Anesthetic Management for Pediatric Awake Tracheostomy.

Anesthetic Management for Pediatric Awake Tracheostomy.

A A Case Rep. 2016 Sep 23;

Authors: Yuan I, Bruins BB, Kiell EP, Javia LR, Galvez JA

Abstract
Awake tracheostomy is indicated for acute upper airway obstruction, when other methods of securing the airway, such as intubation and cricothyrotomy, have failed or are inappropriate. This option is rarely considered in pediatrics because of the concerns of patient cooperation and safety and has not been described in the literature. We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus.

PMID: 27669029 [PubMed - as supplied by publisher]

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Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube.

Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube.

Acta Otolaryngol. 2016 Sep 26;:1-6

Authors: Kikuchi T, Ikeda R, Oshima H, Takata I, Kawase T, Oshima T, Katori Y, Kobayashi T

Abstract
CONCLUSIONS: Trans-tympanic plugging of the Eustachian tube (ET) with the silicone plug (Kobayashi Plug) induced long-term effectiveness for over 80% of chronic and severe patulous ET (PET) patients. The New Kobayashi Plug was more effective with fewer complication of plug descent to the pharyngeal orifice.
OBJECTIVE: To investigate the effectiveness and complications of trans-tympanic plugging of the ET using a Kobayashi Plug for chronic PET.
METHOD: Trans-tympanic plugging of the ET using the Kobayashi Plug was performed for 252 ears of 191 patients. The Prototype Plug (115 ears of 82 patients in 2001-2007) and the New Plug (137 ears of 109 patients in 2008-2013) were inserted for chronic PET patients.
RESULTS: The success rate of the Kobayashi Plug for PET was 83.0% of a total (Prototype Plug 80.0%, New Plug 85.4%). In 26 ears, the Prototype Plugs were found to have descended toward the nasopharynx. Conversely, this did not happen with the New Plug. The rate of TM perforation (Prototype 22.6%, New 17.5%), middle ear effusion (Prototype 20.2%, New 10.2%) and ventilation tube placement (Prototype 14.8%, New 4.4%) decreased after transition to the New Plug.

PMID: 27666086 [PubMed - as supplied by publisher]

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Management of CSF leak in base of skull fractures in adults.

Management of CSF leak in base of skull fractures in adults.

Br J Neurosurg. 2016 Sep 26;:1-9

Authors: Phang SY, Whitehouse K, Lee L, Khalil H, McArdle P, Whitfield PC

Abstract
AIMS: CSF leaks are not uncommon after a base of skull fracture. Currently there is no standardised algorithm for the investigation and management of post-traumatic CSF leaks. In this paper we aim to provide an evidence-based framework for managing post-traumatic CSF leaks.
METHODS: We searched the English literature over the past 45 years using CINAHL, EMBASE and MEDLINE for the terms (1) post-traumatic CSF leaks or fistulas, and (2) basilar or base of skull fractures, but excluded papers on post-operative and non-traumatic CSF leaks, and papers on paediatric post- traumatic CSF leaks.
RESULTS: The diagnosis of a base of skull fracture and any resultant CSF leak can be challenging. Therefore a combination of biochemical and radiological studies are needed to optimise the diagnosis of this condition. Post-traumatic CSF leaks are generally treated conservatively, and a majority of them resolve without further surgical management. However for patients who are refractory to such treatments, surgical closure of the CSF fistula is necessary. Surgical obliteration of CSF leaks can be challenging and requires the involvement of multiple surgical specialties such as neurosurgery, otolaryngology, and maxillofacial surgery.
CONCLUSION: Although we have formulated a simple algorithm to aid the investigation and management of post-traumatic CSF leaks, there are still many important unresolved questions requiring further well powered studies to answer.

PMID: 27666293 [PubMed - as supplied by publisher]

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Usefulness of a new gelatin glue sealant system for dural closure in a rat durotomy model.

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Usefulness of a new gelatin glue sealant system for dural closure in a rat durotomy model.

Neurol Med Chir (Tokyo). 2014;54(8):640-6

Authors: Kawai H, Nakagawa I, Nishimura F, Motoyama Y, Park YS, Nakamura M, Nakase H, Suzuki S, Ikada Y

Abstract
Watertight dural closure is imperative after neurosurgical procedures, because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. We used a rat durotomy model to test the usefulness of a new gelatin glue as a dural sealant in a rat model of transdural CSF leakage. All rats were randomly divided into one of the following three treatment groups: no application (control group: N = 18), application of fibrin glue (fibrin glue group: N = 18), and application of the new gelatin glue (new gelatin glue group: N = 18). The craniotomy side was re-opened, and CSF leakage was checked and recorded at 1, 7, and 28 days postoperatively. The new gelatin glue was adequate for stopping CSF leakage; no leakage was observed at postoperative days 1 or 7, and leakage was observed in only one rat at postoperative day 28. This result was statistically significant when compared to the control group (P = 0.002, P = 0.015, P = 0.015, respectively). The pathologic score of the new gelatin group was not different from that of the control or fibrin glue groups. We conclude that our new gelatin glue provides effective watertight closure 1, 7, and 28 days after operation in the rat durotomy model.

PMID: 25070015 [PubMed - indexed for MEDLINE]

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[Advances of the treatments for thyroid carcinoma patients with laryngotracheal invasion].

[Advances of the treatments for thyroid carcinoma patients with laryngotracheal invasion].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Sep 7;51(9):716-720

Authors: Li LY, Yi HL

Abstract
Thyroid carcinoma is one of the most common cancer in the head and neck and its incidence shows an increasing tendency. Due to the special anatomical location of thyroid carcinoma, patients will have a bad prognosis outcome when cancer invades larynx and trachea. Surgical treatment is still a preferred therapy for thyroid carcinoma with laryngotracheal invasion, because it has the advantages such as high survival rate, low recurrence rate, relieving of airway obstruction, improving of postoperative quality of life. Other therapies including radiotherapy, chemotherapy, (131)I and molecular targeted therapy can also be used for treatments of thyroid carcinoma. This article reviews the current treatments for thyroid carcinoma with laryngotracheal invasion.

PMID: 27666718 [PubMed - as supplied by publisher]

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Tympanoplasty for chondrodysplasia punctata: Case report.

Tympanoplasty for chondrodysplasia punctata: Case report.

Auris Nasus Larynx. 2016 Sep 22;

Authors: Hosoya M, Kanzaki S, Wakabayashi S, Ogawa K

Abstract
Chondrodysplasia punctata (CP) is a systemic disorder of chondrogenesis. The most prominent features of patients with CP are abnormal faces characterized by a flat nose and short stature. CP patients show various types and levels of hearing loss. This disease is rare, and no successful tympanoplasties with hearing recovery have been reported. Here, we report on a CP case, in which hearing recovery was successfully treated with tympanoplasty.

PMID: 27666342 [PubMed - as supplied by publisher]

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Fungal contribution in chondroradionecrosis of the larynx.

Fungal contribution in chondroradionecrosis of the larynx.

Laryngoscope. 2016 Sep 26;

Authors: Worthen M, Jusufbegovic M, Bumpous JM, Vaughn A, Cash E, Yang X, Fichandler C, Tennant P

Abstract
OBJECTIVE: To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy.
STUDY DESIGN: Retrospective chart review.
SETTING: Tertiary academic medical center.
METHODS: One hundred fifty-nine patients were identified who underwent salvage total laryngectomy. Pathology reports were reviewed, and all laryngectomy specimens that did not contain residual malignancy were reevaluated for evidence of invasive fungal elements.
RESULTS: Twelve of 159 (7.5%) patients who underwent total laryngectomy after primary radiotherapy or chemoradiotherapy had no evidence of residual malignancy. Each of these specimens contained histopathologic evidence of CRN; invasive fungal elements were identified in 25%. There was no statistical difference in demographic or treatment-related variables between patients who underwent salvage total laryngectomy with evidence of persistent or recurrent malignancy in the laryngectomy specimen versus patients without evidence of tumor on final histopathologic analysis. Patients with evidence of ulceration or necrosis in the laryngectomy specimen had reduced overall survival, irrespective of the presence of persistent malignancy (hazard ratio = 2.923, 95% confidence interval = 1.023-8.352, P = .045).
CONCLUSION: Among salvage total laryngectomy patients, no difference was identified between patients who underwent total laryngectomy for recurrent or persistent malignancy after primary radiotherapy and those who received total laryngectomy without evidence of malignancy in their specimens. Invasive fungal elements were detected in several laryngectomy specimens that did not contain residual malignancy. Empiric antifungal therapy may therefore benefit patients diagnosed with CRN who are at risk for progression to nonfunctional larynx. Patients with evidence of ulceration or necrosis in the salvage laryngectomy specimen had worse overall survival.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 27666333 [PubMed - as supplied by publisher]

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Effect of P2X4R on airway inflammation and airway remodeling in allergic airway challenge in mice.

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Effect of P2X4R on airway inflammation and airway remodeling in allergic airway challenge in mice.

Mol Med Rep. 2016 Jan;13(1):697-704

Authors: Chen H, Xia Q, Feng X, Cao F, Yu H, Song Y, Ni X

Abstract
P2X4 receptor (P2X4R) is the most widely expressed subtype of the P2XRs in the purinergic receptor family. Adenosine triphosphate (ATP), a ligand for this receptor, has been implicated in the pathogenesis of asthma. ATP‑P2X4R signaling is involved in pulmonary vascular remodeling, and in the proliferation and differentiation of airway and alveolar epithelial cell lines. However, the role of P2X4R in asthma remains to be elucidated. This aim of the present study was to investigate the effects of P2X4R in a murine experimental asthma model. The asthmatic model was established by the inhalation of ovalbumin (OVA) in BALB/c mice. The mice were treated with P2X4R‑specific agonists and antagonists to investigate the role of this receptor in vivo. Pathological changes in the bronchi and lung tissues were examined using hematoxylin and eosin staining, Masson's trichrome staining and Alcian blue staining. The inflammatory cells in the bronchoalveolar lavage fluid were counted, and the expression levels of P2X4R, α‑smooth muscle actin (α‑SMA) and proliferating cell nuclear antigen (PCNA) were detected using western blotting. In the OVA‑challenged mice, inflammation, infiltration, collagen deposition, mucus production, and the expression levels of P2X4R and PCNA were all increased; however, the expression of α‑SMA was decreased, compared with the mice in the control group. Whereas treatment with the P2X4R agonist, ATP, enhanced the allergic reaction, treatment with the P2X4R antagonist, 5‑BDBD, attenuated the allergic reaction. The results suggested that ATP‑P2X4R signaling may not only contribute to airway inflammation, but it may also contribute to airway remodeling in allergic asthma in mice.

PMID: 26648454 [PubMed - indexed for MEDLINE]

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Bioengineered vocal fold mucosa for voice restoration.

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Bioengineered vocal fold mucosa for voice restoration.

Sci Transl Med. 2015 Nov 18;7(314):314ra187

Authors: Ling C, Li Q, Brown ME, Kishimoto Y, Toya Y, Devine EE, Choi KO, Nishimoto K, Norman IG, Tsegyal T, Jiang JJ, Burlingham WJ, Gunasekaran S, Smith LM, Frey BL, Welham NV

Abstract
Patients with voice impairment caused by advanced vocal fold (VF) fibrosis or tissue loss have few treatment options. A transplantable, bioengineered VF mucosa would address the individual and societal costs of voice-related communication loss. Such a tissue must be biomechanically capable of aerodynamic-to-acoustic energy transfer and high-frequency vibration and physiologically capable of maintaining a barrier against the airway lumen. We isolated primary human VF fibroblasts and epithelial cells and cocultured them under organotypic conditions. The resulting engineered mucosae showed morphologic features of native tissue, proteome-level evidence of mucosal morphogenesis and emerging extracellular matrix complexity, and rudimentary barrier function in vitro. When grafted into canine larynges ex vivo, the mucosae generated vibratory behavior and acoustic output that were indistinguishable from those of native VF tissue. When grafted into humanized mice in vivo, the mucosae survived and were well tolerated by the human adaptive immune system. This tissue engineering approach has the potential to restore voice function in patients with otherwise untreatable VF mucosal disease.

PMID: 26582902 [PubMed - indexed for MEDLINE]

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Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube.

Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube.

Acta Otolaryngol. 2016 Sep 26;:1-6

Authors: Kikuchi T, Ikeda R, Oshima H, Takata I, Kawase T, Oshima T, Katori Y, Kobayashi T

Abstract
CONCLUSIONS: Trans-tympanic plugging of the Eustachian tube (ET) with the silicone plug (Kobayashi Plug) induced long-term effectiveness for over 80% of chronic and severe patulous ET (PET) patients. The New Kobayashi Plug was more effective with fewer complication of plug descent to the pharyngeal orifice.
OBJECTIVE: To investigate the effectiveness and complications of trans-tympanic plugging of the ET using a Kobayashi Plug for chronic PET.
METHOD: Trans-tympanic plugging of the ET using the Kobayashi Plug was performed for 252 ears of 191 patients. The Prototype Plug (115 ears of 82 patients in 2001-2007) and the New Plug (137 ears of 109 patients in 2008-2013) were inserted for chronic PET patients.
RESULTS: The success rate of the Kobayashi Plug for PET was 83.0% of a total (Prototype Plug 80.0%, New Plug 85.4%). In 26 ears, the Prototype Plugs were found to have descended toward the nasopharynx. Conversely, this did not happen with the New Plug. The rate of TM perforation (Prototype 22.6%, New 17.5%), middle ear effusion (Prototype 20.2%, New 10.2%) and ventilation tube placement (Prototype 14.8%, New 4.4%) decreased after transition to the New Plug.

PMID: 27666086 [PubMed - as supplied by publisher]

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[Analysis of the relevant factors for recurrent sudden sensorineural hearing loss].

[Analysis of the relevant factors for recurrent sudden sensorineural hearing loss].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Sep 7;51(9):691-694

Authors: Liang H, Zhong SX

Abstract
Objective: To investigate the possible factors related to recurrence and prognosis of sudden sensorineural hearing loss(SSNHL). Methods: Four hundred and ninety-five patients with unilateral sudden sensorineural hearing loss between January 2013 to April 2014 were analyzed retrospectively(34 patients lost to follow-up with a dropout rate of 6.87%). Twenty of the 495 patients were diagnosed as recurrent SSNHL and treated again in the same hospital. The data of the patients were summarized to analyze the related factors which might influence the recurrence and prognosis of SSNHL. Results: In the 20 patients with recurrent SSNHL, 19 had the second attack in same ear as the first attack, and the other one had in both ears. There were seven male patients, and thirteen female patients. Patients ranged in age from 24 to 77years, with a median age of 39.5 years. Types of hearing loss: low frequency in eight patients, high frequency in two patients, flat frequency in eight patients, total deafness in two patients, the types of the second attack in 17 patients were same as the first attack, only one patient was changed from total deafness to flat frequency, one case was changed from flat frequency to high frequency, one case changed from flat frequency to total deafness. The intervals between of the first attack time and the second attack time were 1-36 months with the median time of 3.5 months. After systemic oral and (or) transtympanic steroid treatment, recovered in three cases, effective in three cases and 14 cases invalid, the cure rate was 15%, and the total effective rate was 30%. There were statistically significant differences in the recovery rate(χ(2)=8.640, P<0.05) and the overall response rate(χ(2)=12.379, P<0.01)between the first and the second treatments. For the patients with vertigo and/or dizziness, with a history more than seven days, with hypertension or diabetes mellitus, and with a type of hearing loss except low frequency type, the treatment effect was invalid. The patients with hearing loss at low frequency had the best outcomes. The total effective rates were significant different between patients younger and old than 34 years old(P<0.05). There was no difference in the total effective rate between genders, and patients with or without tinnitus and/or aural fullness in the recurrent SSNHL(P>0.05). The recurrence rates of patients with various types of hearing loss were different(F=7.744, P<0.05), with a highest recurrence rate in patients with hearing loss at low frequency. Other factors such as gender, age, accompanied diseases (hypertension or diabetes mellitus), associated symptoms, interval from onset to treatment had no effects on the recurrence rate. Conclusions: Recurrence of SSNHL is more likely to be found in patients with hearing loss of low frequency and flat type. The prognosis of recurrent SSNHL is poorer than that of the first episode, and may be related to the age and type of hearing loss.

PMID: 27666709 [PubMed - as supplied by publisher]

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The Use of Release-Active Antibody-Based Preparations for Vertigo Prevention in Adults.

Related Articles

The Use of Release-Active Antibody-Based Preparations for Vertigo Prevention in Adults.

Bull Exp Biol Med. 2015 Nov;160(1):61-3

Authors: Barchukov VV, Zhavbert ES, Dugina YL, Epstein OI

Abstract
The effectiveness of antibody-based release-active preparations Impaza (antibodies to eNOS), Tenoten (antibodies to brain-specific protein S-100), Dietressa (antibodies to type 1 cannabinoid receptor), Brizantin (combined preparation, antibodies to brain-specific protein S-100 and type 1 cannabinoid receptor), and Divaza (combined preparation, antibodies to brain-specific protein S-100 and eNOS) in the prevention of vertigo was studied on the model of intermittent accumulation of Coriolis accelerations (ICCA). Modification of activity of vestibular receptors and signal systems by release-active preparations contributed to an increase in ICCA tolerance time. Combined preparation Impaza possessed the most significant antinaupathic properties. Brizantin was less potent in this respect.

PMID: 26608378 [PubMed - indexed for MEDLINE]

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Manual Therapy and OMT May Be of Benefit in the Management of Somatosensory Tinnitus.

Manual Therapy and OMT May Be of Benefit in the Management of Somatosensory Tinnitus.

J Am Osteopath Assoc. 2016 Oct 1;116(10):684-685

Authors: King HH

PMID: 27669074 [PubMed - as supplied by publisher]

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Single Institutional Experience With Observing 564 Vestibular Schwannomas: Factors Associated With Tumor Growth.

Single Institutional Experience With Observing 564 Vestibular Schwannomas: Factors Associated With Tumor Growth.

Otol Neurotol. 2016 Sep 23;

Authors: Hunter JB, Francis DO, O'Connell BP, Kabagambe EK, Bennett ML, Wanna GB, Rivas A, Thompson RC, Haynes DS

Abstract
OBJECTIVE: To characterize the risk and predictors of growth during observation of vestibular schwannomas (VS).
STUDY DESIGN: Retrospective case series.
SETTING: Single academic, tertiary care center.
PATIENTS: Five hundred sixty-four consecutive VS patients who underwent at least two magnetic resonance imaging (MRI) studies before intervention.
INTERVENTION(S): Serial MRI studies.
MAIN OUTCOME MEASURE(S): Tumor growth, defined as a ≥2 mm increase in the maximum tumor diameter between consecutive MRI studies, or between the first and last study.
RESULTS: A total of 1296 patients (1995-2015) with VS were identified. Of those, 564 patients (median age 59.2 years; 53.5% female) were initially observed and underwent multiple MRI studies (median follow-up 22.9 months, interquartile range [IQR] 11.7-42.7). The median maximum tumor diameter at presentation was 1.00 cm (IQR 0.6-1.51 cm). In all, 40.8% of tumors demonstrated growth and 32.1% underwent intervention (21.5% microsurgery, 10.5% radiation) during the surveillance period. Multivariable Cox regression analysis showed that for each tumor, the risk of growth or intervention was significantly increased for larger initial VS diameters (HR = 2.22; 95% CI: 1.90-2.61) and when disequilibrium was a presenting symptom (HR = 1.70; 95% CI: 1.30-2.23). Patient age, sex, aspirin use, and presenting symptoms of asymmetric hearing loss, tinnitus, and vertigo were not associated with tumor growth.
CONCLUSION: To date, this is the largest series of observed VS reported in the literature. Risk of VS growth is significantly increased among patients who present with larger tumors and who have concomitant disequilibrium. IRB:: 151481.
DEFINE PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: No cohort with this sample size has assessed vestibular schwannoma growth rates in conjunction with this number of variables.
LEARNING OBJECTIVE: To characterize vestibular schwannoma growth rates and predictors of growth.

PMID: 27668793 [PubMed - as supplied by publisher]

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[Analysis of the relevant factors for recurrent sudden sensorineural hearing loss].

[Analysis of the relevant factors for recurrent sudden sensorineural hearing loss].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Sep 7;51(9):691-694

Authors: Liang H, Zhong SX

Abstract
Objective: To investigate the possible factors related to recurrence and prognosis of sudden sensorineural hearing loss(SSNHL). Methods: Four hundred and ninety-five patients with unilateral sudden sensorineural hearing loss between January 2013 to April 2014 were analyzed retrospectively(34 patients lost to follow-up with a dropout rate of 6.87%). Twenty of the 495 patients were diagnosed as recurrent SSNHL and treated again in the same hospital. The data of the patients were summarized to analyze the related factors which might influence the recurrence and prognosis of SSNHL. Results: In the 20 patients with recurrent SSNHL, 19 had the second attack in same ear as the first attack, and the other one had in both ears. There were seven male patients, and thirteen female patients. Patients ranged in age from 24 to 77years, with a median age of 39.5 years. Types of hearing loss: low frequency in eight patients, high frequency in two patients, flat frequency in eight patients, total deafness in two patients, the types of the second attack in 17 patients were same as the first attack, only one patient was changed from total deafness to flat frequency, one case was changed from flat frequency to high frequency, one case changed from flat frequency to total deafness. The intervals between of the first attack time and the second attack time were 1-36 months with the median time of 3.5 months. After systemic oral and (or) transtympanic steroid treatment, recovered in three cases, effective in three cases and 14 cases invalid, the cure rate was 15%, and the total effective rate was 30%. There were statistically significant differences in the recovery rate(χ(2)=8.640, P<0.05) and the overall response rate(χ(2)=12.379, P<0.01)between the first and the second treatments. For the patients with vertigo and/or dizziness, with a history more than seven days, with hypertension or diabetes mellitus, and with a type of hearing loss except low frequency type, the treatment effect was invalid. The patients with hearing loss at low frequency had the best outcomes. The total effective rates were significant different between patients younger and old than 34 years old(P<0.05). There was no difference in the total effective rate between genders, and patients with or without tinnitus and/or aural fullness in the recurrent SSNHL(P>0.05). The recurrence rates of patients with various types of hearing loss were different(F=7.744, P<0.05), with a highest recurrence rate in patients with hearing loss at low frequency. Other factors such as gender, age, accompanied diseases (hypertension or diabetes mellitus), associated symptoms, interval from onset to treatment had no effects on the recurrence rate. Conclusions: Recurrence of SSNHL is more likely to be found in patients with hearing loss of low frequency and flat type. The prognosis of recurrent SSNHL is poorer than that of the first episode, and may be related to the age and type of hearing loss.

PMID: 27666709 [PubMed - as supplied by publisher]

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Risk of tinnitus in patients with sleep apnea: A nationwide, population-based case control study.

Risk of tinnitus in patients with sleep apnea: A nationwide, population-based case control study.

Laryngoscope. 2016 Sep 26;

Authors: Koo M, Hwang JH

Abstract
OBJECTIVE: To investigate the risk of tinnitus in patients with sleep disturbance or sleep apnea.
STUDY DESIGN: Case control study.
METHODS: We identified 21,798 middle-aged and elderly patients with otolaryngologist-diagnosed tinnitus between January 1, 2000, and December 31, 2012, from the Longitudinal Health Insurance Database 2000 of the Taiwan National Health Insurance Research Database. A total of 108,990 controls were also identified from the same database based on frequency-matching on 10-year age interval, sex, and year of index date of the cases. Diagnoses of sleep disturbance (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] codes 780.50, 780.52, 307.4) and sleep apnea (ICD-9-CM codes 780.51, 780.53, 780.57) in the cases and controls prior to the index date were assessed. The risks of tinnitus in patients with sleep disturbance and sleep apnea were separately evaluated with multivariate logistic regression analyses.
RESULTS: The mean age of the total 130,788 patients was 59.8 years, and 47% of them were males. The risk of tinnitus was higher in patients with sleep disturbance compared to those without the condition (adjusted odds ratio [OR] = 1.13, 95% confidence interval [CI] [95% CI] = 1.11-1.17), and the risk of tinnitus was higher in patients with sleep apnea compared to those without the condition (adjusted OR = 1.36, 95% CI = 1.16-1.60).
CONCLUSION: In this population-based, case-control study, the risk of tinnitus was found to be significantly higher among middle-aged and elderly Taiwanese patients with sleep disturbances, especially with sleep apnea.
LEVEL OF EVIDENCE: 3b. Laryngoscope, 2016.

PMID: 27666578 [PubMed - as supplied by publisher]

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Outcomes After Cochlear Implantation in the Very Elderly.

Related Articles

Outcomes After Cochlear Implantation in the Very Elderly.

Otol Neurotol. 2016 Jan;37(1):46-51

Authors: Wong DJ, Moran M, O'Leary SJ

Abstract
OBJECTIVE: To evaluate the outcomes after cochlear implantation (CI) in the elderly population, with a particular emphasis on perioperative complications, dizziness, and speech perception outcomes.
STUDY DESIGN: A retrospective cohort study of elderly cochlear implant patients.
SETTING: Tertiary referral center (Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne).
PATIENTS: All patients aged 75 and above at the time of first cochlear implant (N = 150). Comparison was made between groups aged 85+ to 80-84, and 75-79.
INTERVENTIONS: All patients received Nucleus devices (either CI512 or CI24RE(CA)).
MAIN OUTCOME MEASURES: Speech recognition scores both pre- and postimplantation, symptomatic dizziness and effects upon independent living after surgery, and the incidence of perioperative medical and surgical complications. Complications were classified as major (intrinsic device failure, device migration, extracochlear insertion, meningitis, surgical site infection requiring reoperation, wound breakdown, permanent facial nerve paralysis) and minor (tinnitus, transient facial nerve palsy, facial nerve stimulation, taste disturbance, delayed wound healing).
RESULTS: All three cohorts had poor preoperative speech perception. There was significant improvement in postoperative word scores at 3 and 12 months across all groups. There was no statistically significant difference between the three cohorts in terms of speech recognition outcomes at 3 and 12 months. After surgery, more than 20% of patients at all ages experienced transient imbalance, although the incidence did not differ significantly between age groups (p = 0.71). In total, there were 13 major complications in 7 patients (4.7%), and 28 minor complications in 25 patients (16.7%).
CONCLUSION: Postoperative disequilibrium was commonly observed in this elderly population, yet patients still benefited with improved speech perception after cochlear implantation. Elderly patients can benefit from cochlear implantation, and age should not be a limitation for CI surgery. Cochlear implantation can be done safely and provides significant patient benefits.

PMID: 26649605 [PubMed - indexed for MEDLINE]

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Peroral endoscopic myotomy for sigmoid-type achalasia: the myotomy length and ways to facilitate the procedure.

Peroral endoscopic myotomy for sigmoid-type achalasia: the myotomy length and ways to facilitate the procedure.

Endoscopy. 2016 Oct;48(10):953

Authors: Tan Y, Liu D, Huo J

PMID: 27669470 [PubMed - as supplied by publisher]

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Serial cVEMP Testing is Sensitive to Disease Progression in Ménière Patients.

Serial cVEMP Testing is Sensitive to Disease Progression in Ménière Patients.

Otol Neurotol. 2016 Sep 23;

Authors: van Tilburg MJ, Herrmann BS, Guinan JJ, Rauch SD

Abstract
OBJECTIVE: To assess the cervical vestibular evoked myogenic potentials (cVEMPs) ability to track disease progression in Ménière's disease patients over time and identify the most sensitive outcome measurement.
STUDY DESIGN: Retrospective.
SETTING: Large specialty hospital, department of otolaryngology.
SUBJECTS: Twenty nine Ménière's patients and seven migraine associated vertigo (MAV) patients.
INTERVENTION: All patients underwent two cervical vestibular evoked myogenic potential tests at 250, 500, 750, and 1000 Hz with a minimum test interval of 3 months.
MAIN OUTCOME MEASURES: Threshold, peak-to-peak (PP) amplitude, interaural asymmetry ratio, and effect size.
RESULTS: In affected Ménière's ears all outcome measures were worse during the second test, for threshold this difference was statistically significant at 750 and 1000 Hz compared with the first test. Compared with young healthy ears the threshold was significantly worse at all frequencies. PP amplitude was significantly decreased at the second test at 750 Hz compared with the first test. In MAV no significant difference between tests was found at any frequency in PP amplitude or threshold. In Ménière's ears, threshold showed a higher first-to-second effect size at 500, 750, and 1000 Hz compared with PP amplitude.
CONCLUSION: cVEMP is able to track progression in Ménière's disease over time. Thresholds were the most effective outcome measure to both track progression and to distinguish between MAV and Ménière's patients.

PMID: 27668791 [PubMed - as supplied by publisher]

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Acoustic-temporal aspects of stop-plosives in the speech of Persian-speaking children with cleft lip and palate.

Acoustic-temporal aspects of stop-plosives in the speech of Persian-speaking children with cleft lip and palate.

Int J Speech Lang Pathol. 2016 Sep 26;:1-9

Authors: Eshghi M, Preisser JS, Bijankhan M, Zajac DJ

Abstract
PURPOSE: The main objective was to examine temporal parameters of stop-plosives in Persian-speaking children with repaired cleft lip and palate (CLP).
METHOD: Eleven children with repaired bilateral CLP and 20 typically-developing children participated in the study. Stop-gap duration (SGD) and voice-onset time (VOT) were measured based on digital waveform and spectrographic displays.
RESULT: Separate linear mixed model analyses showed significantly longer SGDs for children with CLP for all plosives in word-mid and final positions. Furthermore, children with CLP tend to produce longer VOTs for all voiceless plosives.
CONCLUSION: Persian-speaking children with repaired CLP prolong stop-gap segments, similar to findings reported for English-speaking children with CLP. Prolonged segments may be due to an active strategy to increase oral air pressure and/or improve perceptual accuracy of speech segments.

PMID: 27666091 [PubMed - as supplied by publisher]

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Management of CSF leak in base of skull fractures in adults.

Management of CSF leak in base of skull fractures in adults.

Br J Neurosurg. 2016 Sep 26;:1-9

Authors: Phang SY, Whitehouse K, Lee L, Khalil H, McArdle P, Whitfield PC

Abstract
AIMS: CSF leaks are not uncommon after a base of skull fracture. Currently there is no standardised algorithm for the investigation and management of post-traumatic CSF leaks. In this paper we aim to provide an evidence-based framework for managing post-traumatic CSF leaks.
METHODS: We searched the English literature over the past 45 years using CINAHL, EMBASE and MEDLINE for the terms (1) post-traumatic CSF leaks or fistulas, and (2) basilar or base of skull fractures, but excluded papers on post-operative and non-traumatic CSF leaks, and papers on paediatric post- traumatic CSF leaks.
RESULTS: The diagnosis of a base of skull fracture and any resultant CSF leak can be challenging. Therefore a combination of biochemical and radiological studies are needed to optimise the diagnosis of this condition. Post-traumatic CSF leaks are generally treated conservatively, and a majority of them resolve without further surgical management. However for patients who are refractory to such treatments, surgical closure of the CSF fistula is necessary. Surgical obliteration of CSF leaks can be challenging and requires the involvement of multiple surgical specialties such as neurosurgery, otolaryngology, and maxillofacial surgery.
CONCLUSION: Although we have formulated a simple algorithm to aid the investigation and management of post-traumatic CSF leaks, there are still many important unresolved questions requiring further well powered studies to answer.

PMID: 27666293 [PubMed - as supplied by publisher]

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Expression profiling of cutaneous squamous cell carcinoma with perineural invasion implicates the p53 pathway in the process.

Expression profiling of cutaneous squamous cell carcinoma with perineural invasion implicates the p53 pathway in the process.

Sci Rep. 2016;6:34081

Authors: Warren TA, Broit N, Simmons JL, Pierce CJ, Chawla S, Lambie DL, Quagliotto G, Brown IS, Parsons PG, Panizza BJ, Boyle GM

Abstract
Squamous cell carcinoma (SCC) is the second most common cancer worldwide and accounts for approximately 30% of all keratinocyte cancers. The vast majority of cutaneous SCCs of the head and neck (cSCCHN) are readily curable with surgery and/or radiotherapy unless high-risk features are present. Perineural invasion (PNI) is recognized as one of these high-risk features. The molecular changes during clinical PNI in cSCCHN have not been previously investigated. In this study, we assessed the global gene expression differences between cSCCHN with or without incidental or clinical PNI. The results of the analysis showed signatures of gene expression representative of activation of p53 in tumors with PNI compared to tumors without, amongst other alterations. Immunohistochemical staining of p53 showed cSCCHN with clinical PNI to be more likely to exhibit a diffuse over-expression pattern, with no tumors showing normal p53 staining. DNA sequencing of cSCCHN samples with clinical PNI showed no difference in mutation number or position with samples without PNI, however a significant difference was observed in regulators of p53 degradation, stability and activity. Our results therefore suggest that cSCCHN with clinical PNI may be more likely to contain alterations in the p53 pathway, compared to cSCCHN without PNI.

PMID: 27665737 [PubMed - as supplied by publisher]

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Emergency Posterior Fossa Surgery in Sitting Position in a Patient With Pheochromocytoma.

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Emergency Posterior Fossa Surgery in Sitting Position in a Patient With Pheochromocytoma.

J Neurosurg Anesthesiol. 2016 Jan;28(1):83

Authors: Wajekar AS, Oak SP, Shetty AN, Jain RA

PMID: 25929344 [PubMed - indexed for MEDLINE]

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Two cases of subfrontal schwannoma, including a rare case located between the endosteal and meningeal layers of the dura.

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Two cases of subfrontal schwannoma, including a rare case located between the endosteal and meningeal layers of the dura.

Neurol Med Chir (Tokyo). 2014;54(8):681-5

Authors: Okamoto H, Mineta T, Wakamiya T, Tsukamoto H, Katsuta T, Nakagaki H, Matsushima T

Abstract
Subfrontal schwannomas arising from the olfactory groove are rare and their origin remains uncertain because olfactory bulbs do not possess Schwann cells. We present two cases of subfrontal schwannomas treated with surgical resection. In one case, the tumor was located between the endosteal and meningeal layers of the dura mater. This rare case suggests that subfrontal schwannomas may originate from the fila olfactoria.

PMID: 24305023 [PubMed - indexed for MEDLINE]

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