Audiologic, cVEMP, and Radiologic Progression in Superior Canal Dehiscence Syndrome.

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Audiologic, cVEMP, and Radiologic Progression in Superior Canal Dehiscence Syndrome.

Otol Neurotol. 2016 Aug 12;

Authors: Lookabaugh S, Niesten ME, Owoc M, Kozin ED, Grolman W, Lee DJ

Abstract
OBJECTIVE: To assess the change in hearing, vestibular function, and size of superior canal dehiscence (SCD) in patients with SCD syndrome over time.
PATIENTS: Adult patients with SCD in one or both ears with documented sign and symptom progression, as shown by the medical record, audiometry, cervical vestibular-evoked myogenic potentials (cVEMP), and computed tomography (CT).
INTERVENTION: Audiometry, cVEMPs, and temporal bone CT were performed on patients with high clinical suspicion of disease progression.
MAIN OUTCOME MEASURE: Audiometry (magnitude of the air-bone gap [ABG]), cVEMP (magnitude of the thresholds), and CT scans (size of the superior canal dehiscence) were analyzed. Symptoms were assessed at each clinical visit and before repeat testing.
RESULTS: Retrospective review of 250 patients with SCDS showed three patients with disease progression over time with follow-up testing as outlined above. All patients presented initially with mild symptoms, ABGs, low cVEMP thresholds, and small bony defects of the arcuate eminence. Four, 6, and 8 years later, progression of SCD signs and symptoms was observed in these three patients, respectively. Audiometry showed larger ABGs and lower cVEMP thresholds compared with previous testing. CT showed an increase in bony defect size.
CONCLUSION: Progression of SCD symptoms can be associated with a wider air-bone gap, lower cVEMP thresholds, and a larger bony defect. Prospective studies using validated measures of hearing loss and dizziness in patients who have not yet undergone surgery for SCD will determine the association between specific symptoms and objective test outcomes and how these change over time.

PMID: 27525706 [PubMed - as supplied by publisher]

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Correlation of Superior Canal Dehiscence Surface Area With Vestibular Evoked Myogenic Potentials, Audiometric Thresholds, and Dizziness Handicap.

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Correlation of Superior Canal Dehiscence Surface Area With Vestibular Evoked Myogenic Potentials, Audiometric Thresholds, and Dizziness Handicap.

Otol Neurotol. 2016 Sep;37(8):1104-1110

Authors: Hunter JB, O'Connell BP, Wang J, Chakravorti S, Makowiec K, Carlson ML, Dawant B, McCaslin DL, Noble JH, Wanna GB

Abstract
OBJECTIVE: To correlate objective measures of vestibular and audiometric function as well as subjective measures of dizziness handicap with the surface area of the superior canal dehiscence (SCD).
STUDY DESIGN: Retrospective chart review and radiological analysis.
SETTING: Single tertiary academic referral center.
PATIENTS: Preoperative computed tomography imaging, patient survey, audiometric thresholds, and vestibular evoked myogenic potential (VEMP) testing in patients with confirmed SCD.
INTERVENTION(S): Image analysis techniques were developed to measure the surface area of each SCD in computed tomography imaging.
MAIN OUTCOME MEASURE(S): Preoperative ocular and cervical VEMPs, air and bone conduction thresholds, air-bone gap, dizziness handicap inventory scores, and surface area of the SCD.
RESULTS: Fifty-three patients (mean age 52.7 yr) with 84 SCD were analyzed. The median surface area of dehiscence was 1.44 mm (0.068-8.23 mm). Ocular VEMP amplitudes (r = 0.61, p <0.0001), cervical VEMP amplitudes (r = 0.62, p <0.0001), air conduction thresholds at 250 Hz (r = 0.25, p = 0.043), and air-bone gap at 500 Hz (r = 0.27, p = 0.01) positively correlated with increasing size of dehiscence. An inverse relationship between cervical VEMP thresholds (r = -0.56, p < 0.0001) and surface area of the dehiscence was observed. No association between dizziness handicap and surface area was identified.
CONCLUSION: Among patients with confirmed SCD, ocular and cervical VEMP amplitudes, cervical VEMP thresholds, and air conduction thresholds at 250 Hz are significantly correlated with the surface area of the dehiscence.

PMID: 27525621 [PubMed - as supplied by publisher]

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An unexpected skin ulcer and soft tissue necrosis after the nonconcurrent combination of proton beam therapy and pazopanib: A case of myxofibrosarcoma.

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An unexpected skin ulcer and soft tissue necrosis after the nonconcurrent combination of proton beam therapy and pazopanib: A case of myxofibrosarcoma.

Auris Nasus Larynx. 2016 Aug 11;

Authors: Uwa N, Terada T, Mohri T, Tsukamoto Y, Futani H, Demizu Y, Okimoto T, Sakagami M

Abstract
We herein report the case of a patient presenting with myxofibrosarcoma (MFS) who underwent treatment with surgery, proton beam therapy (PBT), and pazopanib. A 64-year-old male was diagnosed with MFS, which ranged from the posterior neck to the shoulder. Surgery was performed as an initial treatment; however, the primary tumor recurred 83 months after the initial treatment. We, therefore, administered PBT. Although most of the recurrent tumor disappeared after PBT, multiple lung metastases were identified 3 months after the completion of PBT. We initiated antiangiogenic treatment with pazopanib. Although long-term survival was achieved with the treatments, the patient suffered from a skin ulcer and soft tissue necrosis and eventually died of general prostration caused by infection, and complicated by pneumonia. Although PBT and pazopanib were effective for treating the local recurrence and lung metastases of MFS, respectively, clinicians must be cognizant of the fact that the combination of high-dose irradiation and angiogenesis inhibitors, even in nonconcurrent cases, can result in a severe skin ulcer and soft tissue necrosis.

PMID: 27523716 [PubMed - as supplied by publisher]

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[The clinical and pathological features of laryngeal tuberculosis].

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[The clinical and pathological features of laryngeal tuberculosis].

Zhonghua Jie He He Hu Xi Za Zhi. 2016 Aug 12;39(8):612-615

Authors: Zang J, Liu Q, Jiang XJ

Abstract
Objective: To investigate the clinical and pathological features of laryngeal tuberculosis. Methods: The clinical data of 75 patients with laryngeal tuberculosis from Jan 2010 to Jan 2013 in our hospital were studied retrospectively. There were 50 male and 25 female patients, aged from 18 to 91 years, with a median age of 44 years. The course of disease was 1 to 19 months. Results: The prominent presenting symptoms were hoarseness (n=59, 79%), and sore throat (n=48, 64%). Systemic symptoms included fatigue with weight loss (n=26, 35%) and fever (n=17, 23%). Primary laryngeal tuberculosis was found in 23 patients (31%) while secondary laryngeal tuberculosis together with pulmonary tuberculosis in 52 patients (69%). There were 2 or less lesions in the larynx in 44 patients, while multiple lesions were found in 31 patients. Vocal cords were the most common sites affected(n=51, 68%), followed by epiglottis(n=41, 55%). Proliferation was the main type of lesions (n=34, 45%). After pathologic diagnosis, all patients received systemic anti-tuberculosis therapy, and the prognosis was good. Conclusions: Severe local symptoms of the larynx with slightly general symptoms are the clinical characteristics of laryngeal tuberculosis for the time being. Primary laryngeal tuberculosis often present with fewer (2 or less) lesions. Different morphology of laryngeal lesions can exist at the same time. The diagnosis of laryngeal tuberculosis depends on pathological biopsy. The treatment should be systemic anti-tuberculosis therapy.

PMID: 27523895 [PubMed - as supplied by publisher]

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The Interaction of Surface Hydration and Vocal Loading on Voice Measures.

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The Interaction of Surface Hydration and Vocal Loading on Voice Measures.

J Voice. 2016 Aug 10;

Authors: Fujiki RB, Chapleau A, Sundarrajan A, McKenna V, Sivasankar MP

Abstract
OBJECTIVES: Vocal loading tasks provide insight regarding the mechanisms underlying healthy laryngeal function. Determining the manner in which the larynx can most efficiently be loaded is a complex task. The goal of this study was to determine if vocal loading could be achieved in 30 minutes by altering phonatory mode. Owing to the fact that surface hydration facilitates efficient vocal fold oscillation, the effects of environmental humidity on vocal loading were also examined. This study also investigated whether the detrimental effects of vocal loading could be attenuated by increasing environmental humidity.
METHODS: Sixteen vocally healthy adults (8 men, 8 women) completed a 30-minute vocal loading task in low and moderate humidity. The order of humidities was counterbalanced across subjects. The vocal loading task consisted of reading with elevated pitch and pressed vocal quality and low pitch and pressed and/or raspy vocal quality in the presence of 65 dB ambient, multi-talker babble noise.
RESULTS: Significant effects were observed for (1) cepstral peak prominence on soft sustained phonation at 10th and 80th pitches, (2) perceived phonatory effort, and (3) perceived tiredness ratings. No loading effects were observed for cepstral peak prominence on the rainbow passage, although fundamental frequency on the rainbow passage increased post loading. No main effect was observed for humidity.
CONCLUSIONS: Following a 30-minute vocal loading task involving altering laryngeal vibratory mode in combination with increased volume. Also, moderate environmental humidity did not significantly attenuate the negative effects of loading.

PMID: 27522343 [PubMed - as supplied by publisher]

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[Radiotherapy of larynx cancers].

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[Radiotherapy of larynx cancers].

Cancer Radiother. 2016 Aug 9;

Authors: Pointreau Y, Lafond C, Legouté F, Trémolières P, Servagi-Vernat S, Giraud P, Maingon P, Calais G, Lapeyre M

Abstract
Intensity-modulated radiotherapy is the gold standard in the treatment of larynx cancers (except T1 glottic tumour). Early T1 and T2 tumours may be treated by exclusive radiation or surgery. For tumours requiring total laryngectomy (T2 or T3), induction chemotherapy followed by exclusive radiotherapy or concurrent chemoradiotherapy is possible. For T4 tumour, surgery must be proposed. The treatment of lymph nodes is based on the initial treatment of the primary tumour. In non-surgical procedure, in case of sequential radiotherapy, the curative dose is 70Gy and the prophylactic dose is 50Gy. An integrated simultaneous boost radiotherapy is allowed (70Gy in 2Gy per fraction and 56Gy in 1.8Gy per fraction or 70Gy in 2.12Gy per fraction). Postoperatively, radiotherapy is used in locally advanced cancer with dose levels based on pathologic criteria (66Gy for R1 resection, 50 to 54Gy for complete resection). Volume delineation was based on guidelines.

PMID: 27521037 [PubMed - as supplied by publisher]

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Health-related Quality of Life as Studied by EORTC QLQ and Voice Handicap Index Among Various Patients With Laryngeal Disease.

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Health-related Quality of Life as Studied by EORTC QLQ and Voice Handicap Index Among Various Patients With Laryngeal Disease.

J Voice. 2016 Aug 9;

Authors: Karlsen T, Sandvik L, Heimdal JH, Hjermstad MJ, Aarstad AK, Aarstad HJ

Abstract
OBJECTIVES: Patients with voice-related disorders are often treated by a multidisciplinary team including assessment by patient-reported outcome measures. The present paper aims at documenting the importance of including general health-related quality of life (HRQoL) measures to clinical investigations.
STUDY DESIGN: The participants (N = 80 larynx cancer, N = 32 recurrent palsy, N = 23 dysfunctional, N = 75 degenerative/inflammation, N = 19 various) were included consecutively at the laryngology clinic at Haukeland University Hospital. In addition, HRQoL data were included from one national group with laryngectomies (N = 105), one group with various patients formerly treated for head and neck squamous cell carcinoma (N = 96), and one population-based reference group (N = 1956).
METHOD: Obtained were the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ), the Voice Handicap Index (VHI), and the Eysenck Personality Inventory (EPI) neuroticism scores.
RESULTS: By analysis of variance, we have determined significant dependence of groups analyzing the sum global QoL/health index (F = 9.47; P <0.001), the functional HRQoL sum score (F5,2373 = 7.14, P <0.001), and the symptom sum HRQoL scores (F7,2381 = 8.13; P <0.001). In particular, patients with recurrent palsy and laryngeal cancer had lowered HRQoL. At the index levels, in particular dyspnea scores, were scored depending on larynx disease group (F7,2288 = 24.4; P <0.001). The VHI score correlated with the EORTC H&N35 "speech" index with a common variance of 52%. VHI scores correlated with level of neuroticism with 8% common variance (P <0.001) and EORTC scores with 22% (P <0.001).
CONCLUSION: In particular, among patients with voice-related disease, those with recurrent palsy and laryngeal cancer had lower HRQoL. Furthermore, the HRQoL and VHI scores were inversely tied to neuroticism.

PMID: 27520510 [PubMed - as supplied by publisher]

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Non-invasive Assessment of Swallowing and Respiration Coordination for the OSA Patient.

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Non-invasive Assessment of Swallowing and Respiration Coordination for the OSA Patient.

Dysphagia. 2016 Aug 12;

Authors: Wang CM, Li HY, Lee LA, Shieh WY, Lin SW

Abstract
The objectives of this study are to investigate swallowing and its coordination with respiration in patients with obstructive sleep apnea (OSA). This is a prospective cohort study conducted in a tertiary referred Medical Center. A non-invasive method of assessing swallowing was used to detect the oropharyngeal swallowing parameters and the coordination with respiration during swallowing. The system used to assess swallowing detected: (1) movement of the larynx using a force-sensing resistor; (2) submental muscle activity using surface electromyography; and (3) coordination with respiration by measuring nasal airflow. Five sizes of water boluses (maximum 20 mL) were swallowed three times, and the data recorded and analyzed for each participant. Thirty-nine normal controls and 35 patients with OSA who fulfilled the inclusion criteria were recruited. The oropharyngeal swallowing parameters of the patients differed from the controls, including longer total excursion duration and shorter duration of submental muscles contraction. A longer swallowing respiratory pause (SRP), temporary coordination with respiration during swallowing, was demonstrated in the patients compared with the controls. The frequency of non-expiratory/expiratory pre- and postswallowing respiratory phase patterns of the patients was similar with the controls. There was significantly more piecemeal deglutition in OSA patients when clumping 10- and 20-mL water boluses swallowing together (p = 0.048). Oropharyngeal swallowing and coordination with respiration affected patients with OSA, and it could be detected using a non-invasive method. The results of this study may serve as a baseline for further research and help advance research methods in obstructive sleep apnea swallowing studies.

PMID: 27515710 [PubMed - as supplied by publisher]

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LOCALIZED MUCOSAL LEISHMANIASIS BY LEISHMANIA INFANTUM MIMICKED CANCER IN RHINOLARYNGEAL REGION.

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LOCALIZED MUCOSAL LEISHMANIASIS BY LEISHMANIA INFANTUM MIMICKED CANCER IN RHINOLARYNGEAL REGION.

Int J Infect Dis. 2016 Aug 8;

Authors: Cobo F, Rodríguez-Granger J, Gómez-Camarasa C, Sampedro A, Aliaga-Martínez L, Navarro JM, Fernández JG

Abstract
We report clinical, microbiological, and histopathological findings in six patients with mucosal leishmaniasis; five of them were Spanish with no history of travelling abroad, while the other was from Bolivia but had lived in Spain for more than 5 years. Two patients had no underlying disease, while the other four had several other medical conditions. Lesions were located on the nose in three patients and in the larynx in the other three. Symptoms included difficulty in swallowing, nasal obstruction, dysphonia, and polypoid lesions mimicking cancer. Diagnosis was based on the identification of parasites or on PCR-assay or culture. Five patients were treated with liposomal amphotericin B and the other with antimonial compounds.

PMID: 27515498 [PubMed - as supplied by publisher]

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Retrospective Analysis of Hanging Deaths in Ontario.

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Retrospective Analysis of Hanging Deaths in Ontario.

J Forensic Sci. 2016 Aug 12;

Authors: Tugaleva E, Gorassini DR, Shkrum MJ

Abstract
Hanging deaths from investigation standpoint are rarely problematic. Unusual circumstances can on occasion raise suspicion of foul play. Associated neck injuries are reported in the literature with variable frequency (from 0% to 76.8%). This study retrospectively analyzed 755 hanging deaths in Ontario (Canada) to evaluate the demographic features and circumstances of hanging fatalities, and the frequency of hanging-related neck injuries. A number of cases showed unusual/special circumstances (e.g., complex, double suicides, restraints). Among 632 cases with complete autopsies, hyoid and larynx fractures were present in 46 cases (7.3%) with the most common being isolated hyoid fractures. The incidence of cricoid fractures was 0.5% and cervical spine injuries, 1.1%. A higher incidence of neck injuries occurred among males, long drop hangings, and in cases with complete suspension. There was a tendency for the number of fractures to increase with increasing age and weight of the deceased.

PMID: 27514837 [PubMed - as supplied by publisher]

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Combined modality therapy for thoracic and head and neck cancers: a review of updated literature based on a consensus meeting.

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Combined modality therapy for thoracic and head and neck cancers: a review of updated literature based on a consensus meeting.

Tumori. 2016 Jul 2;:0

Authors: Franco P, Fiorentino A, Dionisi F, Fiore M, Chiesa S, Vagge S, Cellini F, Caravatta L, Tombolini M, De Rose F, Meattini I, Mortellaro G, Apicella G, Marino L, Greto D

Abstract
PURPOSE: Combined modality therapy is a mainstay option for thoracic malignancies and head and neck cancers. The integration of different strategies is based on the multidisciplinary approach of modern clinical oncology. Radiation oncologists have to be educated, trained, and updated to provide state-of-the-art care to cancer patients and thus educational meetings are crucial.
METHODS: The Italian Association of Radiation Oncology Young Members Working Group (AIRO Giovani) organized its 8th national meeting, focused on combination therapy in lung, esophageal, and head and neck cancer (with a specific focus on larynx-preservation strategies for larynx/hypopharynx tumors), involving young professionals working in Italy. The meeting was addressed to young radiation oncologists, presenting state-of-the-art knowledge, based on the latest evidence in this field. We performed a review of the current literature based on the highlights of the Congress.
RESULTS: The multimodality approach of head and neck and thoracic malignancies includes surgery, chemotherapy, and radiotherapy, but also has to take into account new information and data coming from basic and translational research and including molecular biology, genetics, and immunology. All these aspects are crucial for the treatment of non-small-cell lung cancer and esophageal, esophagogastric junction, and larynx/hypopharynx malignancies. The integration of different treatments in the clinical decision-making process to combine therapies is crucial.
CONCLUSIONS: Combination therapy has proved to be a consolidated approach in these specific oncologic settings, highlighting the importance of multimodality management in modern clinical oncology. Dedicated meetings on specific topics are helpful to improve knowledge and skills of young professionals in radiation oncology.

PMID: 27514316 [PubMed - as supplied by publisher]

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Immunotoxicity of β-Diketone Antibiotic Mixtures to Zebrafish (Danio rerio) by Transcriptome Analysis.

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Immunotoxicity of β-Diketone Antibiotic Mixtures to Zebrafish (Danio rerio) by Transcriptome Analysis.

PLoS One. 2016;11(4):e0152530

Authors: Li F, Wang H, Liu J, Lin J, Zeng A, Ai W, Wang X, Dahlgren RA, Wang H

Abstract
Fluoroquinolones and tetracyclines are known as β-diketone antibiotics (DKAs) because of bearing a diketone group in their molecular structure. DKAs are the most widely used antibiotics to prevent generation of disease in humans and animals and to suppress bacterial growth in aquaculture. In recent years, overuse of DKAs has caused serious environmental risk due to their pseudo-persistence in the environment, even though their half-lives are not long. So far, no reports were concerned with the joint immunotoxicity of DKAs. Herein, we reported on the immunotoxicity of DKAs on zebrafish after a 3-month DKAs exposure using transcriptomic techniques. According to transcriptome sequencing, 10 differentially expressed genes were screened out among the genes related to KEGG pathways with high enrichment. The identified 7 genes showed to be consistent between RNA-seq and qRT-PCR. Due to DKAs exposure, the content or activity for a series of immune-related biomarkers (Complement 3, lysozyme, IgM and AKP) showed the inconsistent changing trends as compared with the control group. Histopathological observations showed that the number of goblet cells increased sharply, the columnar epithelial cells swelled, the nucleus became slender in intestinal villi, and numerous brown metachromatic granules occurred in spleens of DKAs-exposed groups. Overall, both detection of biomarkers and histopathological observation corroborated that chronic DKAs exposure could result in abnormal expression of immune genes and enzymes, and variable levels of damage to immune-related organs. These complex effects of DKAs may lead to zebrafish dysfunction and occurrence of diseases related to the immune system.

PMID: 27046191 [PubMed - indexed for MEDLINE]

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Clarification of the terms used to describe procedures for acute airway obstruction management.

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Clarification of the terms used to describe procedures for acute airway obstruction management.

Surgery. 2016 May;159(5):1480-1

Authors: Vassiliu P, Fingerhut A, Konstantoudakis G, Doll D

PMID: 26744246 [PubMed - indexed for MEDLINE]

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The effects of low doses of two Fusarium toxins, zearalenone and deoxynivalenol, on the pig jejunum. A light and electron microscopic study.

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The effects of low doses of two Fusarium toxins, zearalenone and deoxynivalenol, on the pig jejunum. A light and electron microscopic study.

Toxins (Basel). 2015 Nov;7(11):4684-705

Authors: Przybylska-Gornowicz B, Tarasiuk M, Lewczuk B, Prusik M, Ziółkowska N, Zielonka Ł, Gajęcki M, Gajęcka M

Abstract
Immature gilts were administered per os with zearalenone (ZEN) at 40 μg/kg BW (group Z, n = 9), deoxynivalenol (DON) at 12 μg/kg BW (group D, n = 9), a mixture of ZEN and DON (group M, n = 9) or a placebo (group C, n = 9) over a period of six weeks. The pigs were sacrificed after one, three, or six weeks of the treatment (12 pigs per each time-point). Histological investigations revealed an increase in the mucosal thickness and the crypt depth as well as a decrease in the ratio of the villus height to the crypt depth in groups D and M after six weeks of exposure to the mycotoxins. The number of goblet cells in the villus epithelium was elevated in groups Z and M after one week and in group D after three weeks. The administration of ZEN increased the lymphocyte number in the villus epithelium after 1 week and the plasma cell quantity in the lamina propria after one, three, and six weeks of the experiment. DON treatment resulted in an increase in the lymphocyte number in the villus epithelium and the lamina propria after six weeks, and in the plasma cell quantity in the lamina propria after one, three, and six weeks of exposure. In group M, lymphocyte counts in the epithelium and the lamina propria increased significantly after six weeks. Neither mycotoxin induced significant adverse changes in the ultrastructure of the mucosal epithelium and the lamina propria or in the intestinal barrier permeability. Our results indicate that immune cells are the principal target of low doses of ZEN and DON.

PMID: 26569306 [PubMed - indexed for MEDLINE]

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Exploring the role and diversity of mucins in health and disease with special insight into non-communicable diseases.

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Exploring the role and diversity of mucins in health and disease with special insight into non-communicable diseases.

Glycoconj J. 2015 Nov;32(8):575-613

Authors: Behera SK, Praharaj AB, Dehury B, Negi S

Abstract
Mucins are major glycoprotein components of the mucus that coats the surfaces of cells lining the respiratory, digestive, gastrointestinal and urogenital tracts. They function to protect epithelial cells from infection, dehydration and physical or chemical injury, as well as to aid the passage of materials through a tract i.e., lubrication. They are also implicated in the pathogenesis of benign and malignant diseases of secretory epithelial cells. In Human there are two types of mucins, membrane-bound and secreted that are originated from mucous producing goblet cells localized in the epithelial cell layer or in mucous producing glands and encoded by MUC gene. Mucins belong to a heterogeneous family of high molecular weight proteins composed of a long peptidic chain with a large number of tandem repeats that form the so-called mucin domain. The molecular weight is generally high, ranging between 0.2 and 10 million Dalton and all mucins contain one or more domains which are highly glycosylated. The size and number of repeats vary between mucins and the genetic polymorphism represents number of repeats (VNTR polymorphisms), which means the size of individual mucins can differ substantially between individuals which can be used as markers. In human it is only MUC1 and MUC7 that have mucin domains with less than 40% serine and threonine which in turn could reduce number of PTS domains. Mucins can be considered as powerful two-edged sword, as its normal function protects from unwanted substances and organisms at an arm's length while, malfunction of mucus may be an important factor in human diseases. In this review we have unearthed the current status of different mucin proteins in understanding its role and function in various non-communicable diseases in human with special reference to its organ specific locations. The findings described in this review may be of direct relevance to the major research area in biomedicine with reference to mucin and mucin associated diseases.

PMID: 26239922 [PubMed - indexed for MEDLINE]

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Severe Sore Throat Caused by Impacted Laryngeal Foreign Body.

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Severe Sore Throat Caused by Impacted Laryngeal Foreign Body.

J Emerg Med. 2015 Nov;49(5):e161-2

Authors: Min HJ, Lee SY, Yang HS, Kim KS

PMID: 26166467 [PubMed - indexed for MEDLINE]

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Recurrent Cranial Chronic Subdural Hematoma due to Cervical Cerebrospinal Fluid Fistula: Repair of Both Entities in the Same Session.

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Recurrent Cranial Chronic Subdural Hematoma due to Cervical Cerebrospinal Fluid Fistula: Repair of Both Entities in the Same Session.

J Craniofac Surg. 2016 Aug 12;

Authors: Akakin A, Yilmaz B, Ekşi MŞ, Özcan-Ekşi EE, Demir MK, Toktaş ZO, Konya D

Abstract
Cranial chronic subdural hematoma (CSH) occurs secondary to trauma or just spontaneously. In this clinical report, the authors presented a 39-year-old male patient who was admitted with cranial CSH. In further assessment of the patient, the authors found an underlying cerebrospinal fluid (CSF) leak at the level of cervical spine. Following evacuation of the CSH, it recurred. In the second session, the hematoma was re-evacuated and the CSF fistula repaired. The CSH did not recur again. In young adult patients with recurrent CSH and prior presence of bilateral CSH, a survey for an underlying spinal CSF leak should be considered in the differential, especially in the background of trauma. Conservative treatment, epidural blood patching, or microsurgical repair of the dural defect should be conceptualized according to the circumstances of the individual patients with spontaneous intracranial hypotension and spinal CSF fistula.

PMID: 27526247 [PubMed - as supplied by publisher]

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Outcome in patient-specific PEEK cranioplasty: A two-center cohort study of 40 implants.

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Outcome in patient-specific PEEK cranioplasty: A two-center cohort study of 40 implants.

J Craniomaxillofac Surg. 2016 Jul 9;

Authors: Jonkergouw J, van de Vijfeijken SE, Nout E, Theys T, Van de Casteele E, Folkersma H, Depauw PR, Becking AG

Abstract
OBJECTIVE: The best material choice for cranioplasty following craniectomy remains a subject to discussion. Complication rates after cranioplasty tend to be high. Computer-assisted 3-dimensional modelling of polyetheretherketone (PEEK) was recently introduced for cranial reconstruction. The aim of this study was to evaluate patient- and surgery-related characteristics and risk factors that predispose patients to cranioplasty complications.
MATERIAL AND METHODS: This retrospective study included a total of 40 cranial PEEK implants in 38 patients, performed at two reference centers in the Netherlands from 2011 to 2014. Complications were registered and patient- and surgery-related data were carefully analysed.
RESULTS: The overall complication rate of PEEK cranioplasty was 28%. Complications included infection (13 %), postoperative haematoma (10 %), cerebrospinal fluid leak (2.5 %) and wound-related problems (2.5 %). All postoperative infections required removal of the implant. Nonetheless removed implants could be successfully re-used after re-sterilization.
CONCLUSION: Although overall complication rates after PEEK cranioplasty remain high, outcomes are satisfactory, as our results compare favourably to recent literature reports on cranial vault reconstruction.

PMID: 27524384 [PubMed - as supplied by publisher]

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Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis.

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Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis.

Craniomaxillofac Trauma Reconstr. 2016 Sep;9(3):219-23

Authors: Johns D, Anstadt E, Donato D, Kestle J, Riva-Cambrin J, Siddiqi F, Gociman B

Abstract
Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014. During this time period, a total of nine children with an average corrected age of 21.4 weeks were treated. Demographics, intraoperative data, and postoperative distraction data were collected. Occipital frontal head circumferences (OFCs) were recorded pre- and postdistraction, and at 3- and 6-month follow-up examinations. All patients had a substantial increase in head circumference with subjective improvement of the posterior calvarium shape. The average increase in OFC from preoperative to postdistraction was 4.9 cm. Only two significant postoperative complications were encountered, one hardware infection and one cerebrospinal fluid leak. PCVD is an effective procedure in the management of complex craniosynostosis and can be safely initiated very early in life.

PMID: 27516836 [PubMed]

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Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear.

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Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear.

Acta Otorrinolaringol Esp. 2016 Aug 8;

Authors: Altuna X, Navarro JJ, García L, Ugarte A, Thomas I

Abstract
INTRODUCTION: Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach.
MATERIAL AND METHODS: We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014).
RESULTS: Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case.
CONCLUSIONS: The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients.

PMID: 27515765 [PubMed - as supplied by publisher]

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Oxidative Damage and Inflammation Biomarkers: Strategy in Hearing Disorders.

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Oxidative Damage and Inflammation Biomarkers: Strategy in Hearing Disorders.

Otol Neurotol. 2016 Sep;37(8):e303-8

Authors: Haase GM, Prasad KN

Abstract
IMPORTANCE: Excess free radical-induced oxidative stress and inflammatory processes are increasingly recognized as causative factors in hearing and balance disorders. Antioxidant micronutrients neutralize free radicals and, at adequate doses, reduce inflammation and demonstrate benefits in animal models and human trials. Therefore, it is reasonable to expect that biomarkers of oxidative damage and inflammation are appropriate correlative biological outcome parameters in clinical hearing intervention studies.
OBJECTIVE: To provide the otology investigator a selected panel of biomarkers from the large universe of available tests that can be used as reasonable secondary endpoints in hearing and balance research.
BACKGROUND SETTING: The tenets of antioxidant science dictate that there are a great variety of free radicals and that they impact different cellular targets. They also demonstrate varying functions in different cellular environments. In addition, oxidative stress and inflammation may cause direct injury to tissues, cell membrane lipids, proteins and mitochondrial, and nuclear DNA. To accommodate these many pathways, the useful categories of potential biomarkers become extensive. The degree of injury is also reflected by separate markers of inflammation and measures of antioxidant levels. Therefore, to provide a reliable indication of oxidative damage, inflammation and antioxidant level, it is necessary to determine a broad spectrum of lipid peroxidation markers, adducts of DNA, oxidation levels of proteins and pro-inflammatory cytokines.
CONCLUSION: This report highlights some of the most clinically relevant and well-studied biomarkers in each category of tissue damage. It also includes those markers with which the authors have had direct positive clinical experience. The outcome from these studies is intended to provide a list of adjunctive measures that can be recommended as a relevant biomarker panel in hearing disorder clinical trials.

PMID: 27518139 [PubMed - in process]

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The gastric H,K-ATPase in stria vascularis contributes to pH regulation of cochlear endolymph but not to K secretion.

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The gastric H,K-ATPase in stria vascularis contributes to pH regulation of cochlear endolymph but not to K secretion.

BMC Physiol. 2016;17(1):1

Authors: Miyazaki H, Wangemann P, Marcus DC

Abstract
BACKGROUND: Disturbance of acid-base balance in the inner ear is known to be associated with hearing loss in a number of conditions including genetic mutations and pharmacologic interventions. Several previous physiologic and immunohistochemical observations lead to proposals of the involvement of acid-base transporters in stria vascularis.
RESULTS: We directly measured acid flux in vitro from the apical side of isolated stria vascularis from adult C57Bl/6 mice with a novel constant-perfusion pH-selective self-referencing probe. Acid efflux that depended on metabolism and ion transport was observed from the apical side of stria vascularis. The acid flux was decreased to about 40 % of control by removal of the metabolic substrate (glucose-free) and by inhibition of the sodium pump (ouabain). The flux was also decreased a) by inhibition of Na,H-exchangers by amiloride, dimethylamiloride (DMA), S3226 and Hoe694, b) by inhibition of Na,2Cl,K-cotransporter (NKCC1) by bumetanide, and c) by the likely inhibition of HCO3/anion exchange by DIDS. By contrast, the acid flux was increased by inhibition of gastric H,K-ATPase (SCH28080) but was not affected by an inhibitor of vH-ATPase (bafilomycin).  K flux from stria vascularis was reduced less than 5 % by SCH28080.
CONCLUSIONS: These observations suggest that stria vascularis may be an important site of control of cochlear acid-base balance and demonstrate a functional role of several acid-base transporters in stria vascularis, including basolateral H,K-ATPase and apical Na,H-exchange. Previous suggestions that H secretion is mediated by an apical vH-ATPase and that basolateral H,K-ATPase contributes importantly to K secretion in stria vascularis are not supported. These results advance our understanding of inner ear acid-base balance and provide a stronger basis to interpret the etiology of genetic and pharmacologic cochlear dysfunctions that are influenced by endolymphatic pH.

PMID: 27515813 [PubMed - in process]

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Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

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Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

J Nanobiotechnology. 2015;13:5

Authors: Zou J, Hannula M, Misra S, Feng H, Labrador RH, Aula AS, Hyttinen J, Pyykkö I

Abstract
BACKGROUND: Silver nanoparticles (Ag NPs) displayed strong activities in anti-bacterial, anti-viral, and anti-fungal studies and were reportedly efficient in treating otitis media. Information on distribution of AgNPs in different compartments of the ear is lacking.
OBJECTIVE: To detect distribution of Ag NPs in the middle and inner ear and transportation pathways after transtympanic injection.
METHODS: Contrast effect of Ag NPs in the micro CT imaging was assessed in a phantom. AgNPs at various concentrations (1.85 mM, 37.1 mM, and 370.7 mM) were administered to rat middle ear using transtympanic injection and cadaver heads were imaged using micro CT at several time points.
RESULTS: The lowest concentration of Ag NPs that could be visualized using micro CT was 37.1 mM. No difference was observed between the solvents, deionized H2O and saline. Ag NPs at 37.1 mM were visible in the middle ear on 7 d post-administration. Ag NPs at 370.7 mM generated signals in the middle ear, ossicular chain, round window membrane, oval window, scala tympani, and Eustachian tube for both 4 h and 24 h time points. A gradient distribution of Ag NPs from the middle ear to the inner ear was detected. The pathways for Ag NPs to be transported from the middle ear into the inner ear are round and oval windows.
CONCLUSION: This study provided the imaging evidence that Ag NPs are able to access the inner ear in a dose-dependent manner after intratympanic administration, which is relevant to design the delivery concentration in the future clinic application in order to avoid adverse inner ear effect.

PMID: 25622551 [PubMed - indexed for MEDLINE]

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Tumor progression driven by pathways activating matrix metalloproteinases and their inhibitors.

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Tumor progression driven by pathways activating matrix metalloproteinases and their inhibitors.

J Oral Pathol Med. 2015 Jul;44(6):437-43

Authors: Bodnar M, Szylberg Ł, Kazmierczak W, Marszalek A

Abstract
BACKGROUND: Laryngeal squamous cell carcinoma (LSCC) is still a problem worldwide. In some publications interactions between the expression of matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, and their tissue inhibitors (TIMPs) implicated during cancer progression were suggested.
METHODS: The immunohistochemical staining using primary antibody against MMP-2, MMP-9, TIMP-1, TIMP-2, and TIMP-3 were performed. The research group consists of primary N(0) LSCC (20 cases), primary N(+) LSCC (17 cases), and 18 cases of normal mucosa.
RESULTS: Studied MMPs and TIMPs were localized in tumor cells and tumor stroma compartment. MMP-2 expression was higher in stroma compared to tumor cells. MMP-9, TIMP-1, TIMP-2, and TIMP-3 expression was higher in tumor cells than in tumor stroma (P < 0.05). In tumor stroma MMP-2, MMP-9, TIMP-1, and TIMP-3 expression, in LSCC N(0) vs. LSCC N(+) was significantly higher (P < 0.05). The ratios between MMP-2 and TIMP-3 expression were statistically significant (N(0) vs. N(+); P = 0.012). The analyses using classification trees predicted the probability of metastases according to TIMP-3/MMP-14/MMP-2 and MMP-9/TIMP-1 expression levels.
CONCLUSIONS: The presence of MMP-2, MMP-9, TIMP-1, TIMP-2, TIMP-3 expression in tumor cells and in tumor stroma, and additionally different expression according to lymph node involvement suggested of their impact during cancer progression. The significant correlation between TIMP-3 expression and the presence of lymph node metastases and MMP-2 expression might suggest the importance of TIMP-3 as a prognostic factor during tumor progression. The evaluation of molecular markers which participate in MMP-2 activation pathway have a major impact during metastasis.

PMID: 25244188 [PubMed - indexed for MEDLINE]

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Pseudo-low Frequency Hearing Loss and Its Improvement After Treatment May Be Objective Signs of Significant Vascular Pathology in Patients With Pulsatile Tinnitus.

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Pseudo-low Frequency Hearing Loss and Its Improvement After Treatment May Be Objective Signs of Significant Vascular Pathology in Patients With Pulsatile Tinnitus.

Otol Neurotol. 2016 Aug 12;

Authors: Jeon HW, Kim SY, Choi BS, Bae YJ, Koo JW, Song JJ

Abstract
OBJECTIVE: In patients with pulsatile tinnitus (PT), physical examination such as auscultation with head position change or digital compression over the ipsilateral jugular vein provides physicians with important information. However, objective diagnosis of PT is sometimes limited because 1) audible bruit is absent on auscultation in some patients, 2) abnormal vascular structures found in radiologic evaluation is not always pathognomonic because they can be found in asymptomatic subjects as well, and 3) although an objective diagnostic tool using transcanal sound recording has recently been introduced, special equipment is needed. In this regard, recent studies that have reported ipsilateral low-frequency hearing loss (LFHL) on pure-tone audiometry (PTA) in some patients with PT, and its recovery after successful management, prompted us to conduct a retrospective observational study on the characteristics of the audiometric profile, the association between the audiometric profile and radiologic findings, and pre- and posttreatment changes in low-frequency hearing thresholds in PT patients. We tested two hypotheses: PT patients with marked vascular pathologies located close to the cochlea may show ipsilateral pseudo-LFHL (PLFHL) because of the masking effects of the PT itself, and their PLFHL may disappear if their vascular pathology is successfully managed by surgical or endovascular intervention.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary referral center.
PATIENTS: A total of 85 PT subjects who underwent both audiologic and radiologic examinations.
MAIN OUTCOME MEASURE: All patients' pre- and posttreatment PTA thresholds and radiologic findings were analyzed. By comparing the LFHL (an ipsilateral hearing threshold greater than 10 dB HL at both 250 and 500 Hz or greater than 20 dB HL at either 250 or 500 Hz compared with the contralateral side) group and a non-LFHL group with regard to the incidence of vascular structural abnormalities, we evaluated the incidence of abnormal vascular structures in the head and neck between the LFHL and non-LFHL groups. In addition, by comparing pre- and posttreatment PTA thresholds of seven PT patients with ipsilateral LFHL, we further evaluated the changes in low-frequency hearing thresholds and their role as an objective sign for diagnosis and outcome evaluation.
RESULTS: Of 85 patients, 22 (25.9%) presented with ipsilateral LFHL. Compared with patients without this condition, patients with ipsilateral LFHL showed a significantly higher rate of abnormal vascular structure. In addition, most of the radiologic abnormalities found in the LFHL group were highly suspicious causative lesions that are responsible for the perception of PT according to the previous literature. In eight PT patients with ipsilateral LFHL who underwent both pre- and posttreatment audiograms, the average posttreatment pure-tone threshold at 250 Hz showed significant improvement compared with the pretreatment threshold.
CONCLUSION: PT patients presenting with ipsilateral LFHL have higher possibility of having a discrete vascular pathology near the cochlea on radiologic evaluation. As ipsilateral LFHL improves in most patients after treatment, LFHL in patients with PT may be PLFHL because of the masking effects of the pulsatile sound, and the changes in the low-frequency thresholds may be applicable for objective diagnosis and evaluation of the effects of the treatment.

PMID: 27525714 [PubMed - as supplied by publisher]

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Associations between long-term serum platinum and neurotoxicity and ototoxicity, endocrine gonadal function, and cardiovascular disease in testicular cancer survivors.

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Associations between long-term serum platinum and neurotoxicity and ototoxicity, endocrine gonadal function, and cardiovascular disease in testicular cancer survivors.

Urol Oncol. 2016 Aug 11;

Authors: Hjelle LV, Bremnes RM, Gundersen PO, Sprauten M, Brydøy M, Tandstad T, Wilsgaard T, Fosså SD, Oldenburg J, Haugnes HS

Abstract
OBJECTIVE: To evaluate the associations between long-term serum levels of platinum (se-Pt) and neurotoxicity and ototoxicity (NTX), endocrine gonadal function (endocrine-GF), and cardiovascular disease (CVD) in testicular cancer survivors.
MATERIAL AND METHODS: A total of 292 cisplatin-treated testicular cancer survivors (1980-1994) participated in a national follow-up study (2007-2008). Se-Pt was quantified by inductively coupled plasma mass spectrometry, and categorized in quartiles. Symptoms of NTX were assessed with scale for chemotherapy-induced neurotoxicity (SCIN), with each symptom in 4 categories and total SCIN score categorized in quartiles. Endocrine-GF was categorized according to cutoff values for the 25, 50, and 75 percentiles of luteinizing hormone (LH) and testosterone within each decadal age group established from a control group. CVD was defined as ischemic heart disease, stroke, or artery occlusion. Associations between se-Pt levels and NTX, endocrine-GF, or risk for CVD, were analyzed with ordinal logistic regression and Cox regression, respectively.
RESULTS: Median follow-up was 19 years (range: 13-28). In ordinal regression analyses, increasing quartiles of se-Pt were significantly associated with increasing quartiles of SCIN (P for trend = 0.05), increased tinnitus (P<0.001), and increased hearing impairment (P = 0.04). The association remained significant for tinnitus when adjusting for cisplatin dose. Increasing LH quartiles was associated with increasing se-Pt quartiles (P = 0.04). No association between se-Pt in quartiles and CVD was established.
CONCLUSION: Median 19 years after treatment, increasing quartiles of se-Pt are associated with increasing SCIN score, tinnitus, hearing impairment, and increasing LH levels. However, these associations remained significant only for tinnitus and LH when adjusting for administered cisplatin dose.

PMID: 27523611 [PubMed - as supplied by publisher]

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"Measurement" of Tinnitus.

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"Measurement" of Tinnitus.

Otol Neurotol. 2016 Sep;37(8):e276-85

Authors: Henry JA

Abstract
Chronic tinnitus is the persistent sensation of hearing a sound that exists only inside the head. The prevalence of tinnitus in adults in the United States is estimated at 10 to 15%. For about 20% of these individuals the tinnitus is significantly bothersome. Although myriad therapies for tinnitus are offered (often at significant cost), most are not evidence based. Difficulty in the assessment and further development of interventions for tinnitus stems from the limitations of techniques used to evaluate these interventions. Questionnaires are widely available to "measure" (tinnitus can only be indirectly measured) functional effects of tinnitus, such as difficulty sleeping and concentrating, and negative emotions such as anxiety, depression, and annoyance. Questionnaires have recently been documented for sensitivity to change in response to intervention (i.e., "responsiveness"). All of these questionnaires function well to assess the overall impact of tinnitus. The limitations mentioned pertain primarily to measures of tinnitus perception, which typically include the psychoacoustic measures of tinnitus loudness and pitch matches, tinnitus spectral content, minimum masking levels, and residual inhibition. These measures, which are obtained routinely in many clinics and as part of research studies, have not been validated for being diagnostic, prognostic, discriminative, or responsive. In order for these measures to become clinically meaningful, normative standards are needed, both for baseline measures and for repeated measures of tinnitus perception. Evidence-based intervention for tinnitus requires accurately measuring both the perception of, and reactions to, tinnitus.

PMID: 27518136 [PubMed - in process]

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Temporary and Permanent Noise-induced Threshold Shifts: A Review of Basic and Clinical Observations.

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Temporary and Permanent Noise-induced Threshold Shifts: A Review of Basic and Clinical Observations.

Otol Neurotol. 2016 Sep;37(8):e271-5

Authors: Ryan AF, Kujawa SG, Hammill T, Le Prell C, Kil J

Abstract
OBJECTIVE: To review basic and clinical findings relevant to defining temporary (TTS) and permanent (PTS) threshold shifts and their sequelae.
DATA SOURCES: Relevant scientific literature and government definitions were broadly reviewed.
DATA SYNTHESIS: The definitions and characteristics of TTS and PTS were assessed and recent advances that expand our knowledge of the extent, nature, and consequences of noise-induced hearing loss were reviewed.
CONCLUSION: Exposure to intense sound can produce TTS, acute changes in hearing sensitivity that recover over time, or PTS, a loss that does not recover to preexposure levels. In general, a threshold shift ≥10 dB at 2, 3, and 4 kHz is required for reporting purposes in human studies. The high-frequency regions of the cochlea are most sensitive to noise damage. Resonance of the ear canal also results in a frequency region of high-noise sensitivity at 4 to 6 kHz. A primary noise target is the cochlear hair cell. Although the mechanisms that underlie such hair cell damage remain unclear, there is evidence to support a role for reactive oxygen species, stress pathway signaling, and apoptosis. Another target is the synapse between the hair cell and the primary afferent neurons. Large numbers of these synapses and their neurons can be lost after noise, even though hearing thresholds may return to normal. This affects auditory processing and detection of signals in noise. The consequences of TTS and PTS include significant deficits in communication that can impact performance of military duties or obtaining/retaining civilian employment. Tinnitus and exacerbation of posttraumatic stress disorder are also potential sequelae.

PMID: 27518135 [PubMed - in process]

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Reliability and validity of the Lithuanian Tinnitus Handicap Inventory.

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Reliability and validity of the Lithuanian Tinnitus Handicap Inventory.

Medicina (Kaunas). 2016 Jul 22;

Authors: Ulozienė I, Balnytė R, Alzbutienė G, Arechvo I, Vaitkus A, Šileikaitė M, Šaferis V, Ulozas V

Abstract
OBJECTIVE: The aim of this study was to determine the reliability and validity of the Lithuanian version of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap.
MATERIALS AND METHODS: A cross-sectional psychometric validation study was performed in the University Hospital. A total of 248 subjects reporting chronic tinnitus as their primary complaint or secondary to hearing loss were encluded in the study and filled in the Lithuanian version of THI. For assessment of construct validity a subgroup of 55 participants completed the Lithuanian version of the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. Test-retest and internal consistency reliability as well as construct validity were calculated.
RESULTS: The Lithuanian version of the THI and its subscales showed a robust internal consistency reliability (Cronbach's alpha=0.93) comparable to the original version. Statistically significant correlations were observed between the Lithuanian translation of the THI and the measures of self-perceived levels of anxiety and depression using HADS. Confirmatory factor analysis demonstrated that the three subscales of the THI Lithuanian version corresponded to three different factors, which strongly correlated between themselves.
CONCLUSIONS: The results suggest that the Lithuanian version of THI maintains its original validity and may serve as reliable and valid measure of general tinnitus related distress that can be used in a clinical setting to quantify the impact of tinnitus on daily living.

PMID: 27515834 [PubMed - as supplied by publisher]

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Evaluation of 5536 patients treated in an integrative outpatient tinnitus treatment center-immediate effects and a modeling approach for sustainability.

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Evaluation of 5536 patients treated in an integrative outpatient tinnitus treatment center-immediate effects and a modeling approach for sustainability.

BMC Health Serv Res. 2016;16(a):377

Authors: Ostermann T, Boehm K, Kusatz M

Abstract
BACKGROUND: Tinnitus is an increasingly serious problem for health care systems. According to epidemiological data, 7-14 % of outpatients have asked their physician about tinnitus and management strategies. Integrative outpatient treatments are currently regarded as promising therapeutic approaches for managing tinnitus. In this article we report on the treatment success of an outpatient tinnitus treatment center in Germany.
METHODS: This cohort study included pre-post data of 5536 outpatients which were treated between 2003 and 2010 in the tinnitus-therapy center, Krefeld-Düsseldorf (TTZ). The intervention consisted of psychological immunization training as well as an auditory stimulation therapy component. The main outcome parameter was the score of the Tinnitus Questionnaire (TQ) which was assessed before and after a 9 days treatment and (in a small subsample) at a 6 months follow-up. Missing data were multiply imputed. Pre-post effect sizes were calculated and adjusted for regression to the mean (RTM).
RESULTS: RTM-adjusted treatment effects at the end of treatment were estimated as -18.6 (CI: -18.9 to 18.2, p < 0.001) score points which corresponds to a standardized effect of d = -1.03 (CI: -1.05 to -1.01). These effects can be corroborated in various subgroups and all subscales of the TQ (d ranging from -0.31 to -0.97).
CONCLUSION: The study suggests the effectiveness of this outpatient tinnitus therapy concept. Multiple imputations techniques and RTM analysis were helpful in carving out true treatment effects.

PMID: 27515471 [PubMed - in process]

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Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center.

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Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center.

Eur Arch Otorhinolaryngol. 2016 Aug 13;

Authors: Reinhard A, Gorostidi F, Leishman C, Monnier P, Sandu K

Abstract
To review the outcomes of laser supraglottoplasty performed in children with symptomatic laryngomalacia and determine the factors influencing them. We retrospectively reviewed the medical records of patients who underwent laser supraglottoplasty for symptomatic laryngomalacia at the Lausanne University Hospital from November 2001 to November 2014. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes. Seventy-nine patients were included in this study; median age at the time of surgery was 12.7 months. 55.7 % of the cases had comorbidities, 22.8 % of the patients were premature and synchronous airway lesions were present in 32.9 % of the cases. The different morphological types of laryngomalacia (I-III) were seen in 26.6, 62 and 11.4 % of the patients, respectively. Overall, operation specific success rate of laser supraglottoplasty was 86.1 %. Failures in 11 (13.9 %) of the 79 cases required 15 revision procedures. Success rates for patients with associated comorbidities, synchronous airway lesions, neurological disorders and prematurity were 81.8, 76.9, 69.2 and 66.7 %, respectively. Patients with type III laryngomalacia had a limited success rate (66.7 %) as compared to patients with morphological types I and II (90.5 and 87.8 %, respectively). Laser supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia. Patients with prematurity, type III LM, synchronous airway lesions and associated comorbidities are predisposed to surgical failure.

PMID: 27522662 [PubMed - as supplied by publisher]

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The role of IL-25 and IL-33 in chronic rhinosinusitis with or without nasal polyps.

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The role of IL-25 and IL-33 in chronic rhinosinusitis with or without nasal polyps.

Eur Arch Otorhinolaryngol. 2016 Aug 13;

Authors: Ozturan A, Eyigor H, Eyigor M, Osma U, Yilmaz MD, Selcuk OT, Renda L, Gultekin M

Abstract
The role of IL-25 and IL-33 in the aetiology and pathogenesis of nasal polyps has been controversial in the literature. The objective of the study is to detect serum and tissue levels of IL-25 and IL-33 in patients with (CRSwNP) or without (CRSsNP) nasal polyps using enzyme-linked immunosorbent assay (ELISA). Study group consisted of 20 CRSwNP and 20 CRSsNP patients. Control group comprised of 20 volunteers who had been operated with septum deviation without any additional sinonasal pathology, allergy, systemic disease, or medication use. All groups preoperatively underwent paranasal CT examinations and sinonasal pathologies were recorded based on Lund-Mackay radiological staging system. IL-25 and IL-33 levels in serum and tissue samples were analyzed using the ELISA method. Serum IL-25 and IL-33 levels in CRSsNP, CRSwNP, and control groups did not differ statistically significantly (p = 0.345 and p = 0.338). Any statistically significant difference was not detected in mean tissue IL-25 levels among CRSsNP, CRSwNP, and control groups (p = 0.698). Mean tissue IL-33 level in the CRSwNP group was statistically significantly lower when compared with those of CRSsNP and control groups (p < 0.001 and p < 0.001, respectively). A statistically significant negative correlation was detected between tissue IL-33 levels and Lund-Mackay CT scores (r = -0.436 and p = 0.005). In the present study, we conceivably contributed to scarce number of studies conducted on this issue and we think that further studies will better clarify the role of IL-25 and IL-33 in the development of nasal polyps.

PMID: 27522661 [PubMed - as supplied by publisher]

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Pleomorphic adenomas of the salivary glands: retrospective multicentric study of 130 cases with emphasis on histopathological features.

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Pleomorphic adenomas of the salivary glands: retrospective multicentric study of 130 cases with emphasis on histopathological features.

Eur Arch Otorhinolaryngol. 2016 Aug 12;

Authors: Lopes ML, Barroso KM, Henriques ÁC, Dos Santos JN, Martins MD, de Souza LB

Abstract
Pleomorphic adenoma (PA) is the most frequent benign epithelial lesion of salivary gland origin, showing great histopathological diversity. The aim of this study was to perform a retrospective analysis, with emphasis on histopathologic features of PA of salivary glands. Clinical and histopathologic characteristics of 130 cases of minor and major salivary glands PAs from three Brazilian reference centers were studied. Higher frequency of PAs was observed in female (55.4 %) subjects, with mean age of 49.7 years. The most common affected site was palate (64.5 %) for the PAs of minor salivary glands and parotid for cases affecting major glands (86.2 %). Microscopically, most cases were classified as classic PAs (50 %). Incomplete capsule was observed in 36.2 % of the cases, while 47.2 % showed capsular infiltration. Rounded (66.9 %), angular (49.2 %), oval (46.2 %) and plasmacytoid (39.2 %) cells were widely observed, as well as fibrous (73.8 %) and myxoid (69.2 %) stroma, squamous metaplasia (25.4 %) and cystic degeneration (43.1 %). Crystalloids (3.1 %), increased mitotic activity (5.4 %) and vascular invasion (2.3 %) were rarely observed. PAs arising in minor salivary glands were associated with incomplete capsules, spindle, oval, angular, plasmacytoid and pleomorphic cells, fibrous and hyaline stroma, cystic degeneration, squamous metaplasia and pleomorphism (p < 0.05). No association between capsular features and histological subtype was noted (p ≥ 0.05). These results confirm the findings of previous studies regarding major clinicopathological features of pleomorphic adenomas; and highlighted some important morphologic characteristics like the capsule, vascular invasion, pleomorphism and increased mitotic activity, which can reflect the biological behavior of these tumors.

PMID: 27520570 [PubMed - as supplied by publisher]

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The predictive value of MRI in detecting thyroid gland invasion in patients with advanced laryngeal or hypopharyngeal carcinoma.

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The predictive value of MRI in detecting thyroid gland invasion in patients with advanced laryngeal or hypopharyngeal carcinoma.

Eur Arch Otorhinolaryngol. 2016 Aug 12;

Authors: Lin P, Huang X, Zheng C, Cai Q, Guan Z, Liang F, Zheng Y

Abstract
The aim of this study was to evaluate the predictive value of magnetic resonance imaging (MRI) in detecting thyroid gland invasion (TGI) in patients with advanced laryngeal or hypopharyngeal carcinoma. In a retrospective chart review, 41 patients with advanced laryngeal or hypopharyngeal carcinoma underwent MRI scan before total laryngectomy and ipsilateral or bilateral thyroidectomy during the past 5 years. The MRI findings were compared with the postoperative pathological results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Among the 41 patients, 3 had thyroid gland invasion in postoperative pathological results. MRI correctly predicted the absence of TGI in 37 of 38 patients and TGI in all 3 patients. The sensitivity, specificity, PPV, and NPV of MRI were 100.0, 97.4, 75.0, and 100 %, respectively, with the diagnostic accuracy of 97.6 %. In consideration of the high negative predictive value of MRI, it may help surgeons selectively preserve thyroid gland in total laryngectomy and reduce the incidence of hypothyroidism and hypoparathyroidism postoperatively.

PMID: 27520569 [PubMed - as supplied by publisher]

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A preliminary report on the role of endoscopic endonasal nasopharyngectomy in recurrent rT3 and rT4 nasopharyngeal carcinoma.

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A preliminary report on the role of endoscopic endonasal nasopharyngectomy in recurrent rT3 and rT4 nasopharyngeal carcinoma.

Eur Arch Otorhinolaryngol. 2016 Aug 12;

Authors: Wong EH, Liew YT, Abu Bakar MZ, Lim EY, Prepageran N

Abstract
Endoscopic endonasal nasopharyngectomy (EEN) has become increasingly used for recurrent nasopharyngeal carcinoma (rNPC) due to reduced functional and cosmetic morbidities compared to conventional external approach. Majority of the existing studies on EEN focused on patients with lower recurrent staging of rT1 and rT2. The aims of this study were to provide a preliminary report on the outcome of EEN performed in patients with advanced (rT3 and rT4) rNPC, and to determine the prognostic factors for patients' survival. All patients who underwent EEN for rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah, by a single surgeon. We reported the 2-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Fifteen patients with recurrent NPC (2 rT3 and 13 rT4 tumours) underwent EEN over the 13 years period. The mean age was 50.4 years (range 30-65) and the mean follow-up period was 28.7 months (range 9-81 weeks). The 2-year OS, DFS and DSS were 66.7 % (mean 19.4 months), 40 % (mean 15.7 months) and 73.3 % (mean 20.2 months), respectively. No severe operative complications were encountered. No independent prognostic factors for survival outcome were identified. This is the first preliminary report in English that exclusively looked at the use of EEN in advanced rT3 and rT4 NPCs, showing favourable patient outcome. However, further long-term follow-up of patients is required.

PMID: 27520568 [PubMed - as supplied by publisher]

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The pre-treatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and red cell distribution width predict prognosis in patients with laryngeal carcinoma.

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The pre-treatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and red cell distribution width predict prognosis in patients with laryngeal carcinoma.

Eur Arch Otorhinolaryngol. 2016 Aug 12;

Authors: Kara M, Uysal S, Altinişik U, Cevizci S, Güçlü O, Dereköy FS

Abstract
The aim of this study was to identify the potential prognostic roles of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) in patients with laryngeal squamous cell carcinoma (LSCC). 81 patients who underwent surgery for the larynx carcinoma were enrolled in the study. NLR, PLR and RDW were used as outcome measures. Local recurrence was detected in 30 (37.0 %) patients and neck lymph node metastasis was detected 6 (7.4 %) patients during follow-up period. Mortality was seen in 7 (8.6 %) patients. The mean PLR in the T1 and T2 stage tumors were significantly lower than the T4 stage. The mean RDW and PLR were significantly higher in the exitus group than the survivor group. The mean NLR in the patients with local recurrence was significantly higher than the non-recurrent patients. Progression-free survival (PFS) was lower in patients with high NLR. When analyzed by the Cox regression analysis of factors affecting the local recurrence, NLR was found to significantly affect the recurrence. According to ROC analysis for mortality, NLR was not found to be a prognostic factor, although the PLR and RDW were significant prognostic factors. According to Cox regression analysis, a high PLR increases mortality 4.2 times and a high RDW 4.6 times. Although in univariate analysis MCV, RDW and tumor grade were predictors of mortality, RDW and tumor grade independent predictors were found. Further studies involving large patient groups are required.

PMID: 27520567 [PubMed - as supplied by publisher]

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A novel myringoplasty technique: the placement of a complementary graft descending from the scutum to support an anterosuperior perforation.

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A novel myringoplasty technique: the placement of a complementary graft descending from the scutum to support an anterosuperior perforation.

Eur Arch Otorhinolaryngol. 2016 Aug 11;

Authors: Sakalli E, Celikyurt C, Biskin S, Erdurak SC

Abstract
We describe a novel myringoplasty procedure. We placed a separated fascia graft descending from the scutum, combined with underlay myringoplasty, to support an anterosuperior perforation. We reviewed data from patients who underwent myringoplasty procedures to treat perforations extending into the anterosuperior quadrant of the pars tensa from October 2012 to June 2014. A total of 42 patients who were followed for a minimum of 1 year were enrolled. The same technique was used in all operations. The tympanomeatal flap was elevated from the neck of malleus up to the tip of the lateral process of malleus. The anterior mallear fold was incised to create an opening running from the neck of the malleus to the anterior tympanic spine. A separate temporal fascia graft (complementary graft) was next inserted through the opening and pushed down into the protympanum. The upper part of the fascia graft was placed over the superior bony wall of the canal. Underlay myringoplasty was then performed. The inferior part of the fascia graft was next spread out to cover the lateral surface of the underlying graft. We measured graft take rate and preoperative and postoperative hearing parameters. The graft success rate was 97.7 % (41/42 patients). The preoperative air-bone gap was 22.56 ± 18.12 dB, and the postoperative air-bone gap was 8.4 ± 10.05 dB. This difference was statistically significant (P < 0.001). We believe that this myringoplasty technique is a safe, suitable, and effective for cases with tympanic membrane perforations extending into the anterosuperior quadrant of the pars tensa.

PMID: 27515708 [PubMed - as supplied by publisher]

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Genetic polymorphism of antioxidant enzymes in eosinophilic and non-eosinophilic nasal polyposis.

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Genetic polymorphism of antioxidant enzymes in eosinophilic and non-eosinophilic nasal polyposis.

Eur Arch Otorhinolaryngol. 2016 Aug 11;

Authors: Akyigit A, Keles E, Etem EO, Ozercan I, Akyol H, Sakallioglu O, Karlidag T, Polat C, Kaygusuz I, Yalcin S

Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the paranasal sinuses, and its pathophysiology is not yet precisely known. It is suggested that oxygen free radicals play an important role in the pathogenesis of nasal polyposis. This study aimed to identify genetic polymorphisms of superoxide dismutase (SOD 2), catalase (CAT), and inducible nitric oxide synthase (iNOS) enzymes in eosinophilic CRSwNP and non-eosinophilic CRSwNP patients; the study also aimed to evaluate the effect of genetic polymorphism of antioxidant enzymes on CRSwNP etiopathogenesis. One hundred thirty patients, who received endoscopic sinus surgery due to CRSwNP, and 188 control individuals were included in this study. Nasal polyp tissues were divided into two groups histopathologically as eosinophilic CRSwNP and non-eosinophilic CRSwNP. Venous blood samples were taken from the patient and control groups. Polymorphisms in the Ala16Va1 gene, which is the most common variation of SOD-2 gene, and 21 A/T polymorphisms in catalase gene were evaluated with the restriction fragment length polymorphism method and -277 C/T polymorphism in the iNOS gene was evaluated with the DNA sequencing method. The GG genotype distribution for the (-277) A/G polymorphism in the iNOS gene was a statistically significant difference between eosinophilic CRSwNP and control groups (p < 0.05). The CC genotype distribution for the SOD2 A16V (C/T) polymorphism was not statistically significant in all groups (p > 0.05). The TT genotype distribution for the A/T polymorphism in catalase gene at position -21 was statistically significant differences in eosinophilic CRSwNP and control groups (p < 0.05). Increased free oxygen radical levels, which are considered effective factors in the pathogenesis of CRSwNP, can occur due to genetic polymorphism of enzymes in the antioxidant system and genetic polymorphism of antioxidant enzymes in eosinophilic CRSwNP patients might contribute to the pathophysiology.

PMID: 27515707 [PubMed - as supplied by publisher]

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Multicenter surgical experience evaluation on the Mid-Scala electrode and insertion tools.

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Multicenter surgical experience evaluation on the Mid-Scala electrode and insertion tools.

Eur Arch Otorhinolaryngol. 2016 Aug 11;

Authors: Gazibegovic D, Bero EM

Abstract
The HiFocus Mid-Scala electrode is intended to improve hearing for individuals with severe-to-profound hearing loss by providing extended electrical coverage of the cochlea while minimizing trauma related to insertion. The electrode is appropriate for use with a wide range of surgical techniques, including either a cochleostomy or round window insertion, and the use of either a free-hand or tool-assisted approach. The objective of this survey was to evaluate how the HiFocus Mid-Scala electrode and insertion tools was used across a population of cochlear implant recipients of differing ages, audiologic profiles, and anatomical characteristics. The intent was to understand the type and frequency of surgical techniques applicable with the electrode, and to provide guidelines for clinical practice. Two questionnaires were completed by surgeons at implant centres located in the United States, Europe, and Asia. Before any surgeries were conducted, surgeons completed a questionnaire that assessed their overall cochlear implant surgical practice and preferences. Following each HiFocus Mid-Scala electrode insertion, surgeons completed a questionnaire that summarized their experience during that surgical procedure. Questionnaires were completed by 32 surgeons from 16 centres for a total of 143 surgeries (112 adults, 31 children). Most surgeons (62 %) preferred to insert the electrode via the round window or an extended round window compared with a cochleostomy (16 %), whereas the remaining 22 % indicated that they made an insertion choice based on presenting anatomy. Sixty-nine percent preferred a free-hand approach over using insertion tools. In 32 procedures, surgeons elected to deviate from an intended round window insertion to either an extended round window or cochleostomy approach.

PMID: 27515706 [PubMed - as supplied by publisher]

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The role of narrow-band imaging (NBI) endoscopy in optical biopsy of vocal cord leukoplakia.

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The role of narrow-band imaging (NBI) endoscopy in optical biopsy of vocal cord leukoplakia.

Eur Arch Otorhinolaryngol. 2016 Aug 11;

Authors: Staníková L, Šatanková J, Kučová H, Walderová R, Zeleník K, Komínek P

Abstract
The aim of this study was to investigate whether observing microvascular changes by narrow-band imaging (NBI) endoscopy in the area surrounding leukoplakia is sufficient for discriminating between benign and malignant patterns of vocal cord leukoplakia. A total of 282 patients were investigated using white-light high-definition TV laryngoscopy and NBI endoscopy from 6/2013 to 8/2015, and 63 patients with a primary case of laryngeal leukoplakia were enrolled. Patients were divided into two groups based on leukoplakia with surrounding malignant intraepithelial papillary capillary loops (group I; 26/63) and leukoplakia with a surrounding benign vascular network (group II; 37/63), both by NBI endoscopy. All 63 patients were evaluated by blinded histological examination, and results were compared with NBI optical biopsy. Carcinoma in situ or invasive squamous cell carcinoma was confirmed in 22/26 cases (84.6 %) in group I. Hyperkeratosis or low-grade dysplasia was confirmed histologically in 31/37 (83.8 %) and squamous cell carcinoma in 2/37 (5.4 %) cases in group II. Accordance of NBI endoscopy and histopathological features of vocal cord leukoplakia lesions was statistically significant (kappa index 0.77, p < 0.001), with a sensitivity of 88.0 % (95 % CI 67.8-97.5 %) and specificity of 89.5 % (95 % CI 71.2-97.1 %). NBI is convenient for improving evaluation of laryngeal leukoplakias based on optic prehistological diagnosis. The close accordance between NBI features and histological results suggests that a negative NBI endoscopy may be an indication for long-term endoscopy follow-up without histological evaluation.

PMID: 27515705 [PubMed - as supplied by publisher]

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Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy.

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Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy.

Clin Exp Otorhinolaryngol. 2016 Aug 13;

Authors: Ji YB, Song CM, Sung ES, Jeong JH, Lee CB, Tae K

Abstract
Objectives: To prevent hypoparathyroidism after thyroidectomy, preservation of the parathyroid glands and their vascularity are essential. The aim of this study was to determine the association between postoperative parathyroid function and the viability of the parathyroid glands during thyroidectomy.
Methods: We prospectively analyzed 111 patients who underwent total thyroidectomy and in whom all 4 parathyroid glands were preserved in situ during the operation. The surgeons scored the viability of each parathyroid gland from 0 (normal) to 3 (severely compromised viability) based on its gross appearance and vascularity intraoperatively. The index of parathyroid viability score (IPVS) was defined as the sum of the viability scores of the 4 parathyroid glands. We evaluated the relationship between postoperative parathyroid function and IPVS.
Results: Transient hypoparathyroidism occurred in 25 patients (22.5%), and permanent hypoparathyroidism in 4 patients (3.6%). The IPVS were significantly different in the three groups: 2.87±1.46 in the normal group, 3.68±1.41 in the transient hypoparathyroidism group and 7.50±1.00 in the permanent hypoparathyroidism group. The rates of transient hypoparathyroidism were 13.6% in patients with IPVS 0-2, 23.8% in patients with IPVS 3-4, and 42.9% in patients with IPVS 5-6. All the patients with IPVS of 7 or more had permanent hypoparathyroidism.
Conclusion: IPVS is correlated with the incidence of hypoparathyroidism. It could be a good quantitative indicator of the probability of hypoparathyroidism after thyroidectomy.

PMID: 27515510 [PubMed - as supplied by publisher]

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Is pharyngeal pouch stapling superior to open pharyngeal pouch repair? An analysis of a single institution's series.

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Is pharyngeal pouch stapling superior to open pharyngeal pouch repair? An analysis of a single institution's series.

J Laryngol Otol. 2016 Aug 12;:1-5

Authors: Agalato E, Jose J, England RJ

Abstract
BACKGROUND: Endoscopic stapling has become the primary procedure for pharyngeal pouch surgery because it is quick, less invasive and safe, but less is known about long-term outcomes.
METHOD: Medical records were reviewed to compare rates of morbidity, operative failure, symptom control and revision surgery between open and closed procedures.
RESULTS: A total of 120 pharyngeal pouch procedures, carried out on 97 patients from 2000 to 2014, were studied. These included 80 endoscopic stapling and 40 open procedures. Twelve patients had complications (15 per cent) and there was one mortality (1.2 per cent) in the endoscopic stapling group. Ten patients (25 per cent) developed complications in the open procedure group, with no mortalities. Symptom recurrence was significantly greater in the endoscopic stapling group (26 per cent) than in the open procedure group (7.5 per cent). Multiple surgical procedures were required for 22 endoscopically stapled patients (32 per cent); none were required in the open procedure group. Although the male-to-female ratio for pharyngeal pouch incidence was 2:1, the ratio for multiple surgical procedures was 10:1.
CONCLUSION: Endoscopic stapling outcomes are not as good as those following an open approach on long-term follow up, and the early advantages are eliminated if pouch excision is avoided.

PMID: 27515737 [PubMed - as supplied by publisher]

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Polydimethylsiloxane elastomer injection in the management of the patulous eustachian tube.

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Polydimethylsiloxane elastomer injection in the management of the patulous eustachian tube.

J Laryngol Otol. 2016 Aug 12;:1-6

Authors: Mackeith SA, Bottrill ID

Abstract
OBJECTIVE: To determine the effectiveness of augmentation surgery using polydimethylsiloxane elastomer injection for the management of patulous eustachian tube.
METHOD: All patients were treated with eustachian tube injection augmentation performed via a combined transnasal-transoral endoscopic approach. Clinical presentation, volume of injection, complications and initial response were all prospectively recorded. Longer-term follow up was conducted through structured telephone interviews using previously described patient-reported outcome measures.
RESULTS: Overall, 8 of 11 patients (73 per cent) derived complete or significant symptom improvement; 1 patient had significant improvements but was dissatisfied, and in 2 patients the symptoms were unchanged. The eight satisfied patients showed improvement in their quality-of-life scores.
CONCLUSION: This study describes an effective treatment option for patulous eustachian tube. Unlike many prior published reports, previously described patient-reported outcome measures were utilised in order to allow more direct comparison.

PMID: 27515559 [PubMed - as supplied by publisher]

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Meniett device in meniere disease: Randomized, double-blind, placebo-controlled multicenter trial.

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Meniett device in meniere disease: Randomized, double-blind, placebo-controlled multicenter trial.

Laryngoscope. 2016 Aug 12;

Authors: Russo FY, Nguyen Y, De Seta D, Bouccara D, Sterkers O, Ferrary E, Bernardeschi D

Abstract
OBJECTIVE: To evaluate the efficacy of portable Meniett low-pressure pulse generator (Medtronic Xomed, Jacksonville, FL) in Meniere disease.
STUDY DESIGN: Randomized, double-blind, placebo-controlled, multicenter trial carried out in 17 academic medical centers.
METHODS: One hundred twenty-nine adults presenting Meniere disease (American Academy of Otolaryngology-Head and Neck Surgery criteria) not controlled by conventional medical treatment were included. The protocol included three phases: 1) placement of a transtympanic tube and evaluation of its effect (if resolution of symptoms, the patient was excluded); 2) randomization: 6-weeks treatment with Meniett (Medtronic Xomed) or placebo device; 3) removal of the device and 6-week follow-up period. The evaluation criteria were the number of vertigo episodes (at least 20 minutes with a 12-hour free interval) and the impact on daily life as assessed by self-questionnaires.
RESULTS: Ninety-seven patients passed to the second phase of the study: 49 and 48 patients received the Meniett (Medtronic Xomed) or the placebo device, respectively. In the placebo group, the number of vertigo episodes decreased from 4.3 ± 0.6 (mean ± standard error of the mean) during the first phase to 2.6 ± 0.5 after 6 weeks of treatment, and to 1.8 ± 0.8 after the removal of the device. Similar results were observed in the Meniett device (Medtronic Xomed) group: 3.2 ± 0.4 episodes during the first phase, 2.5 ± after 6 weeks of Meniett device (Medtronic Xomed) treatment, and 1.5 ± 0.2 after the third phase.
CONCLUSION: An improvement of symptoms was evidenced in all patients, with no difference between the Meniett (Medtronic Xomed) and the placebo device groups. The decrease in the number of vertigo episodes could be explained by an effect of the medical care.
LEVEL OF EVIDENCE: 1b. Laryngoscope, 2016.

PMID: 27515294 [PubMed - as supplied by publisher]

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Deep round window insertion versus standard approach in cochlear implant surgery.

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Deep round window insertion versus standard approach in cochlear implant surgery.

Eur Arch Otorhinolaryngol. 2016 Jan;273(1):43-50

Authors: Nordfalk KF, Rasmussen K, Bunne M, Jablonski GE

Abstract
The aim of this study was to compare the outcomes of vestibular tests and the residual hearing of patients who have undergone full insertion cochlear implant surgery using the round window approach with a hearing preservation protocol (RW-HP) or the standard cochleostomy approach (SCA) without hearing preservation. A prospective study of 34 adults who underwent unilateral cochlear implantation was carried out. One group was operated using the RW-HP (n = 17) approach with Med-El +Flex(SOFT) electrode array with full insertion, while the control group underwent a more conventional SCA surgery (n = 17) with shorter perimodiolar electrodes. Assessments of residual hearing, cervical vestibular-evoked myogenic potentials (cVEMP), videonystagmography, subjective visual vertical/horizontal (SVH/SVV) were performed before and after surgery. There was a significantly (p < 0.05) greater number of subjects who exhibited complete or partial hearing preservation in the deep insertion RW-HP group (9/17) compared to the SCA group (2/15). A higher degree of vestibular loss but a lower degree of vertigo symptoms could be seen in the RW-HP group, but the differences were not statistically significant. It is possible to preserve residual hearing to a certain extent also with deep insertion. Full insertion with hearing preservation was less harmful to residual hearing particularly at 125 Hz (p < 0.05), than was the standard cochleostomy approach.

PMID: 25549811 [PubMed - indexed for MEDLINE]

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Trends in dental-related emergency department visits in the State of California from 2005 to 2011.

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Trends in dental-related emergency department visits in the State of California from 2005 to 2011.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May 24;

Authors: Rampa S, Wilson FA, Allareddy V

Abstract
OBJECTIVE: Objectives of this study were to provide trends in hospital-based emergency department (ED) visits involving dental conditions in California and to identify clinical and patient characteristics associated with these trends.
STUDY DESIGN: We used 2005 to 2011 data from the California Emergency Department Database. We examined all ED visits related to dental conditions.
RESULTS: During the study period (2005-2011), 402,077 ED visits were attributed to dental conditions. The number of ED visits that were dental-related increased from 44,516 (in 2005) to 70,385 (in 2011). Most of these visits were for dental caries (44.0%) and pulp/periapical lesions (48.6%) in 2011. Nearly one third of patients visiting the ED were uninsured, and the percentage of Medicaid patients increased from 30.3% in 2006 to 35.1% in 2011.
CONCLUSIONS: The number and rate of visits to the ED for dental-related problems has increased substantially in recent years in California. A large proportion of these patients are uninsured and those covered by Medicaid.

PMID: 27515432 [PubMed - as supplied by publisher]

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Pediatric unilateral facial swelling.

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Pediatric unilateral facial swelling.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May 24;

Authors: Draz A, Elias W, El-Sissi A, Liu ML

PMID: 27515431 [PubMed - as supplied by publisher]

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2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis.

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2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis.

Thyroid. 2016 Aug 12;

Authors: Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees S, Samuels M, Sosa JA, Stan MN, Walter M

Abstract
BACKGROUND: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition.
METHODS: The American Thyroid Association (ATA) previously co-sponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since 2011, the ATA felt updated-evidence-based guidelines were needed, and assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group.
RESULTS: Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded.
CONCLUSIONS: One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

PMID: 27521067 [PubMed - as supplied by publisher]

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