Zenker diverticulectomy: first report of robot-assisted transaxillary approach.

Related Articles

Zenker diverticulectomy: first report of robot-assisted transaxillary approach.

J Robot Surg. 2015 Mar;9(1):75-8

Authors: Melotti G, Piccoli M, Mullineris B, Varoli M, Colli G, Gozzo D, Smerieri N, Surendra N, Caruso A, Conigliaro R, Frazzoni M

Abstract
Standard surgical treatment of Zenker's diverticulum consists of open cricopharyngeal myotomy with diverticulectomy. A rigid or flexible endoscopic approach allowing a cricopharyngeal myotomy without diverticulectomy is currently considered as a less invasive alternative to open surgery with reportedly comparable symptom relief at short term follow-up. In recent years, high safety and efficacy of a transaxillary gasless robotic access to the thyroid gland has been shown. The present study describes the feasibility and preliminary results of robot-assisted transaxillary approach for cricopharyngeal myotomy and excision of Zenker's diverticulum. Patients with troublesome dysphagia and radiological evidence of Zenker's diverticulum underwent a robot-assisted cricopharyngeal myotomy and diverticulum excision using left transaxillary access with the support of endoscopic assistance. One month after intervention, symptoms were reevaluated and a barium swallow study was performed. Four patients with symptomatic Zenker's diverticulum were successfully operated. No adverse event was recorded. One month after intervention, total dysphagia remission was declared by all four patients and there was no evidence of diverticulum recurrence at radiology. According to our preliminary data, left transaxillary robot-assisted approach for the surgical management of Zenker's diverticulum is feasible, safe and effective. Whether our encouraging results will be confirmed in larger patient cohorts with prolonged follow-up, the robot-assisted transaxillary Zenker's diverticulectomy may represent an alternative to traditional open diverticulectomy when endoscopic interventions cannot be performed or have failed.

PMID: 26530975 [PubMed - indexed for MEDLINE]

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An Acoustic Study of Vowels Produced by Alaryngeal Speakers in Taiwan.

An Acoustic Study of Vowels Produced by Alaryngeal Speakers in Taiwan.

Am J Speech Lang Pathol. 2016 Aug 17;:1-12

Authors: Liao JS

Abstract
Purpose: This study investigated the acoustic properties of 6 Taiwan Southern Min vowels produced by 10 laryngeal speakers (LA), 10 speakers with a pneumatic artificial larynx (PA), and 8 esophageal speakers (ES).
Method: Each of the 6 monophthongs of Taiwan Southern Min (/i, e, a, ɔ, u, ə/) was represented by a Taiwan Southern Min character and appeared randomly on a list 3 times (6 Taiwan Southern Min characters × 3 repetitions = 18 tokens). Each Taiwan Southern Min character in this study has the same syllable structure, /V/, and all were read with tone 1 (high and level). Acoustic measurements of the 1st formant, 2nd formant, and 3rd formant were taken for each vowel. Then, vowel space areas (VSAs) enclosed by /i, a, u/ were calculated for each group of speakers. The Euclidean distance between vowels in the pairs /i, a/, /i, u/, and /a, u/ was also calculated and compared across the groups.
Results: PA and ES have higher 1st or 2nd formant values than LA for each vowel. The distance is significantly shorter between vowels in the corner vowel pairs /i, a/ and /i, u/. PA and ES have a significantly smaller VSA compared with LA.
Conclusions: In accordance with previous studies, alaryngeal speakers have higher formant frequency values than LA because they have a shortened vocal tract as a result of their total laryngectomy. Furthermore, the resonance frequencies are inversely related to the length of the vocal tract (on the basis of the assumption of the source filter theory). PA and ES have a smaller VSA and shorter distances between corner vowels compared with LA, which may be related to speech intelligibility. This hypothesis needs further support from future study.

PMID: 27538050 [PubMed - as supplied by publisher]

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Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10-year retrospective longitudinal study in Eastern Denmark.

Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10-year retrospective longitudinal study in Eastern Denmark.

Clin Otolaryngol. 2016 Aug 18;

Authors: Wulff NB, Andersen E, Kristensen CA, Sørensen CH, Charabi B, Homøe P

Abstract
OBJECTIVE: The primary aims were to determine the rates of and prognostic factors for overall survival, disease specific survival and disease free survival following salvage total laryngectomy.
DESIGN: Retrospective longitudinal study.
SETTING: Tertiary medical centers.
PARTICIPANTS: 142 patients in Eastern Denmark undergoing salvage total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx.
MAIN OUTCOME MEASURES: Five-year overall survival, 5-year disease specific survival, 5-year disease free survival and prognostic factors for these outcomes.
RESULTS: Five-year overall survival, disease specific survival and disease free survival were 37.7%, 54.9% and 55.3%, respectively. N classification at primary diagnosis, lymph node excision and postoperative complications within one year after salvage total laryngectomy were prognostic factors for shorter overall survival, disease specific survival and disease free survival. Residual tumor/recurrence was negatively associated with overall survival, close or involved resection margins with disease specific survival and second primary cancer was associated with longer disease specific survival and disease free survival. Nine percent of all patients had residual tumor and 33.8% developed a recurrence.
CONCLUSION: Our overall survival, disease specific survival and disease free survival findings are in accordance with previous studies. With the purpose of identifying recurrent tumor, we suggest extra attention being given to patients with higher N classification and need for lymph node excision during salvage total laryngectomy along with use of frozen sections. The high number of patients with recurrence within one year after salvage total laryngectomy occurred although thorough and regular follow-up visits were performed. This article is protected by copyright. All rights reserved.

PMID: 27537427 [PubMed - as supplied by publisher]

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Voice and aging: clinical, endoscopic and acoustic investigation.

Voice and aging: clinical, endoscopic and acoustic investigation.

Clin Otolaryngol. 2016 Aug 18;

Authors: Pessin AB, Tavares EL, Gramuglia AC, de Carvalho LR, Martins RH

Abstract
Vocal symptoms are frequent in the elderly and are consequences of structural changes in the larynx that occur with aging.
OBJECTIVE: to identify the voice alterations in elderly patients attending a voice clinic.
METHODS: elderly patients of both genders were divided into two groups: 60-75 and above 76 years. All patients completed a questionnaire with identification data, profession, vocal symptoms, hearing, habits and addictions, and systemic diseases. All participants were submitted to video laryngoscopy and acoustic and auditory-perceptual vocal analysis.
RESULTS: In this study women predominated (40 F versus 32 M). Hoarseness was reported by 34.72% of the participants. Other symptoms included: singing difficulty (17%) and phonatory effort (15.28%). Maximum Phonation Time showed lower values and scores 2 and 3 of perceptual analysis were registered in 33% of the elderly participants, but without statistical significance. The fundamental frequency values were inferior in older man and high in women and acoustic parameters showed high values in both groups, but without statistical significance. Videolaryngoscopies demonstrated alterations in 47% of the participants, especially bowed and atrophic vocal folds.
CONCLUSIONS: We described the vocal symptoms, vocal perceptual and acoustic analysis and endoscopic findings of an elderly population, characterizing the presbyphonia. Therapeutic measures must involve speech therapy and/or surgery to reduce the glottal gap, allowing less air leakage and, consequently, better vocal performance. This article is protected by copyright. All rights reserved.

PMID: 27537269 [PubMed - as supplied by publisher]

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Laryngeal histoplasmosis.

Laryngeal histoplasmosis.

BMJ Case Rep. 2016;2016

Authors: Ansari HA, Saeed N, Khan N, Hasan N

Abstract
Histoplasmosis is a fungal infection, having interesting synonyms such as Cave disease, Darling's disease, Ohio Valley disease, reticuloendotheliosis, Spelunker's lung and Caver's disease. The aetiological agent is a dimorphic fungus, Histoplasma capsulatum, causing chronic granulomatous disease. The route of transmission is by inhalation of dust particles from soil contaminated by excrement of birds or bats, harbouring the small spores or microconidia, which is considered the infectious form of fungus. The spectrum of illness ranges from subclinical infection of the lung to progressive disseminated disease. The major bulk of histoplasmosis infections are asymptomatic or present with mild influenza like illness and involve immunocompetent individuals. However, the immunocompromised or immunodeficient cases have disseminated/haematogenous infections with multiple organs involved and are usually fatal unless treated immediately. Laryngeal involvement is associated with the disseminated form of the disease. Histoplasmosis of larynx is a rare entity and poses diagnostic difficulty to otolaryngologists because clinically it may be mistaken for malignancy. We report an unusual case of laryngeal histoplasmosis in a man aged 60 years who presented with provisional diagnosis of tuberculosis/malignancy.

PMID: 27535733 [PubMed - in process]

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Authors' Response to Letter: "In Reference to 'Partial Epiglottoplasty for Pharyngeal Dysphagia due to Cervical Spine Pathology'".

Related Articles

Authors' Response to Letter: "In Reference to 'Partial Epiglottoplasty for Pharyngeal Dysphagia due to Cervical Spine Pathology'".

Otolaryngol Head Neck Surg. 2016 Apr;154(4):773-4

Authors: Chhetri D, Jamal N, Erman A

PMID: 27045112 [PubMed - indexed for MEDLINE]

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In Reference to "Partial Epiglottoplasty for Pharyngeal Dysphagia due to Cervical Spine Pathology".

Related Articles

In Reference to "Partial Epiglottoplasty for Pharyngeal Dysphagia due to Cervical Spine Pathology".

Otolaryngol Head Neck Surg. 2016 Apr;154(4):773

Authors: Patel A, Tang CG, Blitzer A

PMID: 27045111 [PubMed - indexed for MEDLINE]

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[Microsurgical management of petroclival meningiomas combined trans-subtemporal and suboccipital retrosigmoid keyhole approach].

[Microsurgical management of petroclival meningiomas combined trans-subtemporal and suboccipital retrosigmoid keyhole approach].

Beijing Da Xue Xue Bao. 2016 Feb 18;48(1):738-742

Authors: Chen LH, Yang Y, Wei Q, Li YJ, Li WD, Gao JB, Yu B, Zhao H, Xu RX

Abstract
OBJECTIVE: With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques, it is necessary to re-examine the therapeutic strategy for the treatment of petroclival meningiomas. To sum up the operative experience and methods in microsurgical resection of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach. To explore the minimally invasive operation approach of petroclival meningiomas, to raise the removal degree and to improve the postoperative result using this approach.
METHODS: The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively. The method, degree of tumor resection,techniques of the combining keyhole approach, Karnofsky performance score (KPS) before and after operation were also analyzed. The neuronavigation guided operation was performed in 9 cases, and 12 cases were operated in the neuroelectrophysiological monitoring.
RESULTS: Total excision of the tumor resection (Simpson, I-II levels) was conducted in 18 cases (85.7%, 18/21), and 3 patients underwent close resection (Simpson III level, 14.3%, 3/21). Postoperative three-dimensional CT showed good lock bone flap restoration; Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%) , including transient trochlear nerve (3 cases), abducent nerve (1 case), and the motor branch of trigeminal nerve paralysis (1 case). Abducent nerve paralysis (1 case) appeared, with hearing impairment. After the 3-month follow-up, 11 cases had the same KPS aspreoperation, 7 cases improved, and 3 cases not improved. The KPS score was 77.14±23.12 on average, and there was no statistically significant difference compared with that before operation (P>0.05). The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher), and general recovery in 2 cases (KPS<70). The postoperative follow-up for 3-29 months showed no tumor recurrence or progress.
CONCLUSION: The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple, safe, and minimally invasive, and an ideal operation approach of petroclival meningioma. To master the operation skills and the intraoperative matters needing attention in the operation, is favorable to improve the resection rate and curative effect.

PMID: 27538163 [PubMed - as supplied by publisher]

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Proton beam therapy in Japan: current and future status.

Proton beam therapy in Japan: current and future status.

Jpn J Clin Oncol. 2016 Aug 17;

Authors: Sakurai H, Ishikawa H, Okumura T

Abstract
The number of patients treated by proton beam therapy in Japan since 2000 has increased; in 2016, 11 proton facilities were available to treat patients. Notably, proton beam therapy is very useful for pediatric cancer; since the pediatric radiation dose to normal tissues should be reduced as much as possible because of the effect of radiation on growth, intellectual development, endocrine organ function and secondary cancer development. Hepatocellular carcinoma is common in Asia, and most of the studies of proton beam therapy for liver cancer have been reported by Japanese investigators. Proton beam therapy is also a standard treatment for nasal and paranasal lesions and lesions at the base of the skull, because the radiation dose to critical organs such as the eyes, optic nerves and central nervous system can be reduced with proton beam therapy. For prostate cancer, comparative studies that address adverse effects, safety, patient quality of life and socioeconomic issues should be performed to determine the appropriate use of proton beam therapy for prostate cancer. Regarding new proton beam therapy applications, experience with proton beam therapy combined with chemotherapy is limited, although favorable outcomes have been recently reported for locally advanced lung cancer, esophageal cancer and pancreatic cancer. Therefore, 'chemoproton' therapy appears to be a very attractive field for further clinical investigations. In conclusion, there are cost issues and considerations regarding national insurance for the use of proton beam therapy in Japan. Further studies and discussions are needed to address the use of proton beam therapy for several types of cancers, and for maintaining the quality of life of patients while retaining a high cure rate.

PMID: 27534798 [PubMed - as supplied by publisher]

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Primary Mucoepidermoid Carcinoma of the Lacrimal Sac - a Case Report and Literature Review.

Primary Mucoepidermoid Carcinoma of the Lacrimal Sac -  a Case Report and Literature Review.

Klin Onkol. 2016;29(4):291-294

Authors: Janakiram TN, Sagar S, Sharma SB, Subramaniam V

Abstract
BACKGROUND: Lacrimal sac tumors are very rare and are often missed because patients present with features consistent with chronic dacryocystitis. Squamous cell carcinoma is the common-est lacrimal sac malignancy. Although primary mucoepidermoid carcinomas of the lacrimal sac are rare, they are locally aggressive. Furthermore, their proximity to vital structures and the skull base makes them potentially life-threatening. Multidisciplinary management is required, and wide excision followed by chemoradiation is the recommended treatment.
CASE: Here, we report a 65-year-old male who presented with watering eyes and a mass in the region of the medial canthus. A dia-gnosis of primary mucoepidermoid carcinoma of the lacrimal sac was made, and the case was managed successfully with radical surgery and reconstruction. The tumor was resected using the extended Lynch-Howarth incision and the resulting defect was reconstructed using a forehead flap. Histopathological examination of the excised specimen revealed mucoepidermoid carcinoma. Immunohistochemical analysis revealed that the speci-men was positive for epithelial growth factor receptor and Ki-67 protein. The patient was referred for post-operative chemoradiation. The literature is reviewed and pathological features, including immunohistochemistry are discussed.
CONCLUSION: Primary mucoepidermoid carcinoma of the lacrimal sac is a rare, locally aggressive tumor that is often mistaken for dacryocystitis. The treatment of choice is radical surgery followed by chemoradiation.
KEY WORDS: lacrimal sac -  mucoepidermoid carcinoma -  epithelial growth factor receptor -  Ki-67 protein.

PMID: 27534787 [PubMed - as supplied by publisher]

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[Georg Schlöndorff-the father of computer-assisted surgery].

[Georg Schlöndorff-the father of computer-assisted surgery].

HNO. 2016 Aug 17;

Authors: Mösges R

Abstract
Georg Schlöndorff (1931-2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987. During the following years, this concept was extended to orbital surgery, neurosurgery, mid-facial traumatology, and brachytherapy of solid tumors in the head and neck region. Further technical developments of this first prototype included touchless optical positioning and the computer vision concept with three orthogonal images, which is still common in contemporary navigation systems. During his time as emeritus professor from 1996, Georg Schlöndorff further pursued his concept of CAS by developing technical innovations such as computational fluid dynamics (CFD).

PMID: 27534760 [PubMed - as supplied by publisher]

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First use of flat-panel computed tomography during cochlear implant surgery : Perspectives for the use of advanced therapies in cochlear implantation.

First use of flat-panel computed tomography during cochlear implant surgery : Perspectives for the use of advanced therapies in cochlear implantation.

HNO. 2016 Aug 17;

Authors: Rotter N, Schmitz B, Sommer F, Röhrer S, Schuler PJ, Bischof F, Scheithauer MO, Hoffmann TK

Abstract
BACKGROUND: Cochlear implantation in routine cases with normal anatomy is commonly performed without intraoperative image guidance. Revision cochlear implantation as well as surgery in malformations require not only a precise understanding of the underlying complex anatomy, but surgeons need to transform two-dimensional computed tomography (2D CT) scans into the surgical field and use this information for intraoperative surgical navigation. So far, information about the exact position of the electrode during insertion cannot be provided to the surgeon. Here, we present our first operative experience with cochlear implant surgery supported by intraoperative Dyna-CT technology, providing the surgeon with detailed views of the electrode location.
METHODS: To prove the feasibility of the procedure, two cases of cochlear implantation were performed with intraoperative application of cone-beam CT acquired by a C-arm Dyna-CT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed intraoperatively in order to assess the correct positioning of the electrodes.
RESULTS: Intraoperative Dyna-CT enabled clear visualization of the surgical anatomy and intracochlear electrode position. Dyna-CT technology can be applied with acceptable additional time requirements without adding too much complexity to the surgical procedure.
CONCLUSION: Intraoperative data acquisition by Dyna-CT represents a suitable option for online surgical navigation during cochlear implant surgery. This imaging technology will push further advances in cochlear implant surgery and lateral skull base surgery, particularly if linked to intraoperative navigation.

PMID: 27534759 [PubMed - as supplied by publisher]

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Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study.

Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study.

Eur Arch Otorhinolaryngol. 2016 Aug 17;

Authors: Oker N, Dupuch V, Herman P, Leclerc N, Vironneau P, Dang H, Majer J, Pastourel R, Pavier Y, Blancal JP, Saroul N, Mom T, Kania R, Vicaut E, Gilain L, Verillaud B

Abstract
Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1 year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients' demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4 % cases associated with septoplasty in 42 %. The majority (95 %) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23 % described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56 %, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97 % of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.

PMID: 27535844 [PubMed - as supplied by publisher]

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Application of desaturation index in post-surgery follow-up in children with obstructive sleep apnea syndrome.

Application of desaturation index in post-surgery follow-up in children with obstructive sleep apnea syndrome.

Eur Arch Otorhinolaryngol. 2016 Aug 17;

Authors: Liu JF, Tsai CM, Su MC, Lin MC, Lin HC, Lee WJ, Hsieh KS, Niu CK, Yu HR

Abstract
Adenotonsillectomy is recommended for children who need surgery for obstructive sleep apnea syndrome (OSAS). Overnight, polysomnography (PSG) is suggested for post-surgery follow-up, but this diagnostic technique is time consuming and inconvenient. Desaturation index (DI) has been reported as a good tool for predicting both the presence and severity of OSAS in children. The purpose of this study was to determine the usefulness of the DI for post-surgery follow-up of children with OSAS. This retrospective study enrolled 42 children, aged 3-12 years, who were snorers diagnosed with OSAS by overnight PSG and who underwent an adenotonsillectomy. Pre- and postoperative PSG parameters, nocturnal pulse oximetry data, and modified Epworth sleepiness scale scores were assessed. Previously determined cut-off DI values (2.05, 3.50, and 4.15 for mild, moderate, and severe OSAS, respectively) were used to predict residual OSAS. Of the 42 children, obvious improvements were observed in apnea-hypopnea index (AHI, decreased 45.5 %), arousal index (decreased 30.5 %), DI (decreased 40.4 %), and snore index (decreased 100.3 %) compared with the preoperative measurements. Among these objective PSG measures, DI had the strongest correlation with AHI both pre- and post-surgeries (r = 0.947 and r = 0.954, respectively; p all <0.001). The DI change, before and after surgery, also had the strongest positive correlation to the AHI change (r = 0.482 and p = 0.001). Using the previously determined DI cut-off values to predict postoperative residual OSAS, there was a good positive predictive value (92.6 %) for mild residual OSAS and a good negative predictive value for moderate and severe residual OSAS (85.2 and 89.7 %, respectively). These findings suggest that DI, as determined using a nocturnal pulse oximeter, may be an alternative tool for postoperative evaluation and follow-up of children with OSAS.

PMID: 27535843 [PubMed - as supplied by publisher]

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HLA-DRB1 allele polymorphism and nasopharyngeal carcinoma risk: a meta-analysis.

HLA-DRB1 allele polymorphism and nasopharyngeal carcinoma risk: a meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Aug 17;

Authors: Yao K, Yang S, Shen J, Zhang R, Li L

Abstract
The human leukocyte antigens (HLA) DRB1 polymorphism has been implicated in susceptibility to nasopharyngeal carcinoma (NPC). However, the results are inconsistent. The aim of this meta-analysis is to evaluate the association between the HLA-DRB1 polymorphisms and NPC risk. All eligible case-control studies published up to June 17, 2015 were identified by searching PubMed, Web of Science, CNKI, Wanfang, and Weipu databases. The NPC risk associated with the HLA-DRB1 polymorphism was estimated for each study by odds ratios (OR) together with its 95 % confidence interval (CI), respectively. Twelve studies with 1152 cases and 1600 controls were included. Overall, a significant positively association between the HLA-DRB1*03, *08, *09, and *10 alleles polymorphism and NPC risk were found (OR = 1.55, 95 % CI 1.30-1.86; OR = 1.44, 95 % CI 1.08-1.92; OR = 1.33, 95 % CI 1.06-1.67; OR = 1.82, 95 % CI 1.02-3.26, respectively), and the HLA-DRB1*01, *11, and *12 alleles were negatively associated with NPC risk (OR = 0.55, 95 % CI 0.39-0.78; OR = 0.62, 95 % CI 0.42-0.91; OR = 0.62, 95 % CI 0.47-0.81, respectively), but we failed to detect any association between other alleles and NPC risk. When stratified by ethnicity, similar results were observed among Asians for HLA-DRB1*03, *08, *09, *11, and *12 alleles and Tunisians for HLA-DRB1*01, *03, and *11 alleles; However, no significant association among Caucasians was observed. This meta-analysis suggests that the HLA-DRB1*03, *08, *09, and *10 alleles polymorphism contributed to the susceptibility of NPC, whereas HLA-DRB1*11 and *12 alleles polymorphism may be an important protective factor for NPC, especially of Asian populations.

PMID: 27535842 [PubMed - as supplied by publisher]

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The validity and reliability of Thai Sinonasal Outcome Test-22.

The validity and reliability of Thai Sinonasal Outcome Test-22.

Eur Arch Otorhinolaryngol. 2016 Aug 17;

Authors: Numthavaj P, Bhongmakapat T, Roongpuwabaht B, Ingsathit A, Thakkinstian A

Abstract
Chronic rhinosinusitis (CRS) symptoms can significantly reduce quality of life. The Sinonasal Outcome Test-22 (SNOT-22) is frequently used to assess this disease-specific quality of life, although it has not been translated into Thai language. We translated the original SNOT-22 questionnaire to Thai using forward-backward technique, and validated it in CRS patients [n = 229, mean age of 52.6 (SD = 15.9)] recruited at outpatient Otolaryngology clinic, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand. A construct validity was assessed using factor analysis, reliability was assessed using intra-class correlation coefficient (ICC) after 3 days of taking the first questionnaire, and internal consistency was assessed using Cronbach's alpha. A total of 201 out of 229 patients completed SNOT-22 questionnaire. Factor analysis with oblique rotation was applied and yielded three domains with eigenvalue of 1 or higher. These domains were named as nasal-related, ear-general-psychological, and sleep-related domains. Estimated ICC ranged from 0.49 to 0.71 with a median of 0.64, and Cronbach's alpha was 0.94. The Thai SNOT-22 questionnaire is reliable and valid with three domains. Thai SNOT-22 may be used in research and clinical practice to assess disease-specific quality of life and aid in management plan at CRS clinic.

PMID: 27535841 [PubMed - as supplied by publisher]

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Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: A temporal bone study.

Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: A temporal bone study.

Int J Audiol. 2016 Aug 18;:1-7

Authors: Wegner I, Shahnaz N, Grolman W, Bance ML

Abstract
OBJECTIVE: To ascertain if wideband acoustic immitance (WAI) measurements are useful in assessing crimping status following stapedotomy.
DESIGN: WAI measurements were obtained using the Mimosa Acoustics HearID system. Wideband chirp sound stimuli and a set of tone stimuli for nine frequencies between 0.2 and 6 kHz were used at 60 dB SPL. Five sets of measurements were performed on each temporal bone: mobile stapes, stapes fixation and stapedotomy followed by insertion of a tightly crimped, a loosely crimped and an uncrimped prosthesis.
STUDY SAMPLE: Eight fresh-frozen temporal bones were harvested from human cadaveric donors.
RESULTS: At lower frequencies, up to 1 kHz, stapes fixation decreased absorbance. Compared to the baseline absorbance, absorbance with stapes fixation dropped by 6 to 17% in absolute terms from the baseline value (p = 0.027). Absorbance was not affected in higher frequencies (p = 0.725). Stapedotomy changed the absorbance curve significantly compared to the normal condition with an increase of absolute absorbance values by 6 to 36% around 0.25-1 kHz (p-value <0.01). The crimping conditions did not differ from one another (p = 0.555).
CONCLUSION: WAI is not useful in distinguishing between tightly crimped, loosely crimped and uncrimped stapes prostheses following stapedotomy.

PMID: 27534272 [PubMed - as supplied by publisher]

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Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture.

Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture.

Hip Pelvis. 2016 Jun;28(2):104-11

Authors: Kim Y, Kim JK, Joo IH, Hwang KT, Kim YH

Abstract
PURPOSE: We investigated the incidence and time of dislocation and other factors associated with dislocation of bipolar hemiarthroplasty related to the treatment of femoral neck fracture in old age patients.
MATERIALS AND METHODS: Between January 2002 and April 2014, 498 femoral neck fractures (467 patients) were treated with bipolar hemiarthroplasty and included in this study. All surgeries were performed using the postero-lateral approach. The incidence of dislocation was investigated. A comparative analysis between a control group and dislocation group was performed with respect to patient factors including age, gender, body mass index, comorbidities, the ASA (American Society of Anesthesiologists) score, mental status and center-edge angle, and surgical factors including type of femoral stem, leg length discrepancy, femoral offset and method of short external rotator (SER) reconstruction.
RESULTS: The incidence of dislocation was 3.8%, and the dislocation occurred on average 2.2 months (range, 0.6-6.5 months) after operation. No difference in patient-related factors was observed between the two groups. However, a smaller center edge (CE) angle was observed in the dislocation group (42.1°±3.2° vs. 46.9°±5.4°, P<0.001), and significantly lower incidence of dislocation was observed in tendon to bone repair group (0.7% vs 7.8%, P<0.001).
CONCLUSION: SERs should be repaired using the tendon-to-bone repair method to reduce dislocation rate in elderly patients who undergo bipolar hemiarthroplasty using the postero-lateral approach due to femoral neck fracture. In addition, patients with smaller CE angle should be carefully monitored due to high incidence of dislocation.

PMID: 27536652 [PubMed]

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[Imaging-based diagnosis of vestibular schwannoma].

[Imaging-based diagnosis of vestibular schwannoma].

HNO. 2016 Aug 17;

Authors: Strasilla C, Sychra V

Abstract
Magnetic resonance imaging (MRI) is the imaging method of choice for patients with vestibular schwannoma, with almost 100 % sensitivity and specificity. The role of computed tomography (CT) is limited to preoperative planning and the postoperative phase. High-resolution sequences and the application of gadolinium-based i.v. contrast medium are crucial for MRI-based diagnosis. Description of the size and location of the tumor, as well as its relationship to adjacent structures and anatomic features, is essential, since these factors, in addition to clinical findings, influence the type of treatment, surgical options, and associated risks. A postoperative linear contrast enhancement is often seen for up to 6 months and sometimes even longer. However, if this is of nodular structure, a recurrent schwannoma is likely. A sufficient statement regarding tumor response is not possible within the first 24 months after stereotactic radiosurgery. An increasing tumor volume after 24 months indicates failure of the treatment. Knowledge of the features of vestibular schwannomas allows all other possible differential diagnoses to be confidently excluded.

PMID: 27534761 [PubMed - as supplied by publisher]

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[Georg Schlöndorff-the father of computer-assisted surgery].

[Georg Schlöndorff-the father of computer-assisted surgery].

HNO. 2016 Aug 17;

Authors: Mösges R

Abstract
Georg Schlöndorff (1931-2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987. During the following years, this concept was extended to orbital surgery, neurosurgery, mid-facial traumatology, and brachytherapy of solid tumors in the head and neck region. Further technical developments of this first prototype included touchless optical positioning and the computer vision concept with three orthogonal images, which is still common in contemporary navigation systems. During his time as emeritus professor from 1996, Georg Schlöndorff further pursued his concept of CAS by developing technical innovations such as computational fluid dynamics (CFD).

PMID: 27534760 [PubMed - as supplied by publisher]

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First use of flat-panel computed tomography during cochlear implant surgery : Perspectives for the use of advanced therapies in cochlear implantation.

First use of flat-panel computed tomography during cochlear implant surgery : Perspectives for the use of advanced therapies in cochlear implantation.

HNO. 2016 Aug 17;

Authors: Rotter N, Schmitz B, Sommer F, Röhrer S, Schuler PJ, Bischof F, Scheithauer MO, Hoffmann TK

Abstract
BACKGROUND: Cochlear implantation in routine cases with normal anatomy is commonly performed without intraoperative image guidance. Revision cochlear implantation as well as surgery in malformations require not only a precise understanding of the underlying complex anatomy, but surgeons need to transform two-dimensional computed tomography (2D CT) scans into the surgical field and use this information for intraoperative surgical navigation. So far, information about the exact position of the electrode during insertion cannot be provided to the surgeon. Here, we present our first operative experience with cochlear implant surgery supported by intraoperative Dyna-CT technology, providing the surgeon with detailed views of the electrode location.
METHODS: To prove the feasibility of the procedure, two cases of cochlear implantation were performed with intraoperative application of cone-beam CT acquired by a C-arm Dyna-CT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed intraoperatively in order to assess the correct positioning of the electrodes.
RESULTS: Intraoperative Dyna-CT enabled clear visualization of the surgical anatomy and intracochlear electrode position. Dyna-CT technology can be applied with acceptable additional time requirements without adding too much complexity to the surgical procedure.
CONCLUSION: Intraoperative data acquisition by Dyna-CT represents a suitable option for online surgical navigation during cochlear implant surgery. This imaging technology will push further advances in cochlear implant surgery and lateral skull base surgery, particularly if linked to intraoperative navigation.

PMID: 27534759 [PubMed - as supplied by publisher]

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Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: A temporal bone study.

Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: A temporal bone study.

Int J Audiol. 2016 Aug 18;:1-7

Authors: Wegner I, Shahnaz N, Grolman W, Bance ML

Abstract
OBJECTIVE: To ascertain if wideband acoustic immitance (WAI) measurements are useful in assessing crimping status following stapedotomy.
DESIGN: WAI measurements were obtained using the Mimosa Acoustics HearID system. Wideband chirp sound stimuli and a set of tone stimuli for nine frequencies between 0.2 and 6 kHz were used at 60 dB SPL. Five sets of measurements were performed on each temporal bone: mobile stapes, stapes fixation and stapedotomy followed by insertion of a tightly crimped, a loosely crimped and an uncrimped prosthesis.
STUDY SAMPLE: Eight fresh-frozen temporal bones were harvested from human cadaveric donors.
RESULTS: At lower frequencies, up to 1 kHz, stapes fixation decreased absorbance. Compared to the baseline absorbance, absorbance with stapes fixation dropped by 6 to 17% in absolute terms from the baseline value (p = 0.027). Absorbance was not affected in higher frequencies (p = 0.725). Stapedotomy changed the absorbance curve significantly compared to the normal condition with an increase of absolute absorbance values by 6 to 36% around 0.25-1 kHz (p-value <0.01). The crimping conditions did not differ from one another (p = 0.555).
CONCLUSION: WAI is not useful in distinguishing between tightly crimped, loosely crimped and uncrimped stapes prostheses following stapedotomy.

PMID: 27534272 [PubMed - as supplied by publisher]

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Genetic polymorphisms affecting antioxidant enzymes are present in tympanosclerosis patients.

Genetic polymorphisms affecting antioxidant enzymes are present in tympanosclerosis patients.

J Laryngol Otol. 2016 Aug 18;:1-6

Authors: Akyigit A, Yalcin Ş, Etem EÖ, Kaygusuz I, Karlidag T, Keles E, Celik ZB, Tektemur A

Abstract
BACKGROUND: This study investigated genetic polymorphisms affecting the inducible nitric oxide synthase, superoxide dismutase and catalase enzymes in chronic otitis media patients with and without tympanosclerosis, and the role of genetic susceptibility in the disease aetiology.
METHODS: A total of 162 patients who underwent surgery for chronic otitis media were divided into two study groups: a tympanosclerosis group and a chronic otitis media group. A third, the control, group comprised 188 healthy volunteers. Venous blood samples were evaluated using reverse transcriptase polymerase chain reaction.
RESULTS: There was a significant difference in GG genotype distribution of the -277A>G polymorphism in the NOS2 gene between the tympanosclerosis and control groups (p T) polymorphism in the SOD2 gene (p > 0.05). There were significant differences in the TT genotype distribution of the -21A>T polymorphism in the CAT gene between the tympanosclerosis and control groups, and between the chronic otitis media and control groups (p < 0.05).
CONCLUSION: These results suggest that genetic predisposition may play a role in the aetiopathogenesis of tympanosclerosis.

PMID: 27534583 [PubMed - as supplied by publisher]

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Prevalence of GJB2 gene mutation in 330 cochlear implant patients in the Jiangsu province.

Prevalence of GJB2 gene mutation in 330 cochlear implant patients in the Jiangsu province.

J Laryngol Otol. 2016 Aug 18;:1-5

Authors: Shi L, Chen J, Li J, Wei X, Gao X

Abstract
OBJECTIVE: GJB2 gene mutations are highly prevalent in pre-lingual hearing loss patients from China. Pre-lingual deafness is a sensorineural disorder that can only be treated with cochlear implantation.
METHOD: The prevalence of GJB2 gene mutations was examined in 330 randomly selected patients treated with cochlear implantation.
RESULTS: Overall, 276 patients (83.64 per cent) carried variations in the GJB2 gene. Seventeen different genotypes were identified, including 10 confirmed pathogenic mutations (c.235delC, c.299delAT, c.176del16, p.E47X, p.T123N, p.V167M, p.C218Y, p.T86R, p.V63L and p.R184Q), 3 polymorphisms (p.V27I, p.E114 G and p.I203 T) and 2 unidentified mutations (p.V37I and c.571 T > C).
CONCLUSION: A total of 103 patients (31.2 per cent) carried 2 confirmed pathogenic mutations. The frequency of c.235delC was higher than that reported previously in the Jiangsu province. The two novel mutations identified, 69C > G and 501G > A, are likely to be polymorphisms.

PMID: 27534436 [PubMed - as supplied by publisher]

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Complications of cochlear implant surgery: A ten-year experience in a referral hospital in Peru, 2006-2015.

Complications of cochlear implant surgery: A ten-year experience in a referral hospital in Peru, 2006-2015.

Cochlear Implants Int. 2016 Aug 18;:1-5

Authors: Alcas O, Salazar MA

Abstract
OBJECTIVES: To describe the frequency and characteristics of complications of cochlear implant (CI) surgery at Edgardo Rebagliati Martins Hospital of social security in Lima-Peru between 2006 and 2015.
METHODS: A retrospective descriptive study of patients that underwent CI surgery between August 2006 and December 2015.
RESULTS: Among the 107 patients with CIs, the overall proportion of complications was 18.7% (20/107): 14.9% (16/107) of minor complications, and 3.7% (4/107) of major complications. Regarding the time of onset of complications, 2.8% (3/107) were intraoperative and 14% (15/107) postoperative.
CONCLUSION: CI surgery in Peru is a safe procedure with a low frequency of major complications, representing an effective therapy for patients with sensorineural hearing loss who do not respond to hearing aids.

PMID: 27535059 [PubMed - as supplied by publisher]

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Patient characteristics and intervention effect as measured by Voice Handicap Index.

Patient characteristics and intervention effect as measured by Voice Handicap Index.

Logoped Phoniatr Vocol. 2016 Aug 18;:1-6

Authors: Hengen J, Peterson M, McAllister A

Abstract
OBJECTIVE: To analyze patients with a confirmed voice disorder in order to identify patterns regarding age, gender, and occupation compared to the general public. To explore effects of voice therapy according to the Voice Handicap Index (VHI) score pre- and post-therapy in relation to the number of sessions, age, and gender.
DESIGN: Prospective cohort study.
MATERIALS AND METHODS: This study was conducted as a collaborative project between Linköping University and hospitals in the south-east health care region in Sweden. Six voice clinics participated by asking their patients voluntarily to complete the Swedish version of the VHI at the beginning and end of therapy.
RESULTS AND CONCLUSIONS: The two most prevalent diagnoses were dysphonia (43%) and phonasthenia (25%). Among the working population, the three most common occupational fields were education, health care, and child-care. The majority of the patients were women (74.3%), and the mean age of all patients was 55 years. A significant improvement in VHI scores was found after therapy, with an average decrease of 19 median points in total score and a substantial effect size (0.55). The number of sessions did not significantly correlate with the mean VHI score difference but had a weak correlation to the start and end scores. Increasing age correlated with a higher median VHI score both at the start and end of therapy but did not affect the average decrease between the two measurements.

PMID: 27536880 [PubMed - as supplied by publisher]

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Novel technique of creating a seal for the vacuum-assisted closure system application in complex head and neck wounds.

Novel technique of creating a seal for the vacuum-assisted closure system application in complex head and neck wounds.

Head Neck. 2016 Aug 18;

Authors: Tian B, Iyer NG, Tan HK, Tay AC, Soo KC, Tan NC

Abstract
BACKGROUND: Achieving a good seal for the application of the vacuum-assisted closure (VAC) system in complex head and neck wounds is difficult.
METHODS: A case series of 4 patients who developed postoperative orocutaneous or pharyngocutaneous fistulas were studied. A sterile green glove was used as a sealant together with the VAC system.
RESULTS: With utilization of a green glove, a good seal for the VAC system was obtained. This gave ample time to cleanse the wound and allow granulation tissue to form before proceeding on to the next stage of treatment.
CONCLUSION: A green glove technique allows for a good seal for the VAC system to work, especially when applied to complex head and neck wounds. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27534613 [PubMed - as supplied by publisher]

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Pretreatment count of peripheral neutrophils, monocytes, and lymphocytes as independent prognostic factor in patients with head and neck cancer.

Pretreatment count of peripheral neutrophils, monocytes, and lymphocytes as independent prognostic factor in patients with head and neck cancer.

Head Neck. 2016 Aug 18;

Authors: Valero C, Pardo L, López M, García J, Camacho M, Quer M, León X

Abstract
BACKGROUND: The purpose of this study was to analyze the prognostic value of pretreatment count of peripheral neutrophils, lymphocytes, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in patients with head and neck squamous cell carcinoma (HNSCC).
METHODS: Local, regional, and distant recurrence-free survival and disease-specific survival were analyzed according to the count of neutrophils, lymphocytes, monocytes, and NLR.
RESULTS: We observed a decrease in disease-specific survival as the quartile category of neutrophils, monocytes, and NLR increased. In the case of lymphocytes, patients in the lower quartile had lower disease-specific survival. Considering the disease-specific survival as the dependent variable, a recursive partitioning analysis classified the patients according to the neutrophil and monocyte counts.
CONCLUSION: High pretreatment count of peripheral neutrophils and/or monocytes was independently related with worse prognosis in patients with HNSCC. Classification based on pretreatment neutrophil and monocyte counts enabled the identification of different prognostic profiles. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27534525 [PubMed - as supplied by publisher]

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Role of surgery in the management of anaplastic thyroid carcinoma: Korean nationwide multicenter study of 329 patients with anaplastic thyroid carcinoma, 2000 to 2012.

Role of surgery in the management of anaplastic thyroid carcinoma: Korean nationwide multicenter study of 329 patients with anaplastic thyroid carcinoma, 2000 to 2012.

Head Neck. 2016 Aug 18;

Authors: Baek SK, Lee MC, Hah JH, Ahn SH, Son YI, Rho YS, Chung PS, Lee YS, Koo BS, Jung KY, Lee BJ

Abstract
BACKGROUND: The Korean Society of Thyroid Head and Neck Surgery established a nationwide multicenter registry of anaplastic thyroid carcinoma (ATC) and evaluated the prognostic factors and treatment outcomes of ATC.
METHODS: The present study enrolled 329 patients who were diagnosed with ATC between January 2000 and December 2012 at 19 medical centers in Korea. Survival outcomes were evaluated according to various clinical factors and treatments.
RESULTS: Multivariate analysis identified age ≥70 years old, the presence of initial clinical symptoms, distant metastasis, and treatment modality as significant risk factors (p <.05). The patients who underwent curative resection and adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CRT) showed the best survival on multivariate analysis (p < 0.05).
CONCLUSION: Although ATC is a lethal neoplasm, long-term survival may be acquired in cases in which the aggressive management, including curative resection or RT/concurrent CRT, is possible for therapeutic intent. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27534388 [PubMed - as supplied by publisher]

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Outcome measures in older persons with acquired joint contractures: a systematic review and content analysis using the ICF (International Classification of Functioning, Disability and Health) as a reference.

Related Articles

Outcome measures in older persons with acquired joint contractures: a systematic review and content analysis using the ICF (International Classification of Functioning, Disability and Health) as a reference.

BMC Geriatr. 2016;16:40

Authors: Bartoszek G, Fischer U, Müller M, Strobl R, Grill E, Nadolny S, Meyer G

Abstract
BACKGROUND: Joint contractures are a common health problem in older persons with significant impact on activities of daily living. We aimed to retrieve outcome measures applied in studies on older persons with joint contractures and to identify and categorise the concepts contained in these outcome measures using the ICF (International Classification of Functioning, Disability and Health) as a reference.
METHODS: Electronic searches of Medline, EMBASE, CINAHL, Pedro and the Cochrane Library were conducted (1/2002-8/2012). We included studies in the geriatric rehabilitation and nursing home settings with participants aged ≥ 65 years and with acquired joint contractures. Two independent reviewers extracted the outcome measures and transferred them to concepts using predefined conceptual frameworks. Concepts were subsequently linked to the ICF categories.
RESULTS: From the 1057 abstracts retrieved, 60 studies met the inclusion criteria. We identified 52 single outcome measures and 24 standardised assessment instruments. A total of 1353 concepts were revealed from the outcome measures; 96.2% could be linked to 50 ICF categories in the 2nd level; 3.8% were not categorised. Fourteen of the 50 categories (28%) belonged to the component Body Functions, 4 (8%) to the component Body Structures, 26 (52%) to the component Activities and Participation, and 6 (12%) to the component Environmental Factors.
CONCLUSIONS: The ICF is a valuable reference for identifying and quantifying the concepts of outcome measures on joint contractures in older people. The revealed ICF categories remain to be validated in populations with joint contractures in terms of clinical relevance and personal impact.

PMID: 26860991 [PubMed - indexed for MEDLINE]

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Systems pharmacology to decipher the combinational anti-migraine effects of Tianshu formula.

Related Articles

Systems pharmacology to decipher the combinational anti-migraine effects of Tianshu formula.

J Ethnopharmacol. 2015 Nov 4;174:45-56

Authors: Li Y, Zhang J, Zhang L, Chen X, Pan Y, Chen SS, Zhang S, Wang Z, Xiao W, Yang L, Wang Y

Abstract
Migraine is the most common neurovascular disorder that imparts a considerable burden to health care system around the world. However, currently there are still no effective and widely applicable pharmacotherapies for migraine patients. Herbal formulae, characterized as multiple herbs, constituents and targets, have been acknowledged with clinical effects in treating migraine, which attract more and more researchers' attention although their exact molecular mechanisms are still unclear. In this work, a novel systems pharmacology-based method which integrates pharmacokinetic filtering, target fishing and network analysis was developed and exemplified by a probe, i.e. Tianshu formula, a widely clinically used anti-migraine herbal formula in China which comprises of Rhizoma chuanxiong and Gastrodia elata. The results exhibit that 20 active ingredients of Tianshu formula possess favorable pharmacokinetic profiles, which have interactions with 48 migraine-related targets to provide potential synergistic therapeutic effects. Additionally, from systematic analysis, we speculate that R. chuanxiong as the monarch herb mediates the major targets like PTGS2, ESR1, NOS2, HTR1B and NOS3 to regulate the vascular and nervous systems, as well as the inflammation and pain-related pathways to benefit migraine patients. Meanwhile, as an adjuvant herb, G. elata may not only assist the monarch herb to improve the outcome of migraine patients, but also regulate multiple targets like ABAT, HTR1D, ALOX15 and KCND3 to modify migraine accompanying symptoms like vomiting, vertigo and gastrointestinal disorders.

PMID: 26231449 [PubMed - indexed for MEDLINE]

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