Anesthesia for peroral endoscopic myotomy: A retrospective case series.

Anesthesia for peroral endoscopic myotomy: A retrospective case series.

J Anaesthesiol Clin Pharmacol. 2016 Jul-Sep;32(3):379-81

Authors: Jayan N, Jacob JS, Mathew M, Mukkada RJ

Abstract
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is a safe and minimally invasive modality regarded as the first-line management of all types of achalasia. POEM is performed under general anesthesia with endotracheal intubation using an orally inserted flexible fiberscope. The aim of this study is to describe the anesthetic management of POEM for achalasia.
MATERIAL AND METHODS: A chart review of 21 patients who underwent POEM for achalasia at our center from March 2013 to June 2015 was performed.
RESULTS: In the 21 patients, the end-tidal carbon dioxide was elevated following esophageal carbon dioxide insufflation and required adjustments in ventilation. POEM was successfully completed, and the patients were extubated immediately afterward. Subcutaneous emphysema occurred in five patients. Complications such as mediastinitis, pleural effusion, pneumoperitoneum, and pneumomediastinum were managed conservatively. Esophageal perforation occurred in one patient and needed surgical intervention.
CONCLUSION: For patients with achalasia, POEM offers the efficacy of surgery with the lower cost and morbidity of an endoscopic procedure. Prevention of aspiration and carbon dioxide insufflation-related complications are the two aspects that demand vigilance from the anesthesiologist.

PMID: 27625490 [PubMed]

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Diagnosis and management of esophageal achalasia.

Diagnosis and management of esophageal achalasia.

BMJ. 2016;354:i2785

Authors: Stavropoulos SN, Friedel D, Modayil R, Parkman HP

Abstract
Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification. Potential treatments include drugs, endoscopic botulinum toxin injection, balloon dilation, traditional surgery (usually laparoscopic Heller myotomy; LHM), and a novel, less invasive, natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy termed peroral endoscopic myotomy (POEM). The first human POEM was performed in 2008, with the first publication appearing in 2010 and evidence now rapidly accumulating showing POEM to be comparable to traditional surgery in terms of clinical success and radiologic and manometric post-therapy outcomes. This review discusses the diagnosis and management of achalasia with particular emphasis on the recent developments of HRM and POEM, which arguably represent the most important advances in the field since the advent of laparoscopic Heller myotomy in the 1990s.

PMID: 27625387 [PubMed - in process]

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[Vibrant Soundbridge®: An Alternative Hearing System for Preschool Children with Aural Atresia].

[Vibrant Soundbridge®: An Alternative Hearing System for Preschool Children with Aural Atresia].

Laryngorhinootologie. 2016 Sep;95(9):627-633

Authors: Leinung M, Zaretsky Y, Ernst B, Vaerst B, Stöver T, Hey C

Abstract
Background: The audiological treatment of children with aural atresia makes high demands on physicians and acousticians. Conventional hearing systems are often not tolerated by children and therefore do not meet the needs of the early and efficient therapy of hearing disorders. Aim of the present study was the evaluation of the audiological functional gain in children with uni- and bilateral aural atresia provided with the middle ear implant Vibrant Soundbridge(®) (VSB(®)) below the age of 6 years as well as the analysis of parents' satisfaction assessed with questionnaires. Material and methods: The VSB(®) was implanted in 16 children, 13 with unilateral and 3 with bilateral aural atresia, with the mean age of 2;11±1;6 years. 3 months after the first fitting of the audio processor, pure-tone audiometry via free field testing with and without the hearing system was performed. Furthermore, parents completed a standardized questionnaire to evaluate their satisfaction with the VSB(®) treatment quality. The questionnaire included items on the acceptance by children, handling, listening effort, behavior, satisfaction, quality of life, aesthetics, and the length of daily use. Results: The use of the VSB(®) resulted in a significantly improved hearing level: 20 dB on average (Z=- 3.06; p=0.002; n=12). The analysis of parents' questionnaire demonstrated high or very high satisfaction with VSB(®) in all subjects. Primarily, the length of daily use of the VSB(®) was significantly higher than that of the hearing system used before with 10.0±2.1 vs. 2.7±2.2 h per day (Z=- 3.06; p=0.002; n=14). Conclusion: The VSB(®) presented a good alternative for audiological treatment of uni- and bilateral aural atresia at toddler and pre-school age.

PMID: 27626815 [PubMed - as supplied by publisher]

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Schädelbasischirurgie - Chirurgische Technik.

Schädelbasischirurgie - Chirurgische Technik.

Laryngorhinootologie. 2016 Sep;95(9):654-659

Authors:

PMID: 27626818 [PubMed - as supplied by publisher]

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[Tracheotomie Revisited].

[Tracheotomie Revisited].

Laryngorhinootologie. 2016 Sep;95(9):640-652

Authors: Gill-Schuster D

PMID: 27626817 [PubMed - as supplied by publisher]

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[From the Expert's Office: Joiner's deafness].

[From the Expert's Office: Joiner's deafness].

Laryngorhinootologie. 2016 Sep;95(9):638-639

Authors: Brusis T

PMID: 27626816 [PubMed - as supplied by publisher]

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[Patients' Rights Act].

[Patients' Rights Act].

Laryngorhinootologie. 2016 Sep;95(9):604-609

Authors: Haier AJ

Abstract
The new Patients' Rights Act does not reflect rights of patients as professional obligations of physicians for the first time. It adopted common longtime jurisdiction, but in some respects it is going beyond. This law clearly extended the documentation requirements of physicians, especially concerning the extent of documentation. In surgical fields the requirements for enlightening physicians were more strongly worded than in previous jurisdiction. In medical facilities it is now mandatory to establish an internal quality management system.

PMID: 27626814 [PubMed - as supplied by publisher]

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[Editors Comment].

[Editors Comment].

Laryngorhinootologie. 2016 Sep;95(9):595

Authors:

PMID: 27626813 [PubMed - as supplied by publisher]

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Diagnosis and management of esophageal achalasia.

Diagnosis and management of esophageal achalasia.

BMJ. 2016;354:i2785

Authors: Stavropoulos SN, Friedel D, Modayil R, Parkman HP

Abstract
Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification. Potential treatments include drugs, endoscopic botulinum toxin injection, balloon dilation, traditional surgery (usually laparoscopic Heller myotomy; LHM), and a novel, less invasive, natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy termed peroral endoscopic myotomy (POEM). The first human POEM was performed in 2008, with the first publication appearing in 2010 and evidence now rapidly accumulating showing POEM to be comparable to traditional surgery in terms of clinical success and radiologic and manometric post-therapy outcomes. This review discusses the diagnosis and management of achalasia with particular emphasis on the recent developments of HRM and POEM, which arguably represent the most important advances in the field since the advent of laparoscopic Heller myotomy in the 1990s.

PMID: 27625387 [PubMed - in process]

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Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI - a preliminary report.

Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI - a preliminary report.

Acta Otolaryngol. 2016 Sep 14;:1-6

Authors: Mikaszewski B, Markiet K, Smugała A, Stodulski D, Szurowska E, Stankiewicz C

Abstract
CONCLUSION: At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (Tpeak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe.
OBJECTIVE: To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: Tpeak and WR.
METHODS: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen.
RESULTS: Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on Tpeak and WR values, two distinct clusters of parotid malignancies were identified. The cut-off value for Tpeak optimally differentiating between the clusters was 140 s; the cut-off value for WR could not be identified. The two clusters did not differ in terms of dynamic and diffusion-weighted MRI parameters, patient age, sex and prevalence of lymphadenopathy. Significant inter-cluster differences were found in the prevalence of deep parotid lobe involvement and presence of a single mass.

PMID: 27627686 [PubMed - as supplied by publisher]

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Non-Monotonic Relation between Noise Exposure Severity and Neuronal Hyperactivity in the Auditory Midbrain.

Non-Monotonic Relation between Noise Exposure Severity and Neuronal Hyperactivity in the Auditory Midbrain.

Front Neurol. 2016;7:133

Authors: Hesse LL, Bakay W, Ong HC, Anderson L, Ashmore J, McAlpine D, Linden J, Schaette R

Abstract
The occurrence of tinnitus can be linked to hearing loss in the majority of cases, but there is nevertheless a large degree of unexplained heterogeneity in the relation between hearing loss and tinnitus. Part of the problem might be that hearing loss is usually quantified in terms of increased hearing thresholds, which only provides limited information about the underlying cochlear damage. Moreover, noise exposure that does not cause hearing threshold loss can still lead to "hidden hearing loss" (HHL), i.e., functional deafferentation of auditory nerve fibers (ANFs) through loss of synaptic ribbons in inner hair cells. While it is known that increased hearing thresholds can trigger increases in spontaneous neural activity in the central auditory system, i.e., a putative neural correlate of tinnitus, the central effects of HHL have not yet been investigated. Here, we exposed mice to octave-band noise at 100 and 105 dB SPL to generate HHL and permanent increases of hearing thresholds, respectively. Deafferentation of ANFs was confirmed through measurement of auditory brainstem responses and cochlear immunohistochemistry. Acute extracellular recordings from the auditory midbrain (inferior colliculus) demonstrated increases in spontaneous neuronal activity (a putative neural correlate of tinnitus) in both groups. Surprisingly, the increase in spontaneous activity was most pronounced in the mice with HHL, suggesting that the relation between hearing loss and neuronal hyperactivity might be more complex than currently understood. Our computational model indicated that these differences in neuronal hyperactivity could arise from different degrees of deafferentation of low-threshold ANFs in the two exposure groups. Our results demonstrate that HHL is sufficient to induce changes in central auditory processing, and they also indicate a non-monotonic relationship between cochlear damage and neuronal hyperactivity, suggesting an explanation for why tinnitus might occur without obvious hearing loss and conversely why hearing loss does not always lead to tinnitus.

PMID: 27625631 [PubMed]

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Effect of Tianeptine on Depressed Tinnitus Patients.

Effect of Tianeptine on Depressed Tinnitus Patients.

J Audiol Otol. 2016 Sep;20(2):90-6

Authors: Hwang SM, Lim SH, Oh DJ, Kim SK, Jung HH, Im GJ

Abstract
BACKGROUND AND OBJECTIVES: Tianeptine is a tricyclic antidepressant that has a novel pharmacological property: it increases the reuptake of 5-hydroxytryptamine. Recent studies have reported that the prevalence of depression is greater in patients with tinnitus than in control subjects who do not have tinnitus. The purpose of this study was to assess the efficacy of tianeptine for the relief of tinnitus, especially in patients with depressive mood.
SUBJECTS AND METHODS: Among a total of 52 tinnitus patients, 15 had depressive mood. The depressed tinnitus patients were prescribed Stablon® 12.5 mg once daily for 1 month without any other drug. We assessed the severity of tinnitus, level of depression, and the quality of sleep in these patients by using the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Hearing impairment and severity of tinnitus were measured with pure tone audiometry, speech audiometry, and tinnitograms. These evaluations were conducted before and after medication treatment.
RESULTS: For the 15 depressed tinnitus patients, THI scores significantly correlated with BDI and PSQI scores prior to medication treatment. These results showed that the discomfort of tinnitus was closely related to depression and sleep disorder. After medication treatment, THI and BDI scores significantly decreased, indicating that tinnitus and depression improved. However, no significant alteration in PSQI score was observed, indicating that there was no improvement in sleep quality.
CONCLUSIONS: In the treatment of depressed tinnitus patients, tianeptine might be an efficient drug to treat both tinnitus and depression. However, tianeptine is unlikely to improve the quality of sleep in these patients.

PMID: 27626082 [PubMed]

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Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies.

Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies.

Eur Arch Otorhinolaryngol. 2016 Sep 13;

Authors: Vlastarakos PV, Iacovou E, Nikolopoulos TP

Abstract
The aim of this study is to review the literature on sustained-release vehicles delivering gentamycin in the inner ear of patients suffering from Meniere's disease (MD), and critically assess their respective clinical effectiveness and safety. A systematic literature review was conducted in Medline and other database sources until January 2016, along with critical analysis of pooled data. Overall, six prospective and four retrospective studies were systematically analyzed. The total number of treated patients was 320. A 2 year patient follow up was only reported in 40 % of studies. Inner ear gentamycin delivery using sustained-release vehicles is associated with improved vertigo control (strength of recommendation B), and quality of life (strength of recommendation B) in MD sufferers. In addition, dynamic-release devices seem to achieve high rates of improvement in the appearance of tinnitus (65.4 %) and aural pressure (76.2 %). By contrast, percentages of complete and partial hearing loss appear unacceptably high (31.08 and 23.38 % of patients, respectively), compared to historical data involving simple intratympanic gentamycin injections. Sustained-release vehicles for gentamycin delivery may have a role in the management of MD patients who have previously failed intratympanic gentamycin injections, or those who have already lost serviceable hearing. Their use as first line treatment over single intratympanic injections for all MD patients, who do not respond to conservative treatment should be discouraged.

PMID: 27623821 [PubMed - as supplied by publisher]

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Altered processing of otolithic information in isolated lateral medullary infarction.

Altered processing of otolithic information in isolated lateral medullary infarction.

J Neurol. 2016 Sep 13;

Authors: Kim HJ, Kim S, Park JH, Kim JS

Abstract
Ocular and cervical vestibular-evoked myogenic potentials (VEMPs) evaluate the function of otolithic pathways in central as well as peripheral vestibular disorders. This study aimed to determine the associations and dissociations of otolithic dysfunction in lateral medullary infarction (LMI), the most well-known disorder of central vestibulopathy. At the Dizziness Clinic of a referral-based University Hospital, 45 patients with isolated LMI (28 men, mean age = 55.6 ± 12.5) had evaluation of the ocular tilt reaction (OTR), tilt of the subjective visual vertical (SVV), and ocular and cervical VEMPs from Janurary 2011 to August 2015 during the acute phase, 1-11 days from the symptom onset (median = 2 days). Almost all (42/45, 93 %) patients showed at least one component of the OTR or SVV tilt that was invariably ipsiversive. In contrast, oVEMPs were abnormal only in 12 (27 %) and cVEMPs in 13 (29 %) patients. Only three patients showed abnormal results in all the tests of the OTR, SVV tilt, and ocular and cervical VEMPs. Abnormal oVEMPs were more common in patients with the OTR than those without (38 vs 6 %, Pearson X (2) test, p = 0.021). In contrast, abnormality of cVEMPs showed no correlation with the presence of OTR (28 vs 31 %, Pearson X (2) test, p = 0.795). In patients with LMI, ipsiversive OTR is invariable, but abnormalities of oVEMPs and cVEMPs were much less common and mostly dissociated even in the patients with abnormal results. This discrepancy in otolithic dysfunction suggests different anatomical substrates and/or dissimilar reciprocal modulation for processing of each otolithic signal in central vestibular structures located in the dorsolateral medulla.

PMID: 27624122 [PubMed - as supplied by publisher]

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Pediatric pituitary resection: characterizing surgical approaches and complications.

Pediatric pituitary resection: characterizing surgical approaches and complications.

Int Forum Allergy Rhinol. 2016 Sep 14;

Authors: Hanba C, Svider PF, Shkoukani MA, Sheyn A, Jacob JT, Eloy JA, Folbe AJ

Abstract
BACKGROUND: Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery.
METHODS: The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed.
RESULTS: A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%).
CONCLUSION: A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children undergoing transsphenoidal surgery.

PMID: 27626904 [PubMed - as supplied by publisher]

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Olfactory neuroblastoma followed by emergency surgery for symptomatic intradural spinal metastasis: A case report.

Olfactory neuroblastoma followed by emergency surgery for symptomatic intradural spinal metastasis: A case report.

Surg Neurol Int. 2016;7:77

Authors: Yunoki M, Suzuki K, Uneda A, Yoshino K

Abstract
BACKGROUND: Olfactory neuroblastoma (ONB) is a rare, aggressive tumor of the nasal cavity. It may invade the paranasal cavities and anterior skull base locally but may also metastasize to the cervical lymph nodes, lungs, or distant central nervous system.
CASE DESCRIPTION: Here, we report a case of ONB in which emergency surgery was performed for intradural spinal metastasis (ISM). The patient was a 52-year-old male who underwent surgery for ONB. The tumor extended from the nasal cavity to the intracranial space and was resected completely. After radiotherapy (60 Gy), the patient was discharged without any neurological deficit except anosmia. Seven months after the surgery, he consulted our department because of progressive tetraparesis. Cervical magnetic resonance imaging demonstrated an intradural spinal mass involving C5-T2 and necessitating emergency surgery. The tumor was resected subtotally followed by 58 Gy whole-spine irradiation. The patient's neurological symptoms improved, however, paralysis of the right upper and both the lower limbs remained. During the 4 months between the spinal surgery and his death, there was no further motor deterioration in any of his four extremities.
CONCLUSION: This case demonstrates the need to be aware of potential ISM in the follow-up of patients with ONB. The early detection of ISM by spinal MRI is crucial to ensuring good palliative care.

PMID: 27625887 [PubMed]

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[Managements and prognostic analyses in patients with invasive fungal rhinosinusitis].

[Managements and prognostic analyses in patients with invasive fungal rhinosinusitis].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Aug 7;51(8):568-72

Authors: Zhou W, Liu Q, Zhao WD, Yu HP, Sun XC, Wang JJ, Liu ZF, Li HY, Zheng CQ, Wang SY, Wang DH

Abstract
OBJECTIVE: To evaluate the survival outcomes of invasive fungal rhinosinusitis by analyzing the clinical features.
METHODS: A retrospective analysis was performed for cases of invasive fungal sinusitis proved by histological analysis between March 2006 and November 2015. All relevant factors including interval from the onset of symptoms to initiation of diagnosis, clinical characteristics, features of CT and MRI, treatment and prognosis were collected. A total of 18 patients (10 males; 8 females) were identified. The median age was 54 years old. Three patients suffered from acute invasive fungal sinusitis, while the other 15 suffered from chronic invasive fungal sinusitis.
RESULTS: The mean duration between onset of symptoms and diagnosis was 5 months. The most common symptom was headache (10/18), followed by visual disturbance (7/18), nasal obstruction (4/18), facial numbness and pain (2/18) and diplopia(2/18). Two patients had diabetes mellitus; one patient had ankylosing spondylitis receiving immunosuppressive drugs treatment for one year. Four patients had the disease confined in the sinus. Complications of this disease included orbital apex involvement in 6 patients, intraorbital and optic nerve involvement in 3 patients, cavernous sinus involvement in 5 patients, pterygopalatine fossa and infratemporal fossa involvement in 5 patients, intracranial extension involvement in 3 patients. Fungal species included aspergillus (15 cases) and mucor (3 cases). Seventeen patients received intravenous antifungal therapy after surgery. The duration of follow-up ranged from 1 to 60 months. Two patients reoccurred and one patient died of the disease.
CONCLUSION: Endoscopic debridement combined with intravenous antifungals is efficacious in the management of invasive fungal sinusitis.

PMID: 27625124 [PubMed - in process]

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Effect of budesonide and azelastine on histamine signaling regulation in human nasal epithelial cells.

Effect of budesonide and azelastine on histamine signaling regulation in human nasal epithelial cells.

Eur Arch Otorhinolaryngol. 2016 Sep 13;

Authors: Liu SC, Lin CS, Chen SG, Chu YH, Lee FP, Lu HH, Wang HW

Abstract
Both glucocorticoids and H1-antihistamines are widely used on patients with airway diseases. However, their direct effects on airway epithelial cells are not fully explored. Therefore, we use the primary culture of human nasal epithelial cells (HNEpC) to delineate in vitro mucosal responses to above two drugs. HNEpC cells were cultured with/without budesonide and azelastine. The growth rate at each group was recorded and measured as population double time (PDT). The histamine1-receptor (H1R), muscarinic1-receptor (M1R) and M3R were measured using immunocytochemistry and western blotting after 7-days treatment. Then, we used histamine and methacholine to stimulate the mucus secretion from HNEpC and observed the MUC5AC expression in culture supernatants. Concentration-dependent treatment-induced inhibition of HNEpC growth rate was observed. Cells incubated with azelastine proliferated significantly slower than that with budesonide and the combined use of those drugs led to significant PDT prolong. The immunocytochemistry showed the H1R, M1R and M3R were obviously located in the cell membrane without apparent difference after treatment. However, western blotting showed that budesonide can significantly up-regulate the H1R, M1R and M3R level while azelastine had opposite effects. Histamine and methacholine stimulated MUC5AC secretion was greater in cells treated with budesonide but was lesser in those treated with azelastine, as compared to controls. Our data suggest that both budesonide and azelastine can significantly inhibit HNEpC proliferation, and therefore, be helpful in against airway remodeling. Long-term use of budesonide might amplify histamine signaling and result in airway hyperreactivity to stimulants by enhancing H1R, M1R and M3R expression while azelastine can oppose this effect. Therefore, combined use of those two drugs in patients with chronic inflammatory airway diseases may be an ideal option.

PMID: 27623823 [PubMed - as supplied by publisher]

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Patient safety in otolaryngology: a descriptive review.

Patient safety in otolaryngology: a descriptive review.

Eur Arch Otorhinolaryngol. 2016 Sep 13;

Authors: Danino J, Muzaffar J, Metcalfe C, Coulson C

Abstract
Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled "To Err Is Human: Building a Safer Health System" was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a "safe specialty". A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within Otolaryngology, although patient safety has evolved along similar themes as other surgical specialties; there are several specific high-risk areas. Medical error is a common problem and its human cost is of immense importance. Steps to reduce such errors require the identification of high-risk practice within a complex healthcare system. The commitment to patient safety and quality improvement in medicine depend on personal responsibility and professional accountability.

PMID: 27623822 [PubMed - as supplied by publisher]

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Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies.

Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies.

Eur Arch Otorhinolaryngol. 2016 Sep 13;

Authors: Vlastarakos PV, Iacovou E, Nikolopoulos TP

Abstract
The aim of this study is to review the literature on sustained-release vehicles delivering gentamycin in the inner ear of patients suffering from Meniere's disease (MD), and critically assess their respective clinical effectiveness and safety. A systematic literature review was conducted in Medline and other database sources until January 2016, along with critical analysis of pooled data. Overall, six prospective and four retrospective studies were systematically analyzed. The total number of treated patients was 320. A 2 year patient follow up was only reported in 40 % of studies. Inner ear gentamycin delivery using sustained-release vehicles is associated with improved vertigo control (strength of recommendation B), and quality of life (strength of recommendation B) in MD sufferers. In addition, dynamic-release devices seem to achieve high rates of improvement in the appearance of tinnitus (65.4 %) and aural pressure (76.2 %). By contrast, percentages of complete and partial hearing loss appear unacceptably high (31.08 and 23.38 % of patients, respectively), compared to historical data involving simple intratympanic gentamycin injections. Sustained-release vehicles for gentamycin delivery may have a role in the management of MD patients who have previously failed intratympanic gentamycin injections, or those who have already lost serviceable hearing. Their use as first line treatment over single intratympanic injections for all MD patients, who do not respond to conservative treatment should be discouraged.

PMID: 27623821 [PubMed - as supplied by publisher]

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Enhanced patient involvement in Swedish aphasia intervention.

Enhanced patient involvement in Swedish aphasia intervention.

Clin Linguist Phon. 2016 Sep 13;:1-19

Authors: Plejert C, Samuelsson C, Anward J

Abstract
The present article is a case study in which participation is investigated in terms of the use of interactional practices that enhance the involvement of a man with severe aphasia in activities that aim to capture his and his wife's experiences of everyday communication, and their views of his speech and language intervention. Five practices are identified: 1) collaborative telling, 2) formulations, 3) yes/no questions, 4) declaratives and 5) hint-and-guess strategies. It is demonstrated how participants' (wife, a speech and language pathologist, and two research assistants) use of these practices are beneficial for making the viewpoints of the man with aphasia come across, despite his communication difficulties. Results are discussed in light of the importance of finding ways to make patients influence their own intervention, both in terms of a raised awareness of facilitative interactional practices and of activities such as interviews and retrospection sessions with patients and their significant others.

PMID: 27624643 [PubMed - as supplied by publisher]

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Boundaries of participation in care home settings: Use of the Swedish token jaså by a person with dementia.

Boundaries of participation in care home settings: Use of the Swedish token jaså by a person with dementia.

Clin Linguist Phon. 2016 Sep 13;:1-17

Authors: Lindholm C

Abstract
This article is a conversation analytic study of how one elderly person with dementia and her interlocutors interact in a care home setting. Participation is studied in the form of responsive action of the person with dementia, focusing on the Swedish response token 'jaså,' which has not previously been analysed in detail. The central claim is that even though the sequential placement of the response token indicates interactional competence, other factors reveal limited competence and communication impairment. First, the person with dementia's use of gaze is reduced, and she seems to rely on the auditory but not on the visual channel. Second, the interlocutors do not in all situations treat her as a ratified participant in spite of her attempts to contribute to the interaction. This study contributes both to the study of participation in the context of communication impairment and to the study of response tokens in Swedish.

PMID: 27624538 [PubMed - as supplied by publisher]

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Atlantoaxial Joint Interlocking Following Type II Odontoid Fracture Associated with Posterolateral Atlantoaxial Dislocation: a Case Report and Review of Published Reports.

Atlantoaxial Joint Interlocking Following Type II Odontoid Fracture Associated with Posterolateral Atlantoaxial Dislocation: a Case Report and Review of Published Reports.

Orthop Surg. 2016 Aug;8(3):405-410

Authors: He DW, Huang WJ, Sheng XY, Wu LJ, Fan SW

Abstract
A rare case of atlantoaxial lateral mass joint interlocking secondary to traumatic posterolateral C1,2 complete dislocation associated with type II odontoid fracture is herein reported and the impact of atlantoaxial joint interlocking on fracture reduction discussed. A 72-year-old man presented with traumatic atlantoaxial lateral mass joint interlocking without spinal cord signal change, the diagnosis being confirmed by radiography and 3-D reconstruction digital anatomy. Posterior internal fixation was performed after failure to achieve closed reduction by skull traction. After many surgical attempts at setting had failed because of interlocking of the lateral mass joints, reduction was achieved by compressing the posterior parts of the atlantal and axial screws. Odontoid bone union and C1,2 posterior bone graft fusion were eventually obtained by the 12-month follow-up. The patient had a complete neurological recovery with no residual neck pain or radiculopathy.

PMID: 27627726 [PubMed - as supplied by publisher]

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Clinical Correlation between Perverted Nystagmus and Brain MRI Abnormal Findings.

Clinical Correlation between Perverted Nystagmus and Brain MRI Abnormal Findings.

J Audiol Otol. 2016 Sep;20(2):85-9

Authors: Han WG, Yoon HC, Kim TM, Rah YC, Choi J

Abstract
BACKGROUND AND OBJECTIVES: To analyze the clinical correlation between perverted nystagmus and brain magnetic resonance imaging (MRI) abnormal findings and to evaluate whether perverted nystagmus is clinically significant results of brain abnormal lesions or not.
SUBJECTS AND METHODS: We performed medical charts review from January 2008 to July 2014, retrospectively. Patients who were suspected central originated vertigo at Frenzel goggles test were included among patients who visited our hospital. To investigate the correlation with nystagmus suspected central originated vertigo and brain MRI abnormal findings, we confirmed whether performing brain MRI or not. Then we exclude that patients not performed brain MRI.
RESULTS: The number of patients with perverted nystagmus was 15, upbeating was 1 and down-beating was 14. Among these patients, 5 patients have brain MRI abnormal findings. However, 2 patients with MRI abnormal findings were not associated correctly with perverted nystagmus and only 3 patients with perverted nystagmus were considered central originated vertigo and further evaluation and treatment was performed by the department of neurology.
CONCLUSIONS: Perverted nystagmus was considered to the abnormalities at brain lesions, especially cerebellum, but neurologic symptoms and further evaluation were needed for exact diagnosis of central originated vertigo.

PMID: 27626081 [PubMed]

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Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies.

Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies.

Eur Arch Otorhinolaryngol. 2016 Sep 13;

Authors: Vlastarakos PV, Iacovou E, Nikolopoulos TP

Abstract
The aim of this study is to review the literature on sustained-release vehicles delivering gentamycin in the inner ear of patients suffering from Meniere's disease (MD), and critically assess their respective clinical effectiveness and safety. A systematic literature review was conducted in Medline and other database sources until January 2016, along with critical analysis of pooled data. Overall, six prospective and four retrospective studies were systematically analyzed. The total number of treated patients was 320. A 2 year patient follow up was only reported in 40 % of studies. Inner ear gentamycin delivery using sustained-release vehicles is associated with improved vertigo control (strength of recommendation B), and quality of life (strength of recommendation B) in MD sufferers. In addition, dynamic-release devices seem to achieve high rates of improvement in the appearance of tinnitus (65.4 %) and aural pressure (76.2 %). By contrast, percentages of complete and partial hearing loss appear unacceptably high (31.08 and 23.38 % of patients, respectively), compared to historical data involving simple intratympanic gentamycin injections. Sustained-release vehicles for gentamycin delivery may have a role in the management of MD patients who have previously failed intratympanic gentamycin injections, or those who have already lost serviceable hearing. Their use as first line treatment over single intratympanic injections for all MD patients, who do not respond to conservative treatment should be discouraged.

PMID: 27623821 [PubMed - as supplied by publisher]

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Thyroid cancer screening in South Korea increases detection of papillary cancers with no impact on other subtypes or thyroid cancer mortality.

Thyroid cancer screening in South Korea increases detection of papillary cancers with no impact on other subtypes or thyroid cancer mortality.

Thyroid. 2016 Sep 14;

Authors: Ahn HS, Kim HJ, Kim KH, Lee YS, Han SJ, Kim Y, Ko MJ, Brito JP

Abstract
Introduction The incidence of thyroid cancer has increased worldwide. The country where the incidence has increased most is South Korea. The goal of this study is to understand the magnitude of association between opportunistic thyroid cancer screening and thyroid cancer incidence, thyroid cancer subtype and disease specific mortality. Data source We used the 2012 Korea Community Health Survey which asked 229,229 individuals if they had been screened for TC in the last two years. Thyroid cancer incidence data from were obtained from the Korea Cancer registry data, and mortality data from were obtained from the Statistics Korea database. The association between thyroid screening and thyroid cancer incidence, and mortality by age and sex were examined by general linear regression models Results Between 2010 and 2012 the incidence of thyroid cancer was 80.2 per 100,000 people: in females 132.3 and males 28.3. There was a very high and positive correlation between thyroid cancer screening and the incidence of thyroid cancer (r2=0.9, p<0.01). The magnitude of correlation was higher for females (r=0.9 , p,0.01) ) than in males ( r=0.78, p0.01) in any age group. Thyroid screening was only associated with increased detection of papillary thyroid cancer only (r=0.77, p<0.01); and not associated with mortality due to thyroid cancer. Conclusions The magnitude of association between thyroid cancer screening in South Korea and the incidence of thyroid cancer strongly suggests that screening is the most important driver of the epidemic of thyroid cancer, particularly among females. Thyroid cancer screening, however, was only associated with the increase of one tumor histology, papillary thyroid cancer, and it did not have any association with thyroid cancer mortality. The extent to which opportunistic thyroid cancer screening is converting thousands of asymptomatic persons to cancer patients without any known benefit to them needs to be examined carefully.

PMID: 27627550 [PubMed - as supplied by publisher]

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Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis.

Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis.

Otolaryngol Head Neck Surg. 2016 Sep 13;

Authors: Sajisevi M, Schulz K, Cyr DD, Wojdyla D, Rosenfeld RM, Tucci D, Witsell DL

Abstract
OBJECTIVE: To estimate the nonadherence rate of pressure equalization (tympanostomy) tube (PET) placement in the preceding 3-year period before release of the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG).
STUDY DESIGN: Analysis of the Truven Health MarketScan Research Databases (2010-2012).
SUBJECTS AND METHODS: Medical claims data from 2010 to 2012 were analyzed. Children aged ≤12 years with otitis media (OM)-related diagnoses were identified. Adherence and nonadherence rates for OM and PET placement were analyzed through administrative codes extrapolated from the key action statements (KASs) of the CPG. KASs were aggregated to estimate the overall nonadherence and determine areas for quality improvement.
RESULTS: A total of 9,726,411 visits with OM-associated codes among 3,710,730 children were identified: 2.9% (80,451 of 3,239,700) were considered nonadherent to KAS 1 because a code for PET placement occurred with a first episode of OM with effusion <3 months; 52.1% (14,534 of 27,913) underwent PET placement for OM with effusion of >3 months and had a concurrent hearing loss code. For those without hearing loss who underwent PET placement, 48.3% (52,921 of 109,583) had a diagnosis code indicating risk for speech, language, or learning problems. For each KAS, we found heterogeneity of computed nonadherence rates by region, age, and season.
CONCLUSION: Before guideline dissemination, we found low to moderate rates of nonadherence to guideline recommendation. Deeper analysis of mega-databases could provide better insights for measurement of guideline adherence. The expansion of administrative and clinical databases provides a unique opportunity to investigate the impact of CPGs.

PMID: 27625028 [PubMed - as supplied by publisher]

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Volumetric Growth of Cervical Schwannoma as a Predictor of Surgical Intervention.

Volumetric Growth of Cervical Schwannoma as a Predictor of Surgical Intervention.

Otolaryngol Head Neck Surg. 2016 Sep 13;

Authors: Alemi AS, Heaton CM, Ryan WR, El-Sayed I, Wang SJ

Abstract
OBJECTIVE: Cervical schwannomas are benign tumors that commonly present as asymptomatic masses and are managed with observation, radiation, or surgery. To our knowledge, the rate of volumetric change seen on serial imaging is not currently used to determine surgical candidacy. We assess average growth rates and determine whether growth rate of cervical schwannoma predicts having undergone surgery.
STUDY DESIGN: Case series with chart review.
SETTING: Quaternary academic medical center.
SUBJECTS AND METHODS: Patients were identified with at least 2 imaging studies and pathologic or imaging characteristics of cervical schwannoma. Volume was calculated with the formula 4/3πxyz, with x, y, and z representing the 3 orthogonal dimensions. Volume and rate of volume change were compared among observed, surgical, and gamma knife groups.
RESULTS: Thirteen patients were identified and divided into subgroups: surgical (n = 5), observation (n = 6), and gamma knife (n = 2). Mean follow-up time was 21 months (range, 1-80 months) and not significantly different among subgroups. The average changes in volume were 3.61 cm(3)/mo (entire group), -2.75 cm(3)/mo (observation), 11.97 cm(3)/mo (surgery), and 1.78 cm(3)/mo (gamma knife). Average initial volume for the entire group was 124.4 cm(3) (range, 5-608 cm(3)) and 142 cm(3) (range 5-613) at follow-up. The surgical group had a statistically significant change in volume (P = .03). A statistically significant difference in growth rate was seen between the surgical and observation groups (P = .016) and between the surgical group and all nonsurgical patients (P = .011).
CONCLUSIONS: Rate of tumor growth can be used in the evaluation of patients with cervical schwannoma, and it may predict surgical intervention.

PMID: 27625027 [PubMed - as supplied by publisher]

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Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis.

Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis.

Otolaryngol Head Neck Surg. 2016 Sep 13;

Authors: Chaaban MR, Zhang D, Resto V, Goodwin JS

Abstract
OBJECTIVE: To determine the demographics and seasonal and geographic variation of epistaxis in the United States.
STUDY DESIGN: Retrospective cohort analysis based on data from Medicare claims.
SETTING: Emergency department visits.
SUBJECTS AND METHODS: We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states.
RESULTS: In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients <65 years old, patients who were 66 to 76, 76 to 85, and >85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States.
CONCLUSION: Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.

PMID: 27625026 [PubMed - as supplied by publisher]

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Auricular Split-Thickness Skin Graft for Ear Canal Coverage.

Auricular Split-Thickness Skin Graft for Ear Canal Coverage.

Otolaryngol Head Neck Surg. 2016 Sep 13;

Authors: Haidar YM, Walia S, Sahyouni R, Ghavami Y, Lin HW, Djalilian HR

Abstract
Split-thickness skin graft (STSG) continues to be the preferred means of external auditory canal (EAC) reconstruction. We thus sought to describe our experience using skin from the posterior aspect of the auricle (SPAA) as a donor site in EAC reconstruction. Grafts were, on average, 5 × 10 mm in size and obtained with a No. 10 blade after tumescence injection. The cases of 39 patients who underwent 41 procedures were retrospectively reviewed. Of the 38 patients with both 3- and 6-month follow-ups, no postoperative stenosis or bony exposure occurred. STSG from the SPAA can be a good option in EAC reconstruction. Total EAC/tympanic membrane coverage can be obtained with STSG from the SPAA.

PMID: 27625025 [PubMed - as supplied by publisher]

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Factors Influencing Head and Neck Surgical Oncologists' Transition from Curative to Palliative Treatment Goals.

Factors Influencing Head and Neck Surgical Oncologists' Transition from Curative to Palliative Treatment Goals.

Otolaryngol Head Neck Surg. 2016 Sep 13;

Authors: Liao K, Blumenthal-Barby J, Sikora AG

Abstract
OBJECTIVE: The factors influencing head and neck surgical oncologists' goals of care and decisions to initiate conversations about transitioning to palliative-intent treatment for patients with limited curative treatment options are incompletely understood. Lack of guidance for physicians on this topic can lead to inconsistent utilization of palliative services, as well as confusing, upsetting experiences for patients and families. We review the literature investigating the clinical factors, inter- and intrapersonal factors, and financial and health care system considerations that head and neck cancer physicians weigh during this decision-making process.
DATA SOURCES: PubMed.
REVIEW METHODS: Selected literature on head and neck surgical oncologists' decision making in end-of-life care and palliative therapy was reviewed and analyzed thematically.
CONCLUSIONS: Physicians taking into account patients' clinical trajectories often overestimate the negative impact of head and neck cancer symptoms on their quality of life, suggesting that patients' expectations of quality of life should be discussed early, before communication barriers arise. How head and neck clinicians perceive and are influenced by patients' desired degree of autonomy, which varies greatly depending on the severity of illness, is still unclear. Patients' financial and insurance status affects decision making about hospice care. Finally, physician demographics (eg, age, subspecialization, practice setting), emotions, and philosophical background may exert unconscious biases that have not been fully determined for head and neck surgical oncologists.
IMPLICATIONS FOR PRACTICE: A more comprehensive understanding of the head and neck surgical oncologist's approach toward considering a transition to therapy with palliative intent may help guide advancements in this complex counseling process, leading to improvements in patient care, quality of life, and outcomes.

PMID: 27625024 [PubMed - as supplied by publisher]

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Incidence of small lymph node metastases in patients with nasopharyngeal carcinoma: Clinical implications for prognosis and treatment.

Incidence of small lymph node metastases in patients with nasopharyngeal carcinoma: Clinical implications for prognosis and treatment.

Head Neck. 2016 Sep 14;

Authors: Xu P, Min Y, Blanchard P, Feng M, Zhang P, Luo Y, Fan Z, Lang J

Abstract
BACKGROUND: Patients with nasopharyngeal carcinoma (NPC) often present small lymph nodes. The purpose of this study was to determine the prognostic impact on local recurrence of small lymph nodes, defined as smaller than 10 mm in greatest diameter.
METHODS: Consecutive patients treated by intensity-modulated radiotherapy (IMRT) for pathologically confirmed NPC were analyzed retrospectively. Those without small lymph nodes were excluded from the study. From January 2005 to January 2011, 275 patients with NPC represented with 2722 small lymph nodes, which were analyzed. Small lymph node axial diameter was measured using CT/MRI before radiotherapy (RT), at 50 Gy, and 6 months after the end of RT. The dose received by the small lymph nodes and the changes in lymph node diameter were recorded. Clinical endpoints were overall survival (OS), locoregional control, disease-specific survival (DSS), and distant metastasis-free survival. Median follow-up time was 55 months (range, 5-96 months).
RESULTS: Patients were grouped according to the dose received by the small lymph nodes and the number of small lymph nodes. Only 27 patients (9.8%) had a decrease ≥50% in the small lymph node diameter at 50 Gy and 53 patients (19.3%) had a decrease ≥50% at 6 months after RT. The 5-year locoregional control, distant metastasis-free survival, DSS, and OS were 93.5%, 85.2%, 88.8%, and 87.0%, respectively. Multivariate analyses showed that T classification and N classification are independent prognostic factors for OS. However, the dose received and the numbers of small lymph nodes were not statistically associated with any of the survival endpoints.
CONCLUSION: In the IMRT era, N classification remains an independent prognostic factor in NPC. However, the incidence of small lymph nodes is not a significant prognostic factor in patients with NPC. The presence of small lymph nodes should not influence the nodal contouring or the dose delivered to nodal areas. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27627795 [PubMed - as supplied by publisher]

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Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta-analysis and surgical implications.

Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta-analysis and surgical implications.

Head Neck. 2016 Sep 14;

Authors: Henry BM, Vikse J, Graves MJ, Sanna S, Sanna B, Tomaszewska IM, Hsieh WC, Tubbs RS, Tomaszewski KA

Abstract
BACKGROUND: The relationship between the recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) is highly variable and traceable back to embryological life.
METHODS: Comprehensive database searches were conducted, followed by judgment of eligibility, assessment, and extraction of data concerning the RLN/ITA relationship. The data were pooled into a meta-analysis and subjected to sex, side-based, geographic origin of study, and study modality subgroup analyses.
RESULTS: Seventy-nine studies (n = 14,269 nerves) reported data on the relationship of the RLN to the ITA. The left versus right-sided comparison revealed stark differences: RLNs were predominantly posterior (62.6% vs 37.0%) and anterior (17.2% vs 37.1%) on the left and right sides, respectively.
CONCLUSION: Symmetry of neurovascular relationships should not be assumed. Extra care should be taken during procedures on the right side, because the nerves are significantly more likely to present in patterns (anterior and between) associated with greater risk of iatrogenic injury. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27627737 [PubMed - as supplied by publisher]

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Perceived listening effort and speech intelligibility in reverberation and noise for hearing-impaired listeners.

Perceived listening effort and speech intelligibility in reverberation and noise for hearing-impaired listeners.

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

Authors: Schepker H, Haeder K, Rennies J, Holube I

Abstract
OBJECTIVE: The purpose of this study was to assess perceived listening effort and speech intelligibility in reverberant and noisy conditions for hearing-impaired listeners for conditions that are similar according to the speech transmission index (STI).
DESIGN: Scaled listening effort was measured in four different conditions at five different STI generated using various relative contributions of noise and reverberant interferences. Intelligibility was measured for a subset of conditions.
STUDY SAMPLE: Twenty mildly to moderately hearing-impaired listeners.
RESULTS: In general, listening effort decreased and speech intelligibility increased with increasing STI. For simulated impulse responses consisting of white Gaussian noise exponentially decaying in time, a good agreement between conditions of different relative contributions of noise and reverberation was found. For real impulse responses, the STI slightly overestimated the effect of reverberation on the perceived listening effort and underestimated its effect on speech intelligibility. Including the average hearing loss in the calculation of the STI led to a better agreement between STI predictions and subjective data.
CONCLUSION: Speech intelligibility and listening effort provide complementary tools to evaluate speech perception over a broad range of acoustic scenarios. In addition, when incorporating hearing loss information the STI provides a rough prediction of listening effort in these acoustic scenarios.

PMID: 27627181 [PubMed - as supplied by publisher]

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Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI - a preliminary report.

Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI - a preliminary report.

Acta Otolaryngol. 2016 Sep 14;:1-6

Authors: Mikaszewski B, Markiet K, Smugała A, Stodulski D, Szurowska E, Stankiewicz C

Abstract
CONCLUSION: At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (Tpeak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe.
OBJECTIVE: To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: Tpeak and WR.
METHODS: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen.
RESULTS: Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on Tpeak and WR values, two distinct clusters of parotid malignancies were identified. The cut-off value for Tpeak optimally differentiating between the clusters was 140 s; the cut-off value for WR could not be identified. The two clusters did not differ in terms of dynamic and diffusion-weighted MRI parameters, patient age, sex and prevalence of lymphadenopathy. Significant inter-cluster differences were found in the prevalence of deep parotid lobe involvement and presence of a single mass.

PMID: 27627686 [PubMed - as supplied by publisher]

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[Immunotherapy for HNSCC : Quo vadis?]

[Immunotherapy for HNSCC : Quo vadis?]

HNO. 2016 Sep 13;

Authors: Döscher J, Busch CJ, Schuler PJ, Laban S

Abstract
BACKGROUND: Immunotherapy remains a hot topic with an endless stream of new upcoming clinical trials. The results of studies to date are promising for second-line palliative treatment of head and neck squamous cell carcinoma (HNSCC). The next step is testing these strategies in randomized trials for first-line and curative treatment in an adjuvant, neoadjuvant, and primarily nonsurgical setting. So far, established biomarkers have not proven reliable enough to predict response rates precisely.
OBJECTIVES: On occasion of the annual meeting of the American Society of Clinical Oncology (ASCO), we aimed to invesitage the future of immunotherapies.
METHODS: We collected the most promising upcoming studies alongside current research in the field of biomarkers with a  view to interesting new immunotherapeutic strategies.
RESULTS: The search for appropriate biomarkers in particular seems to be a central research objective in the short term. There is a broad range of new agents that will be tested in clinical trials as well as the combination of immunotherapy with chemo- and chemoradiotherapy or other immune-modulating drugs.
CONCLUSION: The real challenge will be to find the most fitting therapy for each patient out of a large panel of available regimens. Therefore, it is most important to find a set of reliable biomarkers that together could predict treatment response.

PMID: 27624904 [PubMed - as supplied by publisher]

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[Study results of primary therapy for head and neck tumors : Highlights of the 2016 ASCO Annual Meeting].

[Study results of primary therapy for head and neck tumors : Highlights of the 2016 ASCO Annual Meeting].

HNO. 2016 Sep 13;

Authors: Gliese A, Busch CJ, Knecht R

Abstract
At the annual meeting of the American Society of Clinical Oncology (ASCO) 2016, results of current trials dealing with primary therapy for head and neck squamous cell carcinoma (HNSCC) were presented. Current trials investigate in particular therapy regimens for the treatment of locally advanced HNSCC. Concomitant chemoradiotherapy (CRT) remains the standard therapy approach. Current trials focus on sequential chemoradiation with modifications in induction chemotherapy (ICT) or the subsequent CRT schedule. Studies investigating the combination of targeted therapy with the epidermal growth factor receptor (EGFR) antibody cetuximab and concomitant, sequential, or adjuvant therapy were presented. The most important trials are summarized in this article.

PMID: 27624903 [PubMed - as supplied by publisher]

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[New aspects in the treatment of thyroid cancer : Highlights of the ASCO Annual Meeting 2016].

[New aspects in the treatment of thyroid cancer : Highlights of the ASCO Annual Meeting 2016].

HNO. 2016 Sep 13;

Authors: Lörincz BB, Simon C, Möckelmann N, Knecht R

Abstract
The annual meeting of the American Society of Clinical Oncology (ASCO) took place at the beginning of June 2016 in Chicago. This year a total of 28 studies on the treatment of patients with thyroid cancer were presented, described in this review article according to the degree of cancer cell differentiation. The leading curative treatment modality is still surgery. In contrast, kinase inhibitors are being used increasingly within palliative concepts. The latest state of the art of thyroid cancer treatment, both surgical and medical, is summarized in this review.

PMID: 27624902 [PubMed - as supplied by publisher]

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Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

Related Articles

Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

J Am Acad Orthop Surg. 2015 Dec;23(12):e81-90

Authors: Bible JE, Rihn JA, Lim MR, Brodke DS, Lee JY

Abstract
The incidence of intraoperative complications in cervical spine surgery is low. However, when they do occur, such complications have the potential for causing considerable morbidity and mortality. Spine surgeons should be familiar with methods of minimizing such complications. Furthermore, if they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity.

PMID: 26519429 [PubMed - indexed for MEDLINE]

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The relationship between spoken English proficiency and participation in higher education, employment and income from two Australian censuses.

The relationship between spoken English proficiency and participation in higher education, employment and income from two Australian censuses.

Int J Speech Lang Pathol. 2016 Sep 14;:1-14

Authors: Blake HL, Mcleod S, Verdon S, Fuller G

Abstract
PURPOSE: Proficiency in the language of the country of residence has implications for an individual's level of education, employability, income and social integration. This paper explores the relationship between the spoken English proficiency of residents of Australia on census day and their educational level, employment and income to provide insight into multilingual speakers' ability to participate in Australia as an English-dominant society.
METHOD: Data presented are derived from two Australian censuses i.e. 2006 and 2011 of over 19 million people.
RESULT: The proportion of Australians who reported speaking a language other than English at home was 21.5% in the 2006 census and 23.2% in the 2011 census. Multilingual speakers who also spoke English very well were more likely to have post-graduate qualifications, full-time employment and high income than monolingual English-speaking Australians. However, multilingual speakers who reported speaking English not well were much less likely to have post-graduate qualifications or full-time employment than monolingual English-speaking Australians.
CONCLUSION: These findings provide insight into the socioeconomic and educational profiles of multilingual speakers, which will inform the understanding of people such as speech-language pathologists who provide them with support. The results indicate spoken English proficiency may impact participation in Australian society. These findings challenge the "monolingual mindset" by demonstrating that outcomes for multilingual speakers in education, employment and income are higher than for monolingual speakers.

PMID: 27626507 [PubMed - as supplied by publisher]

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Perceived listening effort and speech intelligibility in reverberation and noise for hearing-impaired listeners.

Perceived listening effort and speech intelligibility in reverberation and noise for hearing-impaired listeners.

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

Authors: Schepker H, Haeder K, Rennies J, Holube I

Abstract
OBJECTIVE: The purpose of this study was to assess perceived listening effort and speech intelligibility in reverberant and noisy conditions for hearing-impaired listeners for conditions that are similar according to the speech transmission index (STI).
DESIGN: Scaled listening effort was measured in four different conditions at five different STI generated using various relative contributions of noise and reverberant interferences. Intelligibility was measured for a subset of conditions.
STUDY SAMPLE: Twenty mildly to moderately hearing-impaired listeners.
RESULTS: In general, listening effort decreased and speech intelligibility increased with increasing STI. For simulated impulse responses consisting of white Gaussian noise exponentially decaying in time, a good agreement between conditions of different relative contributions of noise and reverberation was found. For real impulse responses, the STI slightly overestimated the effect of reverberation on the perceived listening effort and underestimated its effect on speech intelligibility. Including the average hearing loss in the calculation of the STI led to a better agreement between STI predictions and subjective data.
CONCLUSION: Speech intelligibility and listening effort provide complementary tools to evaluate speech perception over a broad range of acoustic scenarios. In addition, when incorporating hearing loss information the STI provides a rough prediction of listening effort in these acoustic scenarios.

PMID: 27627181 [PubMed - as supplied by publisher]

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