Multimodality assessment of upper airway obstruction in children with persistent obstructive sleep apnea after adenotonsillectomy.

Multimodality assessment of upper airway obstruction in children with persistent obstructive sleep apnea after adenotonsillectomy.

Laryngoscope. 2016 Jul 14;

Authors: Clark C, Ulualp SO

Abstract
OBJECTIVES/HYPOTHESIS: Children with obstructive sleep apnea (OSA) may have multiple sites of upper airway obstruction (UAO). A wide variety of techniques has been used to evaluate UAO. Our aim was to compare findings of cine magnetic resonance imaging (MRI) and drug-induced sleep endoscopy (DISE) in identifying UAO sites in children with persistent OSA after adenotonsillectomy (AT).
STUDY DESIGN: Retrospective chart review.
MATERIAL AND METHODS: The medical records of children who underwent DISE and cine MRI were reviewed. Data pertaining to demographics, past medical history, body mass index, polysomnography, findings of DISE, and cine MRI were obtained.
RESULTS: Fifteen children (11 boys, 4 girls; age range, 7-18 years) were identified. Comorbid conditions were Down syndrome in nine patients, cerebral palsy in one, attention deficit hyperactivity disorder in two, and asthma in three. Severity of OSA was moderate in five, and severe in 10. DISE and cine MRI showed the same UAO site in 10 patients: a single site (tongue) in nine and multiple sites (tongue and oropharynx/lateral walls) in one. DISE showed additional UAO sites undetected by cine MRI in three patients. Cine MRI showed additional UAO sites undetected by DISE in one patient. DISE and cine MRI showed different sites of obstruction in one patient.
CONCLUSIONS: Cine MRI and DISE documented single and multiple sites of UAO in children with persistent OSA after AT. Cine MRI and DISE findings were similar in the majority of the children. Assessment of the sensitivity and specificity of cine MRI and DISE in detecting sites of UAO merits further investigation.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 27411973 [PubMed - as supplied by publisher]

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Incidence of Oropharyngeal Cancer Among Elderly Patients in the United States.

Incidence of Oropharyngeal Cancer Among Elderly Patients in the United States.

JAMA Oncol. 2016 Jul 14;

Authors: Zumsteg ZS, Cook-Wiens G, Yoshida E, Shiao SL, Lee NY, Mita A, Jeon C, Goodman MT, Ho AS

Abstract
Importance: An escalating incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) has been reported predominantly among middle-aged adults. However, HPV infection is believed to occur many years before cancer develops, and tissue studies suggest that HPV DNA is found in the majority of OPSCC diagnosed in patients 65 years or older.
Objective: To update the trends in OPSCC incidence using US cancer registry data, with an emphasis on age-specific trends.
Design, Setting, and Participants: Data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2012) were queried to compare changes in incidence and survival trends in OPSCC with selected tobacco-related cancers (larynx, oral cavity, hypopharynx, lung) and an HPV-related cancer (anus). A total of 40 264 patients who received a diagnosis of OPSCC from 2000 to 2012 were included. Elderly patients were defined as those 65 years or older.
Main Outcomes and Measures: The annual percentage change in OPSCC incidence from 2000 to 2012, stratified according to age group.
Results: Among the 40 264 patients who received a diagnosis of OPSCC from 2000 to 2012, 13 313 (33.1%) were aged 65 years or older and 80.3% were male. Significant increases in the age-adjusted incidence of OPSCC were observed during the study period for both younger adults aged 45 to 64 years (annual percentage change [APC], 2.31; 95% CI, 1.76-2.86; P < .001) and patients 65 years or older (APC, 2.92; 95% CI, 2.32-3.51; P < .001). These changes were driven predominantly by base-of-tongue and tonsil cancers in men. Concomitantly, the incidence of tobacco-associated head and neck cancers decreased for elderly patients (larynx: APC, -1.54; 95% CI, -2.00 to -1.08; P < .001; oral cavity: APC, -1.23; 95% CI, -1.84 to -0.62; P = .001; hypopharynx: APC, -2.44; 95% CI, -3.01 to -1.86; P < .001), whereas the incidence of anal cancer significantly increased (APC, 4.42; 95% CI, 3.28 to 5.57; P < .001). Furthermore, improved overall and cause-specific survival over time were observed for both younger and elderly patients with OPSCC. Nevertheless, absolute cause-specific survival remained worse for elderly patients (3-year CSS, 60.8%; 95% CI, 59.6%-61.9%) in comparison with those aged 45 to 64 years (75.7%; 95% CI, 75.1%-76.4%; P < .001).
Conclusions and Relevance: The incidence of OPSCC is increasing among elderly patients in the United States, likely driven by HPV-associated cancers. Given the unique challenges related to treating elderly patients with OPSCC, their limited enrollment in clinical trials, and the aging US population, clinical studies investigating improved therapeutic strategies for elderly patients with HPV-positive OPSCC should be performed.

PMID: 27415639 [PubMed - as supplied by publisher]

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Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2.

Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):212-7

Authors: Chiesa Estomba CM, Reinoso FA, Velasquez AO, Fernandez JL, Conde JL, Hidalgo CS

Abstract
INTRODUCTION: Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected.
OBJECTIVE: The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM.
METHODS: Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate.
RESULTS: The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 ± 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%.
CONCLUSION: TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation.

PMID: 27413401 [PubMed]

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Bitot's Spots in Gastric Bypass Patient.

Related Articles

Bitot's Spots in Gastric Bypass Patient.

Ophthalmology. 2016 Mar;123(3):521

Authors: Surapaneni KR, Koreishi A, Phelps PO

PMID: 26902561 [PubMed - indexed for MEDLINE]

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Does Intubation Improve Outcomes Over Supraglottic Airways in Adult Out-of-Hospital Cardiac Arrest?

Related Articles

Does Intubation Improve Outcomes Over Supraglottic Airways in Adult Out-of-Hospital Cardiac Arrest?

Ann Emerg Med. 2016 Mar;67(3):396-8

Authors: Carlson JN, Wang HE

PMID: 26475247 [PubMed - indexed for MEDLINE]

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In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness.

Related Articles

In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness.

Head Neck. 2015 Oct;37(10):1483-7

Authors: Castillo Farías F, Cobeta I, Souviron R, Barberá R, Mora E, Benito A, Royuela A

Abstract
BACKGROUND: In-office biopsy is an effective technique to diagnose the nature of pharyngolaryngeal lesions.
METHODS: We selected patients with pharyngolaryngeal lesions suspicious for malignancy. For in-office biopsy procedures, laryngeal cytology and direct laryngoscopy biopsy were performed, and diagnostic parameters and costs were estimated.
RESULTS: Eighty-eight patients were selected for this study. For laryngeal cytology, sensitivity was 70.3% (95% confidence interval [CI] = 59.9% to 80.7%), specificity 100% with a positive predictive value of 100% and a negative predictive value of 50% (95% CI = 35.2% to 64.8%). In-office biopsy sensitivity was 81% (95% CI = 72.6% to 89.3%), specificity 100% with a positive predictive value of 100% and a negative predictive value of 20% (95% CI = 2.5% to 37.5%). At our hospital, the use of in-office biopsies as a first approach for diagnosis saves $50,140.80 U.S. per annum.
CONCLUSION: In-office biopsy is a more affordable technique that enables histologic diagnosis of pharyngolaryngeal lesions in a large percentage of patients.

PMID: 24889909 [PubMed - indexed for MEDLINE]

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Oncologic outcomes of supratracheal laryngectomy: Critical analysis.

Related Articles

Oncologic outcomes of supratracheal laryngectomy: Critical analysis.

Head Neck. 2015 Oct;37(10):1417-24

Authors: Rizzotto G, Crosetti E, Lucioni M, Bertolin A, Monticone V, Sprio AE, Berta GN, Succo G

Abstract
BACKGROUND: Laryngeal cancer management should pursue function-sparing therapeutic options. Even though demolitive surgery provides better control of disease at intermediate to advanced stages when compared to chemoradiotherapy, it does not preserve laryngeal function. Supratracheal partial laryngectomy has been described as a function-sparing surgical technique for laryngeal cancer with subglottic extension.
METHODS: In this retrospective study, we analyzed the clinical outcomes of 115 patients who underwent supratracheal partial laryngectomy.
RESULTS: At 5 years, overall survival (OS), disease-free survival (DFS), and locoregional control rates were 78.9%, 68.5%, and 69.6%, respectively; DFS and locoregional control prevalences were greatly affected by pT4a classification (49.0% and 51.4%, respectively); and laryngeal function preservation was maintained in 78.3% of patients despite being affected by pT4a classification (59.3%) and age ≥65 (64.6%).
CONCLUSION: For cases with glottic tumors and with subglottic extension, the choice of supratracheal partial laryngectomy versus chemoradiotherapy can be considered to be effective in terms of prognostic and functional results.

PMID: 24839082 [PubMed - indexed for MEDLINE]

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Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Ann Otol Rhinol Laryngol. 2016 Jul 12;

Authors: Zacharias SR, Myer CM, Meinzen-Derr J, Kelchner L, Deliyski DD, de Alarcón A

Abstract
OBJECTIVES: To compare clinicians' ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation.
METHODS: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings.
RESULTS: Clinicians were more likely to rate regularity on HSV versus VLS videos (P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location (P = .002). Supraglottic phase symmetry (P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions (P < .0001).
CONCLUSIONS: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations.

PMID: 27411363 [PubMed - as supplied by publisher]

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Clinical Translation of Tissue Engineered Trachea Grafts.

Clinical Translation of Tissue Engineered Trachea Grafts.

Ann Otol Rhinol Laryngol. 2016 Jul 12;

Authors: Chiang T, Pepper V, Best C, Onwuka E, Breuer CK

Abstract
OBJECTIVE: To provide a state-of-the-art review discussing recent achievements in tissue engineered tracheal reconstruction.
DATA SOURCES AND REVIEW METHODS: A structured PubMed search of the current literature up to and including October 2015. Representative articles that discuss the translation of tissue engineered tracheal grafts (TETG) were reviewed.
CONCLUSIONS: The integration of a biologically compatible support with autologous cells has resulted in successful regeneration of respiratory epithelium, cartilage, and vascularization with graft patency, although the optimal construct composition has yet to be defined. Segmental TETG constructs are more commonly complicated by stenosis and delayed epithelialization when compared to patch tracheoplasty.
IMPLICATIONS FOR PRACTICE: The recent history of human TETG recipients represents revolutionary proof of principle studies in regenerative medicine. Application of TETG remains limited to a compassionate use basis; however, defining the mechanisms of cartilage formation, epithelialization, and refinement of in vivo regeneration will advance the translation of TETG from the bench to the bedside.

PMID: 27411362 [PubMed - as supplied by publisher]

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Penetration of hypochlorites with lowered surface tension into dentine tubules.

Penetration of hypochlorites with lowered surface tension into dentine tubules.

Minerva Stomatol. 2016 Jul 14;

Authors: Palazzi F, Sadile G, Mohammadi Z, Del Fabbro M, Riccitiello F

Abstract
BACKGROUND: The purpose of the present study was to assess the effect of concentration and temperature of sodium hypochlorite (NaOCl) with added surfactants and time of exposure on its penetration into human dentine.
METHODS: Seventy-five extracted permanent maxillary anterior teeth with single canals were shaped by using ProTaper SX hand-operated instruments. Then teeth were sectioned perpendicular to their long axis. The crowns and apical thirds of all the teeth were removed. The remaining roots were processed into 4-mm-long blocks and stained overnight in crystal violet. One hundred fifty stained blocks were further split into halves and treated by six NaOCl-based solutions from different brands: three solutions added with surfactants (Hypoclean, H6, Chlor-Xtra) and their regular counterparts (5.25%, 6%, <%6NaOCl). The dentine blocks were exposed to the solutions for 2, 5, and 20 minutes at 20°C, 37°C, and 45°C, respectively. The depth of penetration of NaOCl was determined by bleaching of the stain and measured by light microscopy at magnifications of 20x and 40x. Statistical analysis was made by using two way ANOVA and by comparing groups two by two with t-test.
RESULTS: The shortest penetration (130.80±1.92μm) was measured after incubation with 5.25%NaOCl for 2 minutes at 20°C; the highest penetration (375.40 ± 3.05μm) was obtained with Chlor-Xtra for 20 minutes at 45°C. Temperature and exposure time had a significant direct relationship with penetration of sodium hypochlorites with lowered surface tension into dentinal tubules.
CONCLUSIONS: The exposure time and temperature of sodium hypochlorite as well as the addition of surfactants may influence the penetration depth of irrigants into dentinal tubules.

PMID: 27416154 [PubMed - as supplied by publisher]

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The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL).

The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL).

Int Arch Otorhinolaryngol. 2016 Jul;20(3):202-6

Authors: Ayres A, Jotz GP, Rieder CR, Schuh AF, Olchik MR

Abstract
INTRODUCTION: Dysphagia is a common symptom in Parkinson's disease (PD) and it has been associated with poor quality of life (QoL), anxiety, depression.
OBJECTIVE: The aim of this study was to evaluate the quality of life in individuals with PD before and after SLP therapy.
METHODS: The program consisted of four individual therapy sessions. Each session comprised guidelines regarding food and postural maneuvers (chin down). The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was applied before and after therapy.
RESULTS: The sample comprised of 10 individuals (8 men), with a mean (SD) age of 62.2 (11.3) years, mean educational attainment of 7.5 (4.3) years, and mean disease duration of 10.7 (4.7) years. Thirty percent of patients were Hoehn and Yahr (H&Y) stage 2, 50% were H&Y stage 3, and 20% were H&Y stage 4. Mean scores for all SWAL-QOL domains increased after the intervention period, with significant pre- to post-therapy differences in total score (p = 0.033) and domain 4 (symptom frequency) (p = 0.025). There was also a bias significance for domain 5 (food selection) (p = 0.095).
CONCLUSION: Patients exhibited improvement in swallowing-related quality of life after a SLP therapy program. The earlier in the course of PD, greater the improvement observed after therapy.

PMID: 27413399 [PubMed]

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Understanding the Viscosity of Liquids used in Infant Dysphagia Management.

Understanding the Viscosity of Liquids used in Infant Dysphagia Management.

Dysphagia. 2016 Jul 13;

Authors: Frazier J, Chestnut AH, Jackson A, Barbon CE, Steele CM, Pickler L

Abstract
When assessing swallowing in infants, it is critical to have confidence that the liquids presented during the swallow study closely replicate the viscosity of liquids in the infant's typical diet. However, we lack research on rheological properties of frequently used infant formulas or breastmilk, and various forms of barium contrast media used in swallow studies. The aim of the current study was to provide objective viscosity measurements for typical infant liquid diet options and barium contrast media. A TA-Instruments AR2000 Advanced Rheometer was used to measure the viscosity of five standard infant formulas, three barium products, and two breastmilk samples. Additionally, this study measured the viscosity of infant formulas and breastmilk when mixed with powdered barium contrast in a 20 % weight-to-volume (w/v) concentration. The study findings determined that standard infant formulas and the two breastmilk samples had low viscosities, at the lower end of the National Dysphagia Diet (NDD) thin liquid range. Two specialty formulas tested had much thicker viscosities, close to the lower boundary of the NDD nectar-thick liquid range. The study showed differences in viscosity between 60 % w/v barium products (Liquid E-Z-Paque(®) and E-Z-Paque(®) powder); the powdered product had a much lower viscosity, despite identical barium concentration. When E-Z-Paque(®) powdered barium was mixed in a 20 % w/v concentration using water, standard infant formulas, or breastmilk, the resulting viscosities were at the lower end of the NDD thin range and only slightly thicker than the non-barium comparator liquids. When E-Z-Paque(®) powdered barium was mixed in a 20 % w/v concentration with the two thicker specialty formulas (Enfamil AR 20 and 24 kcal), unexpected alterations in their original viscosity occurred. These findings highlight the clinical importance of objective measures of viscosity as well as objective data on how infant formulas or breastmilk may change in consistency when mixed with barium.

PMID: 27412005 [PubMed - as supplied by publisher]

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A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population.

A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population.

Dysphagia. 2016 Jul 13;

Authors: Valenzano TJ, Waito AA, Steele CM

Abstract
Dysphagia is reported to be a common secondary complication for individuals with traumatic spinal injuries. Different etiologies of traumatic spinal injuries may lead to different profiles of swallowing impairment. We conducted a systematic review to determine the characteristics of dysphagia after traumatic spinal injury and to describe interventions currently used to improve swallowing function in this population. A comprehensive multiengine literature search identified 137 articles of which five were judged to be relevant. These underwent review for study quality, rating for level of evidence, and data extraction. The literature describing dysphagia after traumatic spinal injury was comprised predominantly of low-level evidence and single case reports. Aspiration, pharyngeal residue, and decreased/absent hyolaryngeal elevation were found to be common characteristics of dysphagia in this population. The most commonly used swallowing interventions included tube feeding, compensatory swallowing strategies, and steroids/antibiotics. Improvement in swallowing function following swallowing intervention was reported in all studies; however, there was no control for spontaneous recovery. The results demonstrate a need for high-quality research to profile the pathophysiology of dysphagia after traumatic spinal injury and controlled studies to demonstrate the efficacy of swallowing interventions in this population.

PMID: 27412004 [PubMed - as supplied by publisher]

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Prognoses of new complete dentures from the patient's denture assessment of existing dentures.

Prognoses of new complete dentures from the patient's denture assessment of existing dentures.

Clin Oral Investig. 2016 Jul 13;

Authors: Komagamine Y, Kanazawa M, Sasaki Y, Sato Y, Minakuchi S

Abstract
OBJECTIVES: The aim was to determine prognostic factors affecting frequent post-delivery adjustments of new complete dentures using patients' assessments of existing complete dentures.
MATERIALS AND METHODS: A total of 125 edentulous participants (56 men, 69 women; mean age, 76.4 years) who required new complete dentures evaluated existing dentures using the patient's denture assessment (PDA), a questionnaire regarding the self-assessment of dentures composed of 22 question items and containing six subscales: "function," "lower denture," "upper denture," "expectation," "esthetics and speech," and "importance." Moreover, the numbers of post-delivery adjustments of new dentures were recorded. A multiple logistic regression analysis was performed to identify significant factors for frequent adjustments of new dentures with five subscales of the PDA (excluding "importance"), level of mandibular ridge resorption, and age as independent variables.
RESULTS: The analysis showed that "function," "esthetics and speech," and level of mandibular ridge resorption were significant variables for a frequent number of post-delivery adjustments of new complete dentures.
CONCLUSIONS: The results suggested that patients' assessments of existing dentures using the PDA might allow a prediction of prognosis for complete denture treatments. Additionally, low "function" scores and high "esthetics and speech" scores for existing dentures and high levels of mandibular ridge resorption were significant prognostic factors affecting frequent post-delivery adjustments of new complete dentures.
CLINICAL RELEVANCE: It may be difficult for edentulous persons to adapt to new complete dentures, especially those who have complaints about mastication and swallowing with existing dentures and poor mandibular ridges, but are satisfied with esthetics and speech.

PMID: 27411335 [PubMed - as supplied by publisher]

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[COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER].

[COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Apr;30(4):447-52

Authors: Yang H, Zhang H, Chen H, Yang S, Wang J, Hu D

Abstract
OBJECTIVE: To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer.
METHODS: After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014 (chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010 (series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups (P > 0.05). The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region.
RESULTS: Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group (P < 0.05), while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group (P < 0.05). The patients were followed up 1-5 years (mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh-flap group were significantly better than those of the series-wound flaps group (P < 0.05), while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups (P > 0.05).
CONCLUSION: Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.

PMID: 27411273 [PubMed - in process]

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Dysphagia Related to Esophagus Compression by Anterior Cervical Ossification in a Patient with Ankylosing Spondylitis.

Related Articles

Dysphagia Related to Esophagus Compression by Anterior Cervical Ossification in a Patient with Ankylosing Spondylitis.

J Rheumatol. 2015 Oct;42(10):1922-3

Authors: Toussirot É, Mauvais O, Aubry S

PMID: 26429205 [PubMed - indexed for MEDLINE]

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Race and Sex Differences in Adult Facial Fracture Risk.

Race and Sex Differences in Adult Facial Fracture Risk.

JAMA Facial Plast Surg. 2016 Jul 14;

Authors: Hanba C, Svider PF, Chen FS, Carron MA, Folbe AJ, Eloy JA, Zuliani GF

Abstract
Importance: There are well-described racial, sex, and age differences related to osteoporosis and hip and/or extremity fractures. Nonetheless, there has been virtually no inquiry evaluating whether these findings carry over to facial fracture.
Objective: To characterize the incidence of facial fractures by patient demographics and injury mechanism, focusing on whether differences are noted with race, sex, and advancing age.
Main Outcomes and Measures: Retrospective analysis of the National Electronic Injury Surveillance System (NEISS) was performed in October and November 2015, specifically evaluating adult emergency department (ED) visits from 2012 to 2014 related to facial trauma. Entries were organized by age groups (both individual decades as well as younger adults [18-59 years] vs older adults [60-89 years]), sex, and race (white, black, Asian, other/unspecified). Incidence of facial fractures and mechanism of injury were also evaluated.
Results: There were 33 825 NEISS entries correlating to 1 401 196 ED (range, 1 136 048-1 666 344) visits for adult facial injury, with 14.4% involving fracture. A greater proportion of facial injuries among younger men (<60 years) were fractures relative to younger women (15.5% vs 12.5%; difference of the mean [DOM], 3.0%; 95% CI, 2.8%-3.1%; P < .001); however, on comparison by sex in elderly populations (≥ 60 years), women had an increased fracture predilection (15.0% vs 14.0%; DOM, 1.0%; 95% CI, 0.8%-1.2%; P < .001). Also, older women had a significantly greater risk of fracture relative to those younger than 60 years (15.0% vs 12.5%; DOM, 2.5%; 95% CI, 2.4%-2.7%; P < .001), a comparison that was significant among whites and Asians. Black women had a significantly decreased risk of fracture in the older aged population. (8.4% vs 9.1%; DOM, 0.7%; 95% CI, 0.2%- 1.3%; P = .001). Both on individual comparisons of younger and older cohorts, white and Asian individuals of either sex had significantly greater rates of facial fracture injury than blacks. Among younger cohorts in either sex, injuries sustained during participation in recreational activities were a significant factor, replaced largely by injuries due to housing structural elements and falls among older cohorts.
Conclusions and Relevance: There is an increase in the risk of facial fracture among postmenopausal women sustaining facial injuries, with these results significant among whites and Asians. In contrast, a decreased risk was noted on comparison of younger and older black women. Mechanism of injuries also varied significantly by age, race, and sex.
Level of Evidence: 4.

PMID: 27414775 [PubMed - as supplied by publisher]

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The transclival artery: a variant persistent carotid-basilar arterial anastomosis not previously reported.

The transclival artery: a variant persistent carotid-basilar arterial anastomosis not previously reported.

BMJ Case Rep. 2016;2016

Authors: Kirkland JD, Dahlin BC, O'Brien WT

Abstract
During embryological development, primitive anastomoses exist between the carotid and vertebrobasilar arteries. These anastomoses typically regress or are incorporated into the developing vasculature. Persistence beyond fetal development, however, results in vascular anomalies that alter haemodynamic flow with a predisposition for aneurysm formation. The carotid-vertebrobasilar anastomoses mirror the primitive communications and include (from most to least common) the trigeminal, hypoglossal, proatlantal and otic arteries. The hypoglossal and proatlantal variants extend through the hypoglossal canal or foramen magnum, respectively. We present a previously undescribed variant of these persistent fetal anastomoses, the 'transclival artery', which courses through its own transclival skull base canal/foramen.

PMID: 27413022 [PubMed - in process]

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Forgetful but not forgotten: Bathroom-related craniofacial trauma among the elderly.

Forgetful but not forgotten: Bathroom-related craniofacial trauma among the elderly.

Laryngoscope. 2016 Jul 14;

Authors: Hanba C, Gupta A, Svider PF, Folbe AJ, Eloy JA, Zuliani GF, Carron MA

Abstract
OBJECTIVES/HYPOTHESIS: As our population ages, injuries attributable to falls continue to increase, impacting healthcare delivery. Evaluation of craniofacial trauma with focus on elderly patients remains an underappreciated concern. Our objectives were to evaluate injury trends associated with elderly bathroom falls, as this information may be useful for counseling and preventive purposes.
STUDY DESIGN: Database review.
METHODS: The National Electronic Injury Surveillance System was evaluated for craniofacial trauma among patients 60 years and older presenting to the emergency department (ED) (2010-2014). Injury descriptions were reviewed for mechanism of injury, patient demographics, and other injury characteristics.
RESULTS: In total, 7.2% of the estimated 3.4 million ED visits for elderly craniofacial trauma were bathroom related. Females comprised the majority (60.9%) of patients, and a plurality of patients were in their 80s. A greater proportion of facial injuries resulted from syncope (16.6% vs. 10.9% compared to head injuries). Toilets facilitated a greater proportion of facial insults and were more likely to require admission; the most common mechanism was "falling off." Showers contributed a majority of head injuries and had a lower median age than toilet injuries. Fractures comprised 12.6% of facial injuries; of craniofacial fractures, common sites included the nose (54%), mandible (6%), and orbit (6%). Admitted patients were significantly older than those who were released.
CONCLUSIONS: Bathroom falls result in a significant proportion of elderly traumatic injury. The trends we present offer the opportunity for targeted preventative measures to decrease the occurrence of these events. Additionally, this information may adjunct a detailed history and physical to ensure appropriate patient management.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27411519 [PubMed - as supplied by publisher]

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[Infratentorial ischemic stroke in children: Three case reports].

Related Articles

[Infratentorial ischemic stroke in children: Three case reports].

Arch Pediatr. 2011 May;18(5):544-9

Authors: Ouattara-Doumbia M, Le Moing AG, Bourel-Ponchel E, Delignières A, Schauvliege J, de Broca A, Chabrol B, Berquin P

Abstract
Ischemic stroke is rare in children, most of which occur in the supratentorial brain, and infratentorial infarcts are very rare. Some clinical manifestations may be similar but others such as ataxia and cranial nerve palsy are more specific. Vertebral artery dissection is the most frequent cause of stroke in the vertebrobasilar territory, but the cause most often remains unknown in children. We report three cases of infratentorial stroke in children. The first observation concerns a 4-year-old boy brought to medical attention because left hemicorporal motor deficit associated with ataxia following a minor cranial traumatism. While computed tomography (CT) of the brain was normal, magnetic resonance imaging (MRI) revealed an area of signal alteration on the diffusion-weighted image within the right protuberance. The second observation is a 15-year-old girl who developed sudden-onset ataxia. The CT scan and MRI of the brain revealed an acute bilateral cerebellar stroke. MRI angiography showed an anatomical variant of the left vertebral artery that did not participate in the Willis polygon. In these two observations, no other abnormalities were detected except they were homozygotous for MTHFR mutation in the first observation and minor alpha-thalassemia for the second one. The outcome in these two children was good without sequelae after a 6-month follow-up. The third observation is a 6-year-old girl who suddenly exhibited cephalalgia, ataxia, and left visual impairment. The brain MRI revealed left occipital and cerebellar strokes due to vertebral artery dissection. The authors recommend the systematic search for vertebral artery dissection in cases of infratentorial stroke.

PMID: 21458968 [PubMed - indexed for MEDLINE]

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Recurrence and survival after gross total removal of resectable undifferentiated or poorly differentiated thyroid carcinoma.

Recurrence and survival after gross total removal of resectable undifferentiated or poorly differentiated thyroid carcinoma.

Thyroid. 2016 Jul 13;

Authors: Lee DY, Won JK, Choi HS, Park DJ, Jung KC, Sung MW, Kim KH, Hah JH, Park YJ

Abstract
BACKGROUND: This study aimed to evaluate the recurrence and survival after initial curative-intent surgery of resectable anaplastic thyroid cancer (ATC) and poorly differentiated thyroid cancer (PDTC).
METHODS: A retrospective analysis was conducted on patients with ATC and PDTC who had been treated from the period 1985 to 2013. Among them, 119 patients who had undergone surgery with curative intent were included in this study. The outcome measures included the clinical response to treatment and the recurrence rates of three separate thyroid cancer groups: ATC, differentiated thyroid cancer (DTC) with anaplastic foci, and PDTC.
RESULTS: Initial remission was achieved in 100 patients (84.0%), with higher percentages in patients with DTC with anaplastic foci (97.8%) and PDTC (96.7%) compared to ATC (60.5%). Overall recurrence rate after initial remission was 30.8% in ATC, 25.9% PDTC, and 6.7% DTC with anaplastic foci. Pathologic diagnosis, preexisting goiter or tumors, along with tracheal and lymphatic/vascular invasion were correlated with recurrence (p<0.001, p=0.001, 0.006, 0.003, 0.016, respectively). All patients without initial remission died due to local failure, and most patients with recurrence, apart from two PDTC patients, had distant metastasis. Overall mortality after initial curative-intent surgery was 58.1% in ATC, 8.7% DTC with anaplastic foci, and 20% PDTC.
CONCLUSIONS: The initial remission of resectable tumors was higher and the recurrence rate was lower in DTC with anaplastic foci and PDTC compared to ATC. Careful monitoring of the development of distant metastasis is necessary, especially in patients with aggressive pathology with tracheal and lymphovascular invasion.

PMID: 27412715 [PubMed - as supplied by publisher]

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Frequency-Dependent Neural Activity in Patients with Unilateral Vascular Pulsatile Tinnitus.

Frequency-Dependent Neural Activity in Patients with Unilateral Vascular Pulsatile Tinnitus.

Neural Plast. 2016;2016:4918186

Authors: Lv H, Zhao P, Liu Z, Wang G, Zeng R, Yan F, Dong C, Zhang L, Li R, Wang P, Li T, Gong S, Wang Z

Abstract
Previous resting-state functional magnetic resonance imaging (rs-fMRI) studies have shown that neurological changes are important findings in vascular pulsatile tinnitus (PT) patients. Here, we utilized rs-fMRI to measure the amplitude of low-frequency fluctuations (ALFF) in forty patients with unilateral PT and forty age-, gender-, and education-matched normal control subjects. Two different frequency bands (slow-4, 0.027-0.073 Hz, and slow-5, 0.010-0.027 Hz, which are more sensitive to subcortical and cortical neurological signal changes, resp.) were analyzed to examine the intrinsic brain activity in detail. Compared to controls, PT patients had increased ALFF values mainly in the PCu, bilateral IPL (inferior parietal lobule), left IFG (inferior frontal gyrus), and right IFG/anterior insula and decreased ALFF values in the multiple occipital areas including bilateral middle-inferior occipital lobe. For the differences of the two frequency bands, widespread ALFF differences were observed. The ALFF abnormalities in aMPFC/ACC, PCu, right IPL, and some regions of occipital and parietal cortices were greater in the slow-5 band compared to the slow-4 band. Additionally, the THI score of PT patients was positively correlated with changes in slow-5 and slow-4 band in PCu. Pulsatile tinnitus is a disease affecting the neurological activities of multiple brain regions. Slow-5 band is more sensitive in detecting the alternations. Our results also indicated the importance of pathophysiological investigations in patients with pulsatile tinnitus in the future.

PMID: 27413554 [PubMed - in process]

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Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation.

Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):271-4

Authors: Bento RF, Gebrim EM, Magalhães AT, Pereira LV, Fonseca AC

Abstract
INTRODUCTION: Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing.
OBJECTIVE: This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation.
DATA SYNTHESIS: The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochlea measuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochlea was anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB.
CONCLUSION: Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

PMID: 27413411 [PubMed]

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Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):261-70

Authors: Albernaz PL

Abstract
INTRODUCTION: Metabolic activity of the inner ear is very intense, and makes it sensitive to changes in the body homeostasis. This study involves a group of patients with inner ear disorders related to carbohydrate metabolism disturbances, including hearing loss, tinnitus, dizziness, and episodes of vertigo.
OBJECTIVES: To describe the symptoms of metabolic inner ear disorders and the examinations required to establish diagnoses. These symptoms are often the first to allow for an early diagnosis of metabolic disorders and diabetes.
METHODS: Retrospective study of 376 patients with inner ear symptoms suggestive of disturbances of carbohydrate metabolism. The authors present patientś clinical symptoms and clinical evaluations, with emphasis on the glucose and insulin essays.
RESULTS: Authors based their conclusions on otolaryngological findings, diagnostic procedures and treatment principles. They found that auditory and vestibular symptoms usually occur prior to other manifestations of metabolic changes, leading to an early diagnosis of hyperinsulinemia, intestinal sugar malabsorption or diabetes. Previously undiagnosed diabetes mellitus type II was found in 39 patients.
CONCLUSIONS: The identification of carbohydrate metabolism disturbances is important not only to minimize the patients' clinical symptoms, but also to help maintain their general health.

PMID: 27413410 [PubMed]

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Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss.

Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):248-53

Authors: Flores LS, Teixeira AR, Rosito LP, Seimetz BM, Dall'Igna C

Abstract
INTRODUCTION: Tinnitus is one of the symptoms that affects individuals suffering from noise induced hearing loss. This condition can be disabling, leading the affected individual to turn away from work.
OBJECTIVE: This literature review aims to analyze the possible association between gender and tinnitus pitch and loudness, the degree of hearing loss and the frequencies affected in subjects with noise-induced hearing loss.
METHODS: This contemporary cohort study was conducted through a cross-sectional analysis. The study sample consisted of adults with unilateral or bilateral tinnitus, who had been diagnosed with noise-induced hearing loss. The patients under analysis underwent an otorhinolaryngological evaluation, pure tone audiometry, and acuphenometry.
RESULTS: The study included 33 subjects with noise-induced hearing loss diagnoses, of which 22 (66.7%) were men. Authors observed no statistical difference between gender and loudness/pitch tinnitus and loudness/pitch in subjects with bilateral tinnitus. Authors found an inverse relation between tinnitus loudness with intensity greater hearing threshold and the average of the thresholds and the grade of hearing loss. The tinnitus pitch showed no association with higher frequency of hearing threshold.
CONCLUSION: Data analysis shows that, among the individuals evaluated, the greater the hearing loss, the lower the loudness of tinnitus. We did not observe an association between hearing loss and tinnitus pitch.

PMID: 27413408 [PubMed]

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Cognitive Evaluation and Quality of Life Assessment in Patients with Subjective Tinnitus.

Cognitive Evaluation and Quality of Life Assessment in Patients with Subjective Tinnitus.

Acta Neurol Taiwan. 2016 Mar;25(1):1-9

Authors: Dağ E, Bayar Muluk N, Karabiçak H, Kürşat Arikan O, Türkel Y

PMID: 27411793 [PubMed - in process]

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Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Ann Otol Rhinol Laryngol. 2016 Jul 12;

Authors: Zacharias SR, Myer CM, Meinzen-Derr J, Kelchner L, Deliyski DD, de Alarcón A

Abstract
OBJECTIVES: To compare clinicians' ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation.
METHODS: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings.
RESULTS: Clinicians were more likely to rate regularity on HSV versus VLS videos (P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location (P = .002). Supraglottic phase symmetry (P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions (P < .0001).
CONCLUSIONS: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations.

PMID: 27411363 [PubMed - as supplied by publisher]

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Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):261-70

Authors: Albernaz PL

Abstract
INTRODUCTION: Metabolic activity of the inner ear is very intense, and makes it sensitive to changes in the body homeostasis. This study involves a group of patients with inner ear disorders related to carbohydrate metabolism disturbances, including hearing loss, tinnitus, dizziness, and episodes of vertigo.
OBJECTIVES: To describe the symptoms of metabolic inner ear disorders and the examinations required to establish diagnoses. These symptoms are often the first to allow for an early diagnosis of metabolic disorders and diabetes.
METHODS: Retrospective study of 376 patients with inner ear symptoms suggestive of disturbances of carbohydrate metabolism. The authors present patientś clinical symptoms and clinical evaluations, with emphasis on the glucose and insulin essays.
RESULTS: Authors based their conclusions on otolaryngological findings, diagnostic procedures and treatment principles. They found that auditory and vestibular symptoms usually occur prior to other manifestations of metabolic changes, leading to an early diagnosis of hyperinsulinemia, intestinal sugar malabsorption or diabetes. Previously undiagnosed diabetes mellitus type II was found in 39 patients.
CONCLUSIONS: The identification of carbohydrate metabolism disturbances is important not only to minimize the patients' clinical symptoms, but also to help maintain their general health.

PMID: 27413410 [PubMed]

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Neurological Complications of Ebola Virus Infection.

Neurological Complications of Ebola Virus Infection.

Neurotherapeutics. 2016 Jul 13;

Authors: Billioux BJ, Smith B, Nath A

Abstract
Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.

PMID: 27412684 [PubMed - as supplied by publisher]

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[Dysphonia and Dysphagia Caused by a Pedunculated Polyp of the Hypopharynx].

[Dysphonia and Dysphagia Caused by a Pedunculated Polyp of the Hypopharynx].

Laryngorhinootologie. 2016 Jul 14;

Authors: Schwarte B, Bootz F, Zhou H, Schade G

PMID: 27414484 [PubMed - as supplied by publisher]

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Insights on different analysis techniques in the monothermal and bithermal caloric test - which parameter should we use to quantify vestibular function?

Insights on different analysis techniques in the monothermal and bithermal caloric test - which parameter should we use to quantify vestibular function?

Int J Audiol. 2016 Jul 14;:1-8

Authors: Radomskij P, Smith S, Kuttva S

Abstract
OBJECTIVE: To investigate the use of maximum slow component velocity (MSCV) and time-constant duration (TCd) of elicited nystagmus in quantifying the caloric response and to assess the efficacy of these parameters in the monothermal screening test.
DESIGN: Retrospective analysis of caloric results obtained from 150 patients. Bithermal unilateral weakness (UW), directional preponderance (DP), monothermal caloric asymmetry (MCA) based on warm or cool irrigations only, were calculated using both MSCV and TCd.
STUDY SAMPLE: 66 males and 84 females, aged 16-88 years (μ = 50, σ = 17), who underwent vestibular assessment.
RESULTS: The correlation-coefficient between bithermal caloric unilateral weaknesses calculated using either MSCV or TCd is 0.155 (p < 0.01). Using MSCV and setting significant MCA at 10%, the sensitivity and specificity were respectively 100% and 34% for monothermal warm and 82% and 53% for monothermal cool tests. Using TCd and setting significant MCA at 5%, the sensitivity and specificity were respectively 90% and 77% for monothermal warm and 100% and 74% for monothermal cool tests.
CONCLUSIONS: In the monothermal warm caloric test, MSCV can be used more reliably than monothermal cool to predict normal bithermal caloric response. The reverse is true if using TCd. Unilateral-weakness calculated using TCd and MSCV were poorly correlated and therefore likely to be demonstrating different aspects of vestibular function.

PMID: 27414985 [PubMed - as supplied by publisher]

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A review of the perceptual effects of hearing loss for frequencies above 3 kHz.

A review of the perceptual effects of hearing loss for frequencies above 3 kHz.

Int J Audiol. 2016 Jul 14;:1-8

Authors: Moore BC

Abstract
BACKGROUND: Hearing loss caused by exposure to intense sounds usually has its greatest effects on audiometric thresholds at 4 and 6 kHz. However, in several countries compensation for occupational noise-induced hearing loss is calculated using the average of audiometric thresholds for selected frequencies up to 3 kHz, based on the implicit assumption that hearing loss for frequencies above 3 kHz has no material adverse consequences. This paper assesses whether this assumption is correct.
DESIGN: Studies are reviewed that evaluate the role of hearing for frequencies above 3 kHz.
RESULTS: Several studies show that frequencies above 3 kHz are important for the perception of speech, especially when background sounds are present. Hearing at high frequencies is also important for sound localization, especially for resolving front-back confusions.
CONCLUSIONS: Hearing for frequencies above 3 kHz is important for the ability to understand speech in background sounds and for the ability to localize sounds. The audiometric threshold at 4 kHz and perhaps 6 kHz should be taken into account when assessing hearing in a medico-legal context.

PMID: 27414746 [PubMed - as supplied by publisher]

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Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas.

Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas.

Int J Audiol. 2016 Jul 14;:1-11

Authors: Murphy WJ, Themann CL, Murata TK

Abstract
OBJECTIVE: This field study aimed to assess the noise reduction of hearing protection for individual workers, demonstrate the effectiveness of training on the level of protection achieved, and measure the time required to implement hearing protector fit testing in the workplace.
DESIGN: The National Institute for Occupational Safety and Health (NIOSH) conducted field studies in Louisiana and Texas to test the performance of HPD Well-Fit.
STUDY SAMPLE: Fit tests were performed on 126 inspectors and engineers working in the offshore oil industry.
RESULTS: Workers were fit tested with the goal of achieving a 25-dB PAR. Less than half of the workers were achieving sufficient protection from their hearing protectors prior to NIOSH intervention and training; following re-fitting and re-training, over 85% of the workers achieved sufficient protection. Typical test times were 6-12 minutes.
CONCLUSIONS: Fit testing of the workers' earplugs identified those workers who were and were not achieving the desired level of protection. Recommendations for other hearing protection solutions were made for workers who could not achieve the target PAR. The study demonstrates the need for individual hearing protector fit testing and addresses some of the barriers to implementation.

PMID: 27414471 [PubMed - as supplied by publisher]

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Validation of list equivalency for Mandarin speech materials to use with cochlear implant listeners.

Validation of list equivalency for Mandarin speech materials to use with cochlear implant listeners.

Int J Audiol. 2016 Jul 14;:1-10

Authors: Li Y, Wang S, Su Q, Galvin JJ, Fu QJ

Abstract
OBJECTIVES: Speech materials validated with normal-hearing listeners may not be appropriate for clinical assessment of cochlear implant (CI) users. The aim of this study was to validate list equivalency of the Mandarin Speech Perception (MSP) sentences, disyllables, and monosyllables in Mandarin-speaking CI patients.
DESIGN: Recognition of MSP sentences, disyllables, and monosyllables each were measured for all 10 lists.
STUDY SAMPLE: 67 adult and 32 pediatric Mandarin-speaking CI users.
RESULTS: There was no significant difference between adult and pediatric subject groups for all test materials. Significant differences were observed among lists within each test. After removing one or two lists within each test, no significant differences were observed among the remaining lists. While there was equal variance among lists within a given test, the variance was larger for children than for adults, and increased from monosyllables to disyllables to sentences.
CONCLUSIONS: Some adjustment to test lists previously validated with CI simulations was needed to create perceptually equivalent lists for real CI users, suggesting that test materials should be validated in the targeted population. Differences in mean scores and variance across test materials suggest that CI users may differ in their ability to make use of contextual cues available in sentences and disyllables.

PMID: 27414242 [PubMed - as supplied by publisher]

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