The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis

alexandrossfakianakis shared this article with you from Inoreader The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis via Clinical Otolaryngology Abstract Background Olfactory dysfunction (OD) is a common but underreported problem that can significantly impact a patient's quality of life. OD is prevalent in over 5% of the adult population and can be broadly categorised into conductive and sensorineural causes. Magnetic Resonance Imaging (MRI) can form part of the diagnostic work up, although its exact role is often debated. Objectives The aim of this study was to evaluate the value of MRI in managing patients with OD. Design/ Method A retrospective analysis of the records of patients presenting to a national smell and taste clinic over a five-year period was performed. Variables included demographics, endoscopic findings, final diagnosis, psychophysical smell test and imaging results. Results A total of 409 patients, with an age range of 10-93 years, underwent clinical assessment and smell testing, of which 172 patients (42%) had MRI scans. Imaging in younger age-groups was associated with a higher rate of positive findings, however identifiable causes for OD were recorded across the range. MRI provided both diagnostic and prognostic information in those with idiopathic, traumatic, and congenital causes of OD. For example, MRI provided information on the extent or absence of gliosis in those with a head trauma history allowing further treatment and prognosis. Conclusion We recommend the adjunct use of MRI in patients with a clear history and examination findings of head injury, congenital cases and in apparent idiopathic cases. MRI should be requested to compliment clinical findings with a view to aiding decision-making on treatment and prognosis independent of patient's age. View on Web

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Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes

alexandrossfakianakis shared this article with you from Inoreader Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes via The Laryngoscope Our retrospective cohort study identified that Black patients comprised the greatest proportion of patients with iatrogenic laryngotracheal stenosis. Of all etiologies, the iatrogenic form of stenosis had the highest incidence of temporary tracheostomy and tracheostomy dependence. Objective Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency. Methods Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit. Results 129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only. Conclusion This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study. Level of Evidence III Laryngoscope, 2022 View on Web

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The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users

alexandrossfakianakis shared this article with you from Inoreader The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users via The Laryngoscope CI users face significant difficulty with music perception, which negatively impacts sound quality and music appreciation. Our study demonstrates commercially available vocal boost software can be used to improve the perception of musical sound quality appraisals among CI users, which may contribute positively to quality of life. Given these findings, front-end vocal manipulations and settings should be considered as an adjunct to current methods of hearing accessibility and accommodations for CI music listening experiences. Objective To evaluate the impact of vocal boost manipulations on cochlear implant (CI) musical sound quality appraisals. Methods An anonymous, online study was distributed to 33 CI users. Participants listened to auditory tokens and assessed the musical quality of acoustic stimuli with vocal boosting and attenuation using a validated sound quality rating scale. Four versions of real-world musical stimuli were created: a version with +9 dB vocal boost, a version with −9 dB vocal attenuation, a composite stimulus containing a 1,000 Hz low-pass filter and white noise ("anchor"), and an unaltered version ("hidden reference"). Subjects listened to all four versions and provided ratings based on a 100-point scale that reflected the perceived sound quality difference of the music clip relative to the reference excerpt. Results Vocal boost increased musical sound quality ratings relative to the reference clip (11.7; 95% CI, 1.62–21.8, p = 0.016) and vocal attenuation decreased musical sound quality ratings relative to the reference clip (28.5; 95% CI, 18.64–38.44, p < 0.001). When comparing the non-musical training group and musical training group, there was a significant difference in musical sound quality rating scores for the vocal boost condition (21.2; 95% CI: 1.76–40.7, p = 0.028). Conclusions CI-mediated musical sound quality appraisals are impacted by vocal boost and attenuation. Musically trained CI users to report greater musical sound quality enhancement with a vocal boost with respect to CI users with no musical training background. Implementation of front-end vocal boost manipulations in music may improve sound quality and music appreciation among CI users. Level of Evidence II (Individual cohort study) Laryngoscope, 2022 View on Web

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Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

alexandrossfakianakis shared this article with you from Inoreader Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era via The Laryngoscope Osteoradionecrosis (ORN) of the skull base and the craniovertebral junction is a challenging complication of radiation therapy. We describe an endoscopic-assisted approach for the management of ORN of the skull base using fascia lata for microvascular free tissue transfer. This approach is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Objectives Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi-modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic-assisted approach for the management of ORN of the skull base using fascia lata for MFTT. Study Design Retrospective case series. Methods Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long-term follow-up were reviewed. Results Five patients were identified. Mean duration to onset of ORN was 17 months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post-op follow-up was 23 months. Conclusions With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Long‐Term Outcomes of End‐Flexible‐Rigidscopic Transoral Surgery for Pharyngolaryngeal Cancer

alexandrossfakianakis shared this article with you from Inoreader Long‐Term Outcomes of End‐Flexible‐Rigidscopic Transoral Surgery for Pharyngolaryngeal Cancer via The Laryngoscope Objective End-flexible-rigidscopic transoral surgery (E-TOS) is a new and minimally invasive transoral surgery for resection of Tis-selected T3 pharyngolaryngeal cancers. We evaluated long-term oncological outcomes and whether postoperative voice and swallowing function were preserved following E-TOS. Methods In this retrospective single-center study, 154 patients treated with E-TOS using a curved retractor, flexible-tip rigid endoscope, and thin curved instruments were included. Their survival rate, larynx preservation rate, and disease control rate were estimated using the Kaplan–Meier method. Postoperative voice function was evaluated using both objective and subjective tests. Postoperative swallowing function was assessed using the Hyodo score and the functional outcome swallowing scale. Results The 3-year and 5-year overall survival, disease-specific survival, disease-free survival, laryngectomy-free survival, local control, and loco-regional control rates post E-TOS were 89.8% and 82.2%, 95.6% and 92.3%, 78.5% and 70.3%, 87.2% and 80.9%, 93.9% and 92.5%, and 87.2% and 85.7%, respectively. Both objective and subjective postoperative voice and swallowing function tests were within normal limits in more than 90% of the patients. Conclusion E-TOS is an effective, safe, low-cost, and minimally invasive transoral surgery for Tis-selected T3 pharyngolaryngeal cancer; it also preserves postoperative voice, larynx, and swallowing function. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study

alexandrossfakianakis shared this article with you from Inoreader Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study via The Laryngoscope This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics measurements. We found that lower nasal mucosal temperature and higher heat flux anteriorly correlate with a perception of improved unilateral nasal patency in healthy individuals. Objectives Recent evidence suggests that detection of nasal mucosal temperature, rather than direct airflow detection, is the primary determinant of subjective nasal patency. This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics (CFD) measurements. Methods Healthy adult participants completed Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS) questionnaires. A temperature probe measured nasal mucosal temperature at the vestibule, inferior turbinate, middle turbinate, and nasopharynx bilaterally. Participants underwent a CT scan, used to create a 3D nasal anatomy model to perform CFD analysis of nasal mucosal and inspired air temperature and heat flux along with mucosal surface area where heat flux >50 W/m2 (SAHF50). Results Eleven participants with a median age of 27 (IQR 24; 48) were recruited. Probe-measured temperature values correlated strongly with CFD-derived values (r = 0.87, p < 0.05). Correlations were seen anteriorly in the vestibule and inferior turbinate regions between nasal mucosal temperature and unilateral VAS (r = 0.42–0.46; p < 0.05), between SAHF50 and unilateral VAS (r = −0.31 to −0.36; p < 0.05) and between nasal mucosal temperature and SAHF50 (r = −0.37 to −0.41; p < 0.05). Subjects with high patency (VAS ≤10) had increased heat flux anteriorly compared with lower patency subjects (VAS >10; p < 0.05). Conclusion Lower nasal mucosal temperature and higher heat flux within the anterior nasal cavity correlates with a perception of improved unilateral nasal patency in healthy individuals. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Extrarenal Wilms tumor with hypertension and dilated cardiomyopathy in an infant: A report of an unusual case

alexandrossfakianakis shared this article with you from Inoreader Extrarenal Wilms tumor with hypertension and dilated cardiomyopathy in an infant: A report of an unusual case via Pediatric Blood & Cancer Abstract While Wilms tumors are the most frequently detected kidney cancer type in children, extrarenal Wilms tumors (ERWTs) remain rare. This report is the first to describe hypertension and dilated cardiomyopathy in a patient with an ERWT. A 6-month-old male infant presented with an abdominal mass and paroxysmal hypertension; echocardiography revealed dilated cardiomyopathy with an ejection fraction of 34%, as well as substantially increased plasma renin activity. Pathology yielded a definitive diagnosis of ERWT. Cardiac function and blood pressure gradually returned to normal after tumorectomy. The early diagnosis of such a tumor together with efficient oncologic treatment are vital to optimal patient outcomes. View on Web

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Prognostic value of texture analysis of the primary tumour in high‐risk neuroblastoma: An 18F‐DOPA PET study

alexandrossfakianakis shared this article with you from Inoreader Prognostic value of texture analysis of the primary tumour in high‐risk neuroblastoma: An 18F‐DOPA PET study via Pediatric Blood & Cancer Abstract Purpose To evaluate the prognostic value of texture analysis of the primary tumour with 18fluorine-dihydroxyphenylalanine positron emission tomography/X-ray computed tomography (18F-DOPA PET/CT) in patients affected by high-risk neuroblastoma (HR-NBL). Methods We retrospectively analysed 18 patients with HR-NBL, which had been prospectively enrolled in the course of a previous trial investigating the diagnostic role of 18F-DOPA PET/CT at the time of the first onset. Texture analysis of the primary tumour was carried out on the PET images using LifeX. Conventional indices, histogram parameters, grey level co-occurrence (GLCM), run-length (GLRLM), neighbouring difference (NGLDM) and zone-length (GLZLM) matrices parameter were extracted; their values were compared with the overall metastatic load, expressed by means of whole-body metabolic burden (WBMB) score and the progression-free/overall survival (PFS and OS). Results There was a direct correlation between WBMB and radiomics parameter describing uptake intensity (SUVmean: p = .004) and voxel heterogeneity (entropy: p = .026; GLCM_Contrast: p = .001). Conversely, texture indices of homogeneity showed an inverse correlation with WBMB (energy: p = .026; GLCM_Homogeneity: p = .006). On the multivariate model, WBMB (p < .01) and the first standardised uptake value (SUV) quartile (p < .001) predicted PFS; OS was predicted by WBMB and the N-myc proto-oncogene protein (MYCN) amplification (p < .05) for both. Conclusions Textural parameters describing heterogeneity and metabolic intensity of the primary HR-NBL are closely associated with its overall metastatic burden. In turn, the whole-body tumour load appears to be one of the most relevant predictors of progression-free and overall survival. View on Web

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Negative childhood events and the development of the anorexic voice: A grounded theory

alexandrossfakianakis shared this article with you from Inoreader Negative childhood events and the development of the anorexic voice: A grounded theory via Psychology and Psychotherapy: Theory, Research and Practice Abstract Background Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal 'anorexic voice' (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences. Aims This study explores the relationship between adverse experiences in childhood and the development of the AV. Materials and Methods Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology. Results Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood. Discussion Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices. Conclusions The findings have implications for a trauma-focused approach when working with the AV. View on Web

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Non‐carious cervical lesions (NCCLs): morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration

alexandrossfakianakis shared this article with you from Inoreader Non‐carious cervical lesions (NCCLs): morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration via Journal of Prosthodontics Abstract Purpose : To synthesize the literature regarding non-carious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. Material and Methods : A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. Results : NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineral ization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multi-step and single-step adhesives have been used. Dentin etching should be increas ed to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. Conclusions : Non-carious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multi-step or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators. This article is protected by copyright. All rights reserved View on Web

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