A novel insight into the immunologic basis of chronic granulomatous invasive fungal rhinosinusitis.

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A novel insight into the immunologic basis of chronic granulomatous invasive fungal rhinosinusitis.

Allergy Rhinol (Providence). 2016 Jan;7(2):102-106

Authors: Rae W, Doffinger R, Shelton F, Sproson E, Ismail-Koch H, Lund VJ, Harries PG, Eren E, Salib RJ

Abstract
BACKGROUND: Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a rare disease. The underlying immune responses that drive the development of CGIFRS, as opposed to successful pathogen clearance and controlled inflammation, are not currently known.
OBJECTIVE: To characterize the immune responses associated with CGIFRS.
METHODS: In addition to a battery of basic investigations, more in-depth immunologic testing involves ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with interleukin (IL) 12, was undertaken to investigate cell-mediated immune responses associated with CGIFRS.
RESULTS: Ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with IL-12 identified reduced interferon gamma and increased IL-17A levels within the supernatant, which indicated increased in vivo T-helper (Th)17 responses and impaired Th1 responses compared with healthy controls.
CONCLUSION: These findings suggest that the development of CGIFRS may be associated with an abnormally exaggerated host Th17 response, which caused failure to clear the fungal pathogen with refractory fungal infection of mucosal membranes, resulting in chronic tissue inflammation.

PMID: 27658186 [PubMed - as supplied by publisher]

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Immunoglobulin G4-related sclerosing disease of the paranasal sinuses: A case report and literature review.

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Immunoglobulin G4-related sclerosing disease of the paranasal sinuses: A case report and literature review.

Allergy Rhinol (Providence). 2016 Jan;7(2):85-89

Authors: Vandjelovic ND, Humphreys IM

Abstract
OBJECTIVE: Immunoglobulin G4 (IgG4) related sclerosing disease (RSD) of the paranasal sinuses is a rare lesion of dense lymphoplasmacytic tissue, with a high proportion of IgG4+ plasma cells. We presented a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses in the absence of multiorgan involvement.
METHODS: A case report and comprehensive literature review.
RESULTS: To our knowledge, only 11 cases of IgG4-RSD with paranasal sinus involvement have been reported. Patients with IgG4-RSD commonly present with epistaxis and symptoms that mimic chronic rhinosinusitis, e.g., rhinorrhea, nasal obstruction, and facial pressure. On imaging, an expansive and erosive process is described. Surgery provides tissue for immunohistologic evaluation; however, there is a paucity of evidence about the direct extent of surgical resection or medical therapies. Postoperative steroids were typically started, although the regimen was not standardized.
CONCLUSION: Few cases of paranasal sinus IgG4-RSD have been reported in the literature. Evidence-based recommendations regarding treatment and surveillance of paranasal sinus IgG4-RSD are lacking; however, most reports describe systemic steroids as the mainstay of treatment. This single subject analysis, with a review of previously reported cases adds to the expanding body of data related to this rare disorder.

PMID: 27658185 [PubMed - as supplied by publisher]

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Congenital bilateral adult choanal atresia undiagnosed until the second decade: How we did it.

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Congenital bilateral adult choanal atresia undiagnosed until the second decade: How we did it.

Allergy Rhinol (Providence). 2016 Jan;7(2):82-84

Authors: Verma RK, Lokesh P, Panda NK

Abstract
BACKGROUND: Bilateral congenital choanal atresia that presents in adulthood is rare. There are only eight reported cases in the literature.
METHOD: We present a ninth case of adult bilateral choanal atresia diagnosed at the age of 20 years. Can a bilateral choanal atresia present so late in life when such a condition is considered incompatible with life?
RESULTS AND CONCLUSION: Clinical details, diagnosis, and surgical steps with a clear depiction of photographs and comparison with all other previously reported cases, which can help novel otolaryngologists in their clinical practice are discussed.

PMID: 27658184 [PubMed - as supplied by publisher]

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Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis.

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Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis.

Allergy Rhinol (Providence). 2016 Jan;7(2):74-81

Authors: Chauhan B, Gupta M, Chauhan K

Abstract
BACKGROUND: Antioxidants have a preventive or therapeutic role in oxygen free radical-mediated cell and tissue damage. The study aimed to investigate the therapeutic effects of antioxidants and intranasal steroid fluticasone furoate (FF) on the clinical outcome of patients with perennial allergic rhinitis.
METHODS: Subjects with perennial allergic rhinitis (n = 61) were randomly divided into two groups, group A (n = 30) received FF and group B (n = 31) received FF with antioxidants for 6 weeks. Nasal and ocular symptoms were evaluated weekly by using a four-point categoric scale. The efficacy of the study drug was assessed based on the mean change from baseline of the total daytime nasal symptom scores, total nighttime nasal symptom scores, and the composite symptom scores.
RESULTS: The combined therapy (FF with antioxidants) resulted in marked improvements (p ≤ 0.05) in the mean total daytime nasal symptom scores, total nighttime nasal symptom scores, and composite symptom scores of subjects compared with ones treated with intranasal steroid (FF) alone, which highlighted the therapeutic effect of antioxidants in allergic rhinitis.
CONCLUSION: Significant improvement in clinical outcome was observed in subjects who received antioxidants along with FF. However, because this was an open-label study, the results must be interpreted with caution, and further double-blind, placebo-controlled, dose-ranging trials supplemented with different antioxidants together with intranasal steroids are suggested.

PMID: 27658183 [PubMed - as supplied by publisher]

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Are respiratory viruses involved in preseasonal symptoms or severity in Japanese cedar pollinosis?

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Are respiratory viruses involved in preseasonal symptoms or severity in Japanese cedar pollinosis?

Allergy Rhinol (Providence). 2016 Jan;7(2):62-68

Authors: Otsuka H, Tsukagoshi H, Kimura H, Takanashi I, Okubo K

Abstract
BACKGROUND: Respiratory virus infections are involved in asthma exacerbations. However, there are no reports of the relationship between respiratory virus infections and Japanese cedar pollinosis.
OBJECTIVE: We studied the relationship between respiratory viral infection and the appearance of preseasonal symptoms and the severity of seasonal symptoms in Japanese cedar pollinosis.
METHODS: In 36 patients with asthma and with no symptoms (PreAsyP) and 54 patients with asthma and with symptoms (PreSyP) before the cedar pollen shedding commenced (preseason), and 37 patients with mild-to-moderate severity (InMild/Mod) and 45 patients with severe to extreme severity (InSev/Ext) after cedar shedding commenced (in season), the occurrence of respiratory viruses and nasal smear cytology were examined.
RESULTS: In total, seven infections with respiratory viruses were detected among the subjects. Human rhinovirus (HRV) C infection was detected in one subject in each of the PreAsyP and PreSyP groups, and one HRVA infection occurred in the InMild/Mod group. In the InSev/Ext group, one HRVA, one HRVC, one respiratory syncytial virus, and one human metapneumovirus were detected. There was no significant difference in the rate of detection of viral infections between the PreAsyP and the PreSyP groups (p = 0.077), and between the InMild/Mod group and the InSev/Ext group (p = 0.24, Wilcoxon rank sum test). When cells types in nasal smears were identified and their abundance examined, the rate of neutrophilia in the subjects in the PreSyP group was 54%, which was statistically higher (p < 0.01) than the subjects in the PreAsyP group (25%). Interestingly, in the subjects in the InSev/Ext group, the proportion of eosinophils (40%) was larger (p < 0.05) than in the subjects in the InMild/Mod group (19%).
CONCLUSION: These results provided no evidence that respiratory virus infections contributed to preseasonal symptoms and severity in season of Japanese cedar pollinosis. Nasal neutrophilia was related to preseasonal symptoms, whereas nasal eosinophilia was related to severity of symptoms during the pollen season.

PMID: 27658182 [PubMed - as supplied by publisher]

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Sensorineural hearing loss after otitis media with effusion and subacute mastoiditis after viral infections of the upper respiratory tract: A comparative study of conservative and surgical treatment.

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Sensorineural hearing loss after otitis media with effusion and subacute mastoiditis after viral infections of the upper respiratory tract: A comparative study of conservative and surgical treatment.

Ear Nose Throat J. 2016 Sep;95(9):E18-E27

Authors: Wilhelm T, Stelzer T, Hagen R

Abstract
Involvement of the middle ear after viral infections of the upper airways may lead to serous otitis media with effusion in the absence of bacterial infection. This can be accompanied by a concomitant shading of the mastoid air cells, which could manifest as a reduced opacity on computed tomography (CT) in the absence of a history of chronic mastoiditis or acute inflammatory signs. This can lead to a subsequent impairment of inner ear function. CT scans reveal an extended pneumatization of the temporal bones in affected patients. Inner ear hearing impairment can probably be attributed to a concomitant labyrinthine reaction-the so-called toxic inner ear lesion. If no remission occurs within 5 days after initial conservative treatment (paracentesis or hemorrheologic infusions), surgical treatment with a mastoidectomy can accelerate hearing restoration. We conducted a retrospective, nonrandomized study of short- and long-term hearing outcomes in patients with a toxic inner ear lesion who had been treated with conservative measures alone (CONS group) or with surgery (SURG group) in a tertiary care referral center. Our study group was made up of 52 consecutively presenting patients (57 ears) who had been seen over a 10-year period; there were 20 patients (21 ears) in the CONS group and 32 patients (36 ears) in the SURG group. Initially, 15 CONS patients (75%) and 18 SURG patients (56%) complained of dizziness or a balance disorder. The initial averaged sensorineural hearing loss (over 0.5, 1.0, 2.0, and 3.0 kHz) was 32.4 ± 15.6 dB in the CONS group and 35.4 ± 12.0 dB in the SURG group. At follow-up (mean: 31.7 mo), the SURG group experienced a significantly greater improvement in hearing (p = 0.025). We conclude that patients with viral otitis media and concomitant noninflammatory mastoiditis with impairment of inner ear function (sensorineural hearing loss) experience a better hearing outcome when a mastoidectomy is performed during primary treatment.

PMID: 27657322 [PubMed - as supplied by publisher]

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Layered sellar reconstruction with avascular free grafts: Acceptable alternative to the nasoseptal flap for repair of low-volume intraoperative cerebrospinal fluid leak.

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Layered sellar reconstruction with avascular free grafts: Acceptable alternative to the nasoseptal flap for repair of low-volume intraoperative cerebrospinal fluid leak.

Am J Rhinol Allergy. 2016 Sep;30(5):367-371

Authors: Roxbury CR, Saavedra T, Ramanathan M, Lim M, Ishii M, Gallia GL, Reh DD

Abstract
BACKGROUND: Although the nasoseptal flap has become the method of choice for reconstruction of intraoperative cerebrospinal fluid (CSF) leak in endoscopic minimally invasive surgery of the skull base, layered avascular graft techniques, including allografts and middle turbinate mucosal autografts, may provide comparable reconstructive success with decreased nasal morbidity.
OBJECTIVE: To describe a method of reconstruction of intraoperative CSF leak in endoscopic surgery of the sella turcica and analyze its postoperative success rate and associated comorbidities.
METHODS: A retrospective review of expanded endonasal sellar tumor resections from 2008-2014 was performed, and cases of layered intraoperative skull base reconstruction with avascular free grafts were identified. Demographic factors and comorbidities that predisposed to reconstruction failure (obstructive sleep apnea, obesity) were determined. Reconstruction-related nasal complications were also identified. Postoperative CSF leak rate was determined, and statistical analysis was performed to identify predictive factors for reconstructive failure.
RESULTS: Seventy-three cases were identified. Layered closure with avascular free grafts was performed. There were five cases of postoperative CSF leak (6.85%). The mean follow-up was 19 months (range, 1-76 months). Intraoperative high-flow CSF leak was a significant predictor of reconstruction failure on univariate (odds ratio 22 [95% confidence interval, 2.26-214]; p = 0.008) and multivariate analysis (odds ratio 33.6 [95% confidence interval, 2.30-492]; p = 0.010). There were no significant differences in postoperative leak rates among bony overlay graft types. There were five patients (7.9%) who experienced persistent crusting after surgery. There were no significant differences in crusting rates between allografts and mucosal grafts. There were no postoperative mucoceles.
CONCLUSION: In cases of low-volume intraoperative CSF leak, layered skull base repair with avascular free grafts was an acceptable alternative to the nasoseptal flap, which may reduce prolonged sinonasal healing and donor-site morbidities.

PMID: 27657903 [PubMed - as supplied by publisher]

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Image guidance in skull base tumor resection: A synergistic approach using intraoperative navigated angiosonography for real-time vessel visualization.

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Image guidance in skull base tumor resection: A synergistic approach using intraoperative navigated angiosonography for real-time vessel visualization.

Surg Neurol Int. 2016;7:82

Authors: Prada F, Del Bene M, DiMeco F

PMID: 27656313 [PubMed]

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Outcomes of Patients Undergoing Endoscopic Endonasal Skull Base Surgery at a VA Hospital.

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Outcomes of Patients Undergoing Endoscopic Endonasal Skull Base Surgery at a VA Hospital.

JAMA Surg. 2016 Sep 21;

Authors: Jones M, Johans S, Ziegler A, Welch KC, Patadia MO, Patel CR, Germanwala AV

PMID: 27653225 [PubMed - as supplied by publisher]

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Role of intraoperative indocyanine green video-angiography to identify small, posterior fossa arteriovenous malformations mimicking cavernous angiomas. Technical report and review of the literature on common features of these cerebral vascular malformations.

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Role of intraoperative indocyanine green video-angiography to identify small, posterior fossa arteriovenous malformations mimicking cavernous angiomas. Technical report and review of the literature on common features of these cerebral vascular malformations.

Clin Neurol Neurosurg. 2015 Nov;138:45-51

Authors: Barbagallo GM, Certo F, Caltabiano R, Chiaramonte I, Albanese V, Visocchi M

Abstract
OBJECTIVE: To illustrate the usefulness of intraoperative indocyanine green videoangiography (ICG-VA) to identify the nidus and feeders of a small cerebellar AVM resembling a cavernous hemangioma. To review the unique features regarding the overlay between these two vascular malformations and to highlight the importance to identify with ICG-VA, and treat accordingly, the arterial and venous vessels of the AVM.
METHODS: A 36-year old man presented with bilateral cerebellar hemorrhage. MRI was equivocal in showing an underlying vascular malformation but angiography demonstrated a small, Spetzler-Martin grade I AVM. Surgical resection of the AVM with the aid of intraoperative ICG-VA was performed. After hematoma evacuation, pre-resection ICG-VA did not reveal tortuous arterial and venous vessels in keeping with a typical AVM but rather an unusual blackberry-like image resembling a cavernous hemangioma, with tiny surrounding vessels. Such intraoperative appearance, which could also be the consequence of a "leakage" of fluorescent dye from the nidal pathological vessels, with absent blood-brain barrier, into the surrounding parenchymal pathological capillary network, is important to be recognized as an unusual AVM appearance.
RESULTS: Post-resection ICG-VA confirmed the AVM removal, as also shown by postoperative and 3-month follow-up DSAs.
CONCLUSIONS: Despite technical limitations associated with ICG-VA in post-hemorrhage AVMs, this case together with the intraoperative video, demonstrates the useful role of ICG-VA in identifying small AVMs with peculiar features.

PMID: 26276727 [PubMed - indexed for MEDLINE]

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"Ear Nose Throat J"[jour]; +16 new citations

16 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Ear Nose Throat J"[jour]

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Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns.

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Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns.

Br J Sports Med. 2016 Sep 21;

Authors: Murray DA, Meldrum D, Lennon O

Abstract
OBJECTIVE: Concussion symptoms normally resolve within 7-10 days but vertigo, dizziness and balance dysfunction persist in 10-30% of cases causing significant morbidity. This study systematically evaluated the evidence supporting the efficacy, prescription and progression patterns of vestibular rehabilitation therapy (VRT) in patients with concussion.
DESIGN: Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis.
DATA SOURCES: Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May 2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science (1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches and grey literature.
ELIGIBILITY CRITERIA FOR STUDY SELECTION: Article or abstract of original research, population of patients with concussion/mild traumatic brain injury (mTBI) with vestibular symptoms, interventions detailing VRT, measurement of outcomes pre-VRT/post-VRT. Study type was not specified.
RESULTS: Following a double review of abstract and full-text articles, 10 studies met the inclusion criteria: randomised controlled trial (n=2), uncontrolled studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single intervention. 6 studies incorporated VRT in multimodal interventions (including manual therapy, strength training, occupational tasks, counselling or medication). 9 studies reported improvement in outcomes but level I evidence from only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to 11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT (combined with cervical therapy) was compared with usual care. Heterogeneity in study type and outcomes precluded meta-analysis. Habituation and adaptation exercises were employed in 8 studies and balance exercises in 9 studies. Prescription and progression patterns lacked standardisation.
CONCLUSIONS: Current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited. Available evidence, although weak, shows promise in this population. Further high-level studies evaluating the effects of VRT in patients with mTBI/concussion with vestibular and/or balance dysfunction are required.

PMID: 27655831 [PubMed - as supplied by publisher]

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[Reporting quality and effect size comparison in randomized controlled trials of bo's abdominal acupuncture using CONSORT statement and STRICTA].

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[Reporting quality and effect size comparison in randomized controlled trials of bo's abdominal acupuncture using CONSORT statement and STRICTA].

J Tradit Chin Med. 2016 Jun;36(3):382-91

Authors: Wen W, Yang L, Liu S, Zhong Y, Hu X, Huang X, Guo X

Abstract
OBJECTIVE: To evaluate the reporting quality of randomized controlled trials (RCT) that compared Bo's abdominal acupuncture with conventional body acupuncture, and compare the efficacy and safety between them by performing a Meta-analysis.
METHODS: All RCTs comparing Bo's abdominal acupuncture with conventional body acupuncture were included. English and Chinese databases were searched from their respective inceptions to March 2014. The reporting quality was assessed according to the "Consolidated Standards of Reporting Trials" (CONSORT) checklist for parallel RCTs and the revised "Standards for Reporting Interventions in Clinical Trials of Acupuncture" (STRICTA). A Meta-analysis was conducted to synthesize the effect sizes, and publication bias was evaluated by the Egger linear regression test using Stata.
RESULTS: Ninety-seven studies were included, of which most lacked adequate reporting information, and 80.4% showed that the efficacy of abdominal acupuncture is superior to conventional body acupuncture, especially for the following diseases: lumbar disc herniation, cervical spondylosis, omarthritis and cervical vertigo, except simple obesity. Effect-sizes were controversial when evaluating different outcomes.
CONCLUSION: The international standard CONORT statement and STRICTA guidelines should be strictly applied when reporting acupuncture RCTs in the future. Abdominal acupuncture appears to be more effective compared with conventional body acupuncture for some diseases. However, fur-her high quality blind RCTs using validated out-ome indexes and standard reporting are warranted.

PMID: 27468555 [PubMed - indexed for MEDLINE]

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Comparative pharmacokinetics of gastrodin in rats after intragastric administration of free gastrodin, parishin and Gastrodia elata extract.

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Comparative pharmacokinetics of gastrodin in rats after intragastric administration of free gastrodin, parishin and Gastrodia elata extract.

J Ethnopharmacol. 2015 Dec 24;176:49-54

Authors: Tang C, Wang L, Liu X, Cheng M, Qu Y, Xiao H

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Gastrodia elata Blume, a traditional Chinese herb, was widely used against convulsant, vertigo, paralysis, epilepsy, tetanus, asthma and immune dysfunctions. Gastrodin is one of the major bioactive components of G. elata and it is known for its anticonvulsive, anti-inflammatory, antiepileptic and neuroprotective effects.
MATERIALS AND METHODS: An ultra high performance liquid chromatography-fluorescence detection (UHPLC-FLD) method was developed to determine gastrodin in rat plasma. Gastrodin and Thiamphenicol (internal standard, IS) were extracted from rat plasma by immediately protein precipitation. The pharmacokinetics of gastrodin in rats by following differently administered types was studies: intragastric administration of gastrodin (100mg/kg), parishin (116 mg/kg, with the same mole of gastrodin moiety) and G. elata extract (2.3g/kg, with the same mole of gastrodin moiety). Non-compartmental pharmacokinetic profiles were constructed using the software of WinNonlin (Phoenix, version 6.3), and the pharmacokinetic parameters were compared using unpaired Student's t-test.
RESULTS: The results showed that the pharmacokinetic parameters, including Cmax, Tmax, AUC0-∞, t1/2, MRT, Vd, CL, were quite different among the three types of gastrodin administration. The administration of parishin and G. elata extract, which either could convert to gastrodin in vivo or contained free gastrodin and abundant gastrodin conjugates, gave rise to higher elimination half-life (t1/2) and mean residence time (MRT) values for gastrodin compared to free gastrodin administered.
CONCLUSION: The comparison of the pharmacokinetics of gastrodin among three different administered types of gastrodin in rats suggested that administration of parishin or G. elata extract in clinic may result in a longer duration time of action than that of the administration of free gastrodin. The results may provide some guidance for the clinical applications of parishin and G. elata.

PMID: 26471288 [PubMed - indexed for MEDLINE]

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Response to letter to Editor: "The clinical course of recurrent respiratory papillomatosis after the use of cidofovir is influenced by multiple factors" by Michel R. M. San Giorgi et al.

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Response to letter to Editor: "The clinical course of recurrent respiratory papillomatosis after the use of cidofovir is influenced by multiple factors" by Michel R. M. San Giorgi et al.

Eur Arch Otorhinolaryngol. 2016 Sep 21;

Authors: Grasso M, Remacle M, Bachy V, Van Der Vorst S, Lawson G

PMID: 27654254 [PubMed - as supplied by publisher]

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Voice care knowledge by dysphonic and healthy individuals of different generations.

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Voice care knowledge by dysphonic and healthy individuals of different generations.

Codas. 2016 Jul-Aug;28(4):463-9

Authors: Moreti F, Zambon F, Behlau M

Abstract
The purpose of this study was to identify the opinions of both dysphonic and vocally healthy individuals regarding the factors that affect their voices positively and negatively, analyzing them according to the generation to which the participants belong. Eight hundred sixty-six individuals (304 dysphonic and 562 vocally healthy; 196 men and 670 women) categorized by generation: 22 individuals in Silent Generation (1926/-/1945), 180 in Baby Boomers (1946/-/1964), 285 in Generation X (1965/-/1981), and 379 in Generation Y (1982/-/2003) responded to two open questions: "Cite five things that you believe are good/bad to your voice". Five thousand, two hundred sixty answers were identified (2478 positive and 2782 negative) and organized in 365 factors related to voice care. The three most prevalent positive and negative factors for each generation were as follows: Silent Generation - positive factors: 1 - water, honey and pomegranate, 2 - apple, and 3 - ginger tea, voice exercises and gargling; negative factors: 1 - cold drinks, 2 - excessive speaking, and 3 - alcoholic drinks, smoking and screaming; Baby Boomers - positive factors: 1 - water, 2 - apple, and 3 - sleeping well; negative factors: 1 - cold drinks, 2 - screaming, and 3 - smoking; Generation X - positive factors: 1 - water, 2 - apple, and 3 - vocal warm-up; negative factors: 1 - screaming, 2 - smoking, and 3 - alcoholic drinks; and Generation Y - positive factors: 1 - water, 2 - apple, and 3 - vocal warm-up; negative factors: 1 - screaming, 2 - smoking, and 3 - alcoholic drinks. The impact of generation was greater on the frequency of the responses than on their type. Water and apple were the most frequently cited positive factors for all the generations investigated, whereas screaming and smoking were the most frequently mentioned negative factors. Behavioral aspects related to popular beliefs were reported more frequently by the older generations.

PMID: 27652928 [PubMed - in process]

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Direct intralesional ethanol sclerotherapy of extensive venous malformations with oropharyngeal involvement after a temporary tracheotomy in the head and neck: Initial results.

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Direct intralesional ethanol sclerotherapy of extensive venous malformations with oropharyngeal involvement after a temporary tracheotomy in the head and neck: Initial results.

Head Neck. 2016 Sep 22;

Authors: Wang D, Su L, Han Y, Wang Z, Zheng L, Li J, Fan X

Abstract
BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of direct intralesional ethanol sclerotherapy for venous malformations (VMs) with oropharyngeal involvement after a temporary tracheotomy.
METHODS: A retrospective assessment was carried out to evaluate the efficacy of direct intralesional ethanol sclerotherapy on 21 consecutive patients presenting with extensive VMs involving the oropharynx in the head and neck and who had undergone tracheotomy.
RESULTS: Of the 21 patients, 4 were treated once and 17 were treated from 2 to 5 times. The duration of follow-up was, on average, 9.1 months. Of the 21 patients, 7 (33.3%) had complete palliation, whereas the rest (66.7%) achieved partial palliation. Minor complications occurred in 12 of the 21 patients.
CONCLUSION: Direct intralesional ethanol sclerotherapy after a temporary tracheotomy is a safe and effective treatment for extensive VMs involving oropharyngeal areas of the head and neck. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27653619 [PubMed - as supplied by publisher]

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Genomic alterations in human epidermal growth factor receptor 2 (HER2/ERBB2) in head and neck squamous cell carcinoma.

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Genomic alterations in human epidermal growth factor receptor 2 (HER2/ERBB2) in head and neck squamous cell carcinoma.

Head Neck. 2016 Sep 21;

Authors: Chung CH, Germain A, Subramaniam RM, Heilmann AM, Fedorchak K, Ali SM, Miller VA, Palermo RA, Fakhry C

Abstract
BACKGROUND: Despite recent advances, survival outcomes for those with metastatic or recurrent head and neck squamous cell carcinoma (HNSCC) have remained poor. Novel approaches should be investigated to improve outcomes.
METHODS: A retrospective chart review was performed of a patient who presented with a TNM classification III HNSCC of the oropharynx, positive for human papillomavirus (HPV) who had a complete response to a human epidermal growth factor receptor 2 (HER2)-targeted therapy. Amplification rates of HER2 in the HNSCC Cancer Genome Atlas Network (TCGA) dataset and the FoundationOne genomic profiling dataset were evaluated.
RESULTS: Comprehensive genomic profiling of the tumor obtained from the dermal metastasis identified amplification of HER2. Data from TCGA and FoundationOne showed that the frequency of HER2 alteration was not observed to vary significantly with HPV tumor status.
CONCLUSION: This case demonstrates the application of genomic profiling to guide treatments in a patient with HNSCC with advanced metastatic disease refractory to standard of care therapies. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27653501 [PubMed - as supplied by publisher]

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Primary payer status, individual patient characteristics, and hospital-level factors affecting length of stay and total cost of hospitalization in total laryngectomy.

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Primary payer status, individual patient characteristics, and hospital-level factors affecting length of stay and total cost of hospitalization in total laryngectomy.

Head Neck. 2016 Sep 21;

Authors: Mehta V, Flores JM, Thompson RW, Nathan CA

Abstract
BACKGROUND: Medicaid and uninsured patients anecdotally incur higher cost and length of stay because of nonmedical, discharge-related factors. The purpose of this study was to investigate the association between primary payer and length of stay and cost, controlling for comorbidities and complications, in patients undergoing total laryngectomy.
METHODS: The sample included 4128 patients who underwent total laryngectomy in the 2005 to 2010 National Inpatient Sample (NIS). Patients were categorized into 4 subgroups based on payer status: Medicare, Medicaid, uninsured, and private insurance. Using multilevel modeling, we examined differences in length of stay and hospitalization costs.
RESULTS: The odds of being in the top quartile of length of stay increased for Medicaid patients by 41% (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.03-1.92) compared with privately insured patients.
CONCLUSION: After controlling for medical factors, Medicaid patients had increased lengths of stay. Overall costs were highest for those with public insurance, but no difference was seen for the adjusted cost. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27653437 [PubMed - as supplied by publisher]

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Amplification and protein overexpression of cyclin D1: Predictor of occult nodal metastasis in early oral cancer.

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Amplification and protein overexpression of cyclin D1: Predictor of occult nodal metastasis in early oral cancer.

Head Neck. 2016 Sep 21;

Authors: Noorlag R, Boeve K, Witjes MJ, Koole R, Peeters TL, Schuuring E, Willems SM, van Es RJ

Abstract
BACKGROUND: Accurate nodal staging is pivotal for treatment planning in early (stage I-II) oral cancer. Unfortunately, current imaging modalities lack sensitivity to detect occult nodal metastases. Chromosomal region 11q13, including genes CCND1, Fas-associated death domain (FADD), and CTTN, is often amplified in oral cancer with nodal metastases. However, evidence in predicting occult nodal metastases is limited.
METHODS: In 158 patients with early tongue and floor of mouth (FOM) squamous cell carcinomas, both CCND1 amplification and cyclin D1, FADD, and cortactin protein expression were correlated with occult nodal metastases.
RESULTS: CCND1 amplification and cyclin D1 expression correlated with occult nodal metastases. Cyclin D1 expression was validated in an independent multicenter cohort, confirming the correlation with occult nodal metastases in early FOM cancers.
CONCLUSION: Cyclin D1 is a predictive biomarker for occult nodal metastases in early FOM cancers. Prospective research on biopsy material should confirm these results before implementing its use in routine clinical practice. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27653309 [PubMed - as supplied by publisher]

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AHNS series - Do you know your guidelines? Diagnosis and management of cutaneous squamous cell carcinoma.

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AHNS series - Do you know your guidelines? Diagnosis and management of cutaneous squamous cell carcinoma.

Head Neck. 2016 Sep 21;

Authors: Ow TJ, Wang HR, McLellan B, Ciocon D, Amin B, Goldenberg D, Schmalbach CE, Education Committee of the American Head and Neck Society (AHNS)

Abstract
This article is the next installment of the series "Do You Know Your Guidelines" presented by the Education Committee of the American Head and Neck Society. Guidelines for the prevention, diagnosis, workup, and management of cutaneous squamous cell carcinoma (SCC) are reviewed. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27653232 [PubMed - as supplied by publisher]

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Expression of Dopamine Receptor 1A and Cannabinoid Receptor 1 Genes in the Cochlea and Brain after Salicylate-Induced Tinnitus.

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Expression of Dopamine Receptor 1A and Cannabinoid Receptor 1 Genes in the Cochlea and Brain after Salicylate-Induced Tinnitus.

ORL J Otorhinolaryngol Relat Spec. 2016 Sep 23;78(5):268-275

Authors: Hwang JH, Chan YC

Abstract
The purpose of this study was to investigate the mRNA expression of the dopamine receptor 1A (DR1A) and cannabinoid receptor 1 (CR1) genes in mice with tinnitus. Sixteen 3-month-old male SAMP8 mice were randomly and equally divided into two groups (8 mice in each group): a control (saline-treated) group and a tinnitus (salicylate-treated) group. The mRNA expression of the DR1A and CR1 genes in the cochleae and brains of the mice was evaluated after tinnitus had been induced by intraperitoneal injection of sodium salicylate (300 mg/kg body weight). The results showed that 4-day salicylate treatment (unlike 4-day saline treatment) caused a significant increase in the tinnitus score and in mRNA expression of the DR1A gene in the cochlea, the brainstem and inferior colliculus, the hippocampus and parahippocampus, and the temporal lobe, but not the frontal lobe. Conversely, 4-day salicylate treatment caused significantly lower mRNA expression of the CR1 gene in the cochlea and all the brain areas tested. In summary, salicylate-induced tinnitus may be associated with increased mRNA expression of the DR1A gene - but with decreased mRNA expression of the CR1 gene - in the cochlea and in many tinnitus-related brain areas.

PMID: 27658122 [PubMed - as supplied by publisher]

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An unusual cause of tinnitus.

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An unusual cause of tinnitus.

Ear Nose Throat J. 2016 Sep;95(9):368

Authors: Chen PJ, Chen HC

PMID: 27657313 [PubMed - as supplied by publisher]

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Guidelines for Tinnitus-Reply.

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Guidelines for Tinnitus-Reply.

JAMA. 2016 Sep 20;316(11):1215

Authors: Cifu AS, Walker DD, Gluth MB

PMID: 27654616 [PubMed - as supplied by publisher]

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Guidelines for Tinnitus.

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Guidelines for Tinnitus.

JAMA. 2016 Sep 20;316(11):1214-1215

Authors: Tunkel DE, Jones SL, Rosenfeld RM

PMID: 27654612 [PubMed - as supplied by publisher]

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Findings of Esophagography for 25 Patients After Peroral Endoscopic Myotomy for Achalasia.

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Findings of Esophagography for 25 Patients After Peroral Endoscopic Myotomy for Achalasia.

AJR Am J Roentgenol. 2016 Sep 22;:1-9

Authors: Levy JL, Levine MS, Rubesin SE, Falk GW, Metz DC, Dempsey DT, Ginsberg GG

Abstract
OBJECTIVE: The purpose of this study is to better characterize the findings of esophagography after peroral endoscopic myotomy for achalasia.
MATERIALS AND METHODS: We evaluated 25 patients who underwent peroral endoscopic myotomy for achalasia. The findings noted on pre- and postprocedural esophagrams were reviewed retrospectively and were correlated with clinical outcomes.
RESULTS: None of the patients had esophageal perforation noted on esophagrams obtained after myotomy, and all but two patients had a hospital stay that lasted 1 day only. Esophagrams obtained on postoperative day 1 revealed endoscopic clips in 25 patients (100%), pneumoperitoneum in 18 (72%), retroperitoneal gas in 10 (40%), gastric pneumatosis in nine (36%), intramural dissections in seven (28%), and pneumomediastinum in four (16%). Repeat esophagrams obtained 3 weeks later for 22 of the patients revealed endoscopic clips in 16 patients (73%) and intramural dissections in five patients (23%), but the remaining findings had resolved. Eighteen patients (72%) had a successful myotomy and seven (28%) had suboptimal results on the basis of clinical outcomes. Observation of a distal esophageal width of 5 mm or less on postprocedural esophagrams was often associated with suboptimal results.
CONCLUSION: Peroral endoscopic myotomy is a novel procedure that is less invasive than is laparoscopic Heller myotomy for the treatment of achalasia, with fewer complications and shorter recovery times. Radiologists should be aware of the findings expected on esophagography (including pneumoperitoneum, retroperitoneal gas, gastric pneumatosis, intramural dissections, and pneumomediastinum) and should also know that fluoroscopic studies may be helpful for predicting patient outcomes on the basis of the width of the distal esophagus after myotomy.

PMID: 27657919 [PubMed - as supplied by publisher]

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Pulsed dye laser treatment of primary cryptococcal laryngitis: A novel approach to an uncommon disease.

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Pulsed dye laser treatment of primary cryptococcal laryngitis: A novel approach to an uncommon disease.

Am J Otolaryngol. 2016 Aug 18;

Authors: Ihenachor EJ, Dewan K, Chhetri D

Abstract
An 82-year-old supplemental oxygen dependent woman with severe COPD presented with an eight month history of worsening hoarseness and stridor. Office laryngoscopy revealed laryngeal edema and ulcerative masses throughout the larynx. In-office biopsies were positive for Cryptococcus neoformans. This report details a novel approach to the treatment of cryptococcal laryngitis, a combination of in-office pulsed-dye laser (PDL) ablation and medical therapy. Despite treatment with oral fluconazole, the recommended treatment for cryptococcal laryngitis the patient continued to be symptomatic with dysphonia and throat discomfort. Repeated laryngeal exam demonstrated persistent cryptococcal nodules. The patient was subsequently effectively treated with an in-office PDL laser. This case demonstrates the efficacy of in-office laser treatment for residual laryngeal Cryptococcus. For patients like this one, who have failed medical therapy and are unfit for general anesthetic, the in-office laser provides an excellent alternative treatment approach.

PMID: 27654751 [PubMed - as supplied by publisher]

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Are Upper-Body Axial Symptoms a Feature of Early Parkinson's Disease?

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Are Upper-Body Axial Symptoms a Feature of Early Parkinson's Disease?

PLoS One. 2016;11(9):e0162904

Authors: Moreau C, Devos D, Baille G, Delval A, Tard C, Perez T, Danel-Buhl N, Seguy D, Labreuche J, Duhamel A, Delliaux M, Dujardin K, Defebvre L

Abstract
BACKGROUND: Axial disorders are considered to appear late in the course of Parkinson's disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.
OBJECTIVES: To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.
METHODS: We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.
RESULTS: The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).
CONCLUSION: Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.

PMID: 27654040 [PubMed - as supplied by publisher]

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Five-Year Hearing Outcomes in Bilateral Simultaneously Cochlear-Implanted Adult Patients.

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Five-Year Hearing Outcomes in Bilateral Simultaneously Cochlear-Implanted Adult Patients.

Audiol Neurootol. 2016 Sep 22;21(4):261-267

Authors: De Seta D, Nguyen Y, Vanier A, Ferrary E, Bebear JP, Godey B, Robier A, Mondain M, Deguine O, Sterkers O, Mosnier I

Abstract
OBJECTIVE: To report the speech performance and sound localization in adult patients 5 years after bilateral simultaneous cochlear implantation and to evaluate the change in speech scores between 1 and 5 years.
DESIGN: In this prospective multicenter study, 26 patients were evaluated 5 years after implantation using long straight electrode arrays (MED-EL Combi 40+, standard electrode array, 31 mm). Speech perception was measured using disyllabic words in quiet and noise, with the speech coming from the front and a cocktail party background noise coming from 5 loudspeakers. Speech localization measurements were performed in noise under the same test conditions. These results were compared to those obtained at 1 year reported in a previous study.
RESULTS: Five years after implantation, an improvement in speech performance scores compared to 1 year after implantation was found for the poorer ear both in quiet and in noise (+12.1 ± 2.6%, p < 0.001). The lower the speech score of the poorer ear at 1 year, the greater the improvement at 5 years, both in quiet (r = -0.62) and at a signal-to-noise ratio of +15 dB (r = -0.58). The sound localization on the horizontal plane in noise provided by bilateral implantation was better than the unilateral one and remained stable after the results observed at 1 year.
CONCLUSION: In adult patients simultaneously and bilaterally implanted, the poorest speech scores improved between 1 and 5 years after implantation. These findings are an additional element to recommend bilateral implantation in adult patients. The use of both cochlear implants and speech training sessions for patients with poor performance should continue in the period after 1 year following implantation, since the speech scores will improve over time.

PMID: 27653609 [PubMed - as supplied by publisher]

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