Efficacy and safety of tribendimidine against Opisthorchis viverrini: two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials.

Efficacy and safety of tribendimidine against Opisthorchis viverrini: two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials.

Lancet Infect Dis. 2016 Jul 26;

Authors: Sayasone S, Odermatt P, Vonghachack Y, Xayavong S, Senggnam K, Duthaler U, Akkhavong K, Hattendorf J, Keiser J

Abstract
BACKGROUND: Treatment of the liver fluke infection Opisthorchis viverrini relies exclusively on praziquantel. Tribendimidine could be an alternative treatment option. We aimed to assess the efficacy and safety of ascending single, oral doses of tribendimidine in patients with O viverrini infection.
METHODS: We did two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials in children (aged 8-14 years) and adults and adolescents (≥15 years) in three O viverrini endemic villages in Champasack province, southern Laos. Patients with O viverrini infection were randomly assigned, via a computer-generated central block-randomisation procedure, with block sizes of three (study 1) and four, eight, and 12 (study 2), to receive oral tribendimidine at doses of 200 mg, 400 mg, or 600 mg in a 1:1:1 ratio (adults and adolescents in study 1); 25 mg, 50 mg, 100 mg, or 200 mg (four 50 mg tablets) in a 1:1:1:1 ratio (adults and adolescents in study 2); or 100 mg, 200 mg, or 400 mg in a 1:1:1 ratio (children in study 1). One non-randomised group of children received tribendimidine 50 mg (study 2). Participants, investigators, and laboratory technicians doing the diagnostic assessments were masked to group assignment, but the investigator administering treatment could have recognised the treatment group based on the number of tablets. The primary objective was to estimate the dose-response relation in terms of cure rate and egg reduction rate. We did available-case analysis of all patients with primary endpoint data. We predicted dose-response associations with Emax models. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN96948551.
FINDINGS: Between Oct 25, 2012, and Nov 5, 2013, 318 adolescents and adults were randomly assigned to seven tribendimidine dose groups: 200 mg (n=51), 400 mg (n=49), or 600 mg (n=47) in study 1, and 25 mg (n=39), 50 mg (n=47), 100 mg (n=44), or 200 mg (four 50 mg tablets; n=41) in study 2. 128 children were randomly assigned to receive tribendimidine 100 mg (n=44), 200 mg (n=40), or 400 mg (n=44) in study 1; 39 children were enrolled and received tribendimidine 50 mg in study 2. In adolescents and adults, the number of patients cured increased with increasing tribendimidine doses up to 100 mg: ten of 39 patients (25·6%, 95% CI 13·0-42·1) were cured in the 25 mg group, 20 of 47 patients (42·6%, 28·3-57·8) were cured in the 50 mg group, and 34 of 44 patients (77·3%, 62·2-88·5) were cured in the 100 mg group; geometric mean egg reduction rates were 86·9% (95% CI 74·8-93·4), 95·9% (92·7-97·7), and 99·1% (98·2-99·7), respectively. The 200 mg dose resulted in cure in 40 of 47 (83·0%, 69·2-92·5) adolescents and adults given the 200 mg tablet and 25 of 41 (61·0%, 95% CI 44·5-75·8) of those given four 50 mg tablets; the 400 mg dose resulted in cure in 43 of 47 patients (91·5%, 79·6-97·6) and the 600 mg dose resulted in cure in 36 of 45 patients (80·0%, 65·4-90·4). Corresponding egg reduction rates were 99·8% (95% CI 99·7-100·0) with one 200 mg tablet, 97·9% (95·9-99·2) with four 50 mg tablets, 99·9% (99·8-100·0) with 400 mg, and 99·8% (99·6-99·9) with 600 mg. The Emax model predicted an egg reduction rate of 99·0% (95% CI 95·7-99·8) at 111 mg in adolescents and adults. 50 mg tribendimidine had moderate efficacy in children, with cure recorded in 16 of 39 patients (41·0%, 95% CI 25·6-57·9). The 100 mg dose resulted in cure in 40 of 44 children (98·9%, 95% CI 78·3-97·5) and an egg reduction rate of 99·7% (95% CI 99·0-100·0), with no increased efficacy at higher doses. The Emax model predicted an egg reduction rate of 99·0% (95% CI 92·2-99·9) at 215 mg. Few adverse events were reported and were mostly mild, with few moderate and no serious events. The most common adverse events 3 h after treatment in adolescents and adults were vertigo (n=35 [11%]), headache (n=9 [3%]), nausea (n=6 [2%]), and fatigue (n=4 [1%]), and in children were headache (n=3 [2%]), vertigo (n=2 [1%]), and fatigue (n=2 [1%]).
INTERPRETATION: Tribendimidine has excellent efficacy and tolerability at doses of 100 mg and above. Our study included mainly adults and children with low-intensity O viverrini infection; future studies should assess the efficacy of tribendimidine in patients with infections of moderate and high intensity.
FUNDING: Department for International Development, Medical Research Council, Wellcome Trust Joint Global Health Trials Scheme.

PMID: 27472949 [PubMed - as supplied by publisher]

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'Open access' and the International Journal of Audiology.

'Open access' and the International Journal of Audiology.

Int J Audiol. 2016 Jul 29;:1-2

Authors:

PMID: 27472297 [PubMed - as supplied by publisher]

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Facial tremors in patients with and without parkinsonism.

Facial tremors in patients with and without parkinsonism.

Neurol Sci. 2016 Jul 28;

Authors: Rossi M, Wilken M, Morisset P, Fariña S, Cerquetti D, Merello M

Abstract
Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.

PMID: 27470304 [PubMed - as supplied by publisher]

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Line of Sight in Hominoids.

Line of Sight in Hominoids.

J Clin Pediatr Dent. 2016;40(3):251-258

Authors: Stock MK, Reynolds DG, Masters AJ, Bromage TG, Enlow DH

Abstract
OBJECTIVES: It remains unclear how the realignments of the face and basicranium that characterize humans were acquired, both phylogenetically and ontogenetically. The developmentally constrained nature of the skull has been previously demonstrated in other primates using Donald H. Enlow's mammalian craniofacial architectural relationships. Here, we compare crania of our closest relatives to gain greater understanding of how and why the relationship of the face and cranial base is developmentally constrained in order to inform instances of abnormal growth and clinical intervention.
STUDY DESIGN: A method for evaluating these fundamental architectural relationships using 3D landmark data was developed, thereby taking overall size and the geometric relationships among points into account. A sample of cone-beam computed tomography scans derived from humans and extant apes were analyzed (n=10 and n=6, respectively), as well as fossil hominid crania (n=7). Landmarks for 23 craniofacial architectural points were identified and recorded.
RESULTS AND CONCLUSIONS: Principal components analyses reveal that despite the similarities in craniofacial architecture between humans, extant apes and fossil hominids, appreciable trends in variation between the extant species suggest that the repositioning of the foramen magnum was only one of a constellation of traits that realigned the basicranium and face during the transition to bipedalism.

PMID: 27472575 [PubMed - as supplied by publisher]

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Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

J Neurosurg. 2016 Jul 29;:1-9

Authors: Lee JY, Pierce JT, Sandhu SK, Petrov D, Yang AI

Abstract
OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%-80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

PMID: 27471895 [PubMed - as supplied by publisher]

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Endoscopic Management of Middle Ear and Temporal Bone Lesions.

Endoscopic Management of Middle Ear and Temporal Bone Lesions.

Otolaryngol Clin North Am. 2016 Jul 25;

Authors: Isaacson B, Nogueira JF

Abstract
Tantamount to the management of temporal bone neoplasms is the ability to visualize the pathology and its relationship with the numerous critical structures housed therein. Transcanal endoscopic ear surgery provides the surgeon with an unparalleled view of the entire middle ear. This article presents the latest information on the usefulness of transcanal endoscopic ear surgery in the management of middle ear and temporal bone neoplasms.

PMID: 27468636 [PubMed - as supplied by publisher]

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Anatomy of the Eustachian Tube.

Anatomy of the Eustachian Tube.

Otolaryngol Clin North Am. 2016 Jul 25;

Authors: Leuwer R

Abstract
The eustachian tube consists of 2 compartments: the Rüdinger's safety canal and the auxiliary gap. It is surrounded by a cartilaginous wall on the craniomedial side and a membranous wall on the inferolateral side. The eustachian tube cartilage is firmly attached to the skull base by the lateral and the medial suspensory ligaments, which are separated by the medial Ostmann fat pad. The function of the isometric tensor veli palatini muscle is modulated by hypomochlia, which have an influence on the muscular force vectors.

PMID: 27468634 [PubMed - as supplied by publisher]

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[CLOSURE OF NASOCRANIAL FISTULAS WITH "BATH-PLUG" TECHNIQUE AND MULTILAYER RECONSTRUCTION].

[CLOSURE OF NASOCRANIAL FISTULAS WITH "BATH-PLUG" TECHNIQUE AND MULTILAYER RECONSTRUCTION].

Ideggyogy Sz. 2016 Mar 30;69(5-6):211-6

Authors: Piski Z, Büki A, Nepp N, Burián A, Révész P, Gerlinger I

Abstract
BACKGROUND AND PURPOSE: In case of dehiscenses developing on the anterior scull base, complete closure resulting in the cessation of the communication between the nasal cavity and the intracranial space is mandatory as soon as possible, in order to prevent serious complications. With the development of the endoscopic techniques, the endonasal management for the reconstruction has become available in recent decades.
METHODS: We aim to present the reconstruction techniques applied in our department in the cases of two patients recently operated at our institute. The choice of methods primarily depends on the size and the localization of the defect. Dehiscenses under 5 mm of diameter can be closed with the so called "bath-plug" technique, while bigger defects, where the required closure of the plug is not possible, can be solved with multilayer reconstruction. We use autogenous fascia, fat and muco-periosteum in both cases.
RESULTS: Our patient, who underwent the aforementioned "bath-plug" procedure, could be discharged after a few days of uneventful postoperative period. During a ten-month follow-up period new fistula formation was not observed. In the case of a patient who underwent multilayer reconstruction, meningitis occurred postoperatively, which was resolved after antibiotic therapy. During a 17-month follow-up period recurrent liquorrhoea did not occur.
CONCLUSION: With suitable technical background and appropriate endoscopic skills the surgeries of the anterior skull base cerebrospinal fluid fistulas can be performed efficiently and with low complication rate. These are minimally invasive procedures accompanied by less surgical trauma, morbidity and shorter hospitalization, hence these techniques are considered to be cost-effective and well-tolerated for the patients.

PMID: 27468611 [PubMed - in process]

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Relationship between soluble Semaphorin4D and cognitive impairment in patients with obstructive sleep apnea-hypopnea syndrome.

Relationship between soluble Semaphorin4D and cognitive impairment in patients with obstructive sleep apnea-hypopnea syndrome.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: He Y, Xiang L, Zhao LP, Chan SP, Chen R

Abstract
To investigate the relationship between plasma soluble semaphorin4D (sSema4D) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to ascertain the effect of sSema4D on cognitive dysfunction in patients with OSAHS. We prospectively recruited 30 men with moderate-severe OSAHS diagnosed by polysomnography, and 30 healthy controls with matched gender, age and education level. Montreal Cognitive Assessment (MoCA) was administered to determine cognitive impairment. Plasma sSema4D levels were measured. Among the total of 60 study patients, the overall plasma sSema4D level was 7.81 ± 1.91 ng/ml. Plasma sSema4D level in OSAHS group was significantly higher than that in controls (8.92 ± 1.79 vs 6.70 ± 1.28 ng/ml, p < 0.001). In OSAHS subgroup, patients with cognition impairment (CI) had higher plasma sSema4D level (10.50 ± 1.16 vs 8.00 ± 1.41 ng/ml, p < 0.001) and apnea-hypopnea index (AHI) (48.1 ± 14.0 vs 30.3 ± 9.2, p < 0.001) than those in non-CI group. Multiple logistic regression revealed that plasma sSema4D level (AOR 2.824, 95 % CI 1.562-5.103; p = 0.001) and BMI (AOR 2.237, 95 % CI 1.345-3.722; p = 0.002) were significantly associated with OSAHS, and plasma sSema4D was a significant predictor of CI after adjustment for other confounders (AOR 4.956, 95 % CI 1.581-15.538; p = 0.006). OSAHS patients, especially those with cognition impairment, are featured by elevated plasma sSema4D level, and sSema4D is significantly associated with cognition impairment induced by OSAHS.

PMID: 27470118 [PubMed - as supplied by publisher]

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Overexpression of DCLK1 is predictive for recurrent disease in major salivary gland malignancies.

Overexpression of DCLK1 is predictive for recurrent disease in major salivary gland malignancies.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Kadletz L, Aumayr K, Heiduschka G, Schneider S, Enzenhofer E, Lill C

Abstract
Salivary gland carcinomas are a rare malignancy. Therefore, little is known about biomarkers and cancer stem cells in salivary gland malignancies. Double cortin-like kinase 1 (DCLK1) is a promising therapeutic target and cancer stem cell marker, predominantly investigated in pancreatic and colorectal cancer. The purpose of this study was to investigate the expression of DCLK1 in major and minor salivary gland carcinomas and its influence on survival. We examined a total of 80 patients with major or minor salivary gland cancer in this retrospective study. Immunohistochemistry with anti-DCLK1 antibody was applied to assess the expression of DCLK1. Moreover, we evaluated the impact of DCLK1 on overall and disease-free survival. DCLK1 expression could be detected in 66.3 % of all examined cases. Overexpression of DCLK1 was associated with reduced overall and disease-free survival in patients with major salivary gland cancer. Disease-free survival reached statistical significance (p = 0.0107). However, expression of DCLK1 had no influence on survival in patients with minor salivary gland cancer. Since treatment of recurrent disease in oncologic patients is utterly challenging, DCLK1 may be a promising prognostic biomarker that helps to identify patients with a high risk for recurrence of major salivary gland carcinoma.

PMID: 27470117 [PubMed - as supplied by publisher]

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Comparison of drain versus no-drain thyroidectomy: a meta-analysis.

Comparison of drain versus no-drain thyroidectomy: a meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Tian J, Li L, Liu P, Wang X

Abstract
Despite minimal evidence, thyroid drains are routinely used as a precaution against hematoma in thyroidectomy. We undertook the present meta-analysis to evaluate the patient outcomes associated with post-surgical drainage, and whether it offers any advantage over no drainage in patients undergoing thyroidectomy. Randomized and two-arm studies comparing the efficacy of total or partial thyroidectomy with or without post-surgery drainage, in patients undergoing thyroid surgery were included. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 22, 2015, using the terms, "thyroidectomy, subtotal thyroidectomy, total thyroidectomy, drainage, thyroid cancer, and goiter." The primary outcome of interest includes postoperative complications such as infection, hematoma, hemorrhage, hypoparathyroidism, recurrent laryngeal nerve palsy, seroma, and duration of hospital stay. 14 studies comprising of 1927 patients were included in the present analysis. The overall analysis revealed that patients in the drain group were more likely to have a higher postoperative infection rate than no-drain group (pooled OR = 2.94, 95 % CI 1.27-6.85, P = 0.012). Similarly, patients in the drain group had a longer hospital stay in comparison to those in the no-drain group (pooled difference in mean = 1.16, 95 % CI 0.72-1.59, P < 0.001). No statistically significant differences between the groups were found for hematoma, hemorrhage, hypoparathyroidism, recurrent laryngeal nerve palsy, and seroma. In conclusion, the current practice of post-surgical drainage in thyroidectomy did not offer any significant advantage. On the contrary, post-surgical infection rate and duration of hospital stay was higher in patients in the drain group.

PMID: 27470116 [PubMed - as supplied by publisher]

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Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil.

Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Karabayirli S, Ugur KS, Demircioglu RI, Muslu B, Usta B, Sert H, Ark N

Abstract
To compare dexmedetomidine with remifentanil in functional endoscopic sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic consumption and post-operative recovery. Randomized, double blind study. Tertiary care medical center. Fifty patients with nasal polyposis who had been scheduled for FESS were randomly divided into two groups. In group D (n = 25), dexmedetomidine 1 µg/kg infused intravenous (IV) over 10 min before anesthesia induction, followed by a continuous of 0.7 µg/kg/h infusion during operation. In group R (n = 25), 1 µg/kg remifentanil IV bolus, was administered with induction of anesthesia and continued 0.25-0.50 µg/kg/min during operation. Heart rates, mean arterial pressure, end tidal CO2, end tidal sevoflurane were recorded. The amount of bleeding, surgical field condition for bleeding and the time to reach Aldrete recovery score 9-10 were recorded. Postoperative nausea, vomiting, pain, shivering, sedation were followed up over 24 h. There was no significant difference between groups according to the amount of bleeding during surgery, assessment of surgical field condition, consumption of sevoflurane, scores of postoperative VAS, rates of nausea and vomiting, shivering, demands of additional analgesic medication (P > 0.05). The time to reach Aldrete recovery score 9-10, sedation scores at the postoperative first hour were significantly higher in group D (P = 0.001). We concluded that in comparison to remifentanil, dexmedetomidine during FESS for controlled hypotension is of limited value as it has no additional benefits in terms of control of hypotension and amount of bleeding in the surgical field and it is associated with higher recovery time and first-hour postoperative sedation scores.

PMID: 27470115 [PubMed - as supplied by publisher]

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The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

Eur Arch Otorhinolaryngol. 2016 Jul 28;

Authors: Bosi M, De Vito A, Gobbi R, Poletti V, Vicini C

Abstract
The objective of this study is to highlight the importance of anatomical and not-anatomical factors' identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.

PMID: 27470114 [PubMed - as supplied by publisher]

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'Open access' and the International Journal of Audiology.

'Open access' and the International Journal of Audiology.

Int J Audiol. 2016 Jul 29;:1-2

Authors:

PMID: 27472297 [PubMed - as supplied by publisher]

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Use of a mid-scala and a lateral wall electrode in children: insertion depth and hearing preservation.

Use of a mid-scala and a lateral wall electrode in children: insertion depth and hearing preservation.

Acta Otolaryngol. 2016 Jul 29;:1-7

Authors: Benghalem A, Gazibegovic D, Saadi F, Tazi-Chaoui Z

Abstract
CONCLUSIONS: Atraumatic insertion of the HiFocus(TM) Mid-Scala (HFMS) electrode via the round window was successfully achieved in seven children. Residual hearing 6 months post-operatively was preserved to within 10 dB HL of the pre-operative audiogram at 500 Hz for six children, indicating minimal initial insertion trauma to the cochlea.
OBJECTIVES: The objectives were to document the clinical experience and evaluate differences between HFMS and HiFocus(TM) 1j (HF1j) by means of insertion depth and hearing preservation results.
METHOD: Nineteen children were prospectively recruited and consecutively implanted with the HF1j electrode (n = 12) or the HFMS electrode (n = 7) via the round window. Average median angular insertion depths and the amount of residual hearing preserved at 6 months post-operatively were compared between the two electrode groups.
RESULTS: The median angular insertion depth for the HF1j was 439° and for the HFMS 435°. Preservation of residual hearing at 500 Hz was assessed in seven HFMS subjects and 11 HF1j subjects. Based on the Skarzynski formula, three out of seven subjects (42%) in the HFMS group had their residual hearing completely preserved at 500 Hz. In the control group, no subjects had complete hearing preservation and five subjects had a complete loss of residual hearing.

PMID: 27472299 [PubMed - as supplied by publisher]

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The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

Acta Otolaryngol. 2016 Jul 29;:1-8

Authors: Zhu X, Wang Y, Zhu H, Lou W

Abstract
CONCLUSION: HPV + HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can't improve the Survival of the HPV-negative HNSCC patients.
OBJECTIVE: To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.
METHODS: A search in PubMed and Chinese CNKI (2000-2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR).
RESULTS: A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV + patients compared to HPV - patients (HR = 0.48; 95% CI = 0.37-0.62, p < 0.0001) and (HR = 0.49; 95% CI = 0.31-0.78, p < 0.0001). The survival benefit was similar in HPV-16 + patients (adjusted HR = 0.39; 95% CI = 0.21-0.60, p < 0.0001). The DFS of P16 + patients improved (HR = 0.70; 95% CI = 0.55-0.89, p < 0.0001). The treatment response of p16 + patients didn't significantly improve compared with p16- patients (HR = 1.44; 95% CI = 1.01-2.05, p = 0.05).

PMID: 27472193 [PubMed - as supplied by publisher]

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An assessment of olfactory function in patients with laryngopharyngeal reflux disease.

An assessment of olfactory function in patients with laryngopharyngeal reflux disease.

Acta Otolaryngol. 2016 Jul 29;:1-7

Authors: Emre Dinc M, Dalgic A, Avincsal MO, Ulusoy S, Celik A, Develioglu ON

Abstract
CONCLUSIONS: The results reported here indicate that there was a statistically significant difference in the olfactory functions of laryngopharyngeal reflux patients vs the healthy group. To the best of the authors' knowledge, this study is the first to evaluate the olfactory function of patients diagnosed with laryngopharyngeal reflux using an objective method, 24-h pH monitoring.
OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate olfactory functions in laryngopharyngeal reflux (LPR) patients and compare the results with healthy controls.
METHODS: A total of 60 participants; 30 men and women with a diagnosis of laryngopharyngeal reflux and 30 healthy controls, were included in the study. Patients in the laryngopharyngeal reflux group were evaluated by the Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and finally 24-h pH monitoring to confirm the diagnosis of laryngopharyngeal reflux. The Sniffin' Sticks olfactory test results of the laryngopharyngeal reflux and control groups were compared, and the relationship between the study findings and the olfactory parameters were evaluated.
RESULTS: The odor threshold, odor discrimination, odor identification, and TDI scores of the laryngopharyngeal reflux group were significantly lower than those of the control group. Also there was a statistically significant negative correlation detected between the olfactory test and some symptom and finding scores.

PMID: 27472044 [PubMed - as supplied by publisher]

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Two cases of prostheses for flap protection after buccal mucosal incision.

Related Articles

Two cases of prostheses for flap protection after buccal mucosal incision.

Bull Tokyo Dent Coll. 2014;55(1):49-54

Authors: Nomoto S, Sato T, Yoshida S, Saito S, Kamiyama I, Ito A, Tanaka J

Abstract
Here we describe two patients in whom prostheses were applied for flap protection after buccal mucosal incision. In the first case, the patient was a 65-year-old man with a diagnosis of buccal mucosa squamous cell carcinoma (T2N0M0). Left buccal mucosa squamous cell tumor resection and dermoplasty were performed, followed by alveolar ridge augmentation and buccal mucosal graft in the scar area. The carcinoma recurred, however, and left buccal mucosa carcinoma resection was performed, followed by reconstruction surgery using a free forearm flap. After a 12-week healing period, a molar support was constructed on the unaffected side and a protective prosthesis placed on the affected side. Training in ingestion and swallowing were given postoperatively. The patient in the second case was a 62-year-old woman with a diagnosis of buccal mucosa squamous cell carcinoma (T2N1M0). Right buccal mucosa carcinoma resection and supraomohyoid neck dissection were performed, followed by reconstruction surgery using a free forearm flap. A molar support was constructed on the unaffected side and a protective prosthesis placed on the affected side at 5 months postoperatively. Training was given in ingestion and swallowing postoperatively. The prostheses prevented bite wounds to the flaps in the affected areas due to jaw movement during swallowing or speaking. The postoperative courses were uneventful, and the average masticatory score was 92.5 (85, 100), not affecting daily life. The prostheses were placed after reconstruction surgery using free flaps after buccal mucosa squamous cell carcinoma resection. Dysphasia recovered to the preoperative level by dysphasia and pronunciation training in both cases. The postoperative prognosis was favorable, with the prosthesis preventing damage to the flap.

PMID: 24717930 [PubMed - indexed for MEDLINE]

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The Diagnostic and Prognostic Value of sIL-2R as an Immune Biomarker in Head and Neck Cancers.

Related Articles

The Diagnostic and Prognostic Value of sIL-2R as an Immune Biomarker in Head and Neck Cancers.

Anticancer Res. 2016 Aug;36(8):4347-52

Authors: Gross M, Meirovich A, Rachmut J, Kalichman I, Peretz T, Eliashar R, Barak V

Abstract
BACKGROUND/AIM: Head and neck cancer (HNC) patients are usually diagnosed with advanced disease and multimodality therapies are required, as well as prognostic biomarkers to predict their response and assess survival. In this study, we aimed to evaluate the ability and clinical significance of the immune biomarker sIL-2R in HNC patients, to assess therapy response and prognosis.
MATERIALS AND METHODS: We evaluated 328 blood samples from 145 head and neck cancer patients (HNC) from several subgroups: 84 larynx carcinomas pre- and 39 post-therapy, 46 oral cavity carcinomas pre- and 29 post-therapy, 12 nasopharynx carcinomas, 16 parotid and other salivary gland carcinoma patients. The control group included 45 healthy subjects. Serum sIL-2R levels were evaluated by ELISA assays and correlated to disease stage, lymph nodes, response to therapy, survival and cancer differentiation.
RESULTS: Significantly higher sIL-2R levels were recorded in all HNC patients, as opposed to controls, in advanced versus early-stage disease that decreased following therapy. sIL-2R distinguished best, in comparison to other tumor markers, between HNC patients and controls. Survival was strongly associated to lower sIL-2R levels in patients entering the study.
CONCLUSION: sIL-2R is a sensitive immune marker for HNC patients. Its levels correlate to disease stage, assess response to therapy and are predictive of recurrence or better survival. We suggest, therefore, using sIL-2R as a reliable prognostic marker in HNC patients as a single marker, or in a combined panel of biomarkers.

PMID: 27466555 [PubMed - in process]

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An exploratory investigation of the daily talk time of people with non-fluent aphasia and non-aphasic peers.

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An exploratory investigation of the daily talk time of people with non-fluent aphasia and non-aphasic peers.

Int J Speech Lang Pathol. 2016 Jul 28;:1-12

Authors: Brandenburg C, Worrall L, Copland D, Rodriguez A

Abstract
PURPOSE: This paper presents an exploratory investigation of the talk time of people with non-fluent aphasia, as measured by the CommFit™ app. Aims were to compare the talk time of people with aphasia with non-aphasic peers and measures of impairment, activity and participation. The variability of talk time over weeks and days of the week was also investigated.
METHOD: Twelve people with post-stroke, non-fluent aphasia and seven non-aphasic controls measured their talk time using the CommFit™ app for 6 h/day for 14 days.
RESULT: People with aphasia talked for a mean of 4.5 min/h and non-aphasic controls 7.2 min/h, which was not a significant difference (p = 0.056). Talk time of people with aphasia was not significantly correlated with WAB-R AQ or CADL-2 scores, but a moderate-high positive relationship between talk time and SIPSO scores was found (r = 0.648, p = 0.015). Talk time was not significantly different between the first and second weeks of recording for either group, and days of the week were not significantly different except for Saturdays, in which talk time was higher.
CONCLUSION: This study provides some preliminary data on talk time in people with aphasia, suggesting that talk time is an indicator of participation.

PMID: 27467660 [PubMed - as supplied by publisher]

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Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study.

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Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study.

Int J Speech Lang Pathol. 2016 Jul 28;:1-10

Authors: Le HN, Gold L, Mensah F, Eadie P, Bavin EL, Bretherton L, Reilly S

Abstract
PURPOSE: To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4-9 years and (2) the relationship between language impairment and health service utilisation.
METHOD: Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals - Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language.
RESULT: At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language.
CONCLUSION: Language impairment in 4-9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.

PMID: 27467452 [PubMed - as supplied by publisher]

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Treating allergic conjunctivitis: A once-daily medication that provides 24-hour sympton relief.

Related Articles

Treating allergic conjunctivitis: A once-daily medication that provides 24-hour sympton relief.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: Carr W, Schaeffer J, Donnenfeld E

Abstract
BACKGROUND: Allergic conjunctivitis (AC) is a common ocular inflammatory manifestation of allergen exposure in sensitized individuals. Signs and symptoms of AC can decrease quality of life, interfere with productivity, and lead to considerable economic burden. Consistent suppression of conjunctival inflammation is necessary for managing AC, but currently available medications require frequent administration and exhibit limited duration of action.
METHODS: In this review, we summarized AC pathogenesis, diagnosis, and current treatment options as well as their limitations. Findings from the literature were discussed in the context of the unmet need for a once-daily medication with sustained 24-hour effectiveness.
RESULTS: Topical pharmacologic treatments are the most common approach for managing extant AC; however, most available medications require multiple daily instillations. Dual-acting antihistamine-mast cell stabilizing agents are currently considered first-line therapeutics for AC because they provide acute relief of signs and symptoms and block persistent inflammation to promote regression of AC. Recent studies of a newly-developed, higher-concentration formulation of a dual-acting antihistamine- mast cell stabilizer have demonstrated that this formulation provides a 24-hour duration of action with once-daily dosing.
CONCLUSIONS: Dual-acting AC medications exhibit a high degree of overall effectiveness and are well tolerated for chronic use. A newly available once-daily medication that manages signs and symptoms of AC for a full 24 hours may be considered a treatment of choice for patients experiencing seasonal or perennial AC. ClinicalTrials.gov NCT01743027 and NCT01479374.

PMID: 27466061 [PubMed - as supplied by publisher]

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Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis.

Related Articles

Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: Chauhan B, Gupta M, Chauhan K

Abstract
BACKGROUND: Antioxidants have a preventive or therapeutic role in oxygen free radical-mediated cell and tissue damage. The study aimed to investigate the therapeutic effects of antioxidants and intranasal steroid fluticasone furoate (FF) on the clinical outcome of patients with perennial allergic rhinitis.
METHODS: Subjects with perennial allergic rhinitis (n = 61) were randomly divided into two groups, group A (n = 30) received FF and group B (n = 31) received FF with antioxidants for 6 weeks. Nasal and ocular symptoms were evaluated weekly by using a four-point categoric scale. The efficacy of the study drug was assessed based on the mean change from baseline of the total daytime nasal symptom scores, total nighttime nasal symptom scores, and the composite symptom scores.
RESULTS: The combined therapy (FF with antioxidants) resulted in marked improvements (p less then or equal to 0.05) in the mean total daytime nasal symptom scores, total nighttime nasal symptom scores, and composite symptom scores of subjects compared with ones treated with intranasal steroid (FF) alone, which highlighted the therapeutic effect of antioxidants in allergic rhinitis.
CONCLUSION: Significant improvement in clinical outcome was observed in subjects who received antioxidants along with FF. However, because this was an open-label study, the results must be interpreted with caution, and further double-blind, placebo-controlled, dose-ranging trials supplemented with different antioxidants together with intranasal steroids are suggested.

PMID: 27466026 [PubMed - as supplied by publisher]

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Antral bony wall erosion, trigeminal nerve injury, and enophthalmos after root canal surgery.

Related Articles

Antral bony wall erosion, trigeminal nerve injury, and enophthalmos after root canal surgery.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: Costa T, Ferreira E, Antunes L, Dinis PB

Abstract
INTRODUCTION: The frequently used irrigant in dental surgery, sodium hypochlorite, is occasionally the cause of minor, usually circumscribed, adverse effects. Severe, extensive complications, with lasting sequelae, however, also can occur, as in the case we report herein.
CASE REPORT: A 55-year-old woman underwent an endodontic procedure on a maxillary molar, whose roots, unknown to the surgeon, were protruding into the maxillary sinus. After sodium hypochlorite root canal irrigation, the patient immediately developed intense facial pain, facial edema, and periorbital cellulitis. An emergency department evaluation diagnosed an intense inflammatory disease of the maxillary sinus, with significant destruction of its bony walls, accompanied by midface paraesthesia due to infraorbital nerve injury. In the following weeks, the patient slowly developed enophthalmos due to bone erosion of the orbit floor. Treatment, besides prolonged oral steroids, required the endoscopic endonasal opening of the maxillary sinus for profuse irrigation. Two years later, the patient maintained a complete loss of function of the maxillary sinus, anesthesia paraesthesia of the midface, and inferior dystonia of the eye with an enophthalmos.
CONCLUSION: Dentists, maxillofacial surgeons, and otorhinolaryngologists should all be aware of the whole spectrum of complications of even the simplest dental work. Sodium hypochlorite irrigations should be used cautiously in root canal surgery, with the full awareness of its potential for causing soft-tissue damage.

PMID: 27465790 [PubMed - as supplied by publisher]

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Azithromycin for the treatment of eosinophilic nasal polyposis: Clinical and histologic analysis.

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Azithromycin for the treatment of eosinophilic nasal polyposis: Clinical and histologic analysis.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: de Oliveira IS, Crosara PF, Cassali GD, Reis DC, Rodrigues DS, Nunes FB, Guimaraes RE

Abstract
INTRODUCTION: Macrolides used as immunomodulators are a promising tool for chronic inflammatory airway diseases. Eosinophilic nasal polyposis (ENP) is still considered a disease that is difficult to control with the currently standardized treatments.
OBJECTIVES: To evaluate prolonged treatment with low-dose azithromycin for ENP based on clinical and histopathologic variables.
METHODS: The present investigation was a self-paired case study of 33 patients with ENP. A comparison was performed between patients before and after treatment with azithromycin for 8 weeks. The patients were subjected to clinical examinations, staging (three-dimensional imaging by endoscopy), application of the questionnaire, and biopsy of nasal polyps at the beginning and at the end of the treatment.
RESULTS: The treatment yielded a clinical improvement regarding the two variables studied: polyposis staging (69.7%) and questionnaire (57.6%). We did not find significant differences in the inflammatory pattern and in the percentage or absolute number of eosinophils per field between samples obtained before and after the treatment (p > 0.05). There was no difference between the answers obtained from groups with and without asthma and/or aspirin intolerance (p > 0.3). The patients with advanced initial staging exhibited lower subjective improvement index and staging reduction (p = 0.031 and p = 0.012, respectively).
CONCLUSION: Based on this study, azithromycin may be considered as another therapeutic option for ENP. However, further studies are necessary to define the real mechanism of action involved.

PMID: 27465667 [PubMed - as supplied by publisher]

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Treating allergic conjunctivitis: A once-daily medication that provides 24-hour sympton relief.

Treating allergic conjunctivitis: A once-daily medication that provides 24-hour sympton relief.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: Carr W, Schaeffer J, Donnenfeld E

Abstract
BACKGROUND: Allergic conjunctivitis (AC) is a common ocular inflammatory manifestation of allergen exposure in sensitized individuals. Signs and symptoms of AC can decrease quality of life, interfere with productivity, and lead to considerable economic burden. Consistent suppression of conjunctival inflammation is necessary for managing AC, but currently available medications require frequent administration and exhibit limited duration of action.
METHODS: In this review, we summarized AC pathogenesis, diagnosis, and current treatment options as well as their limitations. Findings from the literature were discussed in the context of the unmet need for a once-daily medication with sustained 24-hour effectiveness.
RESULTS: Topical pharmacologic treatments are the most common approach for managing extant AC; however, most available medications require multiple daily instillations. Dual-acting antihistamine-mast cell stabilizing agents are currently considered first-line therapeutics for AC because they provide acute relief of signs and symptoms and block persistent inflammation to promote regression of AC. Recent studies of a newly-developed, higher-concentration formulation of a dual-acting antihistamine- mast cell stabilizer have demonstrated that this formulation provides a 24-hour duration of action with once-daily dosing.
CONCLUSIONS: Dual-acting AC medications exhibit a high degree of overall effectiveness and are well tolerated for chronic use. A newly available once-daily medication that manages signs and symptoms of AC for a full 24 hours may be considered a treatment of choice for patients experiencing seasonal or perennial AC. ClinicalTrials.gov NCT01743027 and NCT01479374.

PMID: 27466061 [PubMed - as supplied by publisher]

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Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis.

Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: Chauhan B, Gupta M, Chauhan K

Abstract
BACKGROUND: Antioxidants have a preventive or therapeutic role in oxygen free radical-mediated cell and tissue damage. The study aimed to investigate the therapeutic effects of antioxidants and intranasal steroid fluticasone furoate (FF) on the clinical outcome of patients with perennial allergic rhinitis.
METHODS: Subjects with perennial allergic rhinitis (n = 61) were randomly divided into two groups, group A (n = 30) received FF and group B (n = 31) received FF with antioxidants for 6 weeks. Nasal and ocular symptoms were evaluated weekly by using a four-point categoric scale. The efficacy of the study drug was assessed based on the mean change from baseline of the total daytime nasal symptom scores, total nighttime nasal symptom scores, and the composite symptom scores.
RESULTS: The combined therapy (FF with antioxidants) resulted in marked improvements (p less then or equal to 0.05) in the mean total daytime nasal symptom scores, total nighttime nasal symptom scores, and composite symptom scores of subjects compared with ones treated with intranasal steroid (FF) alone, which highlighted the therapeutic effect of antioxidants in allergic rhinitis.
CONCLUSION: Significant improvement in clinical outcome was observed in subjects who received antioxidants along with FF. However, because this was an open-label study, the results must be interpreted with caution, and further double-blind, placebo-controlled, dose-ranging trials supplemented with different antioxidants together with intranasal steroids are suggested.

PMID: 27466026 [PubMed - as supplied by publisher]

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Antral bony wall erosion, trigeminal nerve injury, and enophthalmos after root canal surgery.

Antral bony wall erosion, trigeminal nerve injury, and enophthalmos after root canal surgery.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: Costa T, Ferreira E, Antunes L, Dinis PB

Abstract
INTRODUCTION: The frequently used irrigant in dental surgery, sodium hypochlorite, is occasionally the cause of minor, usually circumscribed, adverse effects. Severe, extensive complications, with lasting sequelae, however, also can occur, as in the case we report herein.
CASE REPORT: A 55-year-old woman underwent an endodontic procedure on a maxillary molar, whose roots, unknown to the surgeon, were protruding into the maxillary sinus. After sodium hypochlorite root canal irrigation, the patient immediately developed intense facial pain, facial edema, and periorbital cellulitis. An emergency department evaluation diagnosed an intense inflammatory disease of the maxillary sinus, with significant destruction of its bony walls, accompanied by midface paraesthesia due to infraorbital nerve injury. In the following weeks, the patient slowly developed enophthalmos due to bone erosion of the orbit floor. Treatment, besides prolonged oral steroids, required the endoscopic endonasal opening of the maxillary sinus for profuse irrigation. Two years later, the patient maintained a complete loss of function of the maxillary sinus, anesthesia paraesthesia of the midface, and inferior dystonia of the eye with an enophthalmos.
CONCLUSION: Dentists, maxillofacial surgeons, and otorhinolaryngologists should all be aware of the whole spectrum of complications of even the simplest dental work. Sodium hypochlorite irrigations should be used cautiously in root canal surgery, with the full awareness of its potential for causing soft-tissue damage.

PMID: 27465790 [PubMed - as supplied by publisher]

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Azithromycin for the treatment of eosinophilic nasal polyposis: Clinical and histologic analysis.

Azithromycin for the treatment of eosinophilic nasal polyposis: Clinical and histologic analysis.

Allergy Rhinol (Providence). 2016 Jul 26;

Authors: de Oliveira IS, Crosara PF, Cassali GD, Reis DC, Rodrigues DS, Nunes FB, Guimaraes RE

Abstract
INTRODUCTION: Macrolides used as immunomodulators are a promising tool for chronic inflammatory airway diseases. Eosinophilic nasal polyposis (ENP) is still considered a disease that is difficult to control with the currently standardized treatments.
OBJECTIVES: To evaluate prolonged treatment with low-dose azithromycin for ENP based on clinical and histopathologic variables.
METHODS: The present investigation was a self-paired case study of 33 patients with ENP. A comparison was performed between patients before and after treatment with azithromycin for 8 weeks. The patients were subjected to clinical examinations, staging (three-dimensional imaging by endoscopy), application of the questionnaire, and biopsy of nasal polyps at the beginning and at the end of the treatment.
RESULTS: The treatment yielded a clinical improvement regarding the two variables studied: polyposis staging (69.7%) and questionnaire (57.6%). We did not find significant differences in the inflammatory pattern and in the percentage or absolute number of eosinophils per field between samples obtained before and after the treatment (p > 0.05). There was no difference between the answers obtained from groups with and without asthma and/or aspirin intolerance (p > 0.3). The patients with advanced initial staging exhibited lower subjective improvement index and staging reduction (p = 0.031 and p = 0.012, respectively).
CONCLUSION: Based on this study, azithromycin may be considered as another therapeutic option for ENP. However, further studies are necessary to define the real mechanism of action involved.

PMID: 27465667 [PubMed - as supplied by publisher]

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High sensitization to house-dust mites in patients with allergic rhinitis in the eastern Black Sea region of Turkey: A retrospective study.

High sensitization to house-dust mites in patients with allergic rhinitis in the eastern Black Sea region of Turkey: A retrospective study.

Am J Rhinol Allergy. 2016 Jul 1;

Authors: Coskun ZO, Erdivanli OC, Kazikdas KC, Terzi S, Sahin U, Ozgur A, Demirci M, Dursun E, Cingi C

Abstract
OBJECTIVES: Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis (AR). We determined the distribution of aeroallergens, detected by skin-prick tests (SPT), in adult patients with AR in the Eastern Black Sea region of Turkey and compared the results with the other regions of Turkey and in the world.
METHODS: The medical records of SPT performed on 1457 patients with symptoms of AR (with regard to the Allergic Rhinitis and its Impact on Asthma 2008 guidelines) between March 2010 and March 2013 were analyzed retrospectively. SPT were carried out with the same panel, which included grass; weeds; trees; mold; epidermal mixtures; and with two house-dust mite (HDM) extracts, Dermatophagoides pteronyssinus and Dermatophagoides farinae.
RESULTS: In 1229 of 1457 patients (84.4%), there were positive reactions for at least one aeroallergen on the SPT. The most common aeroallergen was the HDM D. pteronyssinus (84% [n = 1033]) followed by D. farinae (78.2% [n = 962]). Grass pollen sensitivity (70.8% [n = 871]) was higher than tree or weed pollen sensitivity in this region.
CONCLUSIONS: The most common aeroallergens in AR are HDMs of D. pteronyssinus and D. farinae in the Eastern Black Sea region in Turkey. Our study may help in developing environmental control strategies for AR.

PMID: 27465310 [PubMed - as supplied by publisher]

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In Reply: Dominance of Ossicular Route in Sound Transmission.

In Reply: Dominance of Ossicular Route in Sound Transmission.

Clin Exp Otorhinolaryngol. 2016 Jul 28;

Authors: Park H, Hong SN, Kim HS, Han JJ, Chung J, Seo MW, Oh SH, Chang SO, Lee JH

PMID: 27464518 [PubMed - as supplied by publisher]

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The Dominance of Ossicular Route in Sound Transmission.

The Dominance of Ossicular Route in Sound Transmission.

Clin Exp Otorhinolaryngol. 2016 Jul 28;

Authors: Zakaria MN, Lih AC, Wahab NA

PMID: 27464517 [PubMed - as supplied by publisher]

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Normative Hearing Threshold Levels in Koreans with Normal Tympanic Membranes and Estimated Prevalence of Hearing Loss.

Normative Hearing Threshold Levels in Koreans with Normal Tympanic Membranes and Estimated Prevalence of Hearing Loss.

Clin Exp Otorhinolaryngol. 2016 Jul 28;

Authors: Park HJ, Yoo MH, Baek SY, Kim SW, Cho YS

Abstract
Objectives: We investigated the normative data on the hearing threshold levels of Koreans with normal tympanic membranes and the prevalence of hearing loss (HL) and nonserviceable hearing using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2010-2012.
Methods: Data obtained from 16,673 participants ≥12-years-of-age with normal tympanic membranes who completed audiometric testing. We defined HL as the pure tone average (PTA) >25 dB hearing level at 500, 1,000, 2,000, and 3,000 Hz and non-serviceable hearing as PTA >40 dB hearing level.
Results: The hearing levels at some frequencies (0.5, 3, and 6 kHz) did not differ in between the 10's and 20's, but the hearing thresholds at all frequencies increased gradually from the 30's. The hearing thresholds were higher in men than in women at high frequencies (3, 4, and 6 kHz) in the 30's and older. The prevalence of HL in either ear was 16.5% (estimates of 5.9 million), from 2.4% in the 10's up to 75.4% in the 70's and older. The prevalence of nonserviceable hearing in either ear was 6.8% (estimates of 2.5 million) and that of bilateral nonserviceable hearing was 2.5% (estimates of 0.9 million).
Conclusion: Hearing loss aggravated from the 30's at all frequencies and men showed poorer hearing levels than women at high frequencies. Hearing loss was a common condition and the prevalence of non-serviceable hearing in either ear, which needs hearing rehabilitation to help social communication, was 6.8%. Normative pure tone thresholds at each frequency can be used as referent values when counseling patients complaining of hearing loss.

PMID: 27464516 [PubMed - as supplied by publisher]

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Functional Significance of Medial Olivocochlear System Morphology in the Mouse Cochlea.

Functional Significance of Medial Olivocochlear System Morphology in the Mouse Cochlea.

Clin Exp Otorhinolaryngol. 2016 Jul 28;

Authors: Park SY, Park JM, Back SA, Yeo SW, Park SN

Abstract
Objectives: Baso-apical gradients exist in various cochlear structures including medial olivocochlear (MOC) efferent system. This study investigated the cochlear regional differentials in the function and morphology of the MOC system, and addressed the functional implications of regional MOC efferent terminals (ETs) in the mouse cochlea.
Methods: In CBA/J mice, MOC reflex (MOCR) was assessed based on the distortion product otoacoustic emission in the absence and presence of contralateral acoustic stimulation. High, middle, and low frequencies were grouped according to a mouse place-frequency map. Cochlear whole mounts were immunostained for ETs with anti-α-synuclein and examined using confocal laser scanning microscopy. The diameters of ETs and the number of ETs per outer hair cell were measured from the z-stack images of the basal, middle and apical regions, respectively.
Results: The middle cochlear region expressed large, clustered MOC ETs with strong MOCR, the base expressed small, less clustered ETs with strong MOCR, and the apex expressed large, but less clustered ETs with weak MOCR.
Conclusion: The mouse cochlea demonstrated regional differentials in the function and morphology of the MOC system. Strong MOCR along with superior MOC morphology in the middle region may contribute to 'signal detection in noise,' the primary efferent function, in the best hearing frequencies. Strong MOCR in spite of inferior MOC morphology in the base may reflect the importance of 'protection from noise trauma' in the high frequencies.

PMID: 27464515 [PubMed - as supplied by publisher]

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Physiological and metabolic changes during the transition from hyperthyroidism to euthyroidism in Graves' disease.

Physiological and metabolic changes during the transition from hyperthyroidism to euthyroidism in Graves' disease.

Thyroid. 2016 Jul 27;

Authors: Chng CL, Lim AY, Tan HC, Kovalik JP, Tham KW, Bee YM, Lim W, Acharyya S, Lai OF, Chong MF, Yen PM

Abstract
BACKGROUND: The serum metabolomic profile and its relationship to physiological changes during hyperthyroidism and restoration to euthyroidism are not known. We aimed at examining the physiological, adipokine, and metabolomic changes that occur when subjects with Graves' disease transit from hyperthyroidism to euthyroidism with medical treatment.
METHODS: Chinese women between age 21 and 50 years of age and with newly diagnosed Graves' disease attending the Endocrine outpatient clinics in a single institution were recruited between July 2012 and September 2014. All subjects were treated with thioamides to achieve euthyroidism. Clinical parameters (body weight, body composition via bioelectrical impedance analysis, resting energy expenditure and respiratory quotient via indirect calorimetry, reported total energy intake via 24 hr food diary), biochemical parameters (thyroid hormones, lipid profile, fasting insulin and glucose levels), serum leptin, adiponectin and metabolomics profiles were measured during hyperthyroidism and repeated in early euthyroidism.
RESULTS: Twenty four Chinese women with an average age of 36.3 ± 8.6 years were included in the study. The average duration of treatment that was required to reach euthyroidism for these subjects was 38 ± 16.3 weeks. There was a significant increase in body weight (52.6 ± 9.0 kg to 55.3 ± 9.4 kg, p<0.001) and fat mass (14.3 ± 6.9 kg to 16.8 ± 6.5 kg, p=0.005). There was a reduction in resting energy expenditure corrected for weight (28.7 ± 4.0 Kcal/Kg to 21.5 ± 4.1 Kcal/Kg, p<0.001) and an increase in respiratory quotient (0.76 to 0.81, p=0.037). Resting energy expenditure increased significantly with increasing FT3 levels (p=0.007). Significant increases in total cholesterol, LDL-cholesterol and HDL-cholesterol were noted. There was no significant change in leptin levels but adiponectin levels increased significantly (p=0.018). We observed significant reductions in fasting C2, medium, long chain, and total acylcarnitines, but no changes in the fat-free mass, branched chain amino acid levels, or insulin sensitivity during recovery from hyperthyroidism.
CONCLUSIONS: Serum metabolomics profile changes complemented the physiological changes observed during the transition from hyperthyroidism to euthyroidism. Our study provides a comprehensive and integrated view of the changes in fuel metabolism and energy balance that occur following treatment of hyperthyroidism.

PMID: 27465032 [PubMed - as supplied by publisher]

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Long-term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches.

Long-term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches.

Head Neck. 2016 Jul 28;

Authors: Fuller CD, Mohamed AS, Garden AS, Gunn GB, Mulcahy CF, Zafereo M, Phan J, Lai SY, Lewin JS, Hutcheson KA, Frank SJ, Beadle BM, Morrison WH, El-Naggar AK, Kocak-Uzel E, Ginsberg LE, Kies MS, Weber RS, Rosenthal DI

Abstract
BACKGROUND: The purpose of this study was to evaluate the long-term outcomes after initial definitive or adjuvant radiotherapy (RT) for T3 laryngeal cancers.
METHODS: We reviewed 412 patients treated for T3 laryngeal squamous cell cancer from 1985 to 2011.
RESULTS: The 10-year overall survival (OS) was 35%; disease-specific-survival (DSS) was 61%; locoregional control was 76%; and freedom from distant metastasis was 83%. Chemotherapy, age, performance status <2, node-negative status, and glottic subsite were associated with improved survival (all p < .03). Larynx preservation with induction and/or concurrent chemoradiotherapy (LP-CRT) had better laryngectomy-free survival than RT alone (LP-RT; hazard ratio [HR] = 0.62; 95% confidence interval [CI] = 0.47-0.81; p = .0005); 10-year laryngectomy-free survival rates of the LP-CRT cohort (37%) were higher than those of the LP-RT cohort (18%). The 5-year DSS and OS rates of the LP-CRT cohort (79% and 67%) were better after total laryngectomy with postoperative RT (TL-PORT; 61% and 50%) and LP-RT (64% and 46%; p < .006 for all).
CONCLUSION: In patients with T3 laryngeal cancers, LP-CRT provides better functional, oncologic, and survival outcomes than historical TL-PORT or LP-RT does. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27466789 [PubMed - as supplied by publisher]

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Music-induced Hearing Loss in Children, Adolescents, and Young Adults: A Systematic Review and Meta-analysis.

Music-induced Hearing Loss in Children, Adolescents, and Young Adults: A Systematic Review and Meta-analysis.

Otol Neurotol. 2016 Jul 27;

Authors: le Clercq CM, van Ingen G, Ruytjens L, van der Schroeff MP

Abstract
OBJECTIVE: Exposure to loud music has increased significantly because of the current development of personal music players and mobile phones. The aim of this study was to provide an overview of music-induced hearing loss and its symptoms in children.
DATA SOURCES: The search was performed in the databases Embase, Medline (OvidSP), Web-of-science, Scopus, Cinahl, Cochrane, PubMed publisher, and Google Scholar. Only articles written in English were included.
STUDY SELECTION: Articles describing hearing levels and music exposure in children were used, published from 1990 until April 2015.
DATA EXTRACTION: The quality of the studies was assessed on reporting, validity, power, and the quality of audiometric testing.
DATA SYNTHESIS: Data of each publication was extracted into spreadsheet software and analyzed using best evidence synthesis.
CONCLUSION: The prevalence of increased hearing levels (>15 dB HL) was 9.6%, and high-frequency hearing loss was found in 9.3%. The average hearing thresholds were 4.79 dB HL at low frequencies (0.5, 1, and 2 kHz) and 9.54 dB HL at high frequencies (3, 4, and 6 kHz). Most studies reported no significant association between pure-tone air thresholds and exposure to loud music. However, significant changes in hearing thresholds and otoacoustic emissions, and a high tinnitus prevalence suggest an association between music exposure and hearing loss in children.

PMID: 27466893 [PubMed - as supplied by publisher]

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Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery.

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery.

Otol Neurotol. 2016 Jul 27;

Authors: Dobberpuhl MR, Maxwell S, Feddock J, St Clair W, Bush ML

Abstract
OBJECTIVES: The objectives were to evaluate the audiological outcomes, response of symptoms, and response of tumor volume in patients with glomus jugulare tumors treated solely with single fraction gamma knife radiosurgery.
STUDY DESIGN: Single institution retrospective review.
SETTING: Academic, tertiary referral center.
PATIENTS: The diagnosis code for glomus jugulare was used to identify patients. Only those who underwent gamma knife radiosurgery were included. Those previously treated with any modality were excluded. A total of 12 patients were included for the tumor response and symptom response data and 7 of those were included in the audiometric analysis.
MAIN OUTCOMES MEASURES: Audiometric data at most recent follow-up compared with presentation, subjective improvement in pulsatile tinnitus, and change in tumor volume at most recent follow-up compared with pretreatment.
RESULTS: The average time to most recent follow-up was 27.6 months. There was no significant change in pure-tone average or word recognition. Pulsatile tinnitus completely resolved or improved in 80% of patients. Cranial neuropathies were stable or improved. A single patient experienced facial nerve paresis 2 years after treatment, which resolved with steroid treatment. Tumor control was 100% and the average change in tumor volume was a decrease of 37%.
CONCLUSION: Single modality gamma knife radiosurgery treatment of glomus jugulare tumors seems to be safe. Treatment results in decreased tumor volume and improved pulsatile tinnitus in most patients. There was no significant progression of hearing loss after treatment. Lower cranial nerve function remains stable in all patients.

PMID: 27466892 [PubMed - as supplied by publisher]

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Twice-daily application of topical corticosteroids with a squirt system for patients with steroid-responsive olfactory impairment.

Twice-daily application of topical corticosteroids with a squirt system for patients with steroid-responsive olfactory impairment.

Acta Otolaryngol. 2016 Jul 28;:1-5

Authors: Chao YT, Lin DL, Shu CH

Abstract
CONCLUSION: Twice-daily topical corticosteroid treatment using a squirt system was beneficial in maintaining improvements in olfactory dysfunction which had been achieved by oral steroid treatment.
OBJECTIVES: Some patients suffering from olfactory dysfunction respond well to corticosteroids. However, maintaining these improvements is challenging. The aim of this study was to evaluate the maintenance effect of twice-daily topical steroid treatment using a squirt system.
METHODS: Twenty-two anosmic patients with an increase in odor threshold, discrimination, and identification (TDI) scores in Sniffin' Sticks tests by more than six points after 1-week of oral steroid treatment were enrolled. All the patients used a squirt system to apply topical corticosteroids and were followed up at 1, 3, and 6 months.
RESULTS: Nineteen, 16, and 10 patients were followed-up at 1, 3, and 6 months after treatment, respectively. All the patients had significant visual analog scale scores improvements compared to pre-treatment. The mean improvements in TDI scores were 9.80 (p < 0.001), 11.58 (p = 0.001), and 13.87 (p = 0.005) after 1, 3, and 6 months of treatment, respectively. The self-rated and objective olfactory function scores were maintained with steroid squirt therapy without significant decline, even in the patients who were followed up for 6 months.

PMID: 27468143 [PubMed - as supplied by publisher]

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Extended use of systemic steroid is beneficial in preserving hearing in guinea pigs after cochlear implant.

Extended use of systemic steroid is beneficial in preserving hearing in guinea pigs after cochlear implant.

Acta Otolaryngol. 2016 Jul 28;:1-7

Authors: Rah YC, Lee MY, Kim SH, Kim DH, Eastwood H, O'Leary SJ, Lee JH

Abstract
CONCLUSION: Seven-day administration of systemic steroids was more effective in preserving hearing for 12 weeks after cochlear implantation (CI) than a 3-day delivery.
OBJECTIVES: To determine the effectiveness of extended delivery of systemic steroids to preserve hearing in guinea pigs after CI.
METHODS: Dexamethasone (4 mg/ml) was delivered parenterally via a mini-osmotic pump for either 3 or 7 days. A dummy CI electrode was inserted via cochleostomy approach in 8-week-old guinea pigs. Auditory thresholds were assessed from tone burst auditory brainstem responses (2, 8, 16, 24, and 32 kHz) at 1 day prior to CI, and 1, 4, and 12 weeks after implantation. Histologic evaluation of the cochleae was carried out.
RESULTS: No differences were observed in hearing thresholds among groups before CI. Significant hearing preservation was achieved at 8, 16, 24, and 32 kHz only in the 7-day infusion group compared with the control group at 1 week after CI. The same trend was maintained at 4 weeks (16, 24 kHz) and 12 weeks (16, 24, and 32 kHz). Histologic review of the 7-day infusion group revealed less fibrosis and ossification in the scala tympani and the preservation of more spiral ganglion cells, compared with the control group.

PMID: 27466708 [PubMed - as supplied by publisher]

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Long-term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches.

Long-term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches.

Head Neck. 2016 Jul 28;

Authors: Fuller CD, Mohamed AS, Garden AS, Gunn GB, Mulcahy CF, Zafereo M, Phan J, Lai SY, Lewin JS, Hutcheson KA, Frank SJ, Beadle BM, Morrison WH, El-Naggar AK, Kocak-Uzel E, Ginsberg LE, Kies MS, Weber RS, Rosenthal DI

Abstract
BACKGROUND: The purpose of this study was to evaluate the long-term outcomes after initial definitive or adjuvant radiotherapy (RT) for T3 laryngeal cancers.
METHODS: We reviewed 412 patients treated for T3 laryngeal squamous cell cancer from 1985 to 2011.
RESULTS: The 10-year overall survival (OS) was 35%; disease-specific-survival (DSS) was 61%; locoregional control was 76%; and freedom from distant metastasis was 83%. Chemotherapy, age, performance status <2, node-negative status, and glottic subsite were associated with improved survival (all p < .03). Larynx preservation with induction and/or concurrent chemoradiotherapy (LP-CRT) had better laryngectomy-free survival than RT alone (LP-RT; hazard ratio [HR] = 0.62; 95% confidence interval [CI] = 0.47-0.81; p = .0005); 10-year laryngectomy-free survival rates of the LP-CRT cohort (37%) were higher than those of the LP-RT cohort (18%). The 5-year DSS and OS rates of the LP-CRT cohort (79% and 67%) were better after total laryngectomy with postoperative RT (TL-PORT; 61% and 50%) and LP-RT (64% and 46%; p < .006 for all).
CONCLUSION: In patients with T3 laryngeal cancers, LP-CRT provides better functional, oncologic, and survival outcomes than historical TL-PORT or LP-RT does. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27466789 [PubMed - as supplied by publisher]

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The Diagnostic and Prognostic Value of sIL-2R as an Immune Biomarker in Head and Neck Cancers.

The Diagnostic and Prognostic Value of sIL-2R as an Immune Biomarker in Head and Neck Cancers.

Anticancer Res. 2016 Aug;36(8):4347-52

Authors: Gross M, Meirovich A, Rachmut J, Kalichman I, Peretz T, Eliashar R, Barak V

Abstract
BACKGROUND/AIM: Head and neck cancer (HNC) patients are usually diagnosed with advanced disease and multimodality therapies are required, as well as prognostic biomarkers to predict their response and assess survival. In this study, we aimed to evaluate the ability and clinical significance of the immune biomarker sIL-2R in HNC patients, to assess therapy response and prognosis.
MATERIALS AND METHODS: We evaluated 328 blood samples from 145 head and neck cancer patients (HNC) from several subgroups: 84 larynx carcinomas pre- and 39 post-therapy, 46 oral cavity carcinomas pre- and 29 post-therapy, 12 nasopharynx carcinomas, 16 parotid and other salivary gland carcinoma patients. The control group included 45 healthy subjects. Serum sIL-2R levels were evaluated by ELISA assays and correlated to disease stage, lymph nodes, response to therapy, survival and cancer differentiation.
RESULTS: Significantly higher sIL-2R levels were recorded in all HNC patients, as opposed to controls, in advanced versus early-stage disease that decreased following therapy. sIL-2R distinguished best, in comparison to other tumor markers, between HNC patients and controls. Survival was strongly associated to lower sIL-2R levels in patients entering the study.
CONCLUSION: sIL-2R is a sensitive immune marker for HNC patients. Its levels correlate to disease stage, assess response to therapy and are predictive of recurrence or better survival. We suggest, therefore, using sIL-2R as a reliable prognostic marker in HNC patients as a single marker, or in a combined panel of biomarkers.

PMID: 27466555 [PubMed - in process]

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Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy.

Related Articles

Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy.

Epilepsia. 2016 Jan;57(1):e24-7

Authors: Zambrelli E, Saibene AM, Furia F, Chiesa V, Vignoli A, Pipolo C, Felisati G, Canevini MP

Abstract
This study aimed to evaluate the prevalence and the relationship of sleep breathing disorders (SBDs) and laryngeal motility alterations in patients with drug-resistant epilepsy after vagus nerve stimulator (VNS) implantation. Twenty-three consecutive patients with medically refractory epilepsy underwent out-of-center sleep testing before and after VNS implantation. Eighteen eligible subjects underwent endoscopic laryngeal examination post-VNS implantation. Statistical analysis was carried out to assess an association between laryngeal motility alterations and the onset/worsening of SBDs. After VNS implantation, 11 patients showed a new-onset mild/moderate SBD. Half of the patients already affected by obstructive sleep apnea (OSA) showed worsening of SBD. All of the patients with a new-onset OSA had a laryngeal pattern with left vocal cord adduction (LVCA) during VNS stimulation. The association between VNS-induced LVCA and SBD was statistically significant. This study suggests an association between VNS and SBD, hinting to a pivotal role of laryngeal motility alterations. The relationship between SBD and VNS-induced LVCA supports the need to routinely investigate sleep respiratory and laryngeal motility patterns before and after VNS implantation.

PMID: 26589721 [PubMed - indexed for MEDLINE]

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Collagen-grafted porous HDPE/PEAA scaffolds for bone reconstruction.

Collagen-grafted porous HDPE/PEAA scaffolds for bone reconstruction.

Biomater Res. 2016;20:23

Authors: Kim CS, Jung KH, Kim H, Kim CB, Kang IK

Abstract
After tumor resection, bone reconstruction such as skull base reconstruction using interconnected porous structure is absolutely necessary. In this study, porous scaffolds for bone reconstruction were prepared using heat-pressing and salt-leaching methods. High-density polyethylene (HDPE) and poly(ethylene-co-acrylic acid) (PEAA) were chosen as the polymer composites for producing a porous scaffold of high mechanical strength and having high reactivity with biomaterials such as collagen, respectively. The porous structure was observed through surface images, and its intrusion volume and porosity were measured. Owing to the carboxylic acids on PEAA, collagen was successfully grafted onto the porous HDPE/PEAA scaffold, which was confirmed by FT-IR spectroscopy and electron spectroscopy for chemical analysis. Osteoblasts were cultured on the collagen-grafted porous scaffold, and their adhesion, proliferation, and differentiation were investigated. The high viability and growth of the osteoblasts suggest that the collagen-grafted porous HDPE/PEAA is a promising scaffold material for bone generation.

PMID: 27468356 [PubMed - as supplied by publisher]

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State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma.

State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma.

Front Neurol. 2016;7:101

Authors: Saman Y, Mclellan L, Mckenna L, Dutia MB, Obholzer R, Libby G, Gleeson M, Bamiou DE

Abstract
INTRODUCTION: Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function.
AIMS: (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap.
METHODS: Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS-VER.
RESULTS: In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001).
CONCLUSION: Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.

PMID: 27468274 [PubMed - as supplied by publisher]

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The Use of an Ultrasonic Serrated Knife in Transcanal Excision of Exostoses.

The Use of an Ultrasonic Serrated Knife in Transcanal Excision of Exostoses.

Otol Neurotol. 2016 Jul 27;

Authors: Haidar YM, Ajose-Popoola O, Mahboubi H, Moshtaghi O, Ghavami Y, Lin HW, Djalilian HR

Abstract
OBJECTIVE: To describe a novel approach for excision of exostoses and evaluate the outcomes of transcanal excision of exostoses using ultrasonic serrated knife-assistance versus microosteotomes only.
STUDY DESIGN: Retrospective analysis.
SETTING: Academic Tertiary Care Center.
PATIENTS/INTERVENTIONS: Patients receiving a transcanal excision of exostoses between 2007 and 2016.
MAIN OUTCOME MEASURES: The outcomes and postoperative complications of 138 patients who received transcanal microosteotome only technique were compared to 10 patients who received transcanal excision of exostoses using ultrasonic serrated knife-assistance (Stryker Corporation, Kalamazoo, MI).
RESULTS: A total of 175 ears in 128 patients underwent a transcanal microosteotome only technique. Of these, 11 (6.3%) developed an intraoperative tympanic membrane perforation. One developed anterior canal mobilization requiring prolonged (3 wk) packing. One hundred thirty-five ears (77%) were well healed by the 3-week postoperative visit. All but one ear was well healed by the 6-week visit. In comparison, 11 ears in 10 patients were treated for exostoses using a transcanal approach with the use of ultrasonic serrated knife and microosteotomes. One ear canal (the first in the series) was not well healed by the 3-week postoperative visit due to suspected thermal injury. All patients had well-healed ear canals by 6 weeks, and there were no complications.
CONCLUSION: This is the first series to report the use of an ultrasonic serrated knife in the transcanal excision of exostoses. When compared with a transcanal microosteotome only excision of exostoses, the addition of the Sonopet seems to result in a similarly low complication rate. Sonopet can allow for more controlled transcanal excision of broad-based exostoses in patients with severe obstruction.

PMID: 27466896 [PubMed - as supplied by publisher]

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3D HD Endoscopy in Skull Base Surgery: From Darkness to Light.

3D HD Endoscopy in Skull Base Surgery: From Darkness to Light.

Surg Technol Int. 2016 Jul 29;XXIX

Authors: Altieri R, Tardivo V, Pacca P, Pennacchietti V, Penner F, Garbossa D, Ducati A, Garzaro M, Zenga F

Abstract
The introduction of modern endoscopy in neurosurgery brought light to one of the darkest areas: the skull base. In particular, the trans-nasal route allowed skull base surgeons to visualize and dominate the entire midline skull base. We analyzed our surgical series of 199 patients that were affected by several pathologies (pituitary adenomas, clivalchordomas, craniopharyngioma, Rathke's cleft cysts, tuberculum sellaemeningiomas, and craniovertebral junction pathologies with bulbar compression) and treated each by using a 3D-HD endoscope between December 2012 and December 2015 and reviewed the literature. We present our results in terms of tumor resections and decompression inpatients affected by craniovertebral junction pathologies. Analyzing our direct experience, as well as the literature, we can assert that the amount and accuracy of necessary movements in order to achieve a determined target are affected by the screen clarity and image resolution of the device. Additionally, the experience of the surgeon has an important role in the surgical outcome. Moreover, depth perception is critical in order to obtain precise and accurate movements. Our observations and the experts' opinion indicate that this modality provides improved surgical dexterity by affording the surgeon with depth perception while manipulating tissue and maneuvering the endoscope in the endonasal corridor, which is especially crucial in reducing the learning curve of young neurosurgeons.

PMID: 27466871 [PubMed - as supplied by publisher]

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Optic Pathway Glioma and Cerebral Focal Abnormal Signal Intensity in Patients with Neurofibromatosis Type 1: Characteristics, Treatment Choices and Follow-up in 134 Affected Individuals and a Brief Review of the Literature.

Optic Pathway Glioma and Cerebral Focal Abnormal Signal Intensity in Patients with Neurofibromatosis Type 1: Characteristics, Treatment Choices and Follow-up in 134 Affected Individuals and a Brief Review of the Literature.

Anticancer Res. 2016 Aug;36(8):4095-121

Authors: Friedrich RE, Nuding MA

Abstract
UNLABELLED: Optic pathway glioma (OPG) is a rare neoplasm and a defining feature of neurofibromatosis type 1 (NF1), a tumor suppressor genetic disorder. OPG predominantly arises during childhood. In contrast to sporadic OPG, this neoplasm frequently appears to show a more favorable course. Outcome appears to depend on localization of tumor; however, the correlation of imaging findings and visual acuity is in general low. Treatment for symptomatic OPG is not well standardized. Furthermore, determination of visual acuity as the most important parameter of follow-up control is often difficult to determine, particularly in children. Focal abnormal signal intensity (FASI) is a characteristic finding on magnetic resonance imaging (MRI) of NF1 patients. The aim of this study was to evaluate clinical and imaging findings of NF1 patients affected with OPG.
PATIENTS AND METHODS: Data of 925 NF1 patients with appropriate MRI cranial sectional images (N=1,948) were evaluated. A further 50 patients with cranial computed tomograms were included in the study. We compared imaging and clinical findings with respect to localization of OPG. Furthermore, we compared follow-up in treated individuals to those who were only regularly re-examined. The presence of FASI on MRI was determined and correlated to the occurrence of OPG. Dodge classification was applied to categorize OPG location.
RESULTS: OPG was diagnosed in 134 patients. The mean age of patients with symptomatic OPG was 7.6 years (n=57, 42.5%) and 11.6 years (n=77, 57.5%) in asymptomatic patients. The female to male ratio was about 1.1:1. In 48 symptomatic patients, the findings of initial ophthalmological investigations were available. In symptomatic patients, reduced visual acuity was the predominant finding. Strabismus (25%), exophthalmos (22.9%) and amblyopia (20.8%) were most frequently noticed, followed by endrocrinological abnormalities (14.6%). However, these findings did not differ between patients who were treated or who were subjected to a 'wait-and-see' policy. We could not verify an effect of therapy on vision in patients treated for OPG compared to symptomatic patients without treatment. OPG affecting the total optic pathway was more frequently diagnosed in symptomatic patients. FASI did not correlate with functional OPG status.
CONCLUSION: OPG in NF1 is symptomatic in slightly less than 50% of affected individuals. This neurological finding may show a wide range of symptoms. At present, no established treatment protocol emerges from the history of the patients of this study and also from the literature. Although the onset of symptomatic OPG is strongly associated with early childhood, late onset of symptomatic OPG is a feature of adult NF1. Research for association of FASI to neurological findings in these patients should be based on other issues than association with OPG.

PMID: 27466519 [PubMed - in process]

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The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas.

The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas.

Neurosurgery. 2016 Jul 25;

Authors: Jones SH, Iannone AF, Patel KS, Anchouche K, Raza SM, Anand VK, Schwartz TH

Abstract
BACKGROUND: Midline ventral skull base meningiomas may be amenable to an endonasal endoscopic approach, which has theoretical advantages and may help preserve quality of life (QOL) when compared with transcranial approaches.
OBJECTIVE: To investigate the effect of age on QOL following endonasal endoscopic surgery, given the documented impact of age on QOL outcomes following transcranial resection of midline ventral skull base meningiomas.
METHODS: We reviewed a prospectively acquired database of endonasal endoscopic surgery for meningiomas. Inclusion criteria included patients who had completed long-term postoperative (≥6 months follow-up) QOL questionnaires (Anterior Skull Base Questionnaire [ASBQ] and Sino-Nasal Outcome Test [SNOT-22]). Postoperative QOL scores were also compared with preoperative QOL in a patient subset.
RESULTS: Long-term QOL data were available in 34 patients. Average postoperative ASBQ and SNOT-22 scores were 3.39 and 23.0, respectively. Better QOL was statistically associated with age <55 (P = .02). In a subset of patients, preoperative and postoperative ASBQ and SNOT-22 scores were compared. Only SNOT-22 scores significantly increased from 15.9 + 20.8 to 25.9 + 19.5 (P = .04).
CONCLUSION: We report the first study specifically evaluating long-term QOL after endonasal endoscopic resection of skull base meningiomas. QOL was decreased postoperatively in patients aged ≥55.
ABBREVIATIONS: ASBQ, Anterior Skull Base QuestionnaireGTR, gross total resectionQOL, quality of lifeSNOT-22, 22-item Sino-Nasal Outcome Test.

PMID: 27465844 [PubMed - as supplied by publisher]

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State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma.

State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma.

Front Neurol. 2016;7:101

Authors: Saman Y, Mclellan L, Mckenna L, Dutia MB, Obholzer R, Libby G, Gleeson M, Bamiou DE

Abstract
INTRODUCTION: Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function.
AIMS: (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap.
METHODS: Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS-VER.
RESULTS: In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001).
CONCLUSION: Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.

PMID: 27468274 [PubMed - as supplied by publisher]

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