Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma.

Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma.

Audiol Neurootol. 2016 Oct 7;21(5):275-285

Authors: Prasad SC, Piras G, Piccirillo E, Taibah A, Russo A, He J, Sanna M

Abstract
OBJECTIVE: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions.
METHODS: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed.
RESULTS: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years.
CONCLUSIONS: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

PMID: 27710980 [PubMed - as supplied by publisher]

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R2* Map by IDEAL IQ for Acute Cerebral Infarction: Compared with Susceptibility Vessel Sign on T2*-Weighted Imaging.

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R2* Map by IDEAL IQ for Acute Cerebral Infarction: Compared with Susceptibility Vessel Sign on T2*-Weighted Imaging.

Yonago Acta Med. 2016 Sep;59(3):204-209

Authors: Shinohara Y, Kato A, Yamashita E, Ogawa T

Abstract
BACKGROUND: To evaluate the detectability of arterial acute thrombus on R2* map by iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) IQ compared with T2*-weighted imaging (T2*WI).
METHODS: Twenty-six patients with acute cerebral infarction who underwent R2* map and T2*WI were reviewed. We performed visual assessment of each sequence regarding the visibility of susceptibility effect reflecting acute thrombus and quantitative evaluation of the thrombus on R2* map.
RESULTS: Both R2* map and T2*WI showed susceptibility effect reflecting acute thrombi at the occluded site of magnetic resonance angiography (MRA) in 9 patients. R2* map revealed positive while T2*WI showed equivocal findings in 3 patients due to the surrounding vessel signal intensity. Acute thrombus at distal internal carotid artery (ICA) on R2* map was more clearly detected than that on T2*WI without any apparent susceptibility artifact from the skull base in 4 patients. Most of cardiogenic embolic infarction (CEI) and artery-to-artery embolic infarction (A-to-A) demonstrated positive and most of atherothrombotic infarction (ATI) revealed negative findings on R2* map, although quantitative R2* values of thrombi did not show significant differences between CEI (136.6 /msec) and A-to-A (189.9 /msec) (P = 0.332).
CONCLUSION: The detectability of acute thrombus on R2* map is comparable to that on T2*WI. Regarding thrombus at distal ICA, its detectability on R2* map is superior to that on T2*WI. R2* map provide additional information to distinguish between embolic and atherothrombotic infarctions.

PMID: 27708535 [PubMed - in process]

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Platelet-rich fibrin: a boon in regenerative endodontics.

Platelet-rich fibrin: a boon in regenerative endodontics.

Minerva Stomatol. 2016 Dec;65(6):385-392

Authors: Rebentish PD, Umashetty G, Kaur H, Doizode T, Kaslekar M, Chowdhury S

Abstract
Research into regenerative dentistry has contributed momentum to the field of molecular biology. Periapical surgery aims at removing periapical pathology to achieve complete wound healing and regeneration of bone and periodontal tissue. Regenerative endodontic procedures are widely being added to the current armamentarium of pulp therapy procedures. The regenerative potential of platelets has been deliberated. Platelet-rich fibrin (PRF) is a wonderful tissue-engineering product and has recently gained much popularity due its promising results in wound healing bone induction. The features of this product are an attribute of platelets which, after cellular interactions, release growth factors and have shown application in diverse disciplines of dentistry. This paper is intended to shed light onto the various prospects of PRF and to provide clinical insight into regenerative endodontic therapy.

PMID: 27711028 [PubMed - in process]

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Quantification of the amount of dental material removed by selective grinding in wax dentures with photogrammetric measurements.

Quantification of the amount of dental material removed by selective grinding in wax dentures with photogrammetric measurements.

Minerva Stomatol. 2016 Dec;65(6):335-342

Authors: Ravasini F, Fornari M, Bonanini M

Abstract
BACKGROUND: The use of photogrammetry may be a new method to quantify the amount of artificial dental material removed from the surface of each teeth during the grind procedure (SG). SG is necessary in each denture to reach a correct occlusion. It consists in a refine action on the prosthesis teeth's surface using milling machine tools, aimed to remove the interferences (pre-contacts) between upper and lower teeth during chewing. This measure is achieved after a comparison between pre and post-grinding 3D models. This new application could be of interest for both dentists and dental technicians because it could be used to evaluate, with a accurate numerical description, the action applied on teeth surfaces during the grinding process. Furthermore, results of the analysis could have some value for the dental industry, since the use of photogrammetry can improve the process, reducing costs during the design of artificial teeth and eventually this method could be used as a teaching tool both for dental and "dental technician" high school students. The purpose of this work is to measure the thickness of the artificial enamel removed during grinding phases. Usually, the dental technician adjusts the dental plate on the mount of the patient following the traditional method, without a quantitative evaluation of the material removed. The photogrammetric method (PM) proposed here allows to measure the amount of material removed during the grinding process. This measure is achieved after a comparison between pre and post-grinding 3D models.
METHODS: Under control of three teachers (experts of dentures performed according to the Gerber method) ten complete dentures arrangements (upper and inferior arches) performed by dental students at the Prosthodontic Department of the University of Parma, Italy were analyzed with PM before and after SG.
RESULTS: The average thickness variation between the pre and post-grinding dentures is within the range of 0.1÷0.4 mm. For the upper arches, the mean value of the SG process is 223 µm while for the inferior arches is 240 µm. Results show that the most important grind process in all models appear in correspondence of cusps, with values up to 1660 µm. On the other hand, in correspondence of the fossae the results show a moderate grind action: the value is around 200-300 µm. Conversely to guidelines thought to students: cusps undergo a greater grinding process than fossae, consequently cusps should be revisioned at least on their technical and morphological aspects. The average thickness variation between the pre and post-grinding dentures is within the range of 0.1÷0.4 mm, this mean an equal value loss of vertical dimension. Furthermore, the knowledge of the gauge material removed during the SG could be useful for dental industries, giving important information, that could be considered for project and design of artificial teeth.
CONCLUSIONS: The FM implemented in this article has given satisfactory preliminary results, showing good accuracy, low costs and high versatility. It is necessary to highlight that this is an experimental method and that the present analysis is a pilot study that needs further evaluation. Nevertheless results obtained could be of some value for medical companies, in order to improve the artificial teeth's design and project. Moreover, such a method may serve as educational tool for dental students.

PMID: 27711027 [PubMed - in process]

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Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients.

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Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients.

Eur Arch Otorhinolaryngol. 2016 Oct 5;:

Authors: Koo SK, Kwon SB, Kim YJ, Moon JI, Kim YJ, Jung SH

Abstract
Snoring is a sign of increased upper airway resistance and is the most common symptom suggestive of obstructive sleep apnea. Acoustic analysis of snoring sounds is a non-invasive diagnostic technique and may provide a screening test that can determine the location of obstruction sites. We recorded snoring sounds according to obstruction level, measured by DISE, using a smartphone and focused on the analysis of formant frequencies. The study group comprised 32 male patients (mean age 42.9 years). The spectrogram pattern, intensity (dB), fundamental frequencies (F 0), and formant frequencies (F 1, F 2, and F 3) of the snoring sounds were analyzed for each subject. On spectrographic analysis, retropalatal level obstruction tended to produce sharp and regular peaks, while retrolingual level obstruction tended to show peaks with a gradual onset and decay. On formant frequency analysis, F 1 (retropalatal level vs. retrolingual level: 488.1 ± 125.8 vs. 634.7 ± 196.6 Hz) and F 2 (retropalatal level vs. retrolingual level: 1267.3 ± 306.6 vs. 1723.7 ± 550.0 Hz) of retrolingual level obstructions showed significantly higher values than retropalatal level obstruction (p < 0.05). This suggests that the upper airway is more severely obstructed with retrolingual level obstruction and that there is a greater change in tongue position. Acoustic analysis of snoring is a non-invasive diagnostic technique that can be easily applied at a relatively low cost. The analysis of formant frequencies will be a useful screening test for the prediction of occlusion sites. Moreover, smartphone can be effective for recording snoring sounds.

PMID: 27709292 [PubMed - as supplied by publisher]

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Antibiotic Prescribing by Physicians Versus Nurse Practitioners for Pediatric Upper Respiratory Infections.

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Antibiotic Prescribing by Physicians Versus Nurse Practitioners for Pediatric Upper Respiratory Infections.

Ann Otol Rhinol Laryngol. 2016 Oct 5;:

Authors: Ference EH, Min JY, Chandra RK, Schroeder JW, Ciolino JD, Yang A, Holl J, Shintani Smith S

Abstract
BACKGROUND: This study investigates differences in antibiotic prescribing rates for pediatric upper respiratory infections (URIs) between physicians and nurse practitioners (NPs).
METHODS: Visits by children <18 years old diagnosed with URI to physicians or NPs between 2001 and 2010 were abstracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey. Logistic regression analyses examined variations in antibiotic prescribing rates.
RESULTS: Upper respiratory infections accounted for approximately 439 ± 21.5 million visits. Patients seen by NPs were more likely to have Medicaid, live in the lowest median household income quartile zip codes and micropolitan locations, and live in the South compared to patients seen by physicians. Nurse practitioners prescribed antibiotics 66.7% ± 4.2% of the time versus physicians at 52.8% ± 0.8% for URI visits (unadjusted P-value = .002). Adjusted by specialty, URI type, and chronic diseases, NPs had marginally significantly different odds of prescribing antibiotics (OR = 1.6, 95% CI, 1.0-2.6, P-value = .048), but the association with prescribing broad-spectrum antibiotics is not as strong (adjusted P-value = .063). Patient visits to a pediatric (OR = 0.54, 95% CI, 0.43-0.67) or ENT/surgery practice (OR = 0.11, 95% CI, 0.06-0.18) had lower odds of antibiotic prescribing compared to general/family medicine practices. Year (2001-2010) was not significantly associated with antibiotic or broad-spectrum antibiotic prescribing rates for physicians, but rates for NPs fell for otitis media (P-value = .007) from 90.2% ± 8.2% (2001-2002) to 74.8% ± 6.8% (2009-2010) of visits.
CONCLUSIONS: Nurse practitioners have higher rates of antibiotic prescribing compared to physicians for pediatric patients with URIs; however, this difference is less after adjusting for specialty. Examining comparative antibiotic prescribing is important to promote evidence-based practice and adoption of clinical guidelines.

PMID: 27707916 [PubMed - as supplied by publisher]

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Airway observations during upper endoscopy predicting obstructive sleep apnea.

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Airway observations during upper endoscopy predicting obstructive sleep apnea.

Ann Gastroenterol. 2016 Oct-Dec;29(4):481-486

Authors: Harvin G, Ali E, Raina A, Leland W, Abid S, Vahora Z, Movahed H, Kachru S, Tee R

Abstract
BACKGROUND: This pilot study examined airway characteristics during upper endoscopy to determine who is at high risk for obstructive sleep apnea.
METHODS: Patients undergoing routine upper endoscopy were divided into 2 groups according to the Berlin Questionnaire (high and low risk for sleep disordered breathing). Patients underwent routine upper endoscopy using propofol sedation. The airway was then evaluated for no, partial, or complete collapse at the levels of the palate/uvula/tonsils, the tongue base, the hypopharynx, and the larynx. They were given a score of 0 for no collapse, 1 for partial collapse, and 2 for complete collapse. The score for each of these levels was added to give a total score or severity index. The larynx was also evaluated for lateral pharyngeal collapse (minimal, up to 50%, >50%, or 100%).
RESULTS: We found that patients with a partial obstruction at the level of the palate/uvula/tonsils, tongue base, hypopharynx, or larynx, or complete obstruction at any level more often had a positive Berlin questionnaire. Patients with a positive Berlin questionnaire were more often of increased weight (mean 197 vs 175 lbs, P=0.19), increased body mass index (31.2 vs 27.42 kg/m(2), P=0.11), increased neck circumference (36.7 vs 34.7 cm, P=0.23), and had a higher total airway score (2.61 vs 1.67, P=0.09).
CONCLUSIONS: The results of our pilot study represent preliminary data regarding the use of upper endoscopy as a potential tool to evaluate patients for obstructive sleep apnea.

PMID: 27708514 [PubMed - in process]

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Foreign Body Granuloma of the Epiglottic Vallecula Mimicking Malignancy on MRI and FDG PET/CT.

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Foreign Body Granuloma of the Epiglottic Vallecula Mimicking Malignancy on MRI and FDG PET/CT.

Clin Nucl Med. 2016 Mar;41(3):227-9

Authors: Dong A, Bai Y, Wang Y, Zuo C

Abstract
A 66-year-old man complained of foreign body sensation of the throat and progressive dysphagia without any trigger. Videolaryngoscopy showed a whitish lesion in the epiglottic vallecula. Neck enhanced MRI showed a lesion in epiglottic vallecula with remarkable enhancement. FDG PET/CT showed intense FDG uptake of the lesion with SUVmax of 28. Malignant tumor was suspected. The patient underwent microlaryngoscopic surgery. Histopathologic findings of the specimen were consistent with foreign body granuloma.

PMID: 26447384 [PubMed - indexed for MEDLINE]

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Vocal fold tear in an operatic tenor.

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Vocal fold tear in an operatic tenor.

Ear Nose Throat J. 2014 Sep;93(9):E41-2

Authors: Portnoy JE, Sataloff RT

PMID: 25255360 [PubMed - indexed for MEDLINE]

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[Conjunctival impression cytology in patients with normal and impaired OSDI scores].

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[Conjunctival impression cytology in patients with normal and impaired OSDI scores].

Arch Soc Esp Oftalmol. 2014 Oct;89(10):391-6

Authors: Zuazo F, López-Ponce D, Salinas-Toro D, Valenzuela F, Sans-Puroja J, Srur M, López-Solís RO, Traipe-Castro L

Abstract
PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores.
MATERIAL AND METHODS: Patients (n=166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces.
RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41±0.14) compared to normal patients (0.86±0.09) (P<.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24±56.24 cells per sample) compared with normal subjects (497.31±50.07 cells per sample) (P<.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<.01) and moderate (P<.001) OSDI scores.
CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva.

PMID: 24993073 [PubMed - indexed for MEDLINE]

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