Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

HNO. 2016 Sep 2;

Authors: Aschendorff A, Arndt S, Laszig R, Wesarg T, Hassepaß F, Beck R

Abstract
BACKGROUND: To date, the therapy of intralabyrinthine schwannoma consists mainly of a wait-and-see approach, completely ignoring auditory rehabilitation. Only a few single-case reports are as yet available on treatment with cochlear implants (CI).
AIM OF THE STUDY: This study aimed to assess the results of auditory rehabilitation after treatment with CI in a series of cases.
MATERIALS AND METHODS: The demographic findings, symptoms, and results of surgical therapy in 8 patients were evaluated in a retrospective analysis.
RESULTS: Prior to surgery, all patients presented with profound hearing loss and tinnitus. Episodic dizziness was reported by 3 patients. Among the patients, 4 had an intracochlear and 3 an intravestibular schwannoma, and a transmodiolar schwannoma was found in 1 patient. A total of 6 patients underwent treatment with CI. The results of auditory rehabilitation are favorable with open-set speech comprehension.
CONCLUSION: CI treatment following resection of an intralabyrinthine schwannoma is a promising option for auditory rehabilitation, even in single-sided deafness. This is a new treatment concept in contrast to the wait-and-scan policy. Expectant management appears justified only if the patient still has usable hearing.

PMID: 27590489 [PubMed - as supplied by publisher]

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Expressions of ion co-transporter genes in salicylate-induced tinnitus and treatment effects of spirulina.

Expressions of ion co-transporter genes in salicylate-induced tinnitus and treatment effects of spirulina.

BMC Neurol. 2016;16(1):159

Authors: Hwang JH, Chan YC

Abstract
BACKGROUND: Although the activity of tinnitus-related ion co-transporter are known, their mRNA expressions has seldom been reported. We aimed to investigate the mRNA expressions of tinnitus-related ion co-transporter genes, and treatment effects of Spirulina.
METHODS: The mRNA expressions of K(+)-Cl(-) co-transporter (KCC2) and Na-K-2Cl co-transporter 1 (NKCC1) genes in the cochlea and brain of mice were evaluated after tinnitus was induced by intraperitoneal injection of salicylate. The effects of spirulina water extract on these gene expressions were investigated.
RESULTS: Compared to the control group, the tinnitus scores increased significantly, however, the salicylate-induced tinnitus could be reduced significantly by spirulina water extract. The tinnitus group had higher of borderline significance mRNA expression of KCC2 gene in the cochlear, significantly higher in the temporal lobes and in the frontal lobes. Meanwhile, compared to the tinnitus group, the spirulina group had significantly lower mRNA expression of KCC2 gene in the cochlear, temporal lobes, frontal lobes and parahippocampus/hippocampus. However, the NKCC1 mRNA expression was not significantly different between three groups in the cochlea and these brain areas.
CONCLUSION: Salicylate-induced tinnitus might be associated with increased mRNA expression of KCC2 gene, but not with mRNA expressions of NKCC1 gene in the cochlear and some tinnitus-related brain areas. Spirulina reduced the expression of KCC2 genes in salicylate-induced tinnitus.

PMID: 27590453 [PubMed - as supplied by publisher]

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Management and outcome of chordomas in the pediatric population: The Hospital for Sick Children experience and review of the literature.

Management and outcome of chordomas in the pediatric population: The Hospital for Sick Children experience and review of the literature.

J Clin Neurosci. 2016 Aug 30;

Authors: Tsitouras V, Wang S, Dirks P, Drake J, Bouffet E, Hawkins C, Laughlin S, Rutka JT

Abstract
Chordomas are tumors arising from remnants of the embryological notochord, most commonly found in the spheno-occipital, spinal, or sacro-coccygeal areas. They are rare tumors in the pediatric population and are challenging to manage due to their difficult accessibility, proximity to important anatomy and extension into adjacent structures. We report a series of 10 children treated for chordoma at The Hospital for Sick Children focusing on their surgery, adjuvant therapy and long-term outcomes. A retrospective review involving patient charts, radiographic imaging, and pathology slides was performed for 10 chordoma patients during the period from 1987-2015. Important variables, including patient demographics, chordoma location, presentation, imaging characteristics, pathology subtype, treatment options, and long-term outcome were analysed. The series consists of seven girls and three boys with cranial or upper cervical spine chordomas. One patient presented with an extradural left cerebellopontine angle chordoma demonstrating aggressive and dedifferentiated features, which, to our knowledge, has not been previously described in the literature. All patients received surgical resection followed by photon or proton radiotherapy. Four patients with chondroid or atypical pathology also received chemotherapeutic adjuvants. All patients with classical pathology achieved favourable outcome, while the four patients with atypical pathology progressed quickly despite aggressive therapy, suggesting that pathology subtype is a crucial prognostic factor. This study summarizes 30years of surgical and adjuvant therapy experience in a large academic center for pediatric chordoma patients. Patient outcomes were dependent on pathology subtype, and a multidisciplinary approach involving surgery, radiotherapy, and chemotherapy can be considered on an individual basis.

PMID: 27590862 [PubMed - as supplied by publisher]

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Patients cured of acromegaly do not experience improvement of their skull deformities.

Patients cured of acromegaly do not experience improvement of their skull deformities.

Pituitary. 2016 Sep 2;

Authors: Rick JW, Jahangiri A, Flanigan PM, Aghi MK

Abstract
PURPOSE: Acromegaly is a rare disease that is associated with many co-morbidities. This condition also causes progressive deformity of the skull which includes frontal bossing and cranial thickening. Surgical and/or medical management can cure this condition in many patients, but it is not understood if patients cured of acromegaly experience regression of their skull deformities.
METHODS: We performed a retrospective analysis on patients treated at our dedicated pituitary center from 2009 to 2014. We looked at all MRI images taken during the treatment of these patients and recorded measurements on eight skull dimensions. We then analyzed these measurements for changes over time.
RESULTS: 29 patients underwent curative treatment for acromegaly within our timeframe. The mean age for this population was 45.0 years old (range 19-70) and 55.2 % (n = 16) were female. All of these patients were treated with a transsphenoidal resection for a somatotropic pituitary adenoma. 9 (31.1%) of these patients required further medical therapy to be cured. We found statically significant variation in the coronal width of the sella turcica after therapy, which is likely attributable to changes from transsphenoidal surgery. None of the other dimensions had significant variation over time after cure.
CONCLUSION: Patients cured of acromegaly should not expect natural regression of their skull deformities. Our study suggests that both frontal bossing and cranial thickening do not return to normal after cure.

PMID: 27590786 [PubMed - as supplied by publisher]

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An observational, prospective study to evaluate the preoperative planning tool "CI-Wizard" for cochlear implant surgery.

An observational, prospective study to evaluate the preoperative planning tool "CI-Wizard" for cochlear implant surgery.

Eur Arch Otorhinolaryngol. 2016 Sep 2;

Authors: Pirlich M, Tittmann M, Franz D, Dietz A, Hofer M

Abstract
"CI-Wizard" is a new, three-dimensional software planning tool for cochlear implant surgery with manual and semi-automatic algorithms to visualize anatomical risk structures of the lateral skull base preoperatively. Primary endpoints of the study represented the evaluation of the CI-Wizards usability, accuracy, subjectively perceived and objectively measured time in clinical practice. In a period from January 2014 to March 2015, n = 36 participants were included in this study. These members were divided into three groups of equal number (n = 12), but different level of experience. Senior doctors and consultants (group 1), residents (group 2) and medical students (group 3) segmented 12 different CT-scan data sets of the CI-Wizard (four per participant). In total, n = 144 data sets were collected. The usability of the CI-Wizard was measured by the given questionnaire with an interval rating scale. The Jaccard coefficient (JT) was used to evaluate the accuracy of the anatomical structures segmented. The subjectively perceived time was measured with an interval rating scale in the questionnaire and was compared with the objectively mean measured time (time interact). Across all three groups, the usability of the CI-Wizard has been assessed between 1 ("very good") and 2 ("with small defects"). Subjectively, the time was stated as "appropriate" by questionnaire. Objective measurements of the required duration revealed averages of t = 9.8 min for creating a target view. Concerning the accuracy, semi-automatic anatomical structures such as the external acoustic canal (JT = 0.90), the tympanic cavity (JT = 0.87), the ossicles (JT = 0.63), the cochlea (JT = 0.66), and the semicircular canals (JT = 0.61) reached high Jaccard values, which describes a great match of the segmented structures between the partcipants and the gold standard. Facial nerve (JT = 0.39) and round window (JT = 0.37) reached lower Jaccard values. Very little overlap tendency was found for the chorda tympani (JT = 0.11). This software program represents a further important step in the development of preoperative planning tools in cochlear implant surgery. The study revealed a high level of satisfaction in the usability. The subjectively required time was considered as "appropriate" and the objectively mean measured time was t = 9.8 min short enough, so that a clinical application seems realistic. Particularly for semi-automatically segmented structures, it represented a good accuracy. For purely manual segmented structures, further improvements are desirable. Finally, this program also provides a good learning tool for medical students and residents to become familiar with the anatomy of the lateral skull base.

PMID: 27589966 [PubMed - as supplied by publisher]

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[Hearing results after middle fossa removal of small (T1/T2) vestibular schwannomas].

[Hearing results after middle fossa removal of small (T1/T2) vestibular schwannomas].

HNO. 2016 Sep 2;

Authors: Scheich M, Ehrmann-Müller D, Shehata-Dieler W, Hagen R

Abstract
OBJECTIVE: The aim of this study was to evaluate the hearing results after surgery for T1 and T2 vestibular schwannomas (VS) via the middle cranial fossa (MCF) approach at one institution and to review outcomes in the recent literature.
PATIENTS AND METHODS: In our department, 208 consecutive patients have undergone surgery using the MCF approach between December 2005 and February 2015. Audiological testing included pure-tone audiometry, speech-discrimination-tests pre- and postoperatively, as well as a pre- and intraoperative brainstem evoked response audiometry (BERA). Hearing status was categorized according to the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) or Gardner-Robertson classification. Hearing preservation was assessed when postoperative values were still within class A + B.
RESULTS: In 167 of the 208 patients, preoperative hearing levels corresponded to class A+B. In 78 tumors, extension of the VS was limited to the internal auditory canal (T1) and in 89 tumors there was an extrameatal growth without touching the brainstem (T2). In 109 patients (65 %), postoperative hearing was still in class A+B. In the group of intrameatal tumors, the hearing preservation rate was even 69 %. The analysis of the literature of the past 16 years revealed comparable results (46-82 %).
CONCLUSIONS: Surgery for VS using the MCF approach is an established technique for reliable tumor removal with an adequate rate of hearing preservation. For small tumors without brainstem contact, particularly satisfying results can be achieved. This should be taken into account when discussing the possibility of early hearing preservation surgery.

PMID: 27590491 [PubMed - as supplied by publisher]

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[Current treatment concepts in head and neck cancer : Highlights of the 2016 ASCO Annual Meeting].

[Current treatment concepts in head and neck cancer : Highlights of the 2016 ASCO Annual Meeting].

HNO. 2016 Sep 2;

Authors: Knecht R

PMID: 27590490 [PubMed - as supplied by publisher]

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Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

HNO. 2016 Sep 2;

Authors: Aschendorff A, Arndt S, Laszig R, Wesarg T, Hassepaß F, Beck R

Abstract
BACKGROUND: To date, the therapy of intralabyrinthine schwannoma consists mainly of a wait-and-see approach, completely ignoring auditory rehabilitation. Only a few single-case reports are as yet available on treatment with cochlear implants (CI).
AIM OF THE STUDY: This study aimed to assess the results of auditory rehabilitation after treatment with CI in a series of cases.
MATERIALS AND METHODS: The demographic findings, symptoms, and results of surgical therapy in 8 patients were evaluated in a retrospective analysis.
RESULTS: Prior to surgery, all patients presented with profound hearing loss and tinnitus. Episodic dizziness was reported by 3 patients. Among the patients, 4 had an intracochlear and 3 an intravestibular schwannoma, and a transmodiolar schwannoma was found in 1 patient. A total of 6 patients underwent treatment with CI. The results of auditory rehabilitation are favorable with open-set speech comprehension.
CONCLUSION: CI treatment following resection of an intralabyrinthine schwannoma is a promising option for auditory rehabilitation, even in single-sided deafness. This is a new treatment concept in contrast to the wait-and-scan policy. Expectant management appears justified only if the patient still has usable hearing.

PMID: 27590489 [PubMed - as supplied by publisher]

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[Otoconia : Current aspects of research].

[Otoconia : Current aspects of research].

HNO. 2016 Sep 2;

Authors: Walther LE

Abstract
Otoconia are calcite-based nanocomposites containing >90 % calcite and <10 % organic material. The mean size is approximately 10 µm. The external structure of all otoconia in the utricle and saccule is similar, with a cylindrical bulbous body with a slightly hexagonal contour. The internal structure consists of a composite with varying volume thickness, dense branching structures (branches) and less dense surrounding areas (bellies). Intact otoconia can be clearly identified only by scanning electron microscopy. In the case of morphological changes (e.g. due to "degeneration") the origin of even very small particles of otoconia can be assigned using physical and chemical analytical methods. The inorganic component of otoconia (calcite) is extremely sensitive to chemical influences, which leads to morphological alterations. A "degeneration" of otoconia can be objectively accomplished in vitro by alterations in pH, electrolyte imbalance and by the influence of complex formation. These three main processes then lead to irreversible morphological alterations. Artificial (biomimetic) otoconia serve as a suitable model system for detailed investigation of growth and degenerative processes.

PMID: 27590488 [PubMed - as supplied by publisher]

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[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

Pol Merkur Lekarski. 2016 Aug 29;41(242):74-78

Authors: Kosztyła-Hojna B, Moskal D, Falkowski D, Łobaczuk-Sitnik A, Kraszewska A, Skorupa M

Abstract
Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation.
AIM: The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically.
MATERIALS AND METHODS: The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice.
RESULTS: Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases.
CONCLUSIONS: HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.

PMID: 27591443 [PubMed - as supplied by publisher]

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[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

Pol Merkur Lekarski. 2016 Jul 29;41(241):74-78

Authors: Kosztyła-Hojna B, Moskal D, Falkowski D, Łobaczuk-Sitnik A, Kraszewska A, Skorupa M

Abstract
Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation.
AIM: The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically.
MATERIALS AND METHODS: The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice.
RESULTS: Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases.
CONCLUSIONS: HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.

PMID: 27590648 [PubMed - as supplied by publisher]

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Contextualizing learning to improve care using collaborative communities of practices.

Contextualizing learning to improve care using collaborative communities of practices.

BMC Health Serv Res. 2016;16(1):464

Authors: Jeffs L, McShane J, Flintoft V, White P, Indar A, Maione M, Lopez AJ, Bookey-Bassett S, Scavuzzo L

Abstract
BACKGROUND: The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.
METHODS: The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.
RESULTS: Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.
CONCLUSIONS: Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.

PMID: 27590455 [PubMed - as supplied by publisher]

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Feasibility of real-time near-infrared indocyanine green fluorescence endoscopy for the evaluation of mucosal head and neck lesions.

Feasibility of real-time near-infrared indocyanine green fluorescence endoscopy for the evaluation of mucosal head and neck lesions.

Head Neck. 2016 Sep 2;

Authors: Schmidt F, Dittberner A, Koscielny S, Petersen I, Guntinas-Lichius O

Abstract
BACKGROUND: The purpose of this study was to explore the feasibility and potential drawbacks of near-infrared (NIR) endoscopy with indocyanine green (ICG) to examine mucosal head and neck lesions.
METHODS: NIR ICG endoscopy was applied to image head and neck cancer epithelium in vivo. The evaluation of the ICG videos was performed off-line independently by 2 evaluators and blinded with respect to final histopathological results from biopsies taken as the gold standard.
RESULTS: Forty percent of the lesions from 55 patients were histologically malignant. ICG positivity showed a sensitivity, specificity, and accuracy to be related to a malignant tumor of 90.5%, 90.9%, and 89.1%, respectively. The kappa index for the interobserver assessment showed a 94.4% agreement for the assessment of the ICG positivity. Side effects of the NIR ICG endoscopy did not arise.
CONCLUSION: NIR ICG endoscopy in patients with mucosal head and neck lesions was feasible and safe. It might help intraoperatively to differentiate benign from malignant lesions. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27590351 [PubMed - as supplied by publisher]

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Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

HNO. 2016 Sep 2;

Authors: Aschendorff A, Arndt S, Laszig R, Wesarg T, Hassepaß F, Beck R

Abstract
BACKGROUND: To date, the therapy of intralabyrinthine schwannoma consists mainly of a wait-and-see approach, completely ignoring auditory rehabilitation. Only a few single-case reports are as yet available on treatment with cochlear implants (CI).
AIM OF THE STUDY: This study aimed to assess the results of auditory rehabilitation after treatment with CI in a series of cases.
MATERIALS AND METHODS: The demographic findings, symptoms, and results of surgical therapy in 8 patients were evaluated in a retrospective analysis.
RESULTS: Prior to surgery, all patients presented with profound hearing loss and tinnitus. Episodic dizziness was reported by 3 patients. Among the patients, 4 had an intracochlear and 3 an intravestibular schwannoma, and a transmodiolar schwannoma was found in 1 patient. A total of 6 patients underwent treatment with CI. The results of auditory rehabilitation are favorable with open-set speech comprehension.
CONCLUSION: CI treatment following resection of an intralabyrinthine schwannoma is a promising option for auditory rehabilitation, even in single-sided deafness. This is a new treatment concept in contrast to the wait-and-scan policy. Expectant management appears justified only if the patient still has usable hearing.

PMID: 27590489 [PubMed - as supplied by publisher]

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[Pneumomediastinum - a case report].

[Pneumomediastinum - a case report].

Pol Merkur Lekarski. 2016 Aug 29;41(242):93-96

Authors: Szmygin-Milanowska K, Grzywa-Celińska A, Krusiński A, Cielma M, Wawrzecka A, Emeryk-Maksymiuk J, Milanowski J

Abstract
Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed.
AIM: The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica).
A CASE REPORT: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.
CONCLUSIONS: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.

PMID: 27591447 [PubMed - as supplied by publisher]

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[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

Pol Merkur Lekarski. 2016 Aug 29;41(242):74-78

Authors: Kosztyła-Hojna B, Moskal D, Falkowski D, Łobaczuk-Sitnik A, Kraszewska A, Skorupa M

Abstract
Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation.
AIM: The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically.
MATERIALS AND METHODS: The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice.
RESULTS: Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases.
CONCLUSIONS: HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.

PMID: 27591443 [PubMed - as supplied by publisher]

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[Pneumomediastinum - a case report].

[Pneumomediastinum - a case report].

Pol Merkur Lekarski. 2016 Jul 29;41(241):93-96

Authors: Szmygin-Milanowska K, Grzywa-Celińska A, Krusiński A, Cielma M, Wawrzecka A, Emeryk-Maksymiuk J, Milanowski J

Abstract
Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed.
AIM: The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica).
A CASE REPORT: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.
CONCLUSIONS: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.

PMID: 27590652 [PubMed - as supplied by publisher]

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[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx].

Pol Merkur Lekarski. 2016 Jul 29;41(241):74-78

Authors: Kosztyła-Hojna B, Moskal D, Falkowski D, Łobaczuk-Sitnik A, Kraszewska A, Skorupa M

Abstract
Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation.
AIM: The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically.
MATERIALS AND METHODS: The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice.
RESULTS: Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases.
CONCLUSIONS: HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.

PMID: 27590648 [PubMed - as supplied by publisher]

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An observational, prospective study to evaluate the preoperative planning tool "CI-Wizard" for cochlear implant surgery.

An observational, prospective study to evaluate the preoperative planning tool "CI-Wizard" for cochlear implant surgery.

Eur Arch Otorhinolaryngol. 2016 Sep 2;

Authors: Pirlich M, Tittmann M, Franz D, Dietz A, Hofer M

Abstract
"CI-Wizard" is a new, three-dimensional software planning tool for cochlear implant surgery with manual and semi-automatic algorithms to visualize anatomical risk structures of the lateral skull base preoperatively. Primary endpoints of the study represented the evaluation of the CI-Wizards usability, accuracy, subjectively perceived and objectively measured time in clinical practice. In a period from January 2014 to March 2015, n = 36 participants were included in this study. These members were divided into three groups of equal number (n = 12), but different level of experience. Senior doctors and consultants (group 1), residents (group 2) and medical students (group 3) segmented 12 different CT-scan data sets of the CI-Wizard (four per participant). In total, n = 144 data sets were collected. The usability of the CI-Wizard was measured by the given questionnaire with an interval rating scale. The Jaccard coefficient (JT) was used to evaluate the accuracy of the anatomical structures segmented. The subjectively perceived time was measured with an interval rating scale in the questionnaire and was compared with the objectively mean measured time (time interact). Across all three groups, the usability of the CI-Wizard has been assessed between 1 ("very good") and 2 ("with small defects"). Subjectively, the time was stated as "appropriate" by questionnaire. Objective measurements of the required duration revealed averages of t = 9.8 min for creating a target view. Concerning the accuracy, semi-automatic anatomical structures such as the external acoustic canal (JT = 0.90), the tympanic cavity (JT = 0.87), the ossicles (JT = 0.63), the cochlea (JT = 0.66), and the semicircular canals (JT = 0.61) reached high Jaccard values, which describes a great match of the segmented structures between the partcipants and the gold standard. Facial nerve (JT = 0.39) and round window (JT = 0.37) reached lower Jaccard values. Very little overlap tendency was found for the chorda tympani (JT = 0.11). This software program represents a further important step in the development of preoperative planning tools in cochlear implant surgery. The study revealed a high level of satisfaction in the usability. The subjectively required time was considered as "appropriate" and the objectively mean measured time was t = 9.8 min short enough, so that a clinical application seems realistic. Particularly for semi-automatically segmented structures, it represented a good accuracy. For purely manual segmented structures, further improvements are desirable. Finally, this program also provides a good learning tool for medical students and residents to become familiar with the anatomy of the lateral skull base.

PMID: 27589966 [PubMed - as supplied by publisher]

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