdx mice: a comparative analysis of the quadriceps, diaphragm and intrinsic laryngeal muscles.

Related Articles

Changes in calsequestrin, TNF-α, TGF-β and MyoD levels during the progression of skeletal muscle dystrophy in mdx mice: a comparative analysis of the quadriceps, diaphragm and intrinsic laryngeal muscles.

Int J Exp Pathol. 2015 Oct;96(5):285-93

Authors: Barros Maranhão J, de Oliveira Moreira D, Maurício AF, de Carvalho SC, Ferretti R, Pereira JA, Santo Neto H, Marques MJ

Abstract
In Duchenne muscular dystrophy (DMD), the search for new biomarkers to follow the evolution of the disease is of fundamental importance in the light of the evolving gene and pharmacological therapies. In addition to the lack of dystrophin, secondary events including changes in calcium levels, inflammation and fibrosis greatly contribute to DMD progression and the molecules involved in these events may represent potential biomarkers. In this study, we performed a comparative evaluation of the progression of dystrophy within muscles that are differently affected by dystrophy (diaphragm; DIA and quadriceps; QDR) or spared (intrinsic laryngeal muscles) using the mdx mice model of DMD. We assessed muscle levels of calsequestrin (calcium-related protein), tumour necrosis factor (TNF-α; pro-inflammatory cytokine), tumour growth factor (TGF-β; pro-fibrotic factor) and MyoD (muscle proliferation) vs. histopathology at early (1 and 4 months of age) and late (9 months of age) stages of dystrophy. Fibrosis was the primary feature in the DIA of mdx mice (9 months: 32% fibrosis), which was greater than in the QDR (9 months: 0.6% fibrosis). Muscle regeneration was the primary feature in the QDR (9 months: 90% of centrally nucleated fibres areas vs. 33% in the DIA). The QDR expressed higher levels of calsequestrin than the DIA. Laryngeal muscles showed normal levels of TNF-α, TGF-β and MyoD. A positive correlation between histopathology and cytokine levels was observed only in the diaphragm, suggesting that TNF-α and TGF-β serve as markers of dystrophy primarily for the diaphragm.

PMID: 26515458 [PubMed - indexed for MEDLINE]

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Large vocal cord polyp: an unusual cause of dyspnoea.

Related Articles

Large vocal cord polyp: an unusual cause of dyspnoea.

BMJ Case Rep. 2015;2015

Authors: Shergill GS, Shergill AK

PMID: 26334311 [PubMed - indexed for MEDLINE]

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Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life.

Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life.

Acta Otorhinolaryngol Ital. 2016 May;36(3):220-227

Authors: Montava M, Rossi V, CurtoFais CL, Mancini J, Lavieille JP

Abstract
Hemifacial spasm is a condition that may severely reduce patients' quality of life. Microvascular decompression is the neurosurgical treatment of choice. The objective of this work was to describe the efficacy and morbidity of microvascular decompression for hemifacial spasm, evaluate the long-term efficacy on the quality of life and investigate prognostic factors for failure of the procedure. A retrospective study of 446 cases of hemifacial spasm treated by 511 retrosigmoid microvascular decompression over 22 years was conducted. Epidemiological, clinical and imaging findings, treatment modalities and outcomes of patients with pre- and postoperative HSF-8 quality of life questionnaire were studied. Success rate was 82% after first surgery and 91.6% after revision surgery. A low rate of perioperative morbidity was found. Facial palsy was mostly transient (5.5% transient and 0.2% permanent) and cochleovestibular deficit was seen in 4.8% of patients. Revision surgery increased nervous lesions (10.6% to 20.7%). Mean quality of life scores were significantly improved from 18 to 2 over 32, evaluated 7.3 years after surgery. Predictive factors of surgical failure were single conflicts (p = 0.041), atypical vasculo-nervous conflicts involving other vessel than postero-inferior cerebellar artery (p = 0.036), such as vein (p = 0.045), and other compression sites than root exit zone (p = 0.027). Retrosigmoid microvascular decompression is a safe and effective treatment of hemifacial spasm. Revision surgery is not to be excluded in case of failure, but does place patients at risk for more complications. Quality of life is improved in the long-term, indicating objective and subjective satisfaction.

PMID: 27214834 [PubMed - as supplied by publisher]

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Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes.

Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes.

Acta Otorhinolaryngol Ital. 2016 May;36(3):194-198

Authors: Battaglia P, Turri-Zanoni M, De Bernardi F, Dehgani Mobaraki P, Karligkiotis A, Leone F, Castelnuovo P

Abstract
Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique appears to be a safe and effective option for ASB reconstruction after endonasal resection of sinonasal malignancies in selected cases. Larger case series with a longer follow-up are needed to validate the preliminary results obtained with such an innovative and promising surgical technique.

PMID: 27214830 [PubMed - as supplied by publisher]

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Outcomes and Complications of Endoscopic Versus Microscopic Transsphenoidal Surgery in Pituitary Adenoma.

Outcomes and Complications of Endoscopic Versus Microscopic Transsphenoidal Surgery in Pituitary Adenoma.

J Craniofac Surg. 2016 May 20;

Authors: Guvenc G, Kizmazoglu C, Pinar E, Imre A, Kaya I, Bezircioglu H, Yuceer N

Abstract
This retrospective study aimed to define outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Data of 94 patients who underwent transsphenoidal endoscopic (n = 45) or microscopic surgery (n = 49) between June 2000 and June 2014 for pituitary adenoma, performed at Katip Çelebi University Hospital, were retrospectively analyzed. The patients' symptomatology, type of adenoma, radiologic findings, surgical outcomes, and preoperative and postoperative complications were investigated. The total subtotal resection rate was 73.4% (69 patients) and partial resection rate was 26.6% (25 patients). Total subtotal resection rate was 77.6% (38 patients) in the microscopic group and 68.9% (31 patients) in the endoscopic group. Total resection was seen more often in the endoscopic group than in the microscopic group, with no significant difference between the groups. Four patients (8.2%) in the microscopic group had postoperative cerebrospinal fluid leak compared with 3 patients (6.7%) in the endoscopic group. Two patients (2.1%) had hematoma, with 1 patient each in the endoscopic and microscopic group. Panhypopituitarism development rate was higher in the endoscopic group (no significant difference between the 2 groups). One patient (2%) developed blindness in the microscopic group and 1 (2.2%) had meningitis in the endoscopic group. Based on this study, the total resection rate was higher in the microscopic group than in the endoscopic group. However, outcomes and complication rate did not differ significantly between the 2 surgical techniques. Both techniques have advantages and disadvantages. Prospective randomized controlled trials should be conducted to compare the 2 surgical methods.

PMID: 27213744 [PubMed - as supplied by publisher]

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Dural-based infantile hemangioma of the posterior fossa: Case report.

Dural-based infantile hemangioma of the posterior fossa: Case report.

Surg Neurol Int. 2016;7:52

Authors: Shakir HJ, McBride P, Reynolds RM

Abstract
BACKGROUND: The authors present the unique case of a dural-based, infantile hemangioma located in the posterior fossa of a 15-day-old infant.
CASE DESCRIPTION: The patient presented with hydrocephalus. The lesion was identified by magnetic resonance imaging and was subsequently resected. Diagnosis of the lesion was confirmed with immunohistochemistry staining. The patient's hospital course was complicated by transverse sinus thrombosis and a cerebrospinal fluid leak that were treated with anticoagulation therapy and ventriculoperitoneal shunt placement, respectively.
CONCLUSION: Although hemangiomas are benign entities, our patient's lesion was in the posterior fossa causing compression and hydrocephalus that necessitated resection. We encourage others to consider the possibility of hemangioma in the differential diagnosis of dural-based posterior fossa lesions in infants.

PMID: 27213106 [PubMed]

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Microvascular decompression for glossopharyngeal neuralgia through a microasterional approach: A case series.

Microvascular decompression for glossopharyngeal neuralgia through a microasterional approach: A case series.

Surg Neurol Int. 2016;7:51

Authors: Revuelta-Gutiérrez R, Morales-Martínez AH, Mejías-Soto C, Martínez-Anda JJ, Ortega-Porcayo LA

Abstract
BACKGROUND: Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome. It is characterized by a sudden onset lancinating pain usually localized in the sensory distribution of the IX cranial nerve associated with excessive vagal outflow, which leads to bradycardia, hypotension, syncope, or cardiac arrest. This study aims to review our surgical experience performing microvascular decompression (MVD) in patients with GPN.
METHODS: Over the last 20 years, 14 consecutive cases were diagnosed with GPN. MVD using a microasterional approach was performed in all patients. Demographic data, clinical presentation, surgical findings, clinical outcome, complications, and long-term follow-up were reviewed.
RESULTS: The median age of onset was 58.7 years. The mean time from onset of symptoms to treatment was 8.8 years. Glossopharyngeal and vagus nerve compression was from the posterior inferior cerebellar artery in eleven cases (78.5%), vertebral artery in two cases (14.2%), and choroid plexus in one case (7.1%). Postoperative mean follow-up was 26 months (3-180 months). Pain analysis demonstrated long-term pain improvement of 114 ± 27.1 months and pain remission in 13 patients (92.9%) (P = 0.0001) two complications were documented, one patient had a cerebrospinal fluid leak, and another had bacterial meningitis. There was no surgical mortality.
CONCLUSIONS: GPN is a rare entity, and secondary causes should be discarded. MVD through a retractorless microasterional approach is a safe and effective technique. Our series demonstrated an excellent clinical outcome with pain remission in 92.9%.

PMID: 27213105 [PubMed]

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Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial.

Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial.

Braz J Otorhinolaryngol. 2016 Apr 30;

Authors: Doi MY, Tano SS, Schultz AR, Borges R, Marchiori LL

Abstract
INTRODUCTION: Tinnitus is a subjective sensation of hearing a sound in the absence of an external stimulus, which significantly worsens the quality of life in 15-25% of affected individuals.
OBJECTIVE: To assess the effectiveness of acupuncture therapy for tinnitus.
METHODS: Randomized clinical trial (REBEC: 2T9T7Q) with 50 participants with tinnitus, divided into two groups: 25 participants in the acupuncture group and 25 participants in the control group. The acupuncture group received acupuncture treatment and the control group received no treatment. After a period of 5 weeks, they were called to perform the final evaluation and the control group received acupuncture treatment for ethical reasons.
RESULTS: A statistically significant result was found for the primary outcome, reducing the intensity of tinnitus, with p=0.0001 and the secondary endpoint, showing improvement in quality of life, with p=0.0001.
CONCLUSION: Chinese scalp acupuncture associated with bilateral electroacupuncture demonstrated, in the short term, a statistically significant improvement by reducing the level of tinnitus intensity, as well as improving the quality of life of individuals with tinnitus.

PMID: 27210823 [PubMed - as supplied by publisher]

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"Vestn Otorinolaringol"[jour]; +19 new citations

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

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Video fluoroscopic techniques for the study of Oral Food Processing.

Video fluoroscopic techniques for the study of Oral Food Processing.

Curr Opin Food Sci. 2016 Jun;9:1-10

Authors: Matsuo K, Palmer JB

Abstract
Food oral processing and pharyngeal food passage cannot be observed directly from the outside of the body without instrumental methods. Videofluoroscopy (x-ray video recording) reveals the movement of oropharyngeal anatomical structures in two dimensions. By adding a radiopaque contrast medium, the motion and shape of the food bolus can be also visualized, providing critical information about the mechanisms of eating, drinking, and swallowing. For quantitative analysis of the kinematics of oral food processing, radiopaque markers are attached to the teeth, tongue or soft palate. This approach permits kinematic analysis with a variety of textures and consistencies, both solid and liquid. Fundamental mechanisms of food oral processing are clearly observed with videofluoroscopy in lateral and anteroposterior projections.

PMID: 27213138 [PubMed - as supplied by publisher]

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Further characterisation of the recently described SLC26A4 c.918+2T>C mutation and reporting of a novel variant predicted to be damaging.

Further characterisation of the recently described SLC26A4 c.918+2T>C mutation and reporting of a novel variant predicted to be damaging.

Acta Otorhinolaryngol Ital. 2016 May;36(3):233-238

Authors: Gonçalves AC, Santos R, O'Neill A, Escada P, Fialho G, Caria H

Abstract
Pendred syndrome (PS) is the second most common type of autosomal recessive syndromic hearing loss (HL). It is characterised by sensorineural HL and goiter with occasional hypothyroidism. These features are generally accompanied by malformations of the inner ear, as enlarged vestibular aqueduct (EVA). In about 50% of probands, mutations in the SLC26A4 gene are the cause of the disease. Here we report the case of a Portuguese female, aged 47, presenting with severe to profound HL and hypothyroidism. Her mother and sister, both deceased, had suffered from HL and goiter. By MRI and CT, an enlarged vestibular aqueduct and endolymphatic sac were observed. Molecular study of the patient included screening for GJB2 coding mutations and GJB6 common deletions followed by screening of all SLC26A4 exons, as well as intronic regions 8 and 14. Mutation c.918+2T>C was found for the first time in homozygosity in the intronic region 7 of the SLC26A4 gene. Whilst sequencing the control samples, a novel mutation c.821C>G was found in heterozygosity in the exon 7 of SLC26A4 gene and was predicted to be damaging. This study thus led to the finding of two novel SLC26A4 genotypes and provides new insight on the phenotypic features associated with PS.

PMID: 27214836 [PubMed - as supplied by publisher]

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Considerations on "Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction".

Considerations on "Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction".

Acta Otorhinolaryngol Ital. 2016 May;36(3):228-230

Authors: Visocchi M

PMID: 27214835 [PubMed - as supplied by publisher]

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Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life.

Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life.

Acta Otorhinolaryngol Ital. 2016 May;36(3):220-227

Authors: Montava M, Rossi V, CurtoFais CL, Mancini J, Lavieille JP

Abstract
Hemifacial spasm is a condition that may severely reduce patients' quality of life. Microvascular decompression is the neurosurgical treatment of choice. The objective of this work was to describe the efficacy and morbidity of microvascular decompression for hemifacial spasm, evaluate the long-term efficacy on the quality of life and investigate prognostic factors for failure of the procedure. A retrospective study of 446 cases of hemifacial spasm treated by 511 retrosigmoid microvascular decompression over 22 years was conducted. Epidemiological, clinical and imaging findings, treatment modalities and outcomes of patients with pre- and postoperative HSF-8 quality of life questionnaire were studied. Success rate was 82% after first surgery and 91.6% after revision surgery. A low rate of perioperative morbidity was found. Facial palsy was mostly transient (5.5% transient and 0.2% permanent) and cochleovestibular deficit was seen in 4.8% of patients. Revision surgery increased nervous lesions (10.6% to 20.7%). Mean quality of life scores were significantly improved from 18 to 2 over 32, evaluated 7.3 years after surgery. Predictive factors of surgical failure were single conflicts (p = 0.041), atypical vasculo-nervous conflicts involving other vessel than postero-inferior cerebellar artery (p = 0.036), such as vein (p = 0.045), and other compression sites than root exit zone (p = 0.027). Retrosigmoid microvascular decompression is a safe and effective treatment of hemifacial spasm. Revision surgery is not to be excluded in case of failure, but does place patients at risk for more complications. Quality of life is improved in the long-term, indicating objective and subjective satisfaction.

PMID: 27214834 [PubMed - as supplied by publisher]

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Point prevalence of vertigo and dizziness in a sample of 2672 subjects and correlation with headaches.

Point prevalence of vertigo and dizziness in a sample of 2672 subjects and correlation with headaches.

Acta Otorhinolaryngol Ital. 2016 May;36(3):215-219

Authors: Teggi R, Manfrin M, Balzanelli C, Gatti O, Mura F, Quaglieri S, Pilolli F, Redaelli de Zinis LO, Benazzo M, Bussi M

Abstract
Vertigo and dizziness are common symptoms in the general population, with an estimated prevalence between 20% and 56%. The aim of our work was to assess the point prevalence of these symptoms in a population of 2672 subjects. Patients were asked to answer a questionnaire; in the first part they were asked about demographic data and previous vertigo and or dizziness. Mean age of the sample was 48.3 ± 15 years, and 46.7% were males. A total of 1077 (40.3%) subjects referred vertigo/dizziness during their lifetime, and the mean age of the first vertigo attack was 39.2 ± 15.4 years; in the second part they were asked about the characteristics of vertigo (age of first episode, rotational vertigo, relapsing episodes, positional exacerbation, presence of cochlear symptoms) and lifetime presence of moderate to severe headache and its clinical features (hemicranial, pulsatile, associated with phono and photophobia, worse on effort). An age and sex effect was demonstrated, with symptoms 4.4 times more elevated in females and 1.8 times in people over 50 years. In the total sample of 2672 responders, 13.7% referred a sensation of spinning, 26.3% relapsing episodes, 12.9% positional exacerbation and 4.8% cochlear symptoms; 34.8% referred headache during their lifetime. Subjects suffering from headache presented an increased rate of relapsing episodes, positional exacerbation, cochlear symptoms and a lower age of occurrence of the first vertigo/dizziness episode. In the discussion, our data are compared with those of previous studies, and we underline the relationship between vertigo/dizziness from one side and headache with migrainous features on the other.

PMID: 27214833 [PubMed - as supplied by publisher]

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Outcomes of long-term audiological rehabilitation in charge syndrome.

Outcomes of long-term audiological rehabilitation in charge syndrome.

Acta Otorhinolaryngol Ital. 2016 May;36(3):206-214

Authors: Trevisi P, Ciorba A, Aimoni C, Bovo R, Martini A

Abstract
The aim of this paper is to assess the long-term audiological features and outcomes of hearing rehabilitation in a large group of individuals with CHARGE Syndrome. The study has been conducted retrospectively, on a paediatric patient database, at the Audiology Department of the University Hospitals of Ferrara and Padua. The study sample included 31 children presenting with different degrees of hearing impairment associated with CHARGE syndrome. Hearing was assessed using auditory brainstem responses (ABRs) and/or electrocochleography, or conditioned audiometry (visual reinforcement audiometry [VRA] or play audiometry). Auditory-perceptual outcomes in terms of communication skills and expressive language were also recorded. The effects of hearing rehabilitation (with hearing aids or cochlear implants) in this group of children and language outcomes after rehabilitation were monitored during long-term follow-up. The outcomes of rehabilitation measures differed in relation to the heterogeneous and often severe disabilities associated with CHARGE syndrome, e.g. developmental delay, intellectual delay, visual impairment, thin 8(th) nerve with retrocochlear auditory dysfunction (as described in cases of auditory neuropathy/dyssynchrony). Oral expressive language was severely impaired in most cases, even after lengthy follow-up, suggesting the need for alternative augmentative communication modes. The early identification of sensorineural hearing loss, and carefully planned rehabilitation treatments, can be of some benefit in children with CHARGE syndrome.

PMID: 27214832 [PubMed - as supplied by publisher]

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Radiofrequency volumetric inferior turbinate reduction: long-term clinical results.

Radiofrequency volumetric inferior turbinate reduction: long-term clinical results.

Acta Otorhinolaryngol Ital. 2016 May;36(3):199-205

Authors: De Corso E, Bastanza G, Di Donfrancesco V, Guidi ML, Morelli Sbarra G, Passali GC, Poscia A, de Waure C, Paludetti G, Galli J

Abstract
The aim of our study was to assess long-term results of radiofrequency volumetric tissue reduction of inferior turbinates (RVTR). We performed a prospective long-term longitudinal evaluation of 305 patients affected by rhinitis (114 allergic and 191 non-allergic) who were unresponsive to medical treatment and underwent RVTR (January 2004 - December 2010). Subjects were followed for a mean period of 39.70 ± 19.41 months (range 24-60). Patients completed the NOSE-scale questionnaire pre- and post-operatively after 1 month and yearly for 5-years. Recurrence was assumed if the post-operative total NOSE score increased by at least 75% during follow-up and the patient restarted medical treatments. Estimation of relapse over time was performed by Kaplan-Meyer analyses. We documented overall good satisfaction of patients regarding the procedure, with a good rate of pain control and a low rate of complications. Post-operatively there was a significant improvement in nasal stuffiness, nasal obstruction and mouth breathing (p < 0.05). We observed a worsening trend for symptoms after 36 months with progressive increasing rate of recurrences that were significantly higher in allergic than non-allergic patients (p < 0.05). We also observed a slight worsening trend of global satisfaction of patients. Our study confirms the minor discomfort and low risk of side effects of RVTR. Our data showed good efficacy of the procedure in the majority of patients for at least 36 months after surgery, and in fact in this time period the cumulative probability to remain relapse-free was up to 0.8. In the following 2 years, we observed a worse temporal trend in term of recurrence rate, and in particular in allergic patients with a significant difference vs non-allergic individuals (p < 0.05).

PMID: 27214831 [PubMed - as supplied by publisher]

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Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes.

Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes.

Acta Otorhinolaryngol Ital. 2016 May;36(3):194-198

Authors: Battaglia P, Turri-Zanoni M, De Bernardi F, Dehgani Mobaraki P, Karligkiotis A, Leone F, Castelnuovo P

Abstract
Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique appears to be a safe and effective option for ASB reconstruction after endonasal resection of sinonasal malignancies in selected cases. Larger case series with a longer follow-up are needed to validate the preliminary results obtained with such an innovative and promising surgical technique.

PMID: 27214830 [PubMed - as supplied by publisher]

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Unravelling the risk factors that underlie laryngeal surgery in elderly.

Unravelling the risk factors that underlie laryngeal surgery in elderly.

Acta Otorhinolaryngol Ital. 2016 May;36(3):185-193

Authors: Crosetti E, Caracciolo A, Molteni G, Sprio AE, Berta GN, Presutti L, Succo G

Abstract
Older patients are not considered good candidates to undergo more challenging therapeutic treatments, e.g. highly invasive surgery and complex chemotherapy. However, their exclusion from standard therapeutic options is not justifiable. Herein, we reviewed 212 patients aged ≥ 70, affected with laryngeal squamous cell carcinoma, and treated with transoral laser microsurgery or open neck (partial / total) laryngectomy with radical intent. The main aim was to compare patient outcomes to identify predictive factors that can be used by surgeons to choose the most appropriate treatment option. In our cohort, patients affected with more advanced tumour and hence treated by invasive open neck surgeries (above all TL) are more prone to develop complications and undergo fatal outcome than those with early disease treated by laser microsurgery, independently of age at surgery. In conclusion, elderly patients affected by laryngeal cancer can be treated similarly to younger patients, keeping in mind that more invasive surgeries are associated with a higher risk of developing complications. The advantages of mini-invasive surgery make it a possible first choice treatment in very old and frail patients suffering from laryngeal cancer, especially considering the recent success in treatment of some advanced stage tumours. Furthermore, comorbidities, by themselves, should not be used as exclusion criteria for subjecting an elderly patient to a different treatment that is from standard therapy.

PMID: 27214829 [PubMed - as supplied by publisher]

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Oncological and complication assessment of CO2 laser-assisted endoscopic surgery for T1-T2 glottic tumours: clinical experience.

Oncological and complication assessment of CO2 laser-assisted endoscopic surgery for T1-T2 glottic tumours: clinical experience.

Acta Otorhinolaryngol Ital. 2016 May;36(3):167-173

Authors: Galli A, Giordano L, Sarandria D, Di Santo D, Bussi M

Abstract
Several therapeutic options are used for treatment of early stage glottic carcinoma (Tis/T1/T2): open partial laryngectomy (OPL), radiotherapy and CO2 laser-assisted endoscopic surgery. Laser surgery has gradually gained approval in the management of laryngeal cancer. We present our experience in endoscopic laser surgery for early stage glottic carcinomas. This was a retrospective analysis of 72 patients with T1-T2 glottic cancer treated with laser cordectomy between 2006 and 2012. All patients had at least a 36-month follow-up period. Percentages for disease-specific survival, disease-free survival (DFS) and laryngeal preservation rates were 98.6%, 84.7% and 97.2% respectively. Considering neoplastic features that could predict long-term oncological outcome, tumoural involvement of anterior commissure and pathological staging (pT) significantly correlate with local recurrence (p = 0.021 and p = 0.035) and with a lowered DFS (p = 0.017 and p = 0.023). Other variables such as clinical staging, type of cordectomy, involvement of other structures and surgical margin status showed no significant impact on oncological endpoints. CO2 laser surgery is a reliable technique for T1-T2 glottic cancer considering oncological outcomes. The recurrence rate seems to be affected by involvement of anterior commissure and pT stage.

PMID: 27214828 [PubMed - as supplied by publisher]

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A review of new insights on the association between hearing loss and cognitive decline in ageing.

A review of new insights on the association between hearing loss and cognitive decline in ageing.

Acta Otorhinolaryngol Ital. 2016 May;36(3):155-166

Authors: Fortunato S, Forli F, Guglielmi V, De Corso E, Paludetti G, Berrettini S, Fetoni AR

Abstract
Age-related hearing loss (ARHL) has a multifactorial pathogenesis and it is an inevitable hearing impairment associated with reduction of communicative skills related to ageing. Increasing evidence has linked ARHL to more rapid progression of cognitive decline and incidental dementia. Many aspects of daily living of elderly people have been associated to hearing abilities, showing that hearing loss (HL) affects the quality of life, social relationships, motor skills, psychological aspects and function and morphology in specific brain areas. Epidemiological and clinical studies confirm the assumption of a relationship between these conditions. However, the mechanisms are still unclear and are reviewed herein. Long-term hearing deprivation of auditory inputs can impact cognitive performance by decreasing the quality of communication leading to social isolation and depression and facilitate dementia. On the contrary, the limited cognitive skills may reduce the cognitive resources available for auditory perception, increasing the effects of HL. In addition, hearing loss and cognitive decline may reflect a 'common cause' on the auditory pathway and brain. In fact, some pathogenetic factors are recongised in common microvascular disease factors such as diabetes, atherosclerosis and hypertension. Interdisciplinary efforts to investigate and address HL in the context of brain and cognitive ageing are needed. Surprisingly, few studies have been adressed on the effectiveness of hearing aids in changing the natural history of cognitive decline. Effective interventions with hearing aids or cochlear implant may improve social and emotional function, communication, cognitive function and positively impact quality of life. The aim of this review is to overview new insights on this challenging topic and provide new ideas for future research.

PMID: 27214827 [PubMed - as supplied by publisher]

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Large vocal cord polyp: an unusual cause of dyspnoea.

Related Articles

Large vocal cord polyp: an unusual cause of dyspnoea.

BMJ Case Rep. 2015;2015

Authors: Shergill GS, Shergill AK

PMID: 26334311 [PubMed - indexed for MEDLINE]

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Clinical implications of serum galactomannan measurement in patients with acute invasive fungal rhinosinusitis.

Clinical implications of serum galactomannan measurement in patients with acute invasive fungal rhinosinusitis.

Rhinology. 2016 May 23;

Authors: Cho HJ, Hong SD, Kim HY, Chung SK, Dhong HJ

Abstract
BACKGROUND: Acute invasive fungal rhinosinusitis (AIFR) is an aggressive opportunistic infection with a high mortality rate. Recently, non-invasive techniques have been introduced for diagnosis of invasive fungal disease. The purpose of this study is to evaluate the diagnostic significance of serum galactomannan measurement in patients with AIFR.
METHODOLOGY: We conducted a retrospective case-control study of 28 patients with AIFR and 36 fungus ball (FB) patients. We evaluated clinical, laboratory, and pathologic findings along with disease course.
RESULTS: In 28 patients with AIFR, there were 21 cases of invasive aspergillosis (IA) and 7 cases of invasive mucormycosis (IM). The control group was comprised of 36 patients with FB. The three-group analysis showed a statistically significant difference among the groups. At the cut-off value of 0.48, the sensitivity and specificity were 71.4% and 93.0%, respectively. Comparison of mean serum galactomannan levels in 5 non-survivors and 9 survivors at initial measurement showed no significant difference, but that became significantly different 1 week later. Statistical analysis showed that the levels of serum galactomannan decreased significantly according to the measurement-point in within survivor-group analysis. The difference in between survivor-groups analysis was also significant.
CONCLUSION: Serum galactomannan measurement seems useful for early diagnosis and discrimination of fungal species in patients with AIFR. In addition, clinical outcomes may be related to the levels and patterns of serum galactomannan, especially in IA. The appropriate measurement of galactomannan might be helpful in treating the patients at high risk for AIFR.

PMID: 27213721 [PubMed - as supplied by publisher]

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Design and assessment of an anatomical diagram for sinonasal malignant tumour resection.

Design and assessment of an anatomical diagram for sinonasal malignant tumour resection.

Rhinology. 2016 May 23;

Authors: Bastier PL, de Gabory L

Abstract
BACKGROUND: The aim of our work was to design and assess the comprehensibility of an anatomical diagram for recording surgical and pathological results after the removal of sinonasal malignant tumours by endoscopic endonasal surgery.
METHODOLOGY: To create the first version of the diagram, we determined the functional and technical specifications for its use. The anatomical structures that appear on it were selected from the pathological reports of previous interventions. The comprehensibility of the diagram was tested by two successive multicentre labelling tests. Successive modifications led to the creation of a definitive version of the diagram.
RESULTS: A diagram of the sinonasal cavities in exploded view was created from 47 selected anatomical structures. Labelling tests led to modifying the diagram by the overall restructuring and removal of the least recognized structures. In the labelling test of version 2, the mean global identification rate was 97.1 plus/minus 4.9% for 36 participants and all tested structures achieved a specific identification rate equal to or greater than 75%.
CONCLUSIONS: This diagram of the sinonasal cavities is a comprehensible validated tool that allows the resection and invasion of sinonasal malignant tumours to be recorded. This three-dimensional diagram facilitates the understanding of the size, location and extensions of tumours. It may improve case presentations and communication in multidisciplinary team meetings.

PMID: 27213612 [PubMed - as supplied by publisher]

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