Effects of repeated snowboard exercise in virtual reality with time lags of visual scene behind body rotation on head stability and subjective slalom run performance in healthy young subjects.

Effects of repeated snowboard exercise in virtual reality with time lags of visual scene behind body rotation on head stability and subjective slalom run performance in healthy young subjects.

Acta Otolaryngol. 2016 Jun 20;:1-4

Authors: Wada Y, Nishiike S, Kitahara T, Yamanaka T, Imai T, Ito T, Sato G, Matsuda K, Kitamura Y, Takeda N

Abstract
CONCLUSION: After repeated snowboard exercises in the virtual reality (VR) world with increasing time lags in trials 3-8, it is suggested that the adaptation to repeated visual-vestibulosomatosensory conflict in the VR world improved dynamic posture control and motor performance in the real world without the development of motion sickness.
OBJECTIVES: The VR technology was used and the effects of repeated snowboard exercise examined in the VR world with time lags between visual scene and body rotation on the head stability and slalom run performance during exercise in healthy subjects.
METHODS: Forty-two healthy young subjects participated in the study. After trials 1 and 2 of snowboard exercise in the VR world without time lag, trials 3-8 were conducted with 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6 s time lags of the visual scene that the computer creates behind board rotation, respectively. Finally, trial 9 was conducted without time lag. Head linear accelerations and subjective slalom run performance were evaluated.
RESULTS: The standard deviations of head linear accelerations in inter-aural direction were significantly increased in trial 8, with a time lag of 0.6 s, but significantly decreased in trial 9 without a time lag, compared with those in trial 2 without a time lag. The subjective scores of slalom run performance were significantly decreased in trial 8, with a time lag of 0.6 s, but significantly increased in trial 9 without a time lag, compared with those in trial 2 without a time lag. Motion sickness was not induced in any subjects.

PMID: 27319356 [PubMed - as supplied by publisher]

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Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base.

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base.

Braz J Otorhinolaryngol. 2016 May 31;

Authors: Dolci RL, Miyake MM, Tateno DA, Cançado NA, Campos CA, Dos Santos AR, Lazarini PR

Abstract
INTRODUCTION: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination.
OBJECTIVE: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used.
METHODS: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations.
RESULTS: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation.
CONCLUSION: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.

PMID: 27320654 [PubMed - as supplied by publisher]

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Primary repair of open neural tube defect in adulthood: case example and review of management strategies.

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Primary repair of open neural tube defect in adulthood: case example and review of management strategies.

Spine J. 2015 Nov 1;15(11):e57-63

Authors: Godzik J, Ravindra VM, Ray WZ, Eskandari R, Dailey AT

Abstract
BACKGROUND CONTEXT: Neural tube defects are congenital malformations that develop when the neural plate fails to close during embryogenesis. The most common open neural tube defect, myelomeningocele (MMC), is declining in frequency in North America. If identified, an MMC must be closed in the perinatal period to prevent lethal complications. Lesions presenting in older adults are, thus, very uncommon.
PURPOSE: The purpose of this study was to describe the surgical management of an adult with an unrepaired ulcerated lumbosacral MMC who presented with persistent cerebrospinal fluid (CSF) leakage and to review the management strategies for adult patients with unrepaired MMC.
STUDY DESIGN: A case report was used for this study.
METHODS: The patient was a 62-year-old woman with an unrepaired ulcerated lumbosacral MMC and associated lower extremity weakness. She sought medical care for persistent lumbar tenderness and ulceration after sustaining a fall 4 months before admission. Physical and radiological assessment revealed a lumbosacral MMC at the L5 and S1 levels and a tethered cord. Surgical resection of the placode and de-tethering were performed.
RESULTS: One week after repair of the lumbosacral MMC, the patient was readmitted for management of continued CSF leakage and hydrocephalus, requiring external ventricular drainage, wound revision, and placement of lumboperitoneal shunt. The patient experienced complete resolution of back pain without additional episodes of CSF leakage.
CONCLUSIONS: This rare case and review of management strategies suggests that proper surgical management of open MMC in adulthood can successfully be performed and improve patient symptoms and prevent further complications.

PMID: 26235466 [PubMed - indexed for MEDLINE]

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Right Internal Jugular Vein Cannulation: Carotid Artery-directed versus Sternocleidomastoid-directed Methods.

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Right Internal Jugular Vein Cannulation: Carotid Artery-directed versus Sternocleidomastoid-directed Methods.

Am Surg. 2016 Feb;82(2):161-5

Authors: Yu ZY, Yuan P, Pan Y, Zhang ZM

Abstract
The aim of the present study was to explore a simple and safe method for central venous catheterization (CVC) from the right internal jugular vein (RIJV) by comparing carotid artery (CA) positioning with sternocleidomastoid (SCM) positioning. The medical records of patients who underwent CVC between January 2011 and January 2015 were retrospectively reviewed. Central venous catheters were inserted into the RIJV either above the level of the cricoid cartilage using the CA-directed method (419 patients, Group 1) or below the level of the cricoid cartilage using the SCM-directed method (436 patients, Group 2). Success rate and related complications of catheterization were evaluated in the two groups. The total success rate of RIJV cannulation in Group 1 (97.2%) was higher than that in Group 2 (94.5%). Moreover, the success rate at first attempt was significantly higher in Group 1 than in Group 2 (92.4% vs 86.9%). The incidence of hematoma was 1.6 per cent in Group 1 and 3.8 per cent in Group 2. The rate of other complications such as pneumothorax, catheter-related infections, and catheter occlusion did not significantly differ between the groups. In conclusions, CA-directed RIJV cannulation is more effective and simple to perform than the SCM-directed method, and should become the preferred CVC technique in the absence of ultrasound guidance.

PMID: 26874140 [PubMed - indexed for MEDLINE]

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Comparison of ultrasonography and surface landmarks in detecting the localization for cricothyroidotomy.

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Comparison of ultrasonography and surface landmarks in detecting the localization for cricothyroidotomy.

Am J Emerg Med. 2016 Feb;34(2):254-6

Authors: Yıldız G, Göksu E, Şenfer A, Kaplan A

Abstract
OBJECTIVE: The aim of the study was to compare ultrasonography (US) and surface landmark techniques for detecting the cricothyroid membrane (CTM) to perform a cricothyroidotomy on healthy volunteers.
METHODS: In this prospective observational study, 5 operators and 24 models were included. The borders of the CTM were marked with an invisible pen. The operators were asked to point the CTM either with the palpation method or the US-guided fashion.
RESULTS: The CTM was detected accurately in 80 (66.7%) attempts with palpation and 83 (69.2%) attempts with US. There was no statistically significant difference in the accuracy of detection of the CTM with palpation and US. The mean time for detecting the CTM with palpation was 8.25 ± 4.8 seconds (95% confidence interval, 7.3-9.1). The mean time for detecting CTM with US was 17 ± 9.2 seconds (95% confidence interval, 15.3-18.7). The duration for detecting the localization of the CTM was longer with US.
CONCLUSION: According to the results of this study, the accuracy of US and palpation was similar in detecting the localization of the CTM. However, the duration for detecting the CTM was longer with US when compared with the palpation technique.

PMID: 26614580 [PubMed - indexed for MEDLINE]

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Use of endotracheal tubes with subglottic secretion drainage reduces ventilator-associated pneumonia in trauma patients.

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Use of endotracheal tubes with subglottic secretion drainage reduces ventilator-associated pneumonia in trauma patients.

J Trauma Acute Care Surg. 2016 Feb;80(2):218-22

Authors: Hubbard JL, Veneman WL, Dirks RC, Davis JW, Kaups KL

Abstract
BACKGROUND: Patients sustaining traumatic injuries have a higher incidence of ventilator-associated pneumonia (VAP) compared with other critically ill patient populations. Previous studies of patients with predominantly medical diagnoses and use of endotracheal tubes allowing subglottic secretion drainage (ETT-SSD) have shown significant reduction in VAP rates. We hypothesized that the use of ETT-SSD would reduce VAP in trauma patients.
METHODS: A retrospective review from 2010 to 2014 of adult trauma patients orotracheally intubated for more than 48 hours was performed at a Level 1 trauma center. Patients were compared based on standard endotracheal tube (ETT) versus ETT-SSD for the primary outcome VAP per 1,000 ventilator days. The diagnosis of VAP was made by quantitative bronchoalveolar lavage cultures as defined by Centers for Disease Control and Prevention criteria. Patients with ETT-SSD were matched to patients with ETT based on age group, sex, mechanism of injury, head and chest Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS).
RESULTS: Of 1,135 patients included in the study, 667 patients had ETT and 468 had ETT-SSD. Groups did not differ by demographics, mechanism of injury, Glasgow Coma Scale (GCS) score, alcohol intoxication, or ISS. Patients with ETT-SSD had significantly higher head AIS score but lower chest AIS score. In matched cohorts, ETT-SSD had a lower VAP rate (5.7 vs. 9.3 for ETT, p = 0.03), decreased ventilator days (12 vs. 14, p = 0.04), and decreased intensive care unit length of stay (13 days vs. 16 days, p = 0.003).
CONCLUSION: After controlling for confounding factors, ETT-SSD decreased VAP rate, ventilator days, and intensive care unit length of stay in trauma patients. In this high-risk patient population, we recommend routine use of ETT-SSD to decrease VAP.
LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

PMID: 26595709 [PubMed - indexed for MEDLINE]

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Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy.

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Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy.

Cancer. 2016 Feb 15;122(4):546-58

Authors: Pan JJ, Ng WT, Zong JF, Chan LL, O'Sullivan B, Lin SJ, Sze HC, Chen YB, Choi HC, Guo QJ, Kan WK, Xiao YP, Wei X, Le QT, Glastonbury CM, Colevas AD, Weber RS, Shah JP, Lee AW

Abstract
BACKGROUND: An accurate staging system is crucial for cancer management. Evaluations for continual suitability and improvement are needed as staging and treatment methods evolve.
METHODS: This was a retrospective study of 1609 patients with nasopharyngeal carcinoma investigated by magnetic resonance imaging, staged with the 7th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system, and irradiated by intensity-modulated radiotherapy at 2 centers in Hong Kong and mainland China.
RESULTS: Among the patients without other T3/T4 involvement, there were no significant differences in overall survival (OS) between medial pterygoid muscle (MP) ± lateral pterygoid muscle (LP), prevertebral muscle, and parapharyngeal space involvement. Patients with extensive soft tissue involvement beyond the aforementioned structures had poor OS similar to that of patients with intracranial extension and/or cranial nerve palsy. Only 2% of the patients had lymph nodes > 6 cm above the supraclavicular fossa (SCF), and their outcomes resembled the outcomes of those with low extension. Replacing SCF with the lower neck (extension below the caudal border of the cricoid cartilage) did not affect the hazard distinction between different N categories. With the proposed T and N categories, there were no significant differences in outcome between T4N0-2 and T1-4N3 disease.
CONCLUSIONS: After a review by AJCC/UICC preparatory committees, the changes recommended for the 8th edition include changing MP/LP involvement from T4 to T2, adding prevertebral muscle involvement as T2, replacing SCF with the lower neck and merging this with a maximum nodal diameter > 6 cm as N3, and merging T4 and N3 as stage IVA criteria. These changes will lead not only to a better distinction of hazards between adjacent stages/categories but also to optimal balance in clinical practicability and global applicability.

PMID: 26588425 [PubMed - indexed for MEDLINE]

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An automatic method to detect and track the glottal gap from high speed videoendoscopic images.

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An automatic method to detect and track the glottal gap from high speed videoendoscopic images.

Biomed Eng Online. 2015;14:100

Authors: Andrade-Miranda G, Godino-Llorente JI, Moro-Velázquez L, Gómez-García JA

Abstract
BACKGROUND: The image-based analysis of the vocal folds vibration plays an important role in the diagnosis of voice disorders. The analysis is based not only on the direct observation of the video sequences, but also in an objective characterization of the phonation process by means of features extracted from the recorded images. However, such analysis is based on a previous accurate identification of the glottal gap, which is the most challenging step for a further automatic assessment of the vocal folds vibration.
METHODS: In this work, a complete framework to automatically segment and track the glottal area (or glottal gap) is proposed. The algorithm identifies a region of interest that is adapted along time, and combine active contours and watershed transform for the final delineation of the glottis and also an automatic procedure for synthesize different videokymograms is proposed.
RESULTS: Thanks to the ROI implementation, our technique is robust to the camera shifting and also the objective test proved the effectiveness and performance of the approach in the most challenging scenarios that it is when exist an inappropriate closure of the vocal folds.
CONCLUSIONS: The novelties of the proposed algorithm relies on the used of temporal information for identify an adaptive ROI and the use of watershed merging combined with active contours for the glottis delimitation. Additionally, an automatic procedure for synthesize multiline VKG by the identification of the glottal main axis is developed.

PMID: 26510707 [PubMed - indexed for MEDLINE]

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Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: Functional outcomes.

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Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: Functional outcomes.

Laryngoscope. 2016 Jan;126(1):118-21

Authors: Simpson CB, Lee CT, Hatcher JL, Michalek J

Abstract
OBJECTIVES/HYPOTHESIS: Supraglottic injection of botulinum toxin (Botox) has been described as an effective treatment for adductor spasmodic dysphonia (ADSD). Anecdotal evidence suggests that the patients have little to no breathiness after injection, but no formal longitudinal studies have been carried out to date. The purpose of this study was to examine the voice outcomes in patients with ADSD after supraglottic Botox injection.
STUDY DESIGN: Retrospective case series.
METHODS: Patients with ADSD who were treated with supraglottic Botox injections completed a qualitative self-evaluation of voice function after injection using the percentage of normal function (PNF) scale, a validated, quantitative scale from 0% (no function) to 100% (normal function). Posttreatment voice improvement after injection was determined using a Voice Handicap Index-10 (VHI-10) questionnaire.
RESULTS: A total of 198 supraglottic injections were performed between July 2011 and October 2014. Twenty-five questionnaires were completed. Mean postinjection PNF was 95.0% ± 8.4% and was significantly increased from the preinjection mean PNF (62.5%) ± 22.6% (P < 0.001). The mean best VHI-10 for all injections was 7.23. In 19 of 25 patients (76%), there was no reduction in PNF in the early postinjection period. In the remaining six patients (24%), the decline in mean vocal function was 9.2%.
CONCLUSIONS: Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection.

PMID: 26467807 [PubMed - indexed for MEDLINE]

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Cricopharyngeal dysfunction: A systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy.

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Cricopharyngeal dysfunction: A systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy.

Laryngoscope. 2016 Jan;126(1):135-41

Authors: Kocdor P, Siegel ER, Tulunay-Ugur OE

Abstract
OBJECTIVES: Cricopharyngeal dysfunction may lead to severe dysphagia and aspiration. The objective of this systematic review was to evaluate the existing studies on the effectiveness of myotomy, dilatation, and botulinum toxin (BoT) injection in the management of cricopharyngeal dysphagia.
METHODS: PubMed and Web of Science databases were searched to identify eligible studies by using the terms "cricopharyngeal dysfunction," "cricopharyngeal myotomy," "cricopharyngeal botox," "cricopharyngeal dilation," and their combinations from 1990 to 2013. This was supplemented by hand-searching relevant articles. Eligible articles were independently assessed for quality by two authors. Statistical analysis was performed.
RESULTS: The database search revealed 567 articles. Thirty-two articles met eligibility criteria and were further evaluated. The reported success rates of BoT injections was between 43% and 100% (mean = 76%), dilation 58% and 100% (mean = 81%), and myotomy 25% and 100% (mean = 75%). In logistic regression analysis of the patient-weighted averages, the 78% success rate with myotomy was significantly higher than the 69% success rate with BoT injections (P = .042), whereas the intermediate success rate of 73% with dilation was not significantly different from that of either myotomy (P = .37) or BoT (P = .42). There was a statistically significant difference between endoscopic and open myotomy success rates (P = .0025). Endoscopic myotomy had a higher success rate, with a 2.2 odds ratio.
CONCLUSIONS: The success rate of myotomy is significantly higher than the success rate of BoT injections in cricopharyngeal dysfunction. Moreover, endoscopic myotomy was found to have a higher success rate compared to open myotomy.

PMID: 26360122 [PubMed - indexed for MEDLINE]

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The effects of anesthesia and opioids on the upper airway: A systematic review.

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The effects of anesthesia and opioids on the upper airway: A systematic review.

Laryngoscope. 2016 Jan;126(1):270-84

Authors: Ehsan Z, Mahmoud M, Shott SR, Amin RS, Ishman SL

Abstract
OBJECTIVES/HYPOTHESIS: Drug-induced sleep endoscopy (DISE) is used to determine surgical therapy for obstructive sleep apnea (OSA); however, the effects of anesthesia on the upper airway are poorly understood. Our aim was to systematically review existing literature on the effects of anesthetic agents on the upper airway.
DATA SOURCES: PubMed, CINAHL, EBM reviews and Scopus (all indexed years).
REVIEW METHODS: Inclusion criteria included English language articles containing original human data. Two investigators independently reviewed all articles for outcomes related to upper airway morphology, dynamics, neuromuscular response, and respiratory control.
RESULTS: The initial search yielded 180 abstracts; 56 articles were ultimately included (total population = 8,540). The anesthetic agents studied were: topical lidocaine, propofol, dexmedetomidine, midazolam, pentobarbital, sevoflurane, desflurane, ketamine, and opioids. Outcome measures were diverse and included imaging studies, genioglossus electromyography, endoscopic airway assessment, polysomnography, upper airway closing pressure, and clinical evidence of obstruction. All agents caused some degrees of airway collapse. Dexmedetomidine did not have dose-dependent effects when evaluated using cine magnetic resonance imaging, unlike sevoflurane, isoflurane, and propofol, and caused less dynamic collapse than propofol.
CONCLUSIONS: Studies assessing the effect of anesthesia on the upper airway in patients with and without OSA are limited, and few compare effects between agents. Medications with minimal effect on respiratory control (e.g., dexmedetomidine) may work best for DISE.

PMID: 26198715 [PubMed - indexed for MEDLINE]

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Laryngeal morphologic changes and epidemiology in patients with inhalation injury: a retrospective study.

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Laryngeal morphologic changes and epidemiology in patients with inhalation injury: a retrospective study.

Burns. 2015 Sep;41(6):1340-6

Authors: Fang-Gang N, Yang C, Yu-Xuan Q, Yan-Hua R, Wei-Li D, Cheng W, Chun-Quan W, Guo-An Z

Abstract
BACKGROUND AND OBJECTIVES: Laryngeal morphologic changes are important in risk assessment of upper airway obstruction (UAO) after inhalation injury. This retrospective study evaluates the clinical application of laryngeal burn classification system.
MATERIALS AND METHODS: Clinical data from January 1999 to June 2013 were analyzed retrospectively. The following data collected: age, gender, total burned surface area (TBSA), third-degree burn surface area, co-morbid injuries and complications, proportion of patients with tracheotomy, interval between tracheotomy and injury, incidence and mortality of UAO, and reasons for death.
RESULTS: Four hundred and forty-three patients were included; 405 patients underwent multiple fibro-laryngoscopic observation, of which I, II and III types of laryngeal burns were present in 49.9, 38.0, and 12.1% patients, respectively. Laryngeal burn severity was related to TBSA and third-degree burn surface area. Overall tracheotomy rate (n=443) was 37.02%. The mean interval between tracheotomy and injury was 10.0±12.17h. Over 75% patients underwent tracheotomy within 12h. Compared with moderate inhalation burn group, the severe inhalation burn group showed a significantly higher tracheotomy rate within 12h and a significantly shorter interval between tracheotomy and injury. Patient mortality was significantly related to the severity of inhalation injury.
CONCLUSION: The classification system of the morphologic laryngeal changes in laryngeal burn patients could effectively evaluate the UAO risk, enable earlier prophylactic tracheotomy after UAO onset, reduce surgical difficulties and risks, decrease clinical pressure of doctors, and prevent UAO. Laryngeal burn severity was related to TBSA and mortality and may be an important severity and prognosis indicator of inhalation injury.

PMID: 25791918 [PubMed - indexed for MEDLINE]

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Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression.

Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression.

Laryngoscope. 2016 Jun 19;

Authors: Deep NL, Graffeo CS, Copeland WR, Link MJ, Atkinson JL, Neff BA, Raghunathan A, Carlson ML

Abstract
OBJECTIVES/HYPOTHESIS: To report two patients with a history of microvascular decompression (MVD) for hemifacial spasm who presented with Teflon granulomas (TG) mimicking cerebellopontine angle (CPA) tumors and to perform a systematic review of the English-language literature.
STUDY DESIGN: Case series at a single tertiary academic referral center and systematic review.
METHODS: Retrospective chart review with analysis of clinical, radiological, and histopathological findings. Systematic review using PubMed, Embase, MEDLINE, and Web of Science databases.
RESULTS: Two patients with large skull base TGs mimicking CPA tumors clinically and radiographically were managed at the authors' institution. The first presented 4 years after MVD with asymmetrical sensorineural hearing loss, multiple progressive cranial neuropathies, and brainstem edema due to a growing TG. Reoperation with resection of the granuloma confirmed a foreign-body reaction consisting of multinucleated giant cells containing intracytoplasmic Teflon particles. The second patient presented 11 years after MVD with asymmetrical sensorineural hearing loss and recurrent hemifacial spasm. No growth was noted over 2 years, and the patient has been managed expectantly. Only one prior case of TG after MVD for hemifacial spasm has been reported in the English literature.
CONCLUSIONS: TG is a rare complication of MVD for hemifacial spasm. The diagnosis should be suspected in patients presenting with a new-onset enhancing mass of the CPA after MVD, even when performed decades earlier. A thorough clinical and surgical history is critical toward establishing an accurate diagnosis to guide management and prevent unnecessary morbidity. Surgical intervention is not required unless progressive neurologic complications ensue.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27320780 [PubMed - as supplied by publisher]

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Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base.

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base.

Braz J Otorhinolaryngol. 2016 May 31;

Authors: Dolci RL, Miyake MM, Tateno DA, Cançado NA, Campos CA, Dos Santos AR, Lazarini PR

Abstract
INTRODUCTION: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination.
OBJECTIVE: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used.
METHODS: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations.
RESULTS: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation.
CONCLUSION: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.

PMID: 27320654 [PubMed - as supplied by publisher]

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Intraoperative MRI in Skull Base Surgery: a review of 71 consecutive cases.

Intraoperative MRI in Skull Base Surgery: a review of 71 consecutive cases.

World Neurosurg. 2016 Jun 16;

Authors: Ashour R, Reintjes S, Park MS, Sivakanthan S, van Loveren H, Agazzi S

Abstract
BACKGROUND: Although intraoperative magnetic resonance imaging (iMRI) is increasingly utilized during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery.
METHODS: Medical records were retrospectively reviewed on all neurosurgical cases performed at our institution in the IMRIS® iMRI suite between April 2014 and July 2015.
RESULTS: Over the study period, the iMRI suite was utilized for 71 skull base tumors. iMRI was performed in 23/71 cases. Additional tumor resection was pursued after scanning in 7/23 patients. There was a significant difference in procedure length between the scanned vs non-scanned groups, and this was likely attributable to a higher proportion of petroclival meningiomas in the scanned group. Further analyses revealed significant increases in procedure length for the following scanned subgroups: anterolateral approach, anterolateral and petroclival lesion locations, and meningiomas. The rate of non-neurologic complications was significantly higher in the scanned group, particularly for patients with tumors >3cm.
CONCLUSION: Despite the unique challenges associated with skull base tumor surgery, iMRI can be safely obtained while adding a modest though not prohibitive amount of time to the procedure. The immediate evidence of residual tumor with a patient still in position to have additional resection may influence the surgeon to alter the surgical plan and attempt further resection in a critical area.

PMID: 27319315 [PubMed - as supplied by publisher]

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Outcome Measurement in Adult Auditory Rehabilitation: A Scoping Review of Measures Used in Randomized Controlled Trials.

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Outcome Measurement in Adult Auditory Rehabilitation: A Scoping Review of Measures Used in Randomized Controlled Trials.

Ear Hear. 2015 Sep-Oct;36(5):567-73

Authors: Barker F, MacKenzie E, Elliott L, de Lusignan S

Abstract
OBJECTIVES: This review documented the range and nature of reported outcome measures in the context of adult auditory rehabilitative research.
DESIGN: A scoping review conducted as a part of the development of a systematic review of the effect of interventions to improve hearing aid use. The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP; and additional sources for published and unpublished randomized control trials. The date of the search was November 6, 2013. Outcomes were grouped using a framework suggested by the Cochrane Effective Practice and Organization of Care group.
RESULTS: Patient outcomes included adherence to hearing aid use, daily hours of aid use, hearing handicap, hearing aid benefit, quality of life, and communication and psychological outcome. Satisfaction and speech perception were frequent secondary outcomes. There was diversity in measures used to report patient outcomes. Outcome categories other than patient health status and behavior were rarely reported. The timing of outcome measurement was often short term (<12 weeks), with a relative lack of evidence on long-term outcomes (>1 year).
CONCLUSIONS: This review has highlighted considerable diversity in patient-reported outcome measurements in randomized control trials in the context of adult auditory rehabilitation. In addition, there are gaps in the literature with respect to measurement of other outcome types of potential interest to stakeholders, including policymakers and commissioners. Long-term outcome assessment is rare.

PMID: 25919402 [PubMed - indexed for MEDLINE]

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Effects of repeated snowboard exercise in virtual reality with time lags of visual scene behind body rotation on head stability and subjective slalom run performance in healthy young subjects.

Effects of repeated snowboard exercise in virtual reality with time lags of visual scene behind body rotation on head stability and subjective slalom run performance in healthy young subjects.

Acta Otolaryngol. 2016 Jun 20;:1-4

Authors: Wada Y, Nishiike S, Kitahara T, Yamanaka T, Imai T, Ito T, Sato G, Matsuda K, Kitamura Y, Takeda N

Abstract
CONCLUSION: After repeated snowboard exercises in the virtual reality (VR) world with increasing time lags in trials 3-8, it is suggested that the adaptation to repeated visual-vestibulosomatosensory conflict in the VR world improved dynamic posture control and motor performance in the real world without the development of motion sickness.
OBJECTIVES: The VR technology was used and the effects of repeated snowboard exercise examined in the VR world with time lags between visual scene and body rotation on the head stability and slalom run performance during exercise in healthy subjects.
METHODS: Forty-two healthy young subjects participated in the study. After trials 1 and 2 of snowboard exercise in the VR world without time lag, trials 3-8 were conducted with 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6 s time lags of the visual scene that the computer creates behind board rotation, respectively. Finally, trial 9 was conducted without time lag. Head linear accelerations and subjective slalom run performance were evaluated.
RESULTS: The standard deviations of head linear accelerations in inter-aural direction were significantly increased in trial 8, with a time lag of 0.6 s, but significantly decreased in trial 9 without a time lag, compared with those in trial 2 without a time lag. The subjective scores of slalom run performance were significantly decreased in trial 8, with a time lag of 0.6 s, but significantly increased in trial 9 without a time lag, compared with those in trial 2 without a time lag. Motion sickness was not induced in any subjects.

PMID: 27319356 [PubMed - as supplied by publisher]

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Surgery in head and neck cancer: United Kingdom National Multidisciplinary Guidelines - ERRATUM.

Surgery in head and neck cancer: United Kingdom National Multidisciplinary Guidelines - ERRATUM.

J Laryngol Otol. 2016 Jun 20;:1

Authors: Homer JJ

PMID: 27321287 [PubMed - as supplied by publisher]

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Using ultrasound tongue imaging to identify covert contrasts in children's speech.

Using ultrasound tongue imaging to identify covert contrasts in children's speech.

Clin Linguist Phon. 2016 Jun 20;:1-14

Authors: Zharkova N, Gibbon FE, Lee A

Abstract
Ultrasound tongue imaging has become a promising technique for detecting covert contrasts, due to the developments in data analysis methods that allow for processing information on tongue shape from young children. An important feature concerning analyses of ultrasound data from children who are likely to produce covert contrasts is that the data are likely to be collected without head-to-transducer stabilisation, due to the speakers' age. This article is a review of the existing methods applicable in analysing data from non-stabilised recordings. The article describes some of the challenges of ultrasound data collection from children, and analysing these data, as well as possible ways to address those challenges. Additionally, there are examples from typical and disordered productions featuring covert contrasts, with illustrations of quantifying differences in tongue shape between target speech sounds.

PMID: 27322800 [PubMed - as supplied by publisher]

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Prophylactic treatment of vestibular migraine.

Prophylactic treatment of vestibular migraine.

Braz J Otorhinolaryngol. 2016 Jun 2;

Authors: Salmito MC, Duarte JA, Morganti LO, Brandão PV, Nakao BH, Villa TR, Ganança FF

Abstract
INTRODUCTION: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce.
OBJECTIVE: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic.
METHODS: Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed.
RESULTS: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p<0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p<0.001) and headache (p<0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug.
CONCLUSIONS: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

PMID: 27320656 [PubMed - as supplied by publisher]

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Does the intravenous administration of frusemide reduce endolymphatic hydrops?

Related Articles

Does the intravenous administration of frusemide reduce endolymphatic hydrops?

J Laryngol Otol. 2016 Mar;130(3):242-7

Authors: Fiorino F, Mattellini B, Vento M, Mazzocchin L, Bianconi L, Pizzini FB

Abstract
OBJECTIVE: To verify the hypothesis that intravenous frusemide reduces endolymphatic hydrops, as evaluated by three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging following intratympanic gadolinium administration.
METHODS: The study comprised 12 patients (7 females and 5 males, aged 19-74 years) with Ménière's disease. Disease duration ranged from 0.5 to 8 years, with a frequency of 0.5 to 6 vertigo spells per month, as calculated in the last 6 months. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging was performed 24 hours after intratympanic injection of gadobutrol diluted eight-fold. Frusemide 20 mg was given intravenously immediately after imaging. Magnetic resonance imaging was repeated after 1 hour, using the same parameters and sequence.
RESULTS: All patients showed enhancement defects, indicating endolymphatic hydrops of variable degrees. No modifications occurred at the second magnetic resonance imaging performed 1 hour after frusemide administration.
CONCLUSION: There was no evidence of endolymphatic hydrops modification 1 hour after intravenously administered frusemide. Therefore, loop diuretics in Ménière's disease, which are today used on an empirical basis, must be reconsidered. Implications of these outcomes are discussed and related to the role of endolymphatic hydrops in the development of Ménière's disease.

PMID: 26763125 [PubMed - indexed for MEDLINE]

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Longitudinal Evaluation of Community Support Project to Improve Oral Function in Japanese Elderly.

Longitudinal Evaluation of Community Support Project to Improve Oral Function in Japanese Elderly.

Bull Tokyo Dent Coll. 2016;57(2):75-82

Authors: Sakayori T, Maki Y, Ohkubo M, Ishida R, Hirata S, Ishii T

Abstract
Change in oral function was evaluated longitudinally in elderly persons participating in an Exercises for Healthy Oral Function program implemented as part of the Long-Term Care Prevention Project. The participants comprised high-risk and healthy persons aged 65 yr or over. A questionnaire was used to classify them into two groups ('every day or sometimes' or 'rarely') at the end of the study for a comparison of change in repetitive saliva swallowing test (RSST) scores and oral diadochokinesis between 3 time points: at before, at immediately after, and at 1 yr after completion of the program. The average RSST score showed a decrease at 1 yr after intervention, but the difference was not statistically significant. Oral diadochokinesis showed a significant increase for all syllables upon completion of the program compared with at the beginning. This was followed by a significant decrease at 1 yr later compared with at the time of completion in the 'rarely' group for all syllables, but not in the 'every day or sometimes' group. In addition, the number of repetitions was significantly lower in the 'rarely' group than in the 'every day or sometimes' group for all syllables at 1 yr after completion. The results of the present study suggest that Long-Term Care Prevention Projects are necessary to maintain and improve oral function.

PMID: 27320296 [PubMed - in process]

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