OtoRhinoLaryngology News: 09/24/16

Σάββατο 24 Σεπτεμβρίου 2016

Expert perspectives on hereditary angioedema: Key areas for advancements in care across the patient journey.

Expert perspectives on hereditary angioedema: Key areas for advancements in care across the patient journey.

Allergy Rhinol (Providence). 2016 Sep 22;

Authors: Banerji A, Bas M, Bernstein JA, Boccon-Gibod I, Bova M, Dempster J, Grumach AS, Magerl M, Poarch K, Ferreira MB

Abstract
BACKGROUND: Published literature documents the substantial burden of hereditary angioedema (HAE) with C1 inhibitor deficiency on the quality of life and work productivity of patients. However, despite advances in the field and the availability of guidelines to advise health care providers (HCP) on the diagnosis and management of HAE, there are still many challenges to overcome. For example, delayed diagnosis and misdiagnosis are common, and treatment practices vary worldwide.
OBJECTIVE: An international expert panel was convened to consider opportunities for improvements that would benefit patients with HAE.
METHODS: Based on professional and personal experiences, the experts developed schematics to describe the journey of patients through the following stages: (1) onset of symptoms and initial evaluation; (2) referral/diagnosis; and (3) management of HAE. More importantly, the panel identified key areas in which it was possible to optimize the support provided to patients and HCPs along this journey.
RESULTS: Overall, this approach highlighted the need for wider dissemination of algorithms and scientific data to more effectively educate HCPs from multiple disciplines and the need for more research to inform appropriate treatment decisions. Furthermore, HAE awareness campaigns, accurate online information, and referral to patient advocacy groups were all considered helpful approaches to support patients.
CONCLUSION: More detailed and widespread information on the diagnosis and management of HAE is needed and may lead to advancements in care throughout the journey of the patient with HAE.

PMID: 27661998 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfi4pR
via IFTTT

Expert perspectives on hereditary angioedema: Key areas for advancements in care across the patient journey.

Expert perspectives on hereditary angioedema: Key areas for advancements in care across the patient journey.

Allergy Rhinol (Providence). 2016 Sep 22;

Authors: Banerji A, Bas M, Bernstein JA, Boccon-Gibod I, Bova M, Dempster J, Grumach AS, Magerl M, Poarch K, Ferreira MB

PMID: 27661998 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfi4pR
via IFTTT

Otolaryngology.

Otolaryngology.

Am J Rhinol Allergy. 2016 Sep;30(5):372

Authors: Amedee RG

PMID: 27657904 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfgQLk
via IFTTT

Open versus endoscopic medial orbital decompression: Utilization, cost, and operating room time.

Open versus endoscopic medial orbital decompression: Utilization, cost, and operating room time.

Am J Rhinol Allergy. 2016 Sep;30(5):360-6

Authors: Ference EH, Sindwani R, Tan BK, Chandra RK, Kern RC, Conley D, Smith SS

Abstract
BACKGROUND: The advent of endoscopic sinus surgery has created an exciting interface between rhinology and ophthalmology in the area of orbital and optic nerve decompression Objectives: (1) To study the utilization of open versus endoscopic medial orbital decompression based on geography and indication, (2) to describe the demographics of the patient populations who underwent these different techniques, and (3) to compare outcomes, including mean charges and operating room (OR) times Methods: Cases identified by Current Procedural and Terminology codes were extracted from the California, Florida, Maryland, and New York State Ambulatory Surgery Databases from 2009 to 2011. Patient demographics, diagnoses, mean charge, and OR time were compared.
RESULTS: A total of 1009 patients underwent orbital decompression; 93.0% of cases involved the medial wall only; 22.9% of medial decompressions were performed endoscopically, 74.5% were open, and 2.6% were via combined approach. Eighty percent of patients had thyroid eye disease. Analyses adjusted for sex, age, race, state, and diagnosis found that surgeries for infection (N = 47) were more likely to be performed endoscopically compared with procedures for other diagnoses (N = 962) (odds ratio 5.27 [2.67-10.40], p < 0.001). Patients in Florida were more likely to undergo endoscopic decompression compared with patients in California (odds ratio 2.35 [1.42-3.62]). The difference in median charge for endoscopic ($13,119) versus open ($11,291; p = 0.085) procedures was not significant on bivariate analysis but was significant on multivariate analysis (p = 0.04). The median OR time for open procedures was, on average, 33 minutes shorter (endoscopic, 132 minutes; open, 98 minutes; p ≤ 0.001) on bivariate analysis but was not significantly different when controlling for covariables (p = 0.08).
CONCLUSION: In the study sample, endoscopic orbital decompression was performed in 22.9% of patients, with significant variation in surgical technique based on geography and indication. Procedures that used endoscopic compared with open decompression techniques had no significant difference in charge on bivariate analysis. The OR time for open procedures was shorter on bivariate but not on multivariate analysis. Further research is required regarding the relative effectiveness of open versus endoscopic surgical techniques for various indications.

PMID: 27657902 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dmptQr
via IFTTT

Development of a novel T-tube frontal sinus irrigation catheter.

Development of a novel T-tube frontal sinus irrigation catheter.

Am J Rhinol Allergy. 2016 Sep;30(5):356-9

Authors: Rotenberg BW, Ioanidis KE, Sowerby LJ

Abstract
BACKGROUND: The problem of postoperative management after frontal sinus surgery remains a challenge. The bilateral opening created in the Draf III procedure does not fit any currently available stent, and patients find rinsing the frontal sinus difficult, which thus decreases compliance. The objective of this study was to demonstrate the successful use of a novel frontal sinus catheter fashioned from a biliary T tube by addressing these issues in patients with complicated sinus disease.
METHODS: This was a review of 30 patients who underwent a Draf III procedure between January and October 2014, and who had a T-tube stent inserted at the end of the procedure. Patient charts were analyzed for complications such as bleeding, infection, and restenosis as well as indications of ease of rinsing ability after surgery.
RESULTS: From the chart data, there was only one intraoperative bleed and only one postoperative bleed that required packing. Four patients had infections that required antibiotics after surgery. At the time of data collection, only one patient had signs of restenosis as judged by the operating surgeon. Patients reported an ease of rinsing ability with the T-tube stent.
CONCLUSIONS: The novel biliary T-tube stent use presented in this article is a promising future direction for postoperative care after extended frontal sinus surgery.

PMID: 27657901 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dmp4xH
via IFTTT

The Triple Aim and its implications on the management of chronic rhinosinusitis.

The Triple Aim and its implications on the management of chronic rhinosinusitis.

Am J Rhinol Allergy. 2016 Sep;30(5):344-50

Authors: Barry JY, McCrary HC, Kent S, Saleh AA, Chang EH, Chiu AG

Abstract
INTRODUCTION: Accountable care organizations (ACO) and alternative payment models are a sign of the change in reimbursement from fee-for-service to value-based reimbursement. The focus of health care under ACOs is represented by the Triple Aim: to improve the experience of health care, improve the health of populations, and reduce the per capita costs. Individuals with chronic rhinosinusitis (CRS) are heavy consumers of health care services. Results of recent studies have indicated that there is the potential for improved outcomes and cost savings from early surgical intervention. Adhering to the principles of the Triple Aim may signal a paradigm shift in regard to timing of intervention for CRS in certain patients.
METHODS: A scoping review was performed to analyze the current literature related to management of CRS and the impact on cost, population health outcomes, and the patient's experience of health care.
RESULTS: A growing body of literature indicates that, in appropriately selected patients, when compared with medical management, endoscopic sinus surgery has the potential to improve patient outcomes and reduce the long-term cost burden of CRS.
CONCLUSION: With the advent of ACOs, a paradigm shift in the treatment of CRS is inevitable to better conform to the goals of the Triple Aim. Future treatment algorithms will need to account for the heterogeneity within CRS and seek to identify appropriate timing and interventions for patients on an individual basis if the value of health care is to be improved.

PMID: 27657900 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dmn7kL
via IFTTT

Lymphoma of the nasal cavity and paranasal sinuses: A case series.

Lymphoma of the nasal cavity and paranasal sinuses: A case series.

Am J Rhinol Allergy. 2016 Sep;30(5):335-9

Authors: Steele TO, Buniel MC, Mace JC, El Rassi E, Smith TL

Abstract
BACKGROUND: Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms.
OBJECTIVE: To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution.
METHODS: Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability.
RESULTS: Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone.
CONCLUSION: Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.

PMID: 27657899 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2csGHP7
via IFTTT

Local allergic rhinitis in children: Novel diagnostic features and potential biomarkers.

Local allergic rhinitis in children: Novel diagnostic features and potential biomarkers.

Am J Rhinol Allergy. 2016 Sep;30(5):329-34

Authors: Zicari AM, Occasi F, Di Fraia M, Mainiero F, Porzia A, Galandrini R, Giuffrida A, Bosco D, Bertin S, Duse M

Abstract
BACKGROUND: Local allergic rhinitis (LAR) is a phenotype of rhinitis that has been poorly studied in children. It is characterized by the same symptoms of allergic rhinitis but with the absence of markers of systemic atopy.
OBJECTIVE: To identify children affected by LAR and to analyze the pathogenesis of this disease. We chose to focus our attention on interleukin (IL) and thymic stromal lymphopoietin (TSLP).
METHODS: We enrolled 20 children affected by nonallergic rhinitis (negative skin-prick test results and serum specific immunoglobulin E [sIgE] values). Each patient underwent a nasal allergen provocation test (NAPT) with dust mite and grass pollen. Before and after NAPT, nasal lavage was performed to detect sIgE, IL-5, and TSLP; anterior active rhinomanometry was used to evaluate changes in nasal obstruction.
RESULTS: Two patients were positive to a nonspecific NAPT and, thus, were excluded from the study. Of the remaining 18 children, 12 (66.7%) had positive results to at least one NAPT. Among these 12 patients, nasal sIgE levels for Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Lolium perenne increased significantly after NAPT (D. pteronyssinus, p < 0.005; D. farinae, p < 0.05; L. perenne, p < 0.05). Nasal IL-5 levels showed a significant increase after NAPT (p ≤ 0.006), and this increase was significantly higher in children who had positive NAPT results than in those patients with negative NAPT results (p ≤ 0.03). Among the 12 children who had a positive NAPT result, nasal TSLP was detected in 4 patients (33.3%) and its levels showed a relevant increase after NAPT, even though the difference did not reach statistical significance (p ≤ 0.061).
CONCLUSION: Observed results raise the importance of better refining the diagnostic protocol for LAR in children. Nasal TSLP and IL-5 levels offer new insights concerning localized allergic inflammation, although the role of nasal sIgE has still to be clarified.

PMID: 27657898 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfgDYC
via IFTTT

Validation of the Nasal Mucus Index, a novel measurement of acute respiratory infection severity.

Validation of the Nasal Mucus Index, a novel measurement of acute respiratory infection severity.

Am J Rhinol Allergy. 2016 Sep;30(5):324-8

Authors: Dorresteijn PM, Muller D, Xie Y, Zhang Z, Barrett BP

Abstract
BACKGROUND: To assess the concurrent and predictive validity of the Nasal Mucus Index (NMI), a novel measurement of acute respiratory infection (ARI) severity.
OBJECTIVE: ARI, including the common cold and influenza, imposes a great burden on individuals and society. Previous research has attempted to assess the severity of ARI with self-reported and laboratory-based measurements. Self-reported measurements may introduce bias. Laboratory-based metrics are often expensive. Therefore, there is a need for non-self-reported, affordable, and validated ARI severity tests.
METHODS: Participants (N = 719) with an ARI episode underwent nasal lavage on days 1 and 3. The samples were visually assessed for the amount of mucus present in the sample and were given a subsequent NMI score. Collected samples were further assessed for interleukin (IL) 8 values (in pg/mL) and polymorphonuclear neutrophils (PMN) per high-power field. The participants rated episode severity and nasal symptoms daily by using the validated Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21). A subset of nasal symptoms was used as an additional comparator. NMI scores were compared with same-day IL-8 level, PMN count, and WURSS-21 scores for concurrent validation purposes by using the Spearman ρ as the index of correlation. NMI scores were correlated with overall episode severity measurements to assess predictive validity. Overall episode severity was measured as the WURSS-21 area under the curve, nasal symptoms area under the curve, and episode duration.
RESULTS: The NMI score correlated significantly with the same-day IL-8 level (ρ = 0.443, p < 0.001), PMN count (ρ = 0.498, p < 0.001), WURSS-21 score (ρ = 0.098, p = 0.004), and nasal symptom score (ρ = 0.162, p < 0.001). No significant predictive correlations were found.
CONCLUSION: Associations with inflammatory biomarkers and self-reported severity measurements provided evidence of concurrent validity for the novel NMI score. The NMI can be used in future research as a simple, inexpensive, non-self-reported indicator of ARI severity.

PMID: 27657897 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfgior
via IFTTT

New insights into upper airway innate immunity.

New insights into upper airway innate immunity.

Am J Rhinol Allergy. 2016 Sep;30(5):319-23

Authors: Hariri BM, Cohen NA

Abstract
BACKGROUND: Protecting the upper airway from microbial infection is an important function of the immune system. Proper detection of these pathogens is paramount for sinonasal epithelial cells to be able to prepare a defensive response. Toll-like receptors and, more recently, bitter taste receptors and sweet taste receptors have been implicated as sensors able to detect the presence of these pathogens and certain compounds that they secrete. Activation of these receptors also triggers innate immune responses to prevent or counteract infection, including mucociliary clearance and the production and secretion of antimicrobial compounds (e.g., defensins).
OBJECTIVE: To provide an overview of the current knowledge of the role of innate immunity in the upper airway, the mechanisms by which it is carried out, and its clinical relevance.
METHODS: A literature review of the existing knowledge of the role of innate immunity in the human sinonasal cavity was performed.
RESULTS: Clinical and basic science studies have shown that the physical epithelial cell barrier, mucociliary clearance, and antimicrobial compound secretion play pivotal innate immune roles in defending the sinonasal cavity from infection. Clinical findings have also linked dysfunction of these defense mechanisms with diseases, such as chronic rhinosinusitis and cystic fibrosis. Recent discoveries have elucidated the significance of bitter and sweet taste receptors in modulating immune responses in the upper airway.
CONCLUSION: Numerous innate immune mechanisms seem to work in a concerted fashion to keep the sinonasal cavity free of infection. Understanding sinonasal innate immune function and dysfunction in health and disease has important implications for patients with respiratory ailments, such as chronic rhinosinusitis and cystic fibrosis.

PMID: 27657896 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dmoyQ6
via IFTTT

Reality bites: The establishment of accountable care organizations in otolaryngology.

Reality bites: The establishment of accountable care organizations in otolaryngology.

Am J Rhinol Allergy. 2016 Sep;30(5):317-8

Authors: Woodard TD

PMID: 27657895 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfi4pA
via IFTTT

Impact of endoscopic dacryocystorhinostomy on sinonasal quality of life.

Impact of endoscopic dacryocystorhinostomy on sinonasal quality of life.

Am J Rhinol Allergy. 2016 Sep;30(5):189-91

Authors: Miyake MM, Gregorio LL, Freitag SK, Lefebvre DR, Gray ST, Holbrook EH, Bleier BS

Abstract
BACKGROUND: Dacryocystorhinostomy (DCR) is the criterion standard of surgical treatment for complete nasolacrimal obstruction and dacryocystitis. There has been an expansion in the indication of the endonasal DCR (eDCR), but the impact of surgical manipulating an otherwise healthy nasal mucosa on postoperative sinonasal quality of life remains unknown. The purpose of this study was to determine whether patients who underwent eDCR experienced any decrement in sinonasal quality of life.
METHODS: A retrospective chart review of 44 patients who underwent eDCR between June 2012 and May 2015. The primary outcome was the total and nasal-specific domain 1 scores of the disease specific validated Sino-Nasal Outcomes Test 22. Preoperative scores were compared with the postoperative scores on days 0-30, 30-90, and 90-180 visits. A subgroup analysis of patients without nasal symptoms who underwent concomitant nasal surgical procedures was also performed.
RESULTS: A statistically significant increase was observed between the preoperative score and the first postoperative score (days 0-30) in both total (7.5 [0-44] to 24 [0-51], median [interquartile range]) and domain 1 (2.5 [0-11] to 9 [0-18]) scores (p = 0.0066 and p = 0.0001, respectively). In contrast, there was no statistically significant difference between the pre- and postoperative scores on days 30-90 or 90-180. Similar results were observed in the subgroup analysis.
CONCLUSION: Analysis of our findings indicated that, in general, eDCR was well tolerated by patients and nasal symptom scores returned to baseline values within 30-90 days of surgery. The concomitant performance of septoplasty in the setting of asymptomatic septal deviation did not confer any long-term improvement in symptoms of nasal obstruction.

PMID: 27657894 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfgtjH
via IFTTT

Mucocele formation after surgical treatment of inverted papilloma of the frontal sinus drainage pathway.

Mucocele formation after surgical treatment of inverted papilloma of the frontal sinus drainage pathway.

Am J Rhinol Allergy. 2016 Sep;30(5):181-4

Authors: Verillaud B, Le Clerc N, Blancal JP, Guichard JP, Kania R, Classe M, Herman P

Abstract
BACKGROUND: Inverted papillomas (IP) inserted in the frontal sinus and/or recess may be treated by using an endoscopic endonasal or an external approach. There are still few data available on this uncommon localization of IPs.
OBJECTIVE: To report our experience in the management of IP of the frontal drainage pathway, to describe a previously unreported specific complication of this surgery, and to discuss the optimal surgical strategy.
METHODS: A retrospective study of the patients at a tertiary care center between 2004 and 2014 who were operated on for an IP with an insertion in the frontal recess and/or the frontal sinus. Clinical charts were reviewed for demographics, clinical presentation, imaging findings, surgical treatment, and outcome.
RESULTS: Twenty-seven patients were included. Patients were operated on by using a purely endoscopic approach (Draf procedure; n = 14 [51.9%]) when the IP was inserted in the frontal recess and/or the frontal sinus infundibulum (with a nasoseptal-septoturbinal flap placed on the exposed bone in four patients), or by using a combined endoscopic and open approach (osteoplastic flap procedure; n = 13 [48.1%]) when the IP invaded the frontal sinus beyond the infundibulum. There were two recurrences (7.4%), with a mean follow-up of 40 months (range, 9-123 months). During follow-up, single or multiple iatrogenic frontal mucoceles were observed in 10 patients (37%), with a mean delay of 60 months (range, 27-89 months). These mucoceles occurred both after using endoscopic (n = 3) or combined (n = 7) approaches, and required a surgical treatment in eight patients. No postoperative mucocele was observed in the four patients who had had a septal flap.
CONCLUSION: In our experience, an approach based on the localization of the IP insertion provided acceptable results in terms of the local control rate (92.6%). However, the significant rate of postoperative mucoceles indicated that specific strategies (such as local flaps) still need to be developed to avoid this iatrogenic complication.

PMID: 27657893 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dmnVWB
via IFTTT

Sinonasal polyposis in the elderly.

Sinonasal polyposis in the elderly.

Am J Rhinol Allergy. 2016 Sep;30(5):153-6

Authors: Brescia G, Barion U, Pedruzzi B, Cinetto F, Giacomelli L, Pendolino AL, Marino F, Manzato E, Martini A, Marioni G

Abstract
BACKGROUND/OBJECTIVE: The main end point of this investigation was to review our experience gained from 2009 to 2015 of treating chronic rhinosinusitis with nasal polyps (CRSwNP) in elderly patients (≥65 years old) with functional endoscopic sinus surgery. Secondary aims were to analyze the prognostic variables for CRSwNP in elderly patients and to compare the demographic, clinical, laboratory, histologic, and prognostic characteristics of CRSwNP in elderly versus young adult patients (20-40 years old).
METHODS: Forty-three consecutive elderly patients and 71 consecutive young adult patients with CRSwNP were enrolled.
RESULTS: Significant associations were found in the elderly group between CRSwNP recurrence and allergy (p = 0.037), CRSwNP recurrence and asthma (p = 0.017), and CRSwNP recurrence and acetyl salicylic acid (ASA) intolerance (p = 0.032) but not between recurrence and eosinophilic/noneosinophilic CRSwNP histology. Significant associations emerged in the young adult group between CRSwNP recurrence and asthma (p = 0.009), and ASA intolerance (p = 0.016), and serum eosinophil count (p = 0.02). The recurrence rate was also significantly higher for young adult patients with eosinophilic-type CRSwNP (p = 0.001). CRSwNP recurred less often in the elderly than in the young adult patients (p = 0.05).
CONCLUSION: The present preliminary investigation found a lower recurrence rate after functional endoscopic sinus surgery for CRSwNP in elderly patients than in young adult patients. Further investigations on larger, prospective series are mandatory to support the hypothesis that, although eosinophilic-type CRSwNP is generally considered a variant at high risk of recurrence and that probably warrants stricter postoperative follow-up and adjuvant postoperative medical treatment, these considerations could not be applied to elderly patients.

PMID: 27657892 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfftMu
via IFTTT

Impact of breathing patterns on the quality of life of 9- to 10-year-old schoolchildren.

Impact of breathing patterns on the quality of life of 9- to 10-year-old schoolchildren.

Am J Rhinol Allergy. 2016 Sep;30(5):147-52

Authors: Leal RB, Gomes MC, Granville-Garcia AF, Goes PS, de Menezes VA

Abstract
BACKGROUND: Mouth breathing can cause a set of changes in craniofacial growth and development, with esthetic, functional, and psychological repercussions.
OBJECTIVE: To determine the impact of mouth breathing on the quality of life of schoolchildren.
METHODS: A school-based, cross-sectional study was conducted with 1911 children ages 9 and 10 years in the city of Recife, Brazil. The children answered the Mouth Breather Quality of Life questionnaire and a questionnaire that addressed sociodemographic data and health-related aspects. Clinical examinations were performed by an examiner who had undergone a training and calibration process for the diagnosis of mouth breathing (kappa = 0.90). Descriptive statistics were conducted to characterize the sample. Statistical analysis involved the Student's t-test and the F test (analysis of variance) (alpha = 5%).
RESULTS: The prevalence of mouth breathing was 54.81%. Children with oral breathing demonstrated a poorer quality of life in comparison with children with nasal breathing (p < 0.001). The following variables were significantly associated with a poorer quality of life among the children with mouth breathing: a younger age (p < 0.001) and the use of medication (p = 0.002).
CONCLUSION: Based on the present findings, children with the mouth-breathing pattern experience a greater negative impact on quality of life in comparison with those with the nose-breathing pattern. Thus, the early diagnosis and treatment of this clinical condition are fundamental to minimizing the consequences of mouth breathing on the quality of life of schoolchildren with respiration disorders.

PMID: 27657891 [PubMed - in process]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dfg9Sg
via IFTTT

"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]

These pubmed results were generated on 2016/09/24

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dpbnxV
via IFTTT

Unicentric Castleman Disease: An Unusual Cause of An Isolated Neck Mass.

Unicentric Castleman Disease: An Unusual Cause of An Isolated Neck Mass.

Malays J Med Sci. 2016 Jul;23(4):86-9

Authors: Kumar A, Aggarwal K, Agrawal H, Sharma S, Garg PK

Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder of unknown aetiology. It manifests in two distinct clinical presentations: unicentric and multicentric. Unicentric CD is rare and may present as an isolated neck mass. A 22-year-old man presented with a 6-month history of right neck swelling that occupied the posterior triangle of the right neck region. After surgical exploration, a solitary, well defined, and hyper vascular mass was excise. A histopathological examination confirmed the lesion as CD, hyaline-vascular variant. CD of the neck is a diagnosis that is usually not taken into consideration while evaluating neck masses due to its rarity and unassuming presentation. It should be keep in the differential diagnosis of neck masses as the clinical and radiological features evade a firm diagnosis. The treatment of unicentric CD is complete surgical excision, which cures the patient.

PMID: 27660550 [PubMed]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2csrp8a
via IFTTT

Corrigendum.

Corrigendum.

Int J Speech Lang Pathol. 2016 Oct;18(5):i

Authors:

PMID: 27662444 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2drylYb
via IFTTT

Readmission following primary surgery for larynx and oropharynx cancer in the elderly.

Readmission following primary surgery for larynx and oropharynx cancer in the elderly.

Laryngoscope. 2016 Sep 23;

Authors: Chaudhary H, Stewart CM, Webster K, Herbert RJ, Frick KD, Eisele DW, Gourin CG

Abstract
OBJECTIVE: To examine 30-day readmission rates and associations with risk factors, survival, length of hospitalization, and costs in elderly patients with laryngeal and oropharyngeal squamous cell cancer (SCC).
STUDY DESIGN: Retrospective cross-sectional analysis of Surveillance, Epidemiology, and End Results-Medicare data.
METHODS: We evaluated 1,518 patients diagnosed with laryngeal or oropharyngeal SCC from 2004 to 2007 who underwent primary surgery using cross-tabulations, multivariate regression modeling, and survival analysis.
RESULTS: Thirty-day readmission occurred in 14.1% of hospitalizations. Readmission was more likely in patients with postoperative complications during initial hospitalization (24.8% vs. 4.5%, P < 0.001), and was associated with an increased 30-day mortality incidence rate (5.1% vs. 0.9%; P < 0.001). On multivariate analysis, 30-day readmission was significantly associated with advanced stage (odds ratio [OR] = 1.81 [1.13-2.90]), comorbidity (OR = 2.69 [1.65-4.39]), divorced/separated marital status (OR = 2.00 [1.19-3.38]), preoperative tracheostomy (OR = 3.39 [1.55-7.44]), major surgical procedures (OR = 2.58 [1.68-3.97]), greater length of initial hospitalization (OR = 1.72 [1.09-2.71]), pneumonia (OR = 2.86 [1.28-6.40]), postoperative dysphagia (OR = 5.97 [2.48-15.83]), and cardiovascular events (OR = 5.84 [1.89-17.96]). Thirty-day readmission was significantly associated with 30-day mortality (OR = 5.89 [2.21-15.70) and higher 1-year mortality (68.0% vs. 89.2%, P < 0.001). The mean incremental costs of surgical care were significantly greater for patients with unplanned readmission ($15,123 [$10,514-$19,732]), after controlling for all other variables.
CONCLUSION: Unplanned readmissions are associated with increased short- and long-term mortality and costs. Elderly patients with advanced disease, advanced comorbidity, lack of spousal support, pretreatment organ dysfunction, more extensive surgery, postoperative pneumonia, postoperative dysphagia, and prolonged hospitalization are at increased risk of 30-day readmission. These findings suggest a need for targeted interventions before, during, and after hospitalization to reduce morbidity, mortality, and excess costs in this high-risk population.
LEVEL OF EVIDENCE: 2c. Laryngoscope, 2016.

PMID: 27659029 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cPERpC
via IFTTT

HOX genes: potential candidates for the progression of laryngeal squamous cell carcinoma.

HOX genes: potential candidates for the progression of laryngeal squamous cell carcinoma.

Tumour Biol. 2016 Sep 22;

Authors: de Barros E Lima Bueno R, Ramão A, Pinheiro DG, Alves CP, Kannen V, Jungbluth AA, de Araújo LF, Muys BR, Fonseca AS, Plaça JR, Panepucci RA, Neder L, Saggioro FP, Mamede RC, Figueiredo DL, Silva WA

Abstract
Laryngeal squamous cell carcinoma (LSCC) is a very aggressive cancer, considered to be a subtype of the head and neck squamous cell carcinoma (HNSCC). Despite significant advances in the understanding and treatment of cancer, prognosis of patients with LSCC has not improved recently. In the present study, we sought to understand better the genetic mechanisms underlying LSCC development. Thirty-two tumor samples were collected from patients undergoing surgical resection of LSCC. The samples were submitted to whole-genome cDNA microarray analysis aiming to identify genetic targets in LSCC. We also employed bioinformatic approaches to expand our findings using the TCGA database and further performed functional assays, using human HNSCC cell lines, to evaluate viability, cell proliferation, and cell migration after silencing of selected genes. Eight members of the homeobox gene family (HOX) were identified to be overexpressed in LSCC samples when compared to normal larynx tissue. Quantitative RT-PCR analysis validated the overexpression of HOX gene family members in LSCC. Receiver operating characteristic (ROC) statistical method curve showed that the expression level of seven members of HOX gene family can distinguish tumor from nontumor tissue. Correlation analysis of clinical and gene expression data revealed that HOXC8 and HOXD11 genes were associated with the differentiation degree of tumors and regional lymph node metastases, respectively. Additionally, siRNA assays confirmed that HOXC8, HOXD10, and HOXD11 genes might be critical for cell colony proliferation and cell migration. According to our findings, several members of the HOX genes were overexpressed in LSCC samples and seem to be required in biological processes involved in tumor development. This suggests that HOX genes might play a critical role in the physiopathology of LSCC tumors.

PMID: 27658780 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cPGUtL
via IFTTT

A Review of Singing Voice Subsystem Interactions-Toward an Extended Physiological Model of "Support".

A Review of Singing Voice Subsystem Interactions-Toward an Extended Physiological Model of "Support".

J Voice. 2016 Sep 19;

Authors: Herbst CT

Abstract
During phonation, the respiratory, the phonatory, and the resonatory parts of the voice organ can interact, where physiological action in one subsystem elicits a direct effect in another. Here, three major subsystems of these synergies are reviewed, creating a model of voice subsystem interactions: (1) Vocal tract adjustments can influence the behavior of the voice source via nonlinear source-tract interactions; (2) The type and degree of vocal fold adduction controls the expiratory airflow rate; and (3) The tracheal pull caused by the respiratory system affects the vertical larynx position and thus the vocal tract resonances. The relevance of the presented model is discussed, suggesting, among others, that functional voice building work concerned with a particular voice subsystem may evoke side effects or benefits on other subsystems, even when having a clearly defined and isolated physiological target. Finally, four seemingly incongruous historic definitions of the concept of singing voice "support" are evaluated, showing how each of these pertain to different voice subsystems at various levels of detail. It is argued that presumed discrepancies between these definitions can be resolved by putting them into the wider context of the subsystem interaction model presented here, thus offering a framework for reviewing and potentially refining some current and historical pedagogical approaches.

PMID: 27658336 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2d8mhKP
via IFTTT

Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic.

Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic.

BMJ Case Rep. 2015;2015

Authors: George J, Kader JA, Arumugam S, Murphy A

Abstract
We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.

PMID: 26628451 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2d7j1NS
via IFTTT

Comparison of the effects of four different cochlear implant electrodes on intra-cochlear pressure in a model.

Comparison of the effects of four different cochlear implant electrodes on intra-cochlear pressure in a model.

Acta Otolaryngol. 2016 Sep 23;:1-7

Authors: Todt I, Mittmann M, Ernst A, Mittmann P

Abstract
CONCLUSION: Based on this model experiment, a small tip and low volume electrode show lowest intra-cochlear pressure values. Insertional support by a tool minimizes fast pressure changes. Higher electrodes volumes affect slow and fast pressure changes as well.
OBJECTIVE: Insertion causing low intra-cochlear pressure is assumed to be important for atraumatic cochlear implant surgery to preserve residual hearing. Cochlear implant electrodes differ in terms of parameters like tip size, length, volume, and technique of insertion. The aim of this study was to observe the effect of different cochlear implant electrodes on insertional intra-cochlear pressure in a cochlear model.
MATERIALS AND METHODS: Cochlear implant electrode insertions were performed in an artificial cochlear model and intra-cochlear pressure changes were recorded in parallel with a micro-pressure sensor positioned in the apical region of the cochlear model to follow the maximum values, temporal changes, maximum amplitude, and frequency of changes in intra-cochlear pressure. Insertions were performed with four different electrodes (Advanced Bionics 1j, Helix, HFMS, and LW23).
RESULTS: This study found statistically significant differences in the occurrence of initial maximum pressure values correlating with the electrode tip size. The different electrodes and the technique of insertion significantly affected the occurrence of maximum value, amplitude, and frequency of intra-cochlear pressure occurrence.

PMID: 27661767 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2doZesx
via IFTTT

Sialendoscopy under local anaesthesia.

Sialendoscopy under local anaesthesia.

Acta Otolaryngol. 2016 Sep 23;:1-5

Authors: Jokela J, Haapaniemi A, Mäkitie A, Saarinen R

Abstract
CONCLUSIONS: In most cases, both diagnostic and interventional sialendoscopy are well tolerated under local anaesthesia (LA) or under local anaesthesia with sedation (LAS), with reasonably low patient-reported discomfort. Sialendoscopy can be considered a patient-friendly and relatively painless, gland-preserving, minimally invasive procedure suitable for day surgery.
OBJECTIVE: To investigate patient experience and compliance in sialendoscopy under LA/LAS.
METHODS: This prospective study was conducted at an academic tertiary-care university hospital. During a period of 22 months, 89 patients between ages 16-81 years underwent diagnostic or interventional sialendoscopy under LA (20%) or LAS (80%). After the operation the patients filled in a questionnaire formulated by the authors concerning their procedure-related experiences. Patients' demographic data, ASA status score, pre- and intra-operative blood pressure and heart rate measurements, affected gland, operation time, intervention type, as well as pre-, peri-, and postoperative medication were gathered later from the medical records.
RESULTS: The level of discomfort and pain experienced during the operation was assessed as 'mild' or 'none' by 85% and 89% of the patients, respectively. The level of pain experienced after the operation was 'major' in 4% of patients and 'mild' or 'none' in the majority (87%) of patients. The patients' estimations showed no significant difference between the diagnostic and interventional procedures, although it seems that patients who underwent stone removal by transoral incision experienced the operation as a bit more uncomfortable and painful than other patients. Afterwards 97% of patients stated that they would agree to a new LA/LAS sialendoscopy in the future if needed.

PMID: 27659498 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cYMNWb
via IFTTT

Prevalence of Fusobacterium necrophorum in tonsils from patients with chronic tonsillitis.

Prevalence of Fusobacterium necrophorum in tonsils from patients with chronic tonsillitis.

Acta Otolaryngol. 2016 Sep 23;:1-5

Authors: Dapefrid A, Lundström B, Tano K

Abstract
CONCLUSION: There was a high prevalence of Fusobacterium necrophorum (FN) in patients with chronic tonsillitis in the age group 15-23 years. This indicates that FN might play an important role in the pathogenesis of chronic tonsillitis in this age group, which is also the age group in which chronic or recurrent tonsillitis is most common.
OBJECTIVES: The role of FN in patients with acute and chronic tonsillitis is unclear. Thus, this study investigated the occurrence of FN in tonsils of patients with chronic tonsillitis. The aim of the study was to determine the prevalence of FN in patients that underwent tonsillectomy due to chronic tonsillitis. This study also investigated if FN was found at different areas in the tonsils.
METHOD: One hundred and twenty-six consecutive patients undergoing tonsillectomy due to chronic tonsillitis were included from the ENT clinics at Sunderby Hospital and Gällivare Hospital, Sweden. Both children and adults were included to encompass various age groups (age =2-57 years). Culture swabs were taken from three different levels of the tonsils - the surface, the crypts, and the inner core of the tonsils. Selective agar plates for detecting FN were used for culture. Culture was also made for detecting β-hemolytic streptococci, Haemophilus influenzae, and Arcanobacterium.
RESULTS: FN was the most common pathogen (19%). The highest prevalence of FN was found in the age group 15-23 years (in 34% of the patients). FN was detected both at the surface and in the core of the tonsils. Furthermore, in the few patients where FN was not detected in all three areas, FN was always detected at the tonsillar surface, in spite of being an anaerobic bacterium. Streptococci group G and C also occurred most frequently (30%) in the same age group as FN (15-23 years), whereas Streptococci group A was more evenly spread among the age groups.

PMID: 27659315 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2d7m20O
via IFTTT

Patients with severe-to-profound hearing impairment and simultaneous severe vision impairment: a quality-of-life study.

Patients with severe-to-profound hearing impairment and simultaneous severe vision impairment: a quality-of-life study.

Acta Otolaryngol. 2016 Sep 23;:1-7

Authors: Turunen-Taheri S, Skagerstrand Å, Hellström S, Carlsson PI

Abstract
CONCLUSIONS: Patients with severe vision impairment in combination with severe-to-profound hearing loss seem to have a higher risk for effects on QoL, including: mobility, the ability to provide self-care and perform usual activities, and levels of anxiety and depression, compared with patients with only severe-to-profound hearing loss.
OBJECTIVES: To study the quality-of-life (QoL) and audiological rehabilitation of the severely vision-impaired patient population among adults with severe-to-profound hearing loss in Sweden.
METHOD: A study of data collected from 543 patients with severe-to-profound hearing loss combined with severe vision impairment among the total of 2319 persons registered in the Swedish Quality Register of Otorhinolaryngology. QoL was measured with the following instruments: EQ5D, PIRS, and HADS. Audiological rehabilitation was described and evaluated.
RESULTS: The patients with dual sensory loss were younger, were more likely to live alone, and had a lower level of education than the control group. The QoL of the study group was significantly negatively affected. In total, 89% of the study group had been rehabilitated with hearing aids, while 8% had received rehabilitation with cochlear implants. A total of 32% of the study group had received extended audiological rehabilitation.

PMID: 27659206 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cuvXzE
via IFTTT

"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]

These pubmed results were generated on 2016/09/24

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cAOW9Z
via IFTTT

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicenter retrospective study.

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicenter retrospective study.

Clin Otolaryngol. 2016 Sep 23;

Authors: Linder T, Mulazimoglu S, El Hadi T, Darrouzet V, Ayache D, Somers T, Schmerber S, Vincent C, Mondain M, Lescanne E, Bonnard D

Abstract
OBJECTIVES: To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting.
DESIGN AND SETTING: Multicenter retrospective study in 8 tertiary referral hospitals over 17 years.
PARTICIPANTS: Twenty patients with partial or total facial nerve injury during surgery for chronic otitis media (COM) were revised.
MAIN OUTCOME MEASURES: Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final facial nerve outcome were recorded.
RESULTS: In 12 cases, the nerve was completely transected but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 out of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: 7 of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatized nerves.
CONCLUSIONS: We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. This article is protected by copyright. All rights reserved.

PMID: 27661064 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cYNe35
via IFTTT

15th annual meeting of the safety pharmacology society: Focus on traditional sensory systems.

15th annual meeting of the safety pharmacology society: Focus on traditional sensory systems.

J Pharmacol Toxicol Methods. 2016 Sep 19;

Authors: Cavero I, Holzgrefe H

Abstract
INTRODUCTION: This report summarizes and comments key talks on the five traditional senses (ear, vestibular system, vision, taste, olfaction, and touch) which were delivered during the 2015 Annual Meeting of the Safety Pharmacology (SP) Society.
AREAS COVERED: The functional observational battery (FOB) can detect major candidate drug liabilities only on ear, touch and vision. Anatomy, physiology, pharmacology, and pathology notions on each sensory system introduce speaker talks. Techniques for evaluating drug effects on hearing functions are reviewed. Nonclinical approaches to assess vestibular toxicity leading to balance deficits are presented. Retinal explants studied with multielectrode arrays allow the identification of drug liability sites on the retina. Routinely performed Safety Pharmacology assays are not powered to address candidate drug-induced disturbances on taste and smell. This weakness needs correction since unintended pharmacological impairment of these sensorial functions may have serious health consequences. Neuropathy produced by chemotherapeutic agents may cause multiple sensorial perception distortions.
CONCLUSIONS: Safety Pharmacology studies should ensure the safety of any candidate drug on the five sensorial systems.

PMID: 27659846 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cUxmRw
via IFTTT

Long-term measurements using home audiometry with Békésy's technique.

Long-term measurements using home audiometry with Békésy's technique.

Int J Audiol. 2016 Sep 23;:1-10

Authors: Brännström KJ, Grenner J

Abstract
OBJECTIVE: To examine the efficacy of fixed-frequency Békésy's home audiometry to assess hearing fluctuation and treatment outcomes in patients with subjectively fluctuating hearing loss.
DESIGN: SMAPH, a software audiometry program for Windows, was installed and calibrated on laptop computers. Békésy's audiometry was carried out daily in the patients' homes, using sound-attenuating earphones.
STUDY SAMPLE: Seventeen patients with previously or currently subjectively fluctuating hearing loss. Five patients received of treatment for their conditions during the measurement period.
RESULTS: Measurement periods ranged from 6 to 60 days. Varying degrees of compliance were seen, some patients measuring less than 50% of the days, others measuring every day. Based on their long-term measurements the patients were classified into three groups: patients with stable recordings, with fluctuating low-frequency hearing loss, or with fluctuating high-frequency hearing loss. In the patients with stable recordings, significant test-retest differences were seen below 10 dB at frequencies 0.125-8 kHz.
CONCLUSIONS: Home audiometry with Békésy's technique can be used to evaluate disease activity and to monitor hearing results after therapy.

PMID: 27662509 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dddIj0
via IFTTT

Subarachnoid Hemorrhage and Spinal Subdural Hematoma Due to Acute CSF Hypotension.

Subarachnoid Hemorrhage and Spinal Subdural Hematoma Due to Acute CSF Hypotension.

Neurocrit Care. 2016 Sep 22;

Authors: Graffeo CS, Perry A, Wijdicks EF

Abstract
BACKGROUND: Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery.
METHODS: Case report.
RESULTS: An 84-year-old man developed symptomatic spinal stenosis with bilateral lower extremity pseudoclaudication. He underwent L3-5 laminectomy at an outside institution, complicated by a small, incidental, unrepairable intraoperative durotomy. On postoperative day 2, he became confused; and head CT demonstrated intracranial SAH with blood products along the superior cerebellum and bilateral posterior Sylvian fissures. He was transferred to our neurosciences ICU for routine SAH care, with improvement in encephalopathy over several days of supportive care. On postoperative day 10, the patient developed new bilateral lower extremity weakness; MRI of the lumbar spine demonstrated worsening acute spinal SDH above the laminectomy defect, from L4-T12. He was taken to the OR for decompression, at which time a complex 1.5-cm lumbar durotomy was identified and repaired primarily.
CONCLUSIONS: We report the first case of simultaneous intracranial SAH and spinal SDH attributable to postoperative CSF hypotension in the setting of a known intraoperative durotomy. Although rare, each of these entities has the potential to precipitate a poor neurologic outcome, which may be mitigated by early recognition and treatment.

PMID: 27660177 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cZ6wnc
via IFTTT

Postpartum vertebral artery dissection.

Postpartum vertebral artery dissection.

BMJ Case Rep. 2015;2015

Authors: Finley A, Rogers B, Richards T, Vogel H

Abstract
We report a case of a right vertebral artery dissection in a 35-year-old woman, 3 weeks post partum, with manifestations of vertebrobasilar disease. She was 3 weeks out from the uneventful delivery of her fourth child, with presentation of acute neurological symptoms, predominantly intractable vertigo. Vertigo can have many non-specific generalised symptoms and clinical findings. Postpartum women have a lengthy list of possible aetiologies of vertigo not limited to our initially suspected preeclampsia, dural venous thrombosis and vertebral dissection.

PMID: 26604230 [PubMed - indexed for MEDLINE]

from Hearing and Balance via ola Kala on Inoreader http://ift.tt/2cKMMlT
via IFTTT

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

J Voice. 2016 Sep 19;

Authors: Ramos LA, Gama AC

Abstract
OBJECTIVE: This study aimed to verify the effects of execution time on auditory-perceptual and acoustic responses in children with dysphonia completing straw phonation exercises.
STUDY DESIGN: A randomized, prospective, comparative intra-subject study design was used.
METHODS: Twenty-seven children, ranging from 5 to 10 years of age, diagnosed with vocal cord nodules or cysts, were enrolled in the study. All subjects included in the Experimental Group were also included in the Control Group which involved complete voice rest. Sustained vowels (/a/e/ε/e/) counting from 1 to 10 were recorded before the exercises (m0) and then again after the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of straw phonation exercises. The recordings were randomized and presented to five speech therapists, who evaluated vocal quality based on the Grade Roughness Breathiness Asthenia/Strain Instability scale. For acoustic analysis, fundamental frequency, jitter, shimmer, glottal to noise excitation ratio, and noise parameters were analyzed.
RESULTS: Reduced roughness, breathiness, and noise measurements as well as increased glottal to noise excitation ratio were observed in the Experimental Group after 3 minutes of exercise. Reduced grade of dysphonia and breathiness were noted after 5 minutes.
CONCLUSION: The ideal duration of straw phonation in children with dysphonia is from 3 to 5 minutes.

PMID: 27658337 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cKLp6O
via IFTTT

Comparison of the effects of four different cochlear implant electrodes on intra-cochlear pressure in a model.

Comparison of the effects of four different cochlear implant electrodes on intra-cochlear pressure in a model.

Acta Otolaryngol. 2016 Sep 23;:1-7

Authors: Todt I, Mittmann M, Ernst A, Mittmann P

PMID: 27661767 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2doZesx
via IFTTT

Sialendoscopy under local anaesthesia.

Sialendoscopy under local anaesthesia.

Acta Otolaryngol. 2016 Sep 23;:1-5

Authors: Jokela J, Haapaniemi A, Mäkitie A, Saarinen R

PMID: 27659498 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cYMNWb
via IFTTT

Prevalence of Fusobacterium necrophorum in tonsils from patients with chronic tonsillitis.

Prevalence of Fusobacterium necrophorum in tonsils from patients with chronic tonsillitis.

Acta Otolaryngol. 2016 Sep 23;:1-5

Authors: Dapefrid A, Lundström B, Tano K

PMID: 27659315 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2d7m20O
via IFTTT

Patients with severe-to-profound hearing impairment and simultaneous severe vision impairment: a quality-of-life study.

Patients with severe-to-profound hearing impairment and simultaneous severe vision impairment: a quality-of-life study.

Acta Otolaryngol. 2016 Sep 23;:1-7

Authors: Turunen-Taheri S, Skagerstrand Å, Hellström S, Carlsson PI

PMID: 27659206 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cuvXzE
via IFTTT

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicenter retrospective study.

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicenter retrospective study.

Clin Otolaryngol. 2016 Sep 23;

Authors: Linder T, Mulazimoglu S, El Hadi T, Darrouzet V, Ayache D, Somers T, Schmerber S, Vincent C, Mondain M, Lescanne E, Bonnard D

PMID: 27661064 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cYNe35
via IFTTT

Delayed diagnosis of central skull-base osteomyelitis with abscess: case report and learning points.

Delayed diagnosis of central skull-base osteomyelitis with abscess: case report and learning points.

Ann R Coll Surg Engl. 2016 Sep 23;:e1-e4

Authors: Chawdhary G, Hussain S, Corbridge R

Abstract
Central skull-base osteomyelitis (CSBO) is a rare life-threatening infection, usually resulting from medial spread of necrotising otitis externa. Here, we describe a case with no identifiable source of infection, causing a delay in diagnosis. An 80-year-old man with Crohn's disease treated with mesalazine presented with collapse and tonic-clonic seizure. Computed tomography and magnetic resonance imaging showed a nasopharyngeal mass that was initially thought to be a neoplasm. Awaiting formal biopsy, he represented with collapse and repeat imaging showed features of abscess formation. Review of previous scans revealed skull-base erosion and the diagnosis was revised to skull-base osteomyelitis. This is the first reported case of CSBO associated with mesalazine use, an aminosalicylate used in Crohn's disease. It is only the second reported case with abscess formation. We discuss the learning points in making a timely diagnosis and examine the potential association of factors such as mesalazine use and abscess formation in this case.

PMID: 27659382 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dhWh17
via IFTTT

Facial fracture repair and diabetes mellitus: An examination of postoperative complications.

Facial fracture repair and diabetes mellitus: An examination of postoperative complications.

Laryngoscope. 2016 Sep 23;

Authors: Raikundalia M, Svider PF, Hanba C, Folbe AJ, Shkoukani MA, Baredes S, Eloy JA

Abstract
OBJECTIVES/HYPOTHESIS: Our objectives included using a nationally representative resource to evaluate charges, demographics, and complication rates among diabetics undergoing surgical repair of facial fractures.
METHODS: We evaluated the Nationwide Inpatient Sample, a database encompassing nearly 8 million hospitalizations, for patients with a diagnosis of a facial fracture who underwent surgical intervention during their hospitalization. Patients were organized by whether they had a diagnosis of diabetes mellitus (DM).
RESULTS: Of 45,509 inpatients included, diabetics had greater costs, longer length of stays, and were significantly more likely to have a host of baseline comorbidities. On multivariate logistic regression corrected for age, race, gender, and preexisting cardiac disease, DM patients had significantly greater odds for cardiac complications (3.3; P < 0.001) and hepatic failure (15.0; P = 0.007). There were no significant differences associated with DM in the rates of enophthalmos, epiphora, and diplopia among patients with orbital fractures. Diabetics did have a significantly greater risk of postoperative infection after mandible repair.
CONCLUSION: In addition to a significant association with greater length of stay and increased hospital charges, DM patients undergoing surgical repair of facial fractures had a significantly greater risk of postoperative complications, including cardiac complications. Diabetics undergoing mandible repair had a greater risk of postoperative infection, even upon controlling for demographic factors, suggesting the need for further study evaluating the role of postoperative antibiotic prophylaxis in this patient population. These findings reveal the potential value of developing and using standardized postoperative care algorithms aimed at minimizing complications in this susceptible population.
LEVEL OF EVIDENCE: 2c. Laryngoscope, 2016.

PMID: 27658923 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2d8fIaW
via IFTTT

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

J Voice. 2016 Sep 19;

Authors: Ramos LA, Gama AC

PMID: 27658337 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2cKLp6O
via IFTTT

Long-term measurements using home audiometry with Békésy's technique.

Long-term measurements using home audiometry with Békésy's technique.

Int J Audiol. 2016 Sep 23;:1-10

Authors: Brännström KJ, Grenner J

PMID: 27662509 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2dddIj0
via IFTTT

Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic.

Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic.

BMJ Case Rep. 2015;2015

Authors: George J, Kader JA, Arumugam S, Murphy A

PMID: 26628451 [PubMed - indexed for MEDLINE]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2d7j1NS
via IFTTT

Αρχειοθήκη ιστολογίου

Σάββατο 24 Σεπτεμβρίου 2016