Evaluation of the otolith function using c/oVEMPs in patients with Ménière's disease.

Evaluation of the otolith function using c/oVEMPs in patients with Ménière's disease.

J Otolaryngol Head Neck Surg. 2016;45(1):39

Authors: Chen L, Xu H, Wang WQ, Zhang QQ, Lv QY, Song XC

Abstract
BACKGROUND: Cervical and ocular vestibular evoked myogenic potentials (c/oVEMPs) reflect otolith function. Up-to-date, there are no published reports on the systemic evaluation of otolith function in Ménière's Disease (MD) nor are there any reports on the differences in VEMPs between patients with early and late stage MD. The aim of this study was to evaluate the difference in c/oVEMPs between patients with MD and normal controls, as well as between patients with early and late stage MD.
METHODS: Thirty patients with unilateral MD and thirty healthy subjects (as normal controls) were prospectively enrolled. c/oVEMPs using 500 Hz tone-burst stimuli were performed. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response.
RESULTS: In the control group, abnormal cVEMPs and oVEMPs responses were detected in 6.67 and 3.34 % respectively. In MD patients (20 with early stage MD [ES-MD], 10 with late stage MD [LS-MD]), abnormal cVEMPs and oVEMPs responses were detected in 40 and 16.7 % respectively. More patients with MD showed abnormal responses in c/oVEMPs as compared to the control group (p < 0.05). cVEMPs was more often abnormal as compared to oVEMPs in MD patients (p < 0.05). There was a significant difference in abnormal cVEMP responses between ES-MD patients (25 %) and LS-MD patients (70 %) (p < 0.05). Difference in abnormal oVEMP responses (ES-MD, 5 %; LS-MD, 40 %) was significant (p < 0.05).
CONCLUSION: An increased occurrence of abnormal c/oVEMP recordings appeared in MD patients, possibly as a result of hydrops of the otolith. cVEMPs were more often abnormal in MD patients as compared to oVEMPs, suggesting that saccular dysfunction may be more common than utricular dysfunction. Furthermore, o/cVEMP abnormalities in the LS-MD group were significantly higher than those in the ES-MD group, suggesting the trend that otolith damage is gradually increasing with the aggravation of cochlear injury in MD.

PMID: 27329136 [PubMed - in process]

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Signs and Symptoms of Dry Eye in Keratoconus Patients: A Pilot Study.

Related Articles

Signs and Symptoms of Dry Eye in Keratoconus Patients: A Pilot Study.

Curr Eye Res. 2015;40(11):1088-94

Authors: Carracedo G, Recchioni A, Alejandre-Alba N, Martin-Gil A, Crooke A, Morote IJ, Pintor J

Abstract
PURPOSE: To compare signs and symptoms of dry eye in keratoconus (KC) patients versus healthy subjects.
METHODS: A total of 15 KC patients (KC group, n = 15 eyes) and 16 healthy subjects (control group, 16 eyes) were enrolled in this study. The Schirmer I test with no anesthetic, tear break-up time (TBUT), corneal staining characteristics, and ocular surface disease index (OSDI) scores were evaluated for both groups. Impression cytology, combined with/scanning laser confocal microscopy (LCM), was performed to evaluate goblet cell density, mucin cloud height (MCH), and goblet cell layer thickness (CLT). Finally, tear concentrations of di-adenosine tetraphosphate (Ap4A) were assessed. Results were statistically analyzed using Shapiro-Wilk and non-parametric Wilcoxon rank sum tests. Statistical significance was set at p < 0.05.
RESULTS: KC patients had lower tear volumes and greater corneal staining than did healthy subjects (p < 0.05). OSDI scores were 44.96 ± 8.65 and 17.78 ± 6.50 for the KC and control groups, respectively (p < 0.05). We found no statistically significant differences in TBUT between groups. Impression cytology revealed lower goblet cell densities in KC group patients versus control group subjects (84.88 ± 32.98 and 128.88 ± 50.60 cells/mm,(2) respectively, p < 0.05). There was a statistically significant reduction in MCH and CLT in KC group patients compared with control group subjects. Ap4A tear concentrations were higher in KC group patients than in control group subjects (2.56 ± 1.10 and 0.15 ± 0.12 µM, respectively, p < 0.05).
CONCLUSIONS: The parameters evaluated in this study indicate that KC patients suffer greater symptoms of dry eye and greater tear instability, primarily due to the decreased mucin production in their tears, than do healthy patients with no KC.

PMID: 25495191 [PubMed - indexed for MEDLINE]

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Cochlear implantation: Optimizing outcomes through evidence-based clinical decisions.

Cochlear implantation: Optimizing outcomes through evidence-based clinical decisions.

Int J Audiol. 2016;55 Suppl 2:S1-2

Authors: Dowell R, Galvin K, Cowan R

PMID: 27329573 [PubMed - in process]

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Audiology patient fall statistics and risk factors compared to non-audiology patients.

Audiology patient fall statistics and risk factors compared to non-audiology patients.

Int J Audiol. 2016 Jun 22;:1-7

Authors: Criter RE, Honaker JA

Abstract
OBJECTIVE: To compare fall statistics (e.g. incidence, prevalence), fall risks, and characteristics of patients who seek hearing healthcare from an audiologist to individuals who have not sought such services.
DESIGN: Case-control study.
STUDY SAMPLE: Two groups of community-dwelling older adult patients: 25 audiology patients aged 60 years or older (M age: 69.2 years, SD: 4.5, range: 61-77) and a control group (gender- and age-matched ±2 years) of 25 non-audiology patients (M age: 69.6, SD: 4.7, range: 60-77).
RESULTS: Annual incidence of falls (most recent 12 months) was higher in audiology patients (68.0%) than non-audiology patients (28.0%; p = .005). Audiology patients reported a higher incidence of multiple recent falls (p =.025) and more chronic health conditions (p = .028) than non-audiology patients.
CONCLUSIONS: Significantly more audiology patients fall on an annual basis than non-audiology patients, suggesting that falls are a pervasive issue in general hearing clinics. Further action on the part of healthcare professionals providing audiologic services may be necessary to identify individuals at risk for falling.

PMID: 27329486 [PubMed - as supplied by publisher]

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Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

Int J Audiol. 2016 Jun 22;:1-10

Authors: Båsjö S, Möller C, Widén S, Jutengren G, Kähäri K

Abstract
OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children.
DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis.
STUDY SAMPLE: A total of 415 children aged nine years.
RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones.
CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

PMID: 27329351 [PubMed - as supplied by publisher]

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Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes.

Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes.

Int J Audiol. 2016 Jun 22;:1-6

Authors: Kim CH, Shin JE, Yang YS, Im D

Abstract
OBJECTIVES: To investigate the initial findings of positional nystagmus in patients with sudden sensorineural hearing loss (SSNHL) and positional vertigo, and to compare hearing improvement among patients with different types of positional nystagmus.
DESIGN: The characteristics of positional nystagmus upon initial examination were analysed, and the initial mean pure-tone audiometry (PTA) threshold was compared with that at three months after treatment.
STUDY SAMPLE: Forty-four SSNHL patients with concomitant positional vertigo were included.
RESULTS: Positional nystagmus was classified into five subgroups; persistent geotropic direction-changing positional nystagmus (DCPN) in head-roll test (HRT) and negative Dix-Hallpike test (DHT), persistent apogeotropic DCPN in HRT and negative DHT, positive DHT and negative HRT, persistent geotropic DCPN in HRT and positive DHT, and persistent apogeotropic DCPN in HRT and positive DHT. PTA threshold improvement was significantly greater in SSNHL patients with negative DHT than with positive DHT (p = 0.027).
CONCLUSIONS: When geotropic DCPN was elicited by HRT, the nystagmus was persistent, which suggests that alteration of specific gravity of the endolymph, rather than the lateral canal canalolithiasis, may be a cause of this characteristic positional nystagmus. Positive DTH may be a prognostic factor for worse hearing recovery among patients with SSNHL and positional vertigo.

PMID: 27329283 [PubMed - as supplied by publisher]

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Results using the OPAL strategy in Mandarin speaking cochlear implant recipients.

Results using the OPAL strategy in Mandarin speaking cochlear implant recipients.

Int J Audiol. 2016 Jun 22;:1-12

Authors: Vandali AE, Dawson PW, Arora K

Abstract
OBJECTIVE: To evaluate the effectiveness of an experimental pitch-coding strategy for improving recognition of Mandarin lexical tone in cochlear implant (CI) recipients.
DESIGN: Adult CI recipients were tested on recognition of Mandarin tones in quiet and speech-shaped noise at a signal-to-noise ratio of +10 dB; Mandarin sentence speech-reception threshold (SRT) in speech-shaped noise; and pitch discrimination of synthetic complex-harmonic tones in quiet. Two versions of the experimental strategy were examined: (OPAL) linear (1:1) mapping of fundamental frequency (F0) to the coded modulation rate; and (OPAL+) transposed mapping of high F0s to a lower coded rate. Outcomes were compared to results using the clinical ACE™ strategy.
STUDY SAMPLE: Five Mandarin speaking users of Nucleus® cochlear implants.
RESULTS: A small but significant benefit in recognition of lexical tones was observed using OPAL compared to ACE in noise, but not in quiet, and not for OPAL+ compared to ACE or OPAL in quiet or noise. Sentence SRTs were significantly better using OPAL+ and comparable using OPAL to those using ACE. No differences in pitch discrimination thresholds were observed across strategies.
CONCLUSIONS: OPAL can provide benefits to Mandarin lexical tone recognition in moderately noisy conditions and preserve perception of Mandarin sentences in challenging noise conditions.

PMID: 27329178 [PubMed - as supplied by publisher]

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Myxoma of the nasal bone.

Myxoma of the nasal bone.

Auris Nasus Larynx. 2016 Jun 18;

Authors: Al-Qahtani K, Islam T, AlOulah M, Bafaqeeh S, Faqeeh Y

Abstract
Myxoma is a benign tumor that arises from mesenchymal tissue, and found in the soft tissue and less commonly in the bone. The majority of bony myxomas of the head and neck occur in the jaws and maxilla. We report an extremely rare case of nasal bone myxoma in a 52-year-old man. The diagnosis was confirmed by biopsy. Due to the aggressive nature of the lesion the nasal bone was eroded by the disease. The patient underwent resection of the mass with reconstruction of the defect by septal cartilage. The patient remains tumor free after 5 years.

PMID: 27328895 [PubMed - as supplied by publisher]

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A preliminary study of the effect of ECRG4 overexpression on the proliferation and apoptosis of human laryngeal cancer cells and the underlying mechanisms.

Related Articles

A preliminary study of the effect of ECRG4 overexpression on the proliferation and apoptosis of human laryngeal cancer cells and the underlying mechanisms.

Mol Med Rep. 2015 Oct;12(4):5058-64

Authors: Jia J, Dai S, Sun X, Sang Y, Xu Z, Zhang J, Cui X, Song J, Guo X

Abstract
Human esophageal cancer‑related gene 4 (ECRG4) is a potential tumor suppressor gene isolated from human esophageal epithelial cells. Studies have shown that ECRG4 effectively inhibits the proliferation of tumor cells and induces apoptosis. However, the role of ECRG4 in laryngeal cancer has not yet been clearly defined. In this study, a human laryngeal cancer cell line stably overexpressing ECRG4 was established. The effect of ECRG4 on the proliferation and apoptosis of laryngeal cancer cells and the associated mechanisms were investigated. The Hep‑2 human laryngeal carcinoma cell line exhibited a low basal level of ECRG4 expression and was selected for the present study. The eukaryotic expression plasmid pcDNA3.1‑ECRG4 was constructed and introduced into Hep‑2 cells by transfection reagents. Western blot analysis, reverse transcription-quantitative polymerase chain reaction and immunofluorescence staining confirmed high‑level expression of ECRG4. The 3‑(4, 5‑dimethylthiazol‑2‑yl)‑2,5‑diphenyltetrazolium bromide assay and colony formation assay showed that ECRG4 overexpression suppressed the proliferative capacity of laryngeal cancer cells in vitro. Cell cycle analysis showed that ECRG4 induced cell cycle arrest at the G0/G1 phase. Flow cytometric analysis and Hoechst staining demonstrated that overexpression of ECRG4 significantly induced apoptosis. Western blot analysis confirmed that Bcl‑2‑associated X protein, cleaved‑caspase‑3 and cleaved‑poly (ADP‑ribose) polymerase were upregulated in the apoptotic process, whereas B‑cell lymphoma 2 was downregulated. In conclusion, overexpression of ECRG4 inhibited laryngeal cancer cell proliferation and induced cancer cell apoptosis. Therefore, ECRG4 exhibits potential as an effective target in gene therapy for laryngeal cancer.

PMID: 26165988 [PubMed - indexed for MEDLINE]

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Audiology patient fall statistics and risk factors compared to non-audiology patients.

Audiology patient fall statistics and risk factors compared to non-audiology patients.

Int J Audiol. 2016 Jun 22;:1-7

Authors: Criter RE, Honaker JA

Abstract
OBJECTIVE: To compare fall statistics (e.g. incidence, prevalence), fall risks, and characteristics of patients who seek hearing healthcare from an audiologist to individuals who have not sought such services.
DESIGN: Case-control study.
STUDY SAMPLE: Two groups of community-dwelling older adult patients: 25 audiology patients aged 60 years or older (M age: 69.2 years, SD: 4.5, range: 61-77) and a control group (gender- and age-matched ±2 years) of 25 non-audiology patients (M age: 69.6, SD: 4.7, range: 60-77).
RESULTS: Annual incidence of falls (most recent 12 months) was higher in audiology patients (68.0%) than non-audiology patients (28.0%; p = .005). Audiology patients reported a higher incidence of multiple recent falls (p =.025) and more chronic health conditions (p = .028) than non-audiology patients.
CONCLUSIONS: Significantly more audiology patients fall on an annual basis than non-audiology patients, suggesting that falls are a pervasive issue in general hearing clinics. Further action on the part of healthcare professionals providing audiologic services may be necessary to identify individuals at risk for falling.

PMID: 27329486 [PubMed - as supplied by publisher]

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Cochlear implantation: Optimizing outcomes through evidence-based clinical decisions.

Cochlear implantation: Optimizing outcomes through evidence-based clinical decisions.

Int J Audiol. 2016;55 Suppl 2:S1-2

Authors: Dowell R, Galvin K, Cowan R

PMID: 27329573 [PubMed - in process]

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Audiology patient fall statistics and risk factors compared to non-audiology patients.

Audiology patient fall statistics and risk factors compared to non-audiology patients.

Int J Audiol. 2016 Jun 22;:1-7

Authors: Criter RE, Honaker JA

Abstract
OBJECTIVE: To compare fall statistics (e.g. incidence, prevalence), fall risks, and characteristics of patients who seek hearing healthcare from an audiologist to individuals who have not sought such services.
DESIGN: Case-control study.
STUDY SAMPLE: Two groups of community-dwelling older adult patients: 25 audiology patients aged 60 years or older (M age: 69.2 years, SD: 4.5, range: 61-77) and a control group (gender- and age-matched ±2 years) of 25 non-audiology patients (M age: 69.6, SD: 4.7, range: 60-77).
RESULTS: Annual incidence of falls (most recent 12 months) was higher in audiology patients (68.0%) than non-audiology patients (28.0%; p = .005). Audiology patients reported a higher incidence of multiple recent falls (p =.025) and more chronic health conditions (p = .028) than non-audiology patients.
CONCLUSIONS: Significantly more audiology patients fall on an annual basis than non-audiology patients, suggesting that falls are a pervasive issue in general hearing clinics. Further action on the part of healthcare professionals providing audiologic services may be necessary to identify individuals at risk for falling.

PMID: 27329486 [PubMed - as supplied by publisher]

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Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

Int J Audiol. 2016 Jun 22;:1-10

Authors: Båsjö S, Möller C, Widén S, Jutengren G, Kähäri K

Abstract
OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children.
DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis.
STUDY SAMPLE: A total of 415 children aged nine years.
RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones.
CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

PMID: 27329351 [PubMed - as supplied by publisher]

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Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes.

Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes.

Int J Audiol. 2016 Jun 22;:1-6

Authors: Kim CH, Shin JE, Yang YS, Im D

Abstract
OBJECTIVES: To investigate the initial findings of positional nystagmus in patients with sudden sensorineural hearing loss (SSNHL) and positional vertigo, and to compare hearing improvement among patients with different types of positional nystagmus.
DESIGN: The characteristics of positional nystagmus upon initial examination were analysed, and the initial mean pure-tone audiometry (PTA) threshold was compared with that at three months after treatment.
STUDY SAMPLE: Forty-four SSNHL patients with concomitant positional vertigo were included.
RESULTS: Positional nystagmus was classified into five subgroups; persistent geotropic direction-changing positional nystagmus (DCPN) in head-roll test (HRT) and negative Dix-Hallpike test (DHT), persistent apogeotropic DCPN in HRT and negative DHT, positive DHT and negative HRT, persistent geotropic DCPN in HRT and positive DHT, and persistent apogeotropic DCPN in HRT and positive DHT. PTA threshold improvement was significantly greater in SSNHL patients with negative DHT than with positive DHT (p = 0.027).
CONCLUSIONS: When geotropic DCPN was elicited by HRT, the nystagmus was persistent, which suggests that alteration of specific gravity of the endolymph, rather than the lateral canal canalolithiasis, may be a cause of this characteristic positional nystagmus. Positive DTH may be a prognostic factor for worse hearing recovery among patients with SSNHL and positional vertigo.

PMID: 27329283 [PubMed - as supplied by publisher]

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Results using the OPAL strategy in Mandarin speaking cochlear implant recipients.

Results using the OPAL strategy in Mandarin speaking cochlear implant recipients.

Int J Audiol. 2016 Jun 22;:1-12

Authors: Vandali AE, Dawson PW, Arora K

Abstract
OBJECTIVE: To evaluate the effectiveness of an experimental pitch-coding strategy for improving recognition of Mandarin lexical tone in cochlear implant (CI) recipients.
DESIGN: Adult CI recipients were tested on recognition of Mandarin tones in quiet and speech-shaped noise at a signal-to-noise ratio of +10 dB; Mandarin sentence speech-reception threshold (SRT) in speech-shaped noise; and pitch discrimination of synthetic complex-harmonic tones in quiet. Two versions of the experimental strategy were examined: (OPAL) linear (1:1) mapping of fundamental frequency (F0) to the coded modulation rate; and (OPAL+) transposed mapping of high F0s to a lower coded rate. Outcomes were compared to results using the clinical ACE™ strategy.
STUDY SAMPLE: Five Mandarin speaking users of Nucleus® cochlear implants.
RESULTS: A small but significant benefit in recognition of lexical tones was observed using OPAL compared to ACE in noise, but not in quiet, and not for OPAL+ compared to ACE or OPAL in quiet or noise. Sentence SRTs were significantly better using OPAL+ and comparable using OPAL to those using ACE. No differences in pitch discrimination thresholds were observed across strategies.
CONCLUSIONS: OPAL can provide benefits to Mandarin lexical tone recognition in moderately noisy conditions and preserve perception of Mandarin sentences in challenging noise conditions.

PMID: 27329178 [PubMed - as supplied by publisher]

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The results of Kaplan-Meier and multivariate analyses of etiological factors related to the outcome of combined pharmacological therapy against laryngeal granuloma.

The results of Kaplan-Meier and multivariate analyses of etiological factors related to the outcome of combined pharmacological therapy against laryngeal granuloma.

Acta Otolaryngol. 2016 Jun 22;:1-6

Authors: Ogawa M, Hosokawa K, Iwahashi T, Inohara H

Abstract
CONCLUSIONS: The present results indicate that the diagnosis of gastroesophageal reflux disease (GERD) is an independent etiological factor predicting retardation of the resolution of laryngeal granuloma.
OBJECTIVES: To assess the effects of combined usage of an inhaled corticosteroid plus tranilast and/or a proton pump inhibitor on the size of granulomatous lesions, and to reveal etiological factors related to the outcome using the Kaplan-Meier method and a subsequent multivariate analysis.
METHODS: Sixty-two patients with laryngeal granuloma were enrolled. An inhaled corticosteroid plus tranilast (300 mg/day) and rabeprazole (20 mg/day) were administered to all of the patients, and only to those diagnosed to have GERD, respectively. The size of granulomatous lesion was measured for each patient at the initial visit and every 4 weeks. At 48 weeks, the Kaplan-Meier plots for lesion disappearance rate were compared between groups with and without each of the etiological factors, followed by Cox proportional-hazards regression.
RESULTS: The 48-week lesion disappearance rates for the whole population were 82.3%. Although the Kaplan-Meier analysis exhibited significant differences between patients separated by GERD diagnosis, phonotrauma, and habitual smoking, only GERD were identified as a real independent etiological factor affecting the resolution of the lesion by a multivariate analysis using Cox's proportional-hazards regression.

PMID: 27328639 [PubMed - as supplied by publisher]

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ACR Appropriateness Criteria(®) Locoregional therapy for resectable oropharyngeal squamous cell carcinomas.

ACR Appropriateness Criteria(®) Locoregional therapy for resectable oropharyngeal squamous cell carcinomas.

Head Neck. 2016 Jun 22;

Authors: Beitler JJ, Quon H, Jones CU, Salama JK, Busse PM, Cooper JS, Koyfman SA, Ridge JA, Saba NF, Siddiqui F, Smith RV, Worden F, Yao M, Yom SS, Expert Panel on Radiation Oncology - Head and Neck

Abstract
BACKGROUND: There are no level I studies to guide treatment for resectable oropharyngeal squamous cell carcinoma (SCC). Treatment toxicities influence management recommendations. Ongoing investigations are examining deintensified treatments for human papillomavirus (HPV)-associated oropharyngeal SCC.
METHODS: The Appropriateness Criteria panel, using modified Delphi methodology, produced a literature summary, an assessment of treatment recommendations, and cases to illustrate their use.
RESULTS: A multidisciplinary team produces optimum results. Based on HPV status, smoking history, and staging, patients are divided into groups at low, intermediate, and high-risk of death. In the future, treatment recommendations may be influenced by HPV status, which has changed the epidemiology of oropharyngeal SCC.
CONCLUSION: T1 to T2N0M0 resectable oropharyngeal SCC can be treated with surgery or radiation without chemotherapy. Patients with T1-2N1-2aM0 disease can receive radiation, chemoradiation, or transoral surgery with neck dissection and appropriate adjuvant therapy. Patients with T1-2N2b-3M0 disease should receive chemoradiation or transoral surgery with neck dissection and appropriate adjuvant therapy. Concurrent chemoradiation is preferred for T3 to T4 disease. © 2016 American College of Radiology. Head Neck, 2016.

PMID: 27330003 [PubMed - as supplied by publisher]

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Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report.

Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report.

J Neurol Surg Rep. 2016 Jun;77(2):e89-93

Authors: White-Dzuro GA, Entezami P, Wanna G, Russell P, Chambless LB

Abstract
Introduction Traumatic cerebrospinal fluid (CSF) fistulae can be a challenging neurosurgical disease, often requiring complicated surgical intervention. Case Presentation A 54-year-old man presented with a gunshot wound to the head with complex injury to the skull base and significant CSF leakage from multiple sites. A single surgery was performed using a combined Neurosurgery, Neurotology, and Rhinology team, which was successful in repairing the multiple skull base defects and preventing further CSF leak. Discussion Trauma to the skull base is a common inciting factor for the development of CSF fistulae. Endoscopic approaches are often preferred for repairing these defects, but craniotomy remains a viable option that may be required in more complex cases. A combined approach has not been described previously, but was successful for this severe multifocal defect. Conclusion A multidisciplinary approach allowed for a combined intervention that addressed both the anterior and middle fossae fistulae simultaneously. This limited the potential infectious complications of continued CSF leak and allowed for early rehabilitation.

PMID: 27330926 [PubMed]

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Endoscopic Removal of a Bullet in Rosenmuller Fossa: Case Report.

Endoscopic Removal of a Bullet in Rosenmuller Fossa: Case Report.

J Neurol Surg Rep. 2016 Jun;77(2):e83-5

Authors: Burks JD, Glenn CA, Conner AK, Bonney PA, Sanclement JA, Sughrue ME

Abstract
Fractures of the anterior skull base may occur in gunshot victims and can result in traumatic cerebrospinal fluid (CSF) leak. Less commonly, CSF leaks occur days or even weeks after the trauma occurred. Here, we present the case of a 21-year-old man with a delayed-onset, traumatic CSF leak secondary to a missile injury that left a bullet fragment in the Rosenmuller fossa. The patient was treated successfully with endoscopic, endonasal extraction of the bullet, and repair with a nasal septal flap. Foreign bodies lodged in Rosenmuller fossa can be successfully treated with endoscopic skull base surgery.

PMID: 27330924 [PubMed]

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Preventing and Managing Complications in Frontal Sinus Surgery.

Preventing and Managing Complications in Frontal Sinus Surgery.

Otolaryngol Clin North Am. 2016 Jun 18;

Authors: Eloy JA, Svider PF, Setzen M

Abstract
This review covers potential complications of frontal sinus surgical management and strategies for prevention of these complications. Accordingly, recent advances in frontal sinus surgical techniques are described, and the management of complications stemming both from these and traditional techniques are detailed.

PMID: 27329982 [PubMed - as supplied by publisher]

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Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes.

Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes.

Int J Audiol. 2016 Jun 22;:1-6

Authors: Kim CH, Shin JE, Yang YS, Im D

Abstract
OBJECTIVES: To investigate the initial findings of positional nystagmus in patients with sudden sensorineural hearing loss (SSNHL) and positional vertigo, and to compare hearing improvement among patients with different types of positional nystagmus.
DESIGN: The characteristics of positional nystagmus upon initial examination were analysed, and the initial mean pure-tone audiometry (PTA) threshold was compared with that at three months after treatment.
STUDY SAMPLE: Forty-four SSNHL patients with concomitant positional vertigo were included.
RESULTS: Positional nystagmus was classified into five subgroups; persistent geotropic direction-changing positional nystagmus (DCPN) in head-roll test (HRT) and negative Dix-Hallpike test (DHT), persistent apogeotropic DCPN in HRT and negative DHT, positive DHT and negative HRT, persistent geotropic DCPN in HRT and positive DHT, and persistent apogeotropic DCPN in HRT and positive DHT. PTA threshold improvement was significantly greater in SSNHL patients with negative DHT than with positive DHT (p = 0.027).
CONCLUSIONS: When geotropic DCPN was elicited by HRT, the nystagmus was persistent, which suggests that alteration of specific gravity of the endolymph, rather than the lateral canal canalolithiasis, may be a cause of this characteristic positional nystagmus. Positive DTH may be a prognostic factor for worse hearing recovery among patients with SSNHL and positional vertigo.

PMID: 27329283 [PubMed - as supplied by publisher]

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Achalasia: From Bench to Peroral Endoscopic Myotomy.

Achalasia: From Bench to Peroral Endoscopic Myotomy.

Dig Dis. 2016 Jun 22;34(5):476-482

Authors: Boeckxstaens GE

Abstract
Achalasia is a primary esophageal motility disorder with an estimated annual incidence of 1 per 100,000 persons. It is characterized by the absence of esophageal peristalsis and failure of the lower esophageal sphincter (LES) to relax upon swallowing, resulting in progressively severe dysphagia for solids and liquids, regurgitation, aspiration, chest pain and weight loss. Achalasia results from a loss of enteric neurons, most likely due to an autoimmune reaction in patients with a particular immunogenetic background. To date, 3 manometric subtypes have been identified based on high resolution manometry. To what extent these subtypes also indicate differences in underlying pathophysiological mechanisms is however unclear. As achalasia cannot be cured, treatment is confined to disruption of the LES to improve bolus passage and thereby relieving symptoms. The 2 most commonly used treatment modalities available for this purpose include pneumodilation and laparoscopic Heller myotomy. Both treatments have been shown repeatedly to be successful; however, success rates decline in time, most likely due to progression of the disease. A recent European randomized trial provides objective data indicating that both treatments are equally effective. In view of these data and the low incidence of the disease, the choice between these 2 treatments should be based on the expertise and experience available. Recently, excellent short-term success rates have been reported with a new endoscopic technique, that is, peroral endoscopic myotomy. However, longer follow-up data are absolutely needed before accepting this technique as a new treatment option for achalasia in clinical practice.

PMID: 27331393 [PubMed - as supplied by publisher]

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Skull Base; +26 new citations

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

Skull Base

These pubmed results were generated on 2016/06/23

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Gender-specific risk factors in post-tonsillectomy hemorrhage.

Gender-specific risk factors in post-tonsillectomy hemorrhage.

Eur Arch Otorhinolaryngol. 2016 Jun 21;

Authors: Coordes A, Soudry J, Hofmann VM, Lenarz M

Abstract
There are gender-specific differences in the frequency and course of different diseases. Specifically, some studies have shown an increased risk of post-tonsillectomy hemorrhage (PTH). The aim of the study was to investigate gender-specific risk factors for hemorrhage after tonsillectomy (TE)/abscess-TE. We anonymously reviewed and recorded the relevant data of all patients (≥14 years) who underwent a TE/abscess-TE between 2011 and 2013 in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin. A patient survey was used to complete missing data. We analyzed gender-specific risk factors for PTH. During the study period, 460 operations were performed and the data of 250 patients were analyzed (213 TE and 37 abscess-TE). The median patient age was 27 years (ranging from 14 to 83 years). The rate of primary PTH (<24 h after TE/abscess-TE) was 3 %, and the rate of secondary PTH (>24 h) was 23 %. A significantly higher PTH rate was associated with males (p = 0.037), which was still apparent in ages 21-30 after sub-classification. Multivariate analysis calculated diagnosis, regular alcohol consumption and administration of glucocorticoids to be independent risk factors associated with gender. In conclusion, the PTH rate is gender-specific, and male patients are at higher risk, especially in young adulthood. Therefore, doctors should advise male patients of the increased risk of bleeding and stress the importance of compliance. Also, close postoperative follow-up is desirable.

PMID: 27328963 [PubMed - as supplied by publisher]

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Video head impulse test: a review of the literature.

Video head impulse test: a review of the literature.

Eur Arch Otorhinolaryngol. 2016 Jun 21;

Authors: Alhabib SF, Saliba I

Abstract
Video head impulse test (vHIT) is a new testing which able to identify the overt and covert saccades and study the gain of vestibulo-ocular reflex (VOR) of each semicircular canal. The aim of this study is to review the clinical use of vHIT in patients with vestibular disorders in different diseases. PubMed and Cochrane databases were searched for all articles that defined vHIT, compared vHIT with another clinical test, and studied the efficacy of vHIT as diagnostic tools with vestibular disease. 37 articles about vHIT were reviewed. All articles studied the vHIT in English and French languages up to May 2015 were included in the review. Editorial articles or short comments, conference abstracts, animal studies, and language restriction were excluded from the review. Four systems were used in the literature to do the vHIT. vHIT is physiological quick test, which studied the VOR at high frequency of each semicircular canal by calculating the duration ratio between the head impulse and gaze deviation. vHIT is more sensitive than clinical head impulse test (cHIT), especially in patient with isolated covert saccades. vHIT test is diagnostic of vestibular weakness by gain reduction and the appearance of overt and covert saccades. If the vHIT is normal, then caloric test is mandatory to rule out a peripheral origin of vertigo. It is recommended to test each semicircular canal, as isolated vertical canal weakness was identified in the literature. More investigation would be required to determine the evolution of the VOR gain with the progression of the vestibular disease.

PMID: 27328962 [PubMed - as supplied by publisher]

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Expression of the CXCL12/CXCR4 chemokine axis predicts regional control in head and neck squamous cell carcinoma.

Expression of the CXCL12/CXCR4 chemokine axis predicts regional control in head and neck squamous cell carcinoma.

Eur Arch Otorhinolaryngol. 2016 Jun 21;

Authors: León X, Diez S, García J, Lop J, Sumarroca A, Quer M, Camacho M

Abstract
Expression of the CXCL12/CXCR4 chemokine axis has been related with the appearance of metastatic recurrence survival, including regional and distant recurrence, in patients with head and neck squamous cell carcinoma (HNSCC). RT-PCR was used to determine mRNA expression levels of CXCL12 and CXCR4 in biopsy tumor samples in 111 patients with HNSCC. Five-year regional recurrence-free survival for patients with low CXCR4 expression (n = 39, 31.5 %) was 97.4 %, for patients with high CXCR4/high CXCL12 expression (n = 22, 19.8 %) it was 94.7 %, and for patients with high CXCR4/low CXCL12 expression (n = 50, 45.0 %) it was 63.3 %. We found significant differences in the regional recurrence-free survival according to CXCR4/CXCL12 expression values (P = 0.001). HNSCC patients with high CXCR4 and low CXCL12 expression values had a significantly higher risk of regional recurrence and could benefit from a more intense treatment of lymph node areas in the neck.

PMID: 27328961 [PubMed - as supplied by publisher]

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High relative density of lymphatic vessels predicts poor survival in tongue squamous cell carcinoma.

High relative density of lymphatic vessels predicts poor survival in tongue squamous cell carcinoma.

Eur Arch Otorhinolaryngol. 2016 Jun 21;

Authors: Seppälä M, Pohjola K, Laranne J, Rautiainen M, Huhtala H, Renkonen R, Lemström K, Paavonen T, Toppila-Salmi S

Abstract
Tongue cancer has a poor prognosis due to its early metastasis via lymphatic vessels. The present study aimed at evaluating lymphatic vessel density, relative density of lymphatic vessel, and diameter of lymphatic vessels and its predictive role in tongue cancer. Paraffin-embedded tongue and lymph node specimens (n = 113) were stained immunohistochemically with a polyclonal antibody von Willebrand factor, recognizing blood and lymphatic endothelium and with a monoclonal antibody podoplanin, recognizing lymphatic endothelium. The relative density of lymphatic vessels was counted by dividing the mean number of lymphatic vessels per microscopic field (podoplanin) by the mean number of all vessels (vWf) per microscopic field. The high relative density of lymphatic vessels (≥80 %) was associated with poor prognosis in tongue cancer. The relative density of lymphatic vessels predicted poor prognosis in the group of primary tumor size T1-T2 and in the group of non-metastatic cancer. The lymphatic vessel density and diameter of lymphatic vessels were not associated with tongue cancer survival. The relative density of lymphatic vessels might have clinically relevant prognostic impact. Further studies with increased number of patients are needed.

PMID: 27328960 [PubMed - as supplied by publisher]

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Monophasic synovial sarcoma of posterior pharyngeal wall: a rare case report with unique reconstruction using lateral trapezius flap.

Monophasic synovial sarcoma of posterior pharyngeal wall: a rare case report with unique reconstruction using lateral trapezius flap.

Eur Arch Otorhinolaryngol. 2016 Jun 21;

Authors: Agarwal M, Singh A, Abrari A, Singh N

Abstract
Synovial sarcoma is a rare entity to be encountered in the head and neck region and is always a challenge in terms of diagnosis, treatment planning and reconstruction of the surgical defect. In our case, we faced a similar challenge for diagnosis and also have ventured for lateral trapezius flap as a new reconstructive option for such bulky tumour defects. We hereby present a 25-year old male patient with monophasic synovial sarcoma of posterior pharyngeal wall. The radiological and clinicopathological features along with various diagnostic tests and treatment options are discussed.

PMID: 27328959 [PubMed - as supplied by publisher]

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Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Russell JO, Yan K, Burkey B, Scharpf J

Abstract
OBJECTIVE: Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary care hospital.
SUBJECTS AND METHODS: We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available.
RESULTS: Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01).
CONCLUSIONS: Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates.

PMID: 27329421 [PubMed - as supplied by publisher]

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Laryngeal leishmaniasis in a patient taking inhaled corticosteroids.

Laryngeal leishmaniasis in a patient taking inhaled corticosteroids.

BMJ Case Rep. 2016;2016

Authors: Roberts RM, Mukherjee J, Phillips D

Abstract
We present a case of a man in his late 60s, who had spent 3-4 months of the year in rural Spain, presenting with intermittent hoarseness of voice. He had a background of asthma and bronchiectasis, and was taking inhaled corticosteroids. His dysphonia was initially managed as bronchiectasis with little improvement. Bronchoscopy revealed a cystic lesion on his left vocal fold, and tissue biopsy revealed Leishmania amastigotes. This confirmed a diagnosis of laryngeal leishmaniasis. We propose that this is likely secondary to his inhaled corticosteroid therapy. The infection was treated with a 30-day course of miltefosine, and at most recent follow-up the patient was deemed free from leishmanial infection.

PMID: 27329097 [PubMed - in process]

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Quality Indicators for Head and Neck Oncologic Surgery: Academic versus Nonacademic Outcomes.

Quality Indicators for Head and Neck Oncologic Surgery: Academic versus Nonacademic Outcomes.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Puram SV, Bhattacharyya N

Abstract
OBJECTIVES: to determine national benchmarks for established quality indicators in head and neck cancer (HNCA) surgery, focusing on differences between academic and nonacademic institutions.
STUDY DESIGN: Cross-sectional analysis of national database.
SUBJECTS AND METHODS: HNCA surgery admissions from the 2009-2011 Nationwide Inpatient Sample were analyzed for preoperative characteristics and postoperative outcomes. Multivariate analyses were used to identify factors influencing quality indicators after HNCA surgery. Quality metrics-including length of stay (LOS), inpatient death, return to the operating room (OR), wound infection, and transfusion-were compared for academic versus nonacademic institutions.
RESULTS: A total of 38,379 HNCA surgery inpatient admissions (mean age, 56.5 years; 52.4% male) were analyzed (28,288 teaching vs 10,091 nonteaching). Nationally representative quality metrics for HNCA surgery were as follows: mean LOS, 4.26 ± 0.12 days; return to OR, 3.3% ± 0.2%; inpatient mortality, 0.7% ± 0.1%; wound infection rate, 0.9% ± 0.1%; wound complication rate, 4.3% ± 0.2%; and transfusion rate, 4.3% ± 0.3%. HNCA surgery patients at teaching hospitals had a greater proportion of males, radiation history, and high-acuity procedures and greater comorbidity scores (all P < .001). Multivariate analyses adjusting for age, sex, income, payer, prior radiation, comorbidity scores, and procedural acuity demonstrated that teaching hospitals had a slightly increased LOS (+0.30 days; P = .009) and odds ratio for wound infection (1.54; 95% CI: 1.22-1.94) versus nonteaching hospitals. There were no significant differences in return to OR (P = .271), inpatient mortality (P = .686), or transfusion rate (P = .960).
CONCLUSION: Despite caring for substantially more complex HNCA surgery patients with greater comorbidities, teaching hospitals demonstrate only a marginally increased LOS and wound complication rate versus nonteaching hospitals, while other established quality metrics are similar.

PMID: 27329425 [PubMed - as supplied by publisher]

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Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends.

Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Hoang JK, Williams K, Gaillard F, Dixon A, Sosa JA

Abstract
Four-dimensional computed tomography (4D-CT) is a new modality for preoperative localization of parathyroid adenomas. We performed a survey study to describe the role and trends in the utilization of 4D-CT. Of 361 radiologists, 200 (55%) reported that 4D-CT was used in their practices. Nineteen (10%) used 4D-CT as the first-line imaging study; 155 (76%) reported that 4D-CT played a secondary role; and 26 (13%) reported that it is performed routinely in combination with ultrasound and scintigraphy. Early adopters of 4D-CT (use for >3 years) were 3 times more likely to use 4D-CT in a first-line role (18%) when compared with radiologists who used 4D-CT for ≤3 years (6%; P < .05). In conclusion, more than half of radiologists perform 4D-CT, and a majority reported that 4D-CT plays a secondary role. However, this role may change, as utilization is increasing and radiologists may follow early adopters, who are more likely to use it as a first-line study.

PMID: 27329424 [PubMed - as supplied by publisher]

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Clinical Practice Guidelines: Whose Practice Are We Guiding?

Clinical Practice Guidelines: Whose Practice Are We Guiding?

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Harvey M, Bowe SN, Laury AM

Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has just released an update to the clinical practice guideline (CPG) on otitis media with effusion. This common condition is frequently managed by primary care providers; however, their awareness and utilization of the AAO-HNSF CPGs are unknown. We performed a cross-sectional survey to assess familiarity with otologic diagnoses, evaluation skills, and guidelines. Only 38.5% of respondents use pneumatic otoscopy, and roughly 50% utilize a CPG for management of otitis media or for referral for tympanostomy tube insertion. Providers predominantly use the acute otitis media guideline from the American Academy of Pediatrics. In this single-institution study, providers are largely unaware of the AAO-HNSF CPGs and could benefit from additional training, including workshops taught by otolaryngologists within individual health care systems or development of a national otolaryngology medical student curriculum. A more immediate option includes referencing our CPGs on specialty societies' websites or newsletters.

PMID: 27329423 [PubMed - as supplied by publisher]

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ACS NSQIP Risk Calculator: An Accurate Predictor of Complications in Major Head and Neck Surgery?

ACS NSQIP Risk Calculator: An Accurate Predictor of Complications in Major Head and Neck Surgery?

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Prasad KG, Nelson BG, Deig CR, Schneider AL, Moore MG

Abstract
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator is meant to provide an estimation of perioperative risk. Our goal was to determine the clinical applicability of the calculator in major head and neck surgery. A retrospective chart review was completed for major head and neck operations performed at 1 institution from 2013 to 2014. The calculated perioperative complication risks from the ACS NSQIP calculator were compared with observed complication rates. Overall, the ACS NSQIP calculator had little predictive value for pneumonia, surgical site infection, 30-day return to operating room, or length of stay within this cohort (P > .05). The calculator appears to have some value predicting total numbers of complications but has poor performance predicting an individual's risk of suffering a perioperative complication. In conclusion, in our small cohort of patients, the ACS NSQIP calculator was a poor predictor of perioperative complications following major head and neck operations.

PMID: 27329422 [PubMed - as supplied by publisher]

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Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Russell JO, Yan K, Burkey B, Scharpf J

Abstract
OBJECTIVE: Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary care hospital.
SUBJECTS AND METHODS: We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available.
RESULTS: Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01).
CONCLUSIONS: Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates.

PMID: 27329421 [PubMed - as supplied by publisher]

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Use of Lean and CAHPS Surgical Care Survey to Improve Patients' Experiences with Surgical Care.

Use of Lean and CAHPS Surgical Care Survey to Improve Patients' Experiences with Surgical Care.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Jiang N, Malkin BD

Abstract
OBJECTIVES: (1) Measure patients' experiences with surgical care using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surgical Care Survey. (2) Use lean thinking to analyze and improve quality of patient care.
STUDY DESIGN: A prospective quality improvement study.
SETTING: Hospital-based otolaryngology clinic.
SUBJECTS AND METHODS: The CAHPS Surgical Care Survey was distributed to 17 surgical patients to determine their perception of the current state of care. Survey results were analyzed with lean thinking, and changes were made to improve critical areas. A second set of surveys was distributed to 10 patients to assess the success of the interventions immediately and 2 months later. The data were analyzed with the Mann-Whitney U test.
RESULTS: Seventeen patients completed the CAHPS Surgical Care Survey to determine the initial state. A3 Thinking was used to analyze the results and design an improvement. Overall positive patient experience was 57% at the postoperative visit with 3 key aspects of care: time spent during visit, encouragement to ask questions, show of respect to the patient. Two causes were postulated; then, solution approaches were developed and tested in a series of rapid experiments. Two groups of 10 patients completed the CAHPS Surgical Care Survey to determine the postintervention state. Overall positive patient experience significantly improved to 93% (U = 474, P < .001) and 83% (U = 546, P = .009) immediately and 2 months later, respectively.
CONCLUSION: Lean thinking helps to eliminate defects by breaking down complex problem solving into a scientific process. When combined with the CAHPS Surgical Care Survey, it can be successfully used to improve patients' surgical experiences.

PMID: 27329420 [PubMed - as supplied by publisher]

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Decisional Conflict and Regret in Parents Whose Children Undergo Tonsillectomy.

Decisional Conflict and Regret in Parents Whose Children Undergo Tonsillectomy.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Carr MM, Derr JB, Karikari K

Abstract
OBJECTIVE: To determine if decisional regret (DR) in parents following tonsillectomy/adenotonsillectomy (TA) in their children is related to preoperative decisional conflict, perceived outcome of surgery, complications of surgery, or other factors.
STUDY DESIGN: Observational analytic cohort study.
SETTING: Tertiary care children's hospital.
SUBJECTS AND METHODS: Preoperative decisional conflict (DC) and SURE tests were administered to a parent of a child scheduled for TA between July 2014 and July 2015. The DR tests were given 1 to 3 months postoperatively. Data were collected on patient age, sex, perceived outcome of surgery, complications (including bleeding), emergency room visits, and clinic phone calls.
RESULTS: A total of 102 families were studied, including 48 female and 54 male patients with an average age of 6.29 years. Parental respondents included 83 mothers, 14 fathers, and 5 grandmothers. Overall, DC and DR were both low in this group, with a median of 0 for each (means: 7.74 for DC and 8.78 for DR). DC was higher in parents who canceled surgery or failed to keep follow-up appointments (27.19) versus parents who brought their children for surgery (6.78; P < .05). DR was significantly higher in parents with DC (20.00 vs 7.59; P < .05). It was not related to age of the patient, sex, parental perception of resolution of preoperative complaints, complications (including bleeding or dehydration), emergency department visits, or parental phone calls to the otolaryngology clinic. SURE tests indicated that every parent was confident of his or her decision on the day of surgery.
CONCLUSION: Preoperative DC is likely the most important factor in determining parental DR after the child undergoes TA.

PMID: 27329419 [PubMed - as supplied by publisher]

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Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis.

Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Abdurehim Y, Lehmann A, Zeitouni AG

Abstract
OBJECTIVES: To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis.
DATA SOURCES: PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015.
METHODS: Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval.
RESULTS: Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22).
CONCLUSIONS: Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.

PMID: 27329418 [PubMed - as supplied by publisher]

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Near-Infrared Optical Imaging for Diagnosis of Maxillary Sinusitis.

Near-Infrared Optical Imaging for Diagnosis of Maxillary Sinusitis.

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Coughlan CA, Cerussi AE, Kim J, Ison S, Bhandarkar ND

Abstract
Computed tomography (CT) is the current gold standard imaging for chronic rhinosinusitis (CRS) but is limited by cost, risk of radiation, and difficulty of being performed in the typical outpatient primary care setting. We describe the novel use of a low-cost, handheld technology to deliver an intraoral near-infrared (NIR) wavelength light to optically image the maxillary sinuses. Digital images were collected for subjects presenting with sinus disease using an intraoral NIR light source for transillumination of the maxillary sinuses, captured by a modified digital single-lens reflex camera. Light intensity contrasts were enhanced using computer analysis and subsequently compared to CT findings. NIR illumination produced unique patterns reflecting different disease states: normal sinus anatomy, mild sinus disease and/or mucosal thickening, and complete opacification of the sinus. Current results suggest that NIR imaging may facilitate the diagnosis of sinusitis in the outpatient setting with minimal cost and no radiation exposure.

PMID: 27329417 [PubMed - as supplied by publisher]

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Are Online Zenker's Diverticulum Materials Readable and Understandable?

Are Online Zenker's Diverticulum Materials Readable and Understandable?

Otolaryngol Head Neck Surg. 2016 Jun 21;

Authors: Balakrishnan V, Chandy Z, Verma SP

Abstract
OBJECTIVE: Patients use a multitude of resources to learn about Zenker's diverticulum (ZD). The objectives of this study were to assess the readability and understandability of online materials on ZD, evaluate them against the existing criteria, and investigate the relationship between readability and understandability.
METHODS: The first 50 webpages from an online search for ZD were analyzed. Twenty-one webpages had materials intended for patients and were included in the study. The patient education materials (PEMs) were analyzed using 6 readability tools. Four individuals used the Patient Education Materials Evaluation Tool (PEMAT) to assess the understandability. Fleiss κ interrater reliability analysis determined consistency among the raters. Finally, Pearson correlation coefficient analyzed the relationship between readability and understandability.
RESULTS: The reading grade level of the materials reviewed ranged from 10th to 16th grade while the understandability ranged from 31% to 74%. Correlation analysis demonstrated a strong negative correlation between readability and understandability (r = -0.62, P < .05). Fleiss' κ interrater reliability for the raters demonstrated substantial agreement between the 4 raters (κ = 0.64).
CONCLUSION: Online PEMs pertaining to ZD are written well above the recommended reading level. Materials written at a lower reading level are more understandable. A wide range of understandability exists among materials with identical reading grade levels.
IMPLICATIONS FOR PRACTICE: Health care providers need to create new PEMs for ZD that are available online that are both readable and understandable. The PEMAT and readability formulas can provide a framework for authors to create these materials.

PMID: 27329416 [PubMed - as supplied by publisher]

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Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

Int J Audiol. 2016 Jun 22;:1-10

Authors: Båsjö S, Möller C, Widén S, Jutengren G, Kähäri K

Abstract
OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children.
DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis.
STUDY SAMPLE: A total of 415 children aged nine years.
RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones.
CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

PMID: 27329351 [PubMed - as supplied by publisher]

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