The 20th Annual Doctoral Student Colloquium of the SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders (JDP-LCD), on September 23, 2016, was a big success!
Pictured (L-R) are JDP-LCD students who presented research from their 1st and 2nd year doctoral projects: Erin Smolak, Philip Combiths, Brittany Lee, and Gabriela Meade.
Analysis of Prognostic Factors in Malignant External Otitis.
Clin Exp Otorhinolaryngol. 2016 Sep 27;
Authors: Lee SK, Lee SA, Seon SW, Jung JH, Lee JD, Choi JY, Kim BG
Abstract
Objectives: Malignant external otitis (MEO) is a potentially fatal infection of the external auditory canal, temporal bone, and skull base. Despite treatment with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now, there have been few studies on the prognostic factors of MEO.
Methods: We performed a retrospective study to identify prognostic factors of MEO, and a meta-analysis of other articles investigating MEO. On the basis of disease progression the 28 patients in our study were divided into 'controlled' and 'uncontrolled' groups, consisting of 12 and 16 patients, respectively. We identified three categories of prognostic factors: those related to patient, disease, and treatment. We compared these prognostic factors between the controlled and uncontrolled groups.
Results: In our study, the duration of diabetes mellitus (DM), presence of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), and computed tomography or magnetic resonance imaging findings influenced the prognosis of MEO. In contrast, prognosis was unrelated to age, gender, mean glucose level, hemoglobin A1c (HbA1c) level, pathogen, comorbidity, or cranial nerve involvement. No factor related to treatment modality was correlated with prognosis, such as surgery, steroid therapy, or interval to the first appropriate treatment. Cranial nerve involvement has been proven to be associated with disease progression, but the relationship between cranial nerve involvement and the prognosis of MEO remains controversial. As a part of this study, we conducted a meta-analysis of cranial nerve involvement as a prognostic factor of MEO. We found that cranial nerve involvement has a statistically significant influence on the prognosis of MEO.
Conclusion: We found that glycemic control in diabetes mellitus, cranial nerve involvement, and the extent of disease determined from various imaging modalities influence the prognosis of MEO. We suggest that significant prognostic factors should be monitored to determine the prognosis of patients with MEO.
PMID: 27671716 [PubMed - as supplied by publisher]
The Efficacy of Fibroblast Growth Factor for the Treatment of Chronic Vocal Fold Scarring: From Animal Model to Clinical Application.
Clin Exp Otorhinolaryngol. 2016 Sep 27;
Authors: Ban MJ, Park JH, Kim JW, Park KN, Lee JY, Kim HK, Lee SW
Abstract
Objectives: This study assessed the regenerative efficacy of basic fibroblast growth factor (FGF) in a rabbit model of chronic vocal fold scarring and then confirmed its utility and safety in a prospective trial of patients with this condition.
Methods: FGF was injected three times, at 1-week intervals, into a chronic vocal fold scar created in a rabbit model. After 1 month, mRNA level of procollagen I, hyaluronic acid synthetase 2 (HAS 2), and matrix metalloproteinase 2 (MMP 2) were analyzed by real-time polymerase chain reaction. The relative densities of hyaluronic acid (HA) and collagen were examined 3 months post-injection. From April 2012 to September 2014, a prospective clinical trial was conducted at a tertiary hospital in Korea. FGF was injected into the mild vocal fold scar of 17 consecutive patients with a small glottic gap. The patients underwent perceptual, stroboscopic, acoustic aerodynamic test, and Voice Handicap Index (VHI) survey prior to and 3, 6, and 12 months after FGF injection.
Results: FGF injection of the vocal fold scar decreased the density of collagen and increased mRNA level of HAS 2 and MMP 2 expression significantly compared to the control group injected with phosphate buffered solution in a rabbit model (P<0.05). In the clinical trial, significant improvements in the majority of the subjective and objective voice parameters were registered 3 months after FGF injection and were maintained at 12 months. Complications associated with the FGF injections, such as granuloma, were not observed during the follow-up period.
Conclusion: Based on the animal model and the prospective clinical trial, vocal fold injections of FGF in patients with mild chronic vocal fold scarring can significantly improve voice quality for as long as 1 year and without side effects. Our results recommend the use of FGF vocal fold injection as an alternative treatment modality for mild chronic vocal fold scarring.
PMID: 27671715 [PubMed - as supplied by publisher]
Vestibular Neuritis With Minimal Canal Paresis: Characteristics and Clinical Implication.
Clin Exp Otorhinolaryngol. 2016 Sep 27;
Authors: Kim HJ, Kim DY, Hwang JH, Kim KS
Abstract
Objectives: To analyze the clinical characteristics of vestibular neuritis patients with minimal canal paresis (canal paresis <25%).
Methods: Patients clinically diagnosed with vestibular neuritis and treated at our institute (n=201) underwent otoneurological examination and vestibular function tests. Patients were categorized in terms of the.
Results.: of caloric testing (canal paresis<25%, n=58; canal paresis≥25%, n=143). Clinical characteristics and laboratory outcomes were compared between two groups.
Results: Existence of underlying diseases, preceding symptoms, and direction of spontaneous nystagmus were not different between the groups. The mean duration of spontaneous nystagmus was shortest in the minimal canal paresis group (P<0.001) and the direction of spontaneous nystagmus changed more frequently in this group (P<0.001) during recovery. Among the subgroup with minimal canal paresis, only 29.5% had an abnormal finding on the rotatory chair test, as compared to 81.5% of the canal paresis group. The minimal canal paresis group showed higher sensory organization test scores in computerized dynamic posturography.
Conclusion: Patients with minimal canal paresis (canal paresis <25%) show similar clinical manifestations as conventional vestibular neuritis patients, but have faster recovery of symptoms and a higher incidence of recovery nystagmus. This finding support that the minimal canal paresis could be considered as a milder type of vestibular neuritis.
PMID: 27671714 [PubMed - as supplied by publisher]
Interactive iPhone/iPad App for Increased Tympanic Membrane Familiarity.
Ann Otol Rhinol Laryngol. 2016 Sep 26;
Authors: Samra S, Wu A, Redleaf M
Abstract
INTRODUCTION: Otology relies on clinical examination to teach anatomy of the ear. The purpose of this report is to introduce the Buckingham Virtual Tympanum iPhone app as an adjuvant educational tool to teach the anatomical details of the tympanic membrane (TM).
MATERIALS AND METHODS: This app, available free at the Apple Store, was constructed using archival photographs of normal and abnormal TMs, stratified by difficulty. Each image has 4 labeled structures, linked to questions to encourage active learning. Third-year medical students then used the app to familiarize themselves with the TM.
RESULTS: The free app was readily accessible and functioned without technical issues. By being interactive, it forced the user into the role of active learner. This pilot study found that students who used the app understood images of the TM better than those who did not use it.
DISCUSSION: We introduce an interactive, iPhone-based smartphone application that we found to be a useful adjunct for teaching TM anatomy.
PMID: 27670957 [PubMed - as supplied by publisher]
Left paraaortic, inframesenteric lymphadenectomy preserving the superior hypogastric plexus supported by indocyanine green (ICG) labeling of the lymphatic compartment in cervical cancer.
Gynecol Oncol Rep. 2016 Nov;18:14
Authors: Kimmig R, Rusch P, Buderath P, Aktas B
Abstract
Superior hypogastric plexus (SHG) contains mainly sympathetic and most probably also postganglionic parasympathetic fibers. Thus, surgical damage of SHG may cause autonomic pelvic organ dysfunction (Kraima et al., 2015). As already shown for rectal cancer, preservation of the autonomic nerves is facilitated by robotic surgery and may avoid sexual dysfunctions and voiding disorders (Kim et al., 2015). In this educational video, we demonstrate left lower paraaortic lymph node dissection preserving the SHG using ICG fluorescence to label the lymphatic compartment. Prior to total mesometrial resection (TMMR) with therapeutic lymphadenectomy for cervical cancer (Höckel et al., 2009, Kimmig et al., 2013) 4 × 0.5 ml of a 1.66 mg/ml Indocyanine green solution (ICG Pulsion®, PMS SE, Feldkirchen, Germany) was injected into the uterine cervix at all four quadrants, 0.5 cm in depth (Kimmig et al., 2016). The lymphatic network of the downstream common iliac and inferior paraaortic lymph compartments of the uterine cervix is visualized (ICG fluorescence) including the individual connecting vessels between the different compartments. As can be demonstrated, the medial upper common iliac (subaortic) compartment drains preferentially into the anterior (mesenteric) compartment, whereas lateral common iliac lymphatic vessels mainly drain to the posterior (lumbar) paraaortic compartment. The autonomic nerve fibers of the SHP may easily be identified and preserved due to the excellent image resolution and the discrimination from fluorescent lymphatic structures. The video shows the preparation of left lower paraaortic nodes in cervical cancer following ICG labeling using a da Vinci Xi system®. This technique seems not only advantageous for preserving SHP, but even more highly educational to learn surgical anatomy for trainees.
PMID: 27672677 [PubMed]
Effect of a vestibular rehabilitation protocol to improve the health-related quality of life and postural balance in patients with peripheral vertigo.
Ann Phys Rehabil Med. 2016 Sep;59S:e125
Authors: Jeribi S, Yahia A, Achour I, Hammemi B, Ghorbel A, Elleuch MH, Ghroubi S
Abstract
OBJECTIVE: To determine the effect of completing a vestibular rehabilitation treatment protocol on postural balance, dizziness and quality of life in patients with peripheral vertigo.
MATERIAL/PATIENTS AND METHODS: A prospective study concerning patients with instability due to unilateral peripheral vestibular disorder. The patients were evaluated with a clinical examination and a test of static and dynamic balance on the Satel(®) platform in which length, mediolateral (LongX) and anterior-posterior deviations (long Y) were monitored. Information regarding vertigo symptoms and quality of life were assessed through the vertigo symptom Scale (VSS) and the Dizziness Handicap Inventory (DHI). Patients were treated in two sessions per week for two months by a custom protocol. The rehabilitation program included substitutional and/or habitudinal exercises, exercises on a stability platform, and optokinetic stimulation.
RESULTS: Thirty patients with mean age of 52.26±8.45 years were included: 7 men and 23 women. Twelve patients had vestibular neuritis sequelae (46,7%), 10 otolith disorders (33,33%),and 6 Meniere's disease (20%). An improvement in the intensity of dizziness, postural parameters and quality of life was considered (0.01) with the intervention. The main balance parameters (Long X and Long Y) have decreased after the rehabilitation protocol. This improvement was significant in the static condition eyes closed. The mean of Long X decreased from 489.05±327.07 to 365.09±268.82mm (P<0.001). The average Y Long decreased from 853.49±734.19 to 569.08±530.55 (P<0.001). We noted an improvement of vertigo condition (the mean total score of VSS decreased from 22.2±6.74 to 10.86±3.54 (P<0.001)) and the quality of life (the mean total score DHI has decreased from 37.6±8.35 to 18.1±5.56 (P<0.01).
DISCUSSION-CONCLUSION: Postural balance and quality of life improve with postural rehabilitation and optokinetic stimulation in patients with peripheral vertigo. This technique must be applied as early as possible by a specialized physiotherapist to promote the elimination of the unpleasant symptoms related to this dysfunction.
PMID: 27676762 [PubMed - as supplied by publisher]
A novel role for flotillin-containing lipid rafts in negative-feedback regulation of thyroid-specific gene expression by thyroglobulin.
Thyroid. 2016 Sep 27;
Authors: Luo Y, Akama T, Okayama A, Yoshihara A, Sue M, Oda K, Hayashi M, Ishido Y, Hirano H, Hiroi N, Katoh R, Suzuki K
Abstract
BACKGROUND: Thyroglobulin (Tg) stored in thyroid follicles regulates follicular function in thyroid hormone (TH) synthesis by suppressing thyroid-specific gene expression in a concentration-dependent manner. Thus, Tg is an intrinsic negative-feedback regulator that can restrain the effect of thyroid stimulating hormone (TSH) in the follicle. However, the underlying mechanisms by which Tg exerts its prominent autoregulatory effect following recognition by thyrocytes remains unclear.
METHODS: To identify potential proteins that recognize and interact with Tg, mass spectrometry (MS) was used to analyze immunoprecipitated Tg-bound proteins derived from Tg-treated rat thyroid FRTL-5 cells.
RESULTS: Flotillin 1 and flotillin 2, two homologs that are integral membrane proteins in lipid rafts, were identified as novel Tg-binding proteins with high confidence. Further studies revealed that flotillins physically interact with endocytosed Tg, and, together these proteins redistribute from the cell membrane to cytoplasmic vesicles. Treatment with the lipid raft disrputer methyl-β-cyclodextrin (MβCD) abolished both the endocytosis and the negative-feedback effect of Tg on thyroid-specific gene expression. Meanwhile, siRNA-mediated knockdown of flotillin 1 or flotillin 2 also significantly inhibited Tg effects on gene expression.
CONCLUSION: Together these results indicate that flotillin-containing lipid rafts are essential for follicular Tg to be recognized by thyrocytes and exert its negative-feedback effects in the thyroid.
PMID: 27676653 [PubMed - as supplied by publisher]
Circulating 3-T1AM and 3,5-T2 in critically ill patients: a cross-sectional observational study.
Thyroid. 2016 Sep 27;
Authors: Langouche L, Lehmphul I, Vander Perre S, Koehrle J, Van den Berghe G
Abstract
BACKGROUND: Critical illness is hallmarked by low circulating T4 and T3 concentrations, in the presence of elevated rT3 and low-normal TSH, referred to as non-thyroidal illness (NTI). Thyroid hormone (TH) metabolism is substantially increased during NTI, in part explained by enhanced deiodinase 3 (D3) activity. T4- and T3-sulfate concentrations are elevated, due to suppressed D1 activity in the presence of unaltered sulfotransferase activity, and 3,3'-diiodothyronine (3,3'-T2) concentrations are normal. To further elucidate the driving forces behind increased TH metabolism during NTI, two other potential T4 metabolites, 3,5-diiodothyronine (3,5-T2) and 3-iodothyronamine (3-T1AM), were measured and related to their potential TH precursors.
METHODS: Morning blood samples were collected cross-sectionally from 83 critically ill patients on a University Hospital ICU and from 38 demographically matched healthy volunteers. Serum TH and binding proteins were quantified with commercial assays, 3,5-T2 and 3-T1AM with in-house developed immunoassays.
RESULTS: Critically ill patients revealed, besides the NTI, a median 44% lower serum 3-T1AM concentration (p<0.0001) and a 30% higher serum 3,5-T2 concentrations (p=0.01) than healthy volunteers. Non-survivors and patients diagnosed with sepsis upon ICU admission had significantly higher 3,5-T2 (p≤0.01) but comparable 3-T1AM (p>0.2) concentrations than other patients. Multivariable linear regression analysis adjusted for potential precursors revealed that the reduced serum 3-T1AM was positively correlated with the low serum T3 (p<0.001) but unrelated to serum T4 or rT3. The elevated 3,5-T2 concentration did not independently correlate with TH.
CONCLUSIONS: Increased TH metabolism during NTI could not be explained by increased conversion to 3-T1AM, as circulating 3-T1AM was suppressed in proportion to the concomitantly low T3 concentrations. Increased conversion of T4 and/or T3 to 3,5-T2 could be possible, as serum 3,5-T2 concentrations were elevated. Whether 3-T1AM or 3,5-T2 play a functional role during critical illness needs further investigation.
PMID: 27676423 [PubMed - as supplied by publisher]
Respiratory manifestations of hypothyroidism - A systematic review.
Thyroid. 2016 Sep 27;
Authors: Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedus L
Abstract
BACKGROUND: Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. We conducted a systematic review to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency.
METHODS: PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with study eligibility criteria: English-language publications; Adult subclinical or overt hypothyroid patients; Intervention, observational or retrospective studies; and respiratory manifestations. We followed the PRISMA statement and used the Cochrane's risk of bias tool.
RESULTS: A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full text analyses, of which 22 were included in the review. We identified possible mechanisms explaining respiratory problems at multiple physiological levels such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above mentioned areas were only dealt with in a limited number of studies. Therefore, we refrain from giving strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due to e.g. small numbers of patients, lack of control groups, randomization and blinding, and differences in BMI, gender, and age between subjects and controls.
CONCLUSION: Mechanistic data, linking hypothyroidism and respiratory function are at best limited. This area of research is therefore open for retesting hypotheses, using appropriate study designs and methods. Systematic review registration number on PROSPERO: CRD42015016815.
PMID: 27673426 [PubMed - as supplied by publisher]
Medullary Thyroid Carcinoma Associated with Germline RET K666N Mutation.
Thyroid. 2016 Sep 27;
Authors: Xu JY, Grubbs EG, Waguespack SG, Jimenez C, Gagel RF, Sosa JA, Vassilopoulou-Sellin R, Dadu R, Hu MI, Trotter CS, Jackson M, Rich TA, Hyde SM, Sherman SI, Cote GJ
Abstract
BACKGROUND: Multiple endocrine neoplasia type 2 is an autosomal dominant inherited syndrome caused by activating mutations in the RET proto-oncogene. The K666N RET DNA variant was previously reported in two isolated medullary thyroid carcinoma (MTC) cases, but no family studies are available, and its oncogenic significance remains unknown.
METHODS: The clinical features, genetic data, and family information of eight index MTC patients with a germline RET K666N variant were assessed.
RESULTS: Four probands presented with MTC and extensive nodal metastasis, one with biopsy confirmed distant metastasis. Two additional probands presented with localized disease; however, nodal status was not available. Of the final two probands one had an incidental 1.5 mm MTC and C-cell hyperplasia uncovered after surgery for papillary thyroid carcinoma, and one had 2 foci of MTC (largest dimension of 2.3 cm) detected after surgery for dysphagia. Genetic screening identified 16 additional family members carrying the K666N variant (ages 5-90), 11 have documented evaluation for MTC. Of these only 2 were found to have elevated basal serum calcitonin upon screening and the remaining patients were in the normal range. One elected to have a thyroidectomy at age 70 was confirmed to have MTC. The other, age 57, elected surveillance. Four prophylactic thyroidectomies were performed with one case of C-cell hyperplasia at 20 years, and 3 cases that revealed normal pathology at ages 21, 30, and 30 years. None of the K666N DNA variant carriers had evidence of primary hyperparathyroidism or pheochromocytoma.
CONCLUSIONS: From this case series, the largest such experience to date, we conclude that the RET K666N variant is likely pathogenic and associated with low penetrance of MTC. However, we feel the findings are insufficient to clearly define its pathogenicity and make firm recommendations for screening and treatment. Given the potential benefit associated with early detection of aberrant C-cell growth, and the noninvasive nature of genetic testing, we believe that 'at risk' individuals should be screened, and if the K666N variant is identified, they should be managed using a personalized screening approach for detection of MTC.
PMID: 27673361 [PubMed - as supplied by publisher]
The Efficacy of Fibroblast Growth Factor for the Treatment of Chronic Vocal Fold Scarring: From Animal Model to Clinical Application.
Clin Exp Otorhinolaryngol. 2016 Sep 27;
Authors: Ban MJ, Park JH, Kim JW, Park KN, Lee JY, Kim HK, Lee SW
Abstract
Objectives: This study assessed the regenerative efficacy of basic fibroblast growth factor (FGF) in a rabbit model of chronic vocal fold scarring and then confirmed its utility and safety in a prospective trial of patients with this condition.
Methods: FGF was injected three times, at 1-week intervals, into a chronic vocal fold scar created in a rabbit model. After 1 month, mRNA level of procollagen I, hyaluronic acid synthetase 2 (HAS 2), and matrix metalloproteinase 2 (MMP 2) were analyzed by real-time polymerase chain reaction. The relative densities of hyaluronic acid (HA) and collagen were examined 3 months post-injection. From April 2012 to September 2014, a prospective clinical trial was conducted at a tertiary hospital in Korea. FGF was injected into the mild vocal fold scar of 17 consecutive patients with a small glottic gap. The patients underwent perceptual, stroboscopic, acoustic aerodynamic test, and Voice Handicap Index (VHI) survey prior to and 3, 6, and 12 months after FGF injection.
Results: FGF injection of the vocal fold scar decreased the density of collagen and increased mRNA level of HAS 2 and MMP 2 expression significantly compared to the control group injected with phosphate buffered solution in a rabbit model (P<0.05). In the clinical trial, significant improvements in the majority of the subjective and objective voice parameters were registered 3 months after FGF injection and were maintained at 12 months. Complications associated with the FGF injections, such as granuloma, were not observed during the follow-up period.
Conclusion: Based on the animal model and the prospective clinical trial, vocal fold injections of FGF in patients with mild chronic vocal fold scarring can significantly improve voice quality for as long as 1 year and without side effects. Our results recommend the use of FGF vocal fold injection as an alternative treatment modality for mild chronic vocal fold scarring.
PMID: 27671715 [PubMed - as supplied by publisher]
Transoral Endoscopic Laser Microsurgery or Concurrent Chemoradiation Therapy for T2N0 Larynx Cancer.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E380-E381
Authors: Wu YY, Fang TJ, Chang JT
PMID: 27674536 [PubMed - as supplied by publisher]
Reirradiation Outcomes After Upfront Larynx Preservation or Total Laryngectomy: A Multi-institutional Analysis.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E376
Authors: Awan MJ, Zakem SJ, Ward MC, Machtay M, Riaz N, Caudell JJ, Dunlap NE, Isrow D, Dault J, Higgins KA, Beitler JJ, Siddiqui F, Trotti A, Lee N, Koyfman S, Heron DE, Yao M
PMID: 27674522 [PubMed - as supplied by publisher]
Predictive Significance of Early Response to Induction Chemotherapy in Advanced Larynx Cancer.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E371-E372
Authors: Mohamed AS, Browne TS, Kies MS, Gunn GB, Garden AS, Beadle BM, Phan J, Morrison WH, William WN, Lai SY, Weber RS, Rosenthal DI, Fuller CD
PMID: 27674512 [PubMed - as supplied by publisher]
Dose De-Escalation to the Normal Larynx Using Conformal Radiation Therapy Reduces Toxicity While Maintaining Oncologic Outcome for the Treatment of T1/T2 Glottic Cancer.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E347-E348
Authors: Kim JW, Choi HS, Lee IJ
PMID: 27674444 [PubMed - as supplied by publisher]
Identification of Anatomic Correlates of Failure in Patients With T4a Larynx Cancer.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E343
Authors: Mohamed AS, Pham BH, Messer JA, Morrison WH, Zafereo M, Hessel AC, Lai SY, Garden AS, Weber RS, Rosenthal DI, Fuller CD
PMID: 27674433 [PubMed - as supplied by publisher]
Increased Risk of Nononcologic Pulmonary Death in Patients Treated With Definitive Chemoradiation Therapy for Advanced Larynx and Hypopharynx Cancer.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E342
Authors: Lester SC, Kreofsky CR, Graner DE, Foote RL, Ma DJ
PMID: 27674429 [PubMed - as supplied by publisher]
An Excised Canine Model of Anterior Glottic Web and Its Acoustic, Aerodynamic, and High-speed Measurements.
J Voice. 2016 Sep 23;
Authors: Xue C, Pulvermacher A, Calawerts W, Devine E, Jiang J
Abstract
OBJECTIVES: This study aims to build an excised anterior glottic web (AGW) model and study the basic voice-related mechanisms of the AGW through investigating the acoustic, aerodynamic, and vibratory properties.
STUDY DESIGN AND METHODS: Overall, four conditions were tested for each of the eight canine larynges used. At baseline, 10%, 20%, and 33% occlusion (as determined by the placement of the suture), acoustic, aerodynamic, and high-speed video data were collected while each larynx was phonated in a soundproof booth.
RESULTS: The phonation threshold pressure (PTP) and the phonation threshold flow significantly increased as percent occlusion increased (P < 0.001). There were significant increases in jitter % and shimmer % from baseline group to AGW model groups at PTP, 1.25 PTP, and 1.5 PTP (P = 0.039, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). The fundamental frequency significantly increased as percent occlusion increased at all given pressures (P < 0.001). Correlation dimension (D2) was significantly higher in the AGW model groups than in the baseline group at PTP, 1.25 PTP, and 1.5 PTP (P = 0.002, P < 0.001, P = 0.01, respectively). High-speed videos revealed that, the left phase shift in the AGW model groups compared with the baseline at 1.25 PTP was significant (P = 0.027) and right phase shift at 1.5 PTP (P < 0.001).
CONCLUSIONS: We presented an anatomically similar model of a type 1 AGW and confirmed its validity through aerodynamic, acoustic, and high-speed video analysis in our study. We observed and investigated the glottic web movement, which may be a new explanation for the pathologic voice-related mechanism of AGW.
PMID: 27671751 [PubMed - as supplied by publisher]
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Transcutaneous Ultrasonography in Early Postoperative Diagnosis of Vocal Cord Palsy After Total Thyroidectomy.
World J Surg. 2016 Mar;40(3):665-71
Authors: Borel F, Delemazure AS, Espitalier F, Spiers A, Mirallie E, Blanchard C
Abstract
PURPOSE: This study evaluated the efficiency of transcutaneous laryngeal ultrasonography (TLUS) as an alternative to direct flexible laryngoscopy (DFL) in the early postoperative screening of vocal cord palsy (VCP) after total thyroidectomy, performed for benign and non-extensive malignant disease.
METHODS: A prospective study was performed on patients who underwent total thyroidectomy between October 2013 and January 2015 at the Nantes University Hospital (France). Patients underwent DFL on postoperative day 1 performed by an otolaryngologist, followed by TLUS performed by a radiologist on postoperative day 1 or 2.
RESULTS: One hundred and three (103) patients were included in this study, 17.5% were male and 82.5% were female, with a mean age of 51 ± 12 years. Nine patients (9.5%) were diagnosed with postoperative VCP using DFL of these cases 2 were not completely resolved at 3 months postoperatively. Three cases of VCP (33%) were diagnosed using TLUS. TLUS had a sensitivity of 33% and a negative predictive value (NPV) of 95% for the diagnosis of postoperative VCP. Vocal cords (VC) were unassessable in 27.2% of patients. Unassessable VC were significantly associated with male gender (p = 0.0001), age (p = 0.0001), weight (p = 0.002), operating time (p = 0.032), postoperative drainage (p = 0.001), and thyroid weight (p = 0.001). Independent risk factors in the multivariate analysis were male gender (p = 0.0001) and age (p = 0.0001). In the group of women under 50-year old, TLUS had a sensitivity of 50% and a NPV of 97.4%.
CONCLUSION: TLUS sensitivity is insufficient in early postoperative screening of VCP after thyroid surgery. Ultrasonographic VCP diagnosis should be confirmed with DFL.
PMID: 26744341 [PubMed - indexed for MEDLINE]
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Risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis: 232 cases (1987-2012).
J Am Vet Med Assoc. 2016 Jan 15;248(2):188-94
Authors: Wilson D, Monnet E
Abstract
OBJECTIVE: To identify risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis.
DESIGN: Retrospective case series.
ANIMALS: 232 client-owned dogs with a diagnosis of laryngeal paralysis treated with left-sided unilateral arytenoid lateralization.
PROCEDURES: Medical records were reviewed. Signalment, medical history, surgical complications, and outcome data were collected. Follow-up was performed via review of medical records and by telephone interview with the owner, referring veterinarian, or both.
RESULTS: At the 1-, 3-, and 4-year follow-up periods, aspiration pneumonia occurred in 18.6%, 31.8%, and 31.8% of dogs, respectively. The 1-, 3-, and 4-year survival rates for dogs with postoperative aspiration pneumonia were 83.1%, 51.5%, and 25.8%, respectively. None of the dogs with aspiration pneumonia before surgery developed clinical signs of aspiration pneumonia after surgery. Postoperative megaesophagus (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.56 to 3.93) and postoperative administration of opioid analgesics prior to discharge (HR, 1.69; 95% CI, 1.12 to 2.80) were significant risk factors for the long-term development of aspiration pneumonia in this study. Perioperative metoclopramide administration did not significantly decrease the risk for development of aspiration pneumonia (HR, 0.94; 95% CI, 0.67 to 1.37).
CONCLUSIONS AND CLINICAL RELEVANCE: In the present study, aspiration pneumonia was the most commonly reported postoperative complication of unilateral lateralization in dogs treated for laryngeal paralysis; however, preexisting aspiration pneumonia was not associated with an increased risk for development of aspiration pneumonia after surgery. Megaesophagus was identified as an important risk factor for eventual development of aspiration pneumonia. Administration of an opioid analgesic may increase the risk of aspiration pneumonia in dogs treated surgically for laryngeal paralysis.
PMID: 26720085 [PubMed - indexed for MEDLINE]
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Determining the Learning Curve of Transcutaneous Laryngeal Ultrasound in Vocal Cord Assessment by CUSUM Analysis of Eight Surgical Residents: When to Abandon Laryngoscopy.
World J Surg. 2016 Mar;40(3):659-64
Authors: Wong KP, Lang BH, Lam S, Au KP, Chan DT, Kotewall NC
Abstract
Transcutaneous laryngeal ultrasonography (TLUSG) is a promising alternative to laryngoscopy in vocal cords (VCs) assessment which might be challenging in the beginning. However, it remains unclear when an assessor can provide proficient TLUSG enough to abandon direct laryngoscopy . Eight surgical residents (SRs) without prior USG experience were recruited to determine the learning curve. After a standardized training program, SRs would perform 80 consecutive peri-operative VCs assessment using TLUSG. Performances of SRs were quantitatively evaluated by a composite performance score (lower score representing better performance) which comprised total examination time (in seconds), VCs visualization, and assessment accuracy. Cumulative sum (CUSUM) chart was then used to evaluate learning curve. Diagnostic accuracy and demographic data between every twentieth TLUSG were compared. 640 TLUSG examinations had been performed by 8 residents. 95.1% of VCs could be assessed by SRs. The CUSUM curve showed a rising pattern (learning phase) until 7th TLUSG and then flattened. The curve declined continuously after 42nd TLUSG (after reaching a plateau). Rates of assessable VCs were comparable in every twentieth cases performed. It took a longer time to complete TLUSG in 1st-20th than 21st-40th examinations. (45 vs. 32s, p = 0.001). Although statistically not significant, proportion of false-negative results was higher in 21st-40th (2.5%) than 1(st)-20th (0.6%), 41(st)-60th (0.7%), and 61(st)-80th (0.7%) TLUSG performed. After a short formal training, surgeons could master skill in TLUSG after seven examination and assess vocal cord function consistently and accurately after 40 TLUSG.
PMID: 26585950 [PubMed - indexed for MEDLINE]
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Changes of Laryngeal Mobility and Symptoms Following Thyroid Surgery: 6-Month Follow-Up.
World J Surg. 2016 Mar;40(3):636-43
Authors: Gohrbandt AE, Aschoff A, Gohrbandt B, Keilmann A, Lang H, Musholt TJ
Abstract
OBJECTIVE: Swallowing disorders are frequent complaints after thyroidectomy even in the absence of recurrent laryngeal nerve palsy. The aim of this study was to assess different symptoms in relation to laryngeal mobility following thyroidectomy.
MATERIALS AND METHODS: 53 patients (mean age 52.4 ± 12.5 years; 36 female) with initially benign diagnosis and intact recurrent nerve functioning were prospectively evaluated. Laryngeal movement was analyzed by ultrasound preoperatively and 1, 3, and 6 months postoperatively. In addition, a dysphagia and voice-specific quality-of-life questionnaire was used.
RESULTS: Mean laryngeal movement differed between genders preoperatively and postoperatively resulting in a recovery predominantly in women (reduction of mobility at 1, 3, and 6 months postoperatively in females was 6.0, 3.7, and 1.5 mm, and in males 13.8, 11.7, and 10.3 mm, respectively). Mainly, women reported hoarseness (9 females) and cervical discomfort (7 females, 3 males) 1 month postoperatively. After 6 months, these complaints resolved (cervical discomfort 1 female).
CONCLUSION: Laryngeal mobility was significantly impaired postoperatively and only females revealed a recovery close to baseline after 6 months. Although showing only a small grade of recovery of laryngeal movement, subjective clinical symptoms were found to be rare in male patients.
PMID: 26560148 [PubMed - indexed for MEDLINE]
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Using Transcutaneous Laryngeal Ultrasonography (TLUSG) to Assess Post-thyroidectomy Patients' Vocal Cords: Which Maneuver Best Optimizes Visualization and Assessment Accuracy?
World J Surg. 2016 Mar;40(3):652-8
Authors: Wong KP, Woo JW, Li JY, Lee KE, Youn YK, Lang BH
Abstract
To assess vocal cord (VC) movement with transcutaneous laryngeal ultrasound (TLUSG), three maneuvers, namely passive (quiet respiration), active (phonation), and Valsalva maneuvers have been described. It remains unclear which maneuver or using more maneuvers provides better visualization and assessment accuracy. We prospectively evaluated 342 post-thyroidectomy patients from two centers. They underwent TLUSG with direct laryngoscopic (DL) validation afterwards. During TLUSG, patients were instructed to perform all three maneuvers (passive, active, and Valsalva). VC visualization rate and accuracy between three maneuvers were compared. Visualization rate tended to be higher in Valsalva maneuver than that in other two maneuvers (92.1% vs. passive: 91.5%; active: 89.8%). While 19 patients had post-operative VC palsy, passive maneuver had lower test specificity than active (94.3 vs. 97.6%, p = 0.01) and Valsalva maneuvers (94.3 vs. 97.4%, p = 0.02). In assessable VCs, passive maneuver has a higher ability to differentiate between mobile VCs and VC palsy (Area under ROC curve--passive: 0.942, active: 0.863, Valsalva: 0.893). TLUSG with more maneuvers did not improve sensitivity or specificity. On applying TLUSG as a screening tool (i.e., only selected patient with "unassessable" VCs or VCP on TLUSG for DL), Valsalva maneuver (85.96%) saved more patients from DL than passive (81.87%) or active (84.81%) maneuver. Passive maneuver has a higher ability to differentiate VC palsy from normal. Using TLUSG as a screening tool, Valsalva was the preferred maneuver as it was more specific, had high visualization rate, and saved more patients from DL.
PMID: 26552909 [PubMed - indexed for MEDLINE]
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Interaction of IFN-γ with cholinergic agonists to modulate rat and human goblet cell function.
Mucosal Immunol. 2016 Jan;9(1):206-17
Authors: García-Posadas L, Hodges RR, Li D, Shatos MA, Storr-Paulsen T, Diebold Y, Dartt DA
Abstract
Goblet cells populate wet-surfaced mucosa including the conjunctiva of the eye, intestine, and nose, among others. These cells function as part of the innate immune system by secreting high molecular weight mucins that interact with environmental constituents including pathogens, allergens, and particulate pollutants. Herein, we determined whether interferon gamma (IFN-γ), a Th1 cytokine increased in dry eye, alters goblet cell function. Goblet cells from rat and human conjunctiva were cultured. Changes in intracellular [Ca(2+)] ([Ca(2+)](i)), high molecular weight glycoconjugate secretion, and proliferation were measured after stimulation with IFN-γ with or without the cholinergic agonist carbachol. IFN-γ itself increased [Ca(2+)](i) in rat and human goblet cells and prevented the increase in [Ca(2+)](i) caused by carbachol. Carbachol prevented IFN-γ-mediated increase in [Ca(2+)](i). This cross-talk between IFN-γ and muscarinic receptors may be partially due to use of the same Ca(2+)(i) reservoirs, but also from interaction of signaling pathways proximal to the increase in [Ca(2+)](i). IFN-γ blocked carbachol-induced high molecular weight glycoconjugate secretion and reduced goblet cell proliferation. We conclude that increased levels of IFN-γ in dry eye disease could explain the lack of goblet cells and mucin deficiency typically found in this pathology. IFN-γ could also function similarly in respiratory and gastrointestinal tracts.
PMID: 26129651 [PubMed - indexed for MEDLINE]
[An update on tonsillotomy studies].
HNO. 2016 Sep 26;
Authors: Windfuhr JP, Savva K
Abstract
BACKGROUND: Tonsillotomy procedures (TT) are being increasingly performed owing to the low postoperative morbidity compared with extracapsular tonsillectomy (TE). Patients may experience regrowth of tonsillar tissue or tonsillitis in the tonsillar remnants eventually resulting in a secondary tonsillectomy.
OBJECTIVES: A review of the literature was undertaken to evaluate the current indications and contraindications, surgical instruments, risks of surgery, and the need for further research related to TT.
MATERIAL AND METHODS: A search of the PubMed database was performed with the following terms: "tonsillotomy," "partial tonsillectomy," "subtotal tonsillectomy," "intracapsular tonsillectomy," "RFITT," and "tonsil ablation." Filters included language (English; German) and publication date (1960-2016). Articles were excluded if they were not related to tonsil surgery, did not provide clinical data, dealt with uncommon surgical techniques, or presented only data from polysomnographic studies.
RESULTS: In all, 104 papers encompassing 97 studies and seven national surveys were eligible for analysis. In total, 13,270 patients had undergone TT and were compared with 11,485 patients after TE. Partial resection of the tonsils was most commonly accomplished with a microdebrider (51.5 %), and less frequently with coblation (20.5 %), radiofrequency (9.1 %), CO2 laser (6.6 %), or other surgical instruments. The age in the study groups ranged between 6 months and 78 years (median: 6.0 years). The prevailing indication for surgery was upper airway obstruction resulting from tonsillar hyperplasia with (n = 20) or without (n = 60) a history of tonsillits. In seven studies, TT was explicitly performed to resolve tonsillitis, while three authors did not specify the indication for surgery. The hemorrhage rate after TT was 0.2 % on average.
CONCLUSION: TT is predominantly indicated for tonsillar hyperplasia, with or without tonsillitis. Restrictions related to age or surgical instruments are not reported in the literature data. Data concerning operation time, intraoperative bleeding, and outcome favor TT over TE. The median values for regrowth (3.0 %), postoperative tonsillitis (2.85 %), and secondary TE (1.37 %) emphasize the high success rate of TT. Further research utilizing a uniform terminology is mandatory to clarify the benefit of TT over TE in the long term and to resolve sleep-related breathing disorders resulting from tonsillar hyperplasia or tonsillitis.
PMID: 27670422 [PubMed - as supplied by publisher]
[Simulation of speech perception with cochlear implants : Influence of frequency and level of fundamental frequency components with electronic acoustic stimulation].
HNO. 2016 Sep 26;
Authors: Rader T, Fastl H, Baumann U
Abstract
BACKGROUND: After implantation of cochlear implants with hearing preservation for combined electronic acoustic stimulation (EAS), the residual acoustic hearing ability relays fundamental speech frequency information in the low frequency range. With the help of acoustic simulation of EAS hearing perception the impact of frequency and level fine structure of speech signals can be systematically examined.
OBJECTIVE: The aim of this study was to measure the speech reception threshold (SRT) under various noise conditions with acoustic EAS simulation by variation of the frequency and level information of the fundamental frequency f0 of speech. The study was carried out to determine to what extent the SRT is impaired by modification of the f0 fine structure.
MATERIAL AND METHODS: Using partial tone time pattern analysis an acoustic EAS simulation of the speech material from the Oldenburg sentence test (OLSA) was generated. In addition, determination of the f0 curve of the speech material was conducted. Subsequently, either the parameter frequency or level of f0 was fixed in order to remove one of the two fine contour information of the speech signal. The processed OLSA sentences were used to determine the SRT in background noise under various test conditions. The conditions "f0 fixed frequency" and "f0 fixed level" were tested under two different situations, under "amplitude modulated background noise" and "continuous background noise" conditions. A total of 24 subjects with normal hearing participated in the study.
RESULTS: The SRT in background noise for the condition "f0 fixed frequency" was more favorable in continuous noise with 2.7 dB and in modulated noise with 0.8 dB compared to the condition "f0 fixed level" with 3.7 dB and 2.9 dB, respectively.
DISCUSSION: In the simulation of speech perception with cochlear implants and acoustic components, the level information of the fundamental frequency had a stronger impact on speech intelligibility than the frequency information. The method of simulation of transmission of cochlear implants allows investigation of how various parameters influence speech intelligibility in subjects with normal hearing.
PMID: 27670421 [PubMed - as supplied by publisher]
Intraoperative magnetic resonance imaging.
HNO. 2016 Sep 26;
Authors: Hlavac M, Wirtz CR, Halatsch ME
Abstract
Intraoperative magnetic resonance imaging is a widely accepted method for resection control of glial tumors. Increasingly, it is also used during the resection of skull base tumors. Several studies have independently demonstrated an increase in the extent of resection in these tumors with improved prognosis for the patients. Technical innovations combined with the easier operation of this imaging modality have led to its widespread implementation. The development of digital image processing has also brought other modalities such as ultrasound and computed tomography to the focus of skull base surgery.
PMID: 27670420 [PubMed - as supplied by publisher]
Radiation-Induced Optic Neuropathy Following High-Dose Pencil Beam Scanning Proton Therapy in Skull Base Tumors: A Retrospective Study of 157 Patients.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):S65
Authors: Kountouri M, Schneider RA, Walser M, Vinante L, Fiumedinisi F, Bolsi A, Lomax AJ, Weber DC
PMID: 27675982 [PubMed - as supplied by publisher]
The Preliminary Efficacy and Safety of Fractionated Stereotactic Radiosurgery for Skull Base Schwannoma.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E73-E74
Authors: Wang J, Pan L, Ju ZJ, Qu BL, Wang WJ, Sun L, Yu XG, Lin ZP
PMID: 27675449 [PubMed - as supplied by publisher]
Clinical Efficacy and Safety of Surface Imaging Guided Radiosurgery in the Treatment of Benign Skull Base Tumors.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E68
Authors: Lau SK, Patel K, Kim T, Knipprath E, Kim GY, Cervino LI, Lawson JD, Murphy KT, Sanghvi P, Carter BS, Chen C
PMID: 27675340 [PubMed - as supplied by publisher]
Evaluation of Intensity Modulated Proton Therapy for Stereotactic Ablative Radiation Therapy of Recurrent Skull Base Tumors: A Comparative Treatment Planning Study With Volumetric Modulated Arc Therapy.
Int J Radiat Oncol Biol Phys. 2016 Oct 1;96(2S):E677
Authors: Phan J, Frank SJ, Chun S, Zhu XR, Tung S, Wang C, Zhang X, Crawford C, Garden AS, Rosenthal DI, Gunn GB, Nguyen QN, Fuller CD, Wang H
PMID: 27675333 [PubMed - as supplied by publisher]
Sleep quality outcomes after medical and surgical management of chronic rhinosinusitis.
Int Forum Allergy Rhinol. 2016 Sep 27;
Authors: Alt JA, Ramakrishnan VR, Platt MP, Kohli P, Storck KA, Schlosser RJ, Soler ZM
Abstract
BACKGROUND: Endoscopic sinus surgery (ESS) has been shown to improve sleep in patients with chronic rhinosinusitis (CRS). However, it is unknown how this improvement compares with non-CRS control subjects' sleep, and medically treated CRS patients.
METHODS: Patients meeting diagnostic criteria for CRS and controls from the same reference population were recruited from 4 academic centers. Patients chose either medical or surgical treatment. The Pittsburgh Sleep Quality Index (PSQI) was administered to patients before treatment and after 6 months, whereas controls received the PSQI at enrollment.
RESULTS: The study population consisted of 187 cases (64 medical and 123 surgical) and 101 controls. Baseline PSQI scores for CRS patients (9.27 ± 4.76) were worse than for controls (5.78 ± 3.25), even after controlling for potential confounding factors such as asthma and allergy (p < 0.001). There was no significant difference in baseline PSQI between patients choosing medical vs surgical treatment. The PSQI score in surgical patients improved from 8.36 ± 5.05 to 7.44 ± 5.09 (p = 0.020). The PSQI score in medical patients demonstrated a nonsignificant increase with treatment from 8.71 ± 4.48 to 9.06 ± 4.80 (p = 0.640). After controlling for allergy and asthma, 6-month PSQI scores in medical patients remained significantly higher than in controls (p = 0.001), whereas a significant difference could not be demonstrated between surgical patients and controls (p > 0.05). PSQI subdomain analysis mirrored the overall findings.
CONCLUSION: Patients with CRS report worse sleep compared with controls. Surgically treated CRS patients show significant improvement in PSQI scores, whereas those continuing with medical management fail to improve and remain worse than controls.
PMID: 27673437 [PubMed - as supplied by publisher]
Management Scheme For Cerebral Wegener Granulomatosis: An Unusual Pseudotumoral Skull Base pathology.
World Neurosurg. 2016 Sep 23;
Authors: Bernat AL, Lefevre E, Sène D, Herman P, Adle Biassette H, Froelich S
Abstract
Granulomatosis with polyangitis (Wegener's disease) is a rare ANCA (anti-neutrophil cytoplasmic antibody) positive vasculitis that seldom involves brain and meninges. We herein present a case of a 35-year-old woman presenting with granulomatosis with polyangitis involving the brain and the meninges. The histological diagnosis required a complete resection of the lesion. Despite the possibility of post operative wound infection surgery was mandatory to ascertain the diagnostic and to treat locally.
PMID: 27671887 [PubMed - as supplied by publisher]
Factors for overall survival in patients with skull base chordoma: a retrospective analysis of 225 patients.
World Neurosurg. 2016 Sep 23;
Authors: Tian K, Zhang H, Ma J, Wang K, Ru X, Du J, Jia G, Zhang L, Wu Z, Zhang J, Wang L
Abstract
BACKGROUND: Although being a controversial and complex issue, the prognostic factors of skull base chordomas are worth exploring.
METHODS: Prognostic factors associated with overall survival (OS) were retrospectively estimated on an individual cohort of skull base chordomas prospectively maintained for ten years by Kaplan-Meier method and univariate Cox proportional hazards model. Multivariate analysis by Cox regression analysis was performed to identify the independent prognostic factors. Then a nomogram was formulated by R software based on the above results.
RESULTS: A total of 180 primary patients and 45 recurrent cases were included, with a mean follow-up period of 43.7 months (range, 4-127 months). The OS rates of primary group at 5-year and 7-year were 84% and 78%, and its mean OS time was 103.8 months, that was significantly longer than the recurrent group, in which the mean post-recurrent OS time was 68.4 months. In primary group, preoperative Karnofsky' performance status (KPS) score (p=.004) and a decline of perioperative KPS score (p=.015) were identified as independent predictors of OS. A nomogram was contracted to predict 5-year, 7-year OS, which was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.74). In recurrent group, visual deficit was verified as an independent risk factor associated with post-recurrent OS (p=.014).
CONCLUSIONS: Both pathological and perioperative KPS score evaluations own significance in OS prediction of both primary and recurrent cases. The nomogram for primary lesions, consisted of preoperative functional status and its perioperative changes, appears useful for risk stratification of long-term survival.
PMID: 27671886 [PubMed - as supplied by publisher]
Analysis of Prognostic Factors in Malignant External Otitis.
Clin Exp Otorhinolaryngol. 2016 Sep 27;
Authors: Lee SK, Lee SA, Seon SW, Jung JH, Lee JD, Choi JY, Kim BG
Abstract
Objectives: Malignant external otitis (MEO) is a potentially fatal infection of the external auditory canal, temporal bone, and skull base. Despite treatment with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now, there have been few studies on the prognostic factors of MEO.
Methods: We performed a retrospective study to identify prognostic factors of MEO, and a meta-analysis of other articles investigating MEO. On the basis of disease progression the 28 patients in our study were divided into 'controlled' and 'uncontrolled' groups, consisting of 12 and 16 patients, respectively. We identified three categories of prognostic factors: those related to patient, disease, and treatment. We compared these prognostic factors between the controlled and uncontrolled groups.
Results: In our study, the duration of diabetes mellitus (DM), presence of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), and computed tomography or magnetic resonance imaging findings influenced the prognosis of MEO. In contrast, prognosis was unrelated to age, gender, mean glucose level, hemoglobin A1c (HbA1c) level, pathogen, comorbidity, or cranial nerve involvement. No factor related to treatment modality was correlated with prognosis, such as surgery, steroid therapy, or interval to the first appropriate treatment. Cranial nerve involvement has been proven to be associated with disease progression, but the relationship between cranial nerve involvement and the prognosis of MEO remains controversial. As a part of this study, we conducted a meta-analysis of cranial nerve involvement as a prognostic factor of MEO. We found that cranial nerve involvement has a statistically significant influence on the prognosis of MEO.
Conclusion: We found that glycemic control in diabetes mellitus, cranial nerve involvement, and the extent of disease determined from various imaging modalities influence the prognosis of MEO. We suggest that significant prognostic factors should be monitored to determine the prognosis of patients with MEO.
PMID: 27671716 [PubMed - as supplied by publisher]
Repeat Imaging in Idiopathic Unilateral Vocal Fold Paralysis: Is It Necessary?
Ann Otol Rhinol Laryngol. 2016 Sep 26;
Authors: Noel JE, Jeffery CC, Damrose E
Abstract
OBJECTIVE: Imaging plays a critical role in the evaluation of patients presenting with unilateral vocal fold paresis or paralysis of unknown etiology. In those with idiopathic unilateral vocal fold paralysis (iUVFP), there is no consensus regarding the need or timing of repeat imaging. This study seeks to establish the rate of delayed detection of alternate etiologies for these patients to determine if and when imaging should be repeated.
METHODS: Retrospective chart review was conducted identifying patients at our institution with vocal fold movement impairment between 1998 and 2014. Idiopathic paralysis was diagnosed if physical examination, laryngoscopy, and initial imaging excluded a cause. Demographic data, length of follow-up, and the presence of late lesions were noted. Time to detection was plotted using the Kaplan-Meier method.
RESULTS: Of 3210 patients reviewed, 207 had a diagnosis of iUVFP. Of these patients, 8 went on to develop alternate diagnoses, including pulmonary disease, skull-base and laryngeal neoplasms, and thyroid malignancy. In Kaplan-Meir analysis, 90% remained "idiopathic" at 5 years of follow-up. The mean time to detection was 27 months.
CONCLUSIONS: Patients initially diagnosed with iUVFP may have an occult cause that later becomes evident. We recommend repeat imaging within 2 years after diagnosis, but this is likely unnecessary beyond 5 years.
PMID: 27670956 [PubMed - as supplied by publisher]
Intraoperative magnetic resonance imaging.
HNO. 2016 Sep 26;
Authors: Hlavac M, Wirtz CR, Halatsch ME
Abstract
Intraoperative magnetic resonance imaging is a widely accepted method for resection control of glial tumors. Increasingly, it is also used during the resection of skull base tumors. Several studies have independently demonstrated an increase in the extent of resection in these tumors with improved prognosis for the patients. Technical innovations combined with the easier operation of this imaging modality have led to its widespread implementation. The development of digital image processing has also brought other modalities such as ultrasound and computed tomography to the focus of skull base surgery.
PMID: 27670420 [PubMed - as supplied by publisher]
Closure of a Traumatic Esophagomediastinal Fistula in a Child by Endoscopic Fulguration and Fibrin Injection.
Am Surg. 2016 Sep;82(9):789-91
Authors: Maizlin II, Chen JS, Smith NJ, Rogers DA
Abstract
Posttraumatic esophagomediastinal fistula is an uncommon clinical entity that warrants surgical awareness due to its life-threatening potential. Its management, especially in previously operated field, is controversial and several endoscopic methods are being proposed as alternatives. Ours is the first report of endoscopic fulguration and fibrin injection in successful closure of such fistula. A 9-year-old female sustained complete tracheoesophageal transection from a gunshot wound to the neck and underwent immediate primary repair. She presented nine months later with fevers and swelling over anterior neck. CT revealed air tracking posteriorly to the dorsal neck and inferiorly to the mediastinum. Considering difficulty of open surgical approach, endoscopic intervention was attempted. Posterior wall fistula was identified via microlaryngoscopy above the esophageal anastomosis. The fistula tract was de-epithelialized via a Bugbee fulgurating electrode and then sealed with fibrin glue. Consequent imaging studies demonstrated complete occlusion of the fistula. Posterior posttraumatic esophagomediastinal fistula presents a challenging scenario from a surgical standpoint, as it combines difficulty of safe approach, high rate of injury to surrounding structures, and significant postoperative recurrence rate. Endoscopic Bugbee fulguration and fibrin glue injection are a safe and effective alternative to the traditional approach.
PMID: 27670565 [PubMed - in process]
Cervical lymph node metastases of squamous cell carcinoma of unknown origin: the diagnostic value of FDG PET/CT and clinical outcome.
Eur Arch Otorhinolaryngol. 2016 Sep 26;
Authors: Dale E, Moan JM, Osnes TA, Bogsrud TV
Abstract
FDG PET/CT is perceived as a valuable diagnostic tool in addition to the standard diagnostic workup for patients with isolated neck lymph nodes of squamous cell carcinoma of unknown primary (SCCUP). For patients with SCCUP intended for primary radiotherapy, we hypothesize that the previously reported FDG PET/CT detection rates are too high. From 2008 to 2015, 30 SCCUP patients were examined with FDG PET/CT. The objective of the FDG PET/CT examination was twofold: (1) improve the radiotherapy target definition, and (2) identify the primary cancer. Before the FDG PET/CT, the patients had been through a standard workup consisting of CT of the neck and chest, examination with flexible endoscopy with patient awake, panendoscopy and examination under general anesthesia, tonsillectomy and sometimes blind sampling biopsies, and MRI (floor of the mouth). All FDG PET/CTs were performed applying a flat table, head support and fixation mask as part of the radiotherapy treatment planning. Diagnostic CT with contrast was an integrated part of the PET/CT examination. Only 1/30 patients (cancer of the vallecula) had their primary cancer detected by FDG PET/CT. In addition, a non-biopsied patient with high uptake in the ipsilateral palatine tonsil was included, giving a detection rate of ≤7 % (95 % CI 2-21 %). In this retrospective study, we found that the FDG PET/CT detection rate of the primary for SCCUP patients is lower than previously reported. It is questionable whether FDG PET/CT is necessary for these patients when improved, advanced workup is available.
PMID: 27671150 [PubMed - as supplied by publisher]
Viable Ednra (Y129F) mice feature human mandibulofacial dysostosis with alopecia (MFDA) syndrome due to the homologue mutation.
Mamm Genome. 2016 Sep 26;
Authors: Sabrautzki S, Sandholzer MA, Lorenz-Depiereux B, Brommage R, Przemeck G, Vargas Panesso IL, Vernaleken A, Garrett L, Baron K, Yildirim AO, Rozman J, Rathkolb B, Gau C, Hans W, Hoelter SM, Marschall S, Stoeger C, Becker L, Fuchs H, Gailus-Durner V, Klingenspor M, Klopstock T, Lengger C, Stefanie L, Wolf E, Strom TM, Wurst W, de Angelis MH
Abstract
Animal models resembling human mutations are valuable tools to research the features of complex human craniofacial syndromes. This is the first report on a viable dominant mouse model carrying a non-synonymous sequence variation within the endothelin receptor type A gene (Ednra c.386A>T, p.Tyr129Phe) derived by an ENU mutagenesis program. The identical amino acid substitution was reported recently as disease causing in three individuals with the mandibulofacial dysostosis with alopecia (MFDA, OMIM 616367) syndrome. We performed standardized phenotyping of wild-type, heterozygous, and homozygous Ednra (Y129F) mice within the German Mouse Clinic. Mutant mice mimic the craniofacial phenotypes of jaw dysplasia, micrognathia, dysplastic temporomandibular joints, auricular dysmorphism, and missing of the squamosal zygomatic process as described for MFDA-affected individuals. As observed in MFDA-affected individuals, mutant Ednra (Y129F) mice exhibit hearing impairment in line with strong abnormalities of the ossicles and further, reduction of some lung volumetric parameters. In general, heterozygous and homozygous mice demonstrated inter-individual diversity of expression of the craniofacial phenotypes as observed in MFDA patients but without showing any cleft palates, eyelid defects, or alopecia. Mutant Ednra (Y129F) mice represent a valuable viable model for complex human syndromes of the first and second pharyngeal arches and for further studies and analysis of impaired endothelin 1 (EDN1)-endothelin receptor type A (EDNRA) signaling. Above all, Ednra (Y129F) mice model the recently published human MFDA syndrome and may be helpful for further disease understanding and development of therapeutic interventions.
PMID: 27671791 [PubMed - as supplied by publisher]
A rare but morbid neurosurgical target: petrous aneurysms and their endovascular management in the stent/flow diverter era.
J Neurointerv Surg. 2016 Sep 26;
Authors: Gross BA, Moon K, Ducruet AF, Albuquerque FC
Abstract
BACKGROUND/OBJECTIVE: The rarity of petrous internal carotid artery (ICA) aneurysms has largely precluded analyses of their presentation and management in case series format.
METHODS: We performed a retrospective analysis of our endovascular database of patients treated from January 2001 to May 2016 to identify patients with petrous ICA aneurysms. We evaluated the treatment approach and results for patients managed in the era of dedicated intracranial stents and flow diverters, noting clinical and angiographic results.
RESULTS: Our database search identified 10 patients with petrous ICA aneurysms. Six aneurysms were managed in the era of dedicated intracranial stents and flow diverters. Two patients presented with cranial nerve palsies, two with incidental but enlarging aneurysms that had completely eroded through the petrous bone, one with transient ischemic attacks, and one with pulsatile tinnitus. Five aneurysms were large and one was small but symptomatic. In three cases the aneurysm was treated by flow diversion with adjunctive coiling; two patients with at least 4-month follow-up had complete occlusion of their aneurysm and significant improvement of mass effect symptoms. In one case the aneurysm was treated with balloon-assisted coiling with resultant near-complete occlusion. In two cases, prior to the introduction of flow diverters, the aneurysm was treated via stent-assisted coiling with resultant near-complete obliteration; one patient had resolution of pretreatment pulsatile tinnitus. There were no intraprocedural or postprocedural complications; no patients underwent retreatment.
CONCLUSIONS: Endovascular treatment of large or symptomatic petrous ICA aneurysms, in the era of flow diversion, is associated with excellent angiographic and clinical outcomes.
PMID: 27672098 [PubMed - as supplied by publisher]
Differential tinnitus-related neuroplastic alterations of cortical thickness and surface area.
Hear Res. 2016 Sep 23;
Authors: Meyer M, Neff P, Liem F, Kleinjung T, Weidt S, Langguth B, Schecklmann M
Abstract
Structural neuroimaging techniques have been used to identify cortical and subcortical regions constituting the neuroarchitecture of tinnitus. One recent investigation used voxel-based morphometry (VBM) to analyze a sample of tinnitus patients (TI, n=257) [1]. A negative relationship between individual distress and cortical volume (CV) in bilateral auditory regions was observed. However, CV has meanwhile been identified as a neuroanatomical measurement that confounds genetically distinct neuroanatomical traits, namely cortical thickness (CT) and cortical surface area (CSA). We performed a re-analysis of the identical sample using the automated FreeSurfer surface-based morphometry (SBM) approach [2]. First, we replicated the negative correlation between tinnitus distress and bilateral supratemporal gray matter volume. Second, we observed a negative correlation for CSA in the left peri-auditory cortex and anterior insula. Furthermore, we noted a positive correlation between tinnitus duration and CT in the left peri-auditory cortex as well as a negative correlation in the subcallosal anterior cingulate, a region collated to the serotonergic circuit and germane to inhibitory functions. In short, the results elucidate differential neuroanatomical alterations of CSA and CT for the two independent tinnitus-related psychological traits distress and duration. Beyond this, the study provides further evidence for the distinction and specific susceptibility of CSA and CT within the context of neuroplasticity of the human brain.
PMID: 27671157 [PubMed - as supplied by publisher]
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[Sudden hearing loss revealing Vogt-Koyanagi-Harada syndrome].
Pan Afr Med J. 2015;22:103
Authors: Mahfoudhi M, Khamassi K
PMID: 26848350 [PubMed - indexed for MEDLINE]
Magnetic resonance imaging evaluation of endolymphatic hydrops andpost-operative findings in cases with otosclerosis.
Acta Otolaryngol. 2016 Sep 27;:1-4
Authors: Sone M, Yoshida T, Sugimoto S, Morimoto K, Okazaki Y, Teranishi M, Naganawa S, Nakashima T
Abstract
CONCLUSIONS: The presence of endolymphatic hydrops (EH) in the vestibule on magnetic resonance imaging (MRI) might be a high-risk factor for complications in cases that are candidates for stapes surgery.
OBJECTIVE: Pre-operative detection of EH could be valuable in cases that are candidates for stapes surgery to prevent unpredictable complications following surgery. Pre-operative MRI findings and post-operative findings following stapes surgery were compared to evaluate the efficacy of such MRI evaluation for the management of cases with otosclerosis.
SUBJECTS AND METHODS: Sixteen cases who underwent pre-operative evaluation by 3T MRI performed 4 h after intravenous injection of gadolinium and stapes surgery for otosclerosis were recruited. Imaging data concerning the degree of EH in the vestibule and cochlea were compared with post-operative clinical findings for all cases.
RESULTS: Mild EH in the cochlea or the vestibule was observed in eight ears and one ear, respectively, whereas one ear showed significant EH both in the cochlea and the vestibule. The post-operative course was uneventful in 12 of 14 cases with no EH in the vestibule, and the other two cases had a short period of dizziness, but two cases with EH in the vestibule had a long period of dizziness.
PMID: 27676652 [PubMed - as supplied by publisher]
Risk assessment of high-lying innominate artery with neck surgery.
Acta Otolaryngol. 2016 Sep 27;:1-5
Authors: Cai Q, Zhu H, Yu T, Huang X, Liang F, Han P, Lin P
Abstract
CONCLUSION: A high-lying innominate artery (the upper edge of the innominate artery across the anterior midline of the trachea located 2 cm above the suprasternal notch), a rare situation, may produce disturbance to related anterior cervical tracheal surgery and even cause serious complications.
OBJECTIVES: High-lying innominate artery is a high risk factor in anterior cervical tracheal surgery. Pre-operative assessment via imaging technique can help to familiarize the artery and reduce the related disturbance to the surgery.
METHODS: A total of 829 patients were selected. Cervical computed tomography (CT) examination was conducted before surgery. The distance between the upper edge of the innominate artery across the anterior midline of the trachea and the suprasternal notch was measured. The exposure of innominate arteries in these cases during surgery was recorded.
RESULTS: The upper edge of the innominate artery was located above the suprasternal notch in 26.4% (219/829) of patients. The upper edge of the innominate artery across the anterior midline of the trachea was 2 cm above the suprasternal notch in 18 cases, accounting for 2.2% of all cases, and innominate arteries were exposed in 11 cases (61.1%) during surgery.
PMID: 27669999 [PubMed - as supplied by publisher]
A randomised, single-blind comparison of high-level disinfectants for flexible nasendoscopes.
J Laryngol Otol. 2016 Sep 27;:1-7
Authors: Hitchcock B, Moynan S, Frampton C, Reuther R, Gilling P, Rowe F
Abstract
OBJECTIVES: To compare the microbiological efficacy, turnaround time, cost, convenience, and patient and user tolerance of Tristel Trio Wipes, PeraSafe solution and Cidex OPA solution for the high-level disinfection of flexible nasendoscopes.
METHODS: Flexible nasendoscopes were used in routine clinical encounters. They were then disinfected with one of the three disinfectant methods. Surveillance cultures were taken before and after each disinfection process. Data relating to each of the study parameters were recorded.
RESULTS: Positive bacterial cultures were discovered on nasendoscopes disinfected with PeraSafe and Cidex OPA. Tristel Trio Wipes have no capital outlay cost, the lowest running cost, the greatest convenience and the fastest turnaround time. PeraSafe had a faster turnaround time than Cidex OPA, and lower running costs.
CONCLUSION: Tristel Trio Wipes are equal to PeraSafe and Cidex OPA in terms of microbiological efficacy. Turnaround time and cost are dramatically reduced when using Tristel Trio Wipes compared to the other disinfectant methods.
PMID: 27669971 [PubMed - as supplied by publisher]
