Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

J Laryngol Otol. 2016 Mar;130(3):235-241

Authors: Harris AT, Mettias B, Lesser TH

Abstract
BACKGROUND: Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.
METHODS: A literature search for all types of cholesteatoma surgery in the PubMed, Google Scholar and Medline databases and in published conference proceedings was undertaken.
RESULTS: There was no level 1 evidence for the best method of primary cholesteatoma surgery. The highest evidence level found (level 2; 5366 patients) shows no difference in hearing change or discharge rate between open and combined approach surgery; however, these methods fail to cure the cholesteatomas in 16.0 per cent and 29.4 per cent of cases, respectively. In a total of 640 patients, reconstruction and/or repair mastoid surgery using a variety of non-comparable techniques had a failure rate of between 5.3 per cent and 20 per cent.
CONCLUSION: The available evidence suggests that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative. This technique appears to provide the lowest recidivism rate combined with a low post-operative ear discharge rate.

PMID: 26878375 [PubMed - as supplied by publisher]

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Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

J Laryngol Otol. 2016 Mar;130(3):321

Authors: Kouhi A, Vakili Zarch V

PMID: 26878378 [PubMed - as supplied by publisher]

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Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.

Iran J Otorhinolaryngol. 2016 Jan;28(84):39-43

Authors: Mishra SK, Mathew GA, Paul RR, Asif SK, John M, Varghese AM, Kurien M

Abstract
INTRODUCTION: Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting.
MATERIALS AND METHODS: A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year.
RESULTS: Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak.
CONCLUSION: Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.

PMID: 26878002 [PubMed]

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Int J Audiol. 2016 Feb 15;:1-10

Authors: Schulz KA, Modeste N, Lee J, Roberts R, Saunders GH, Witsell DL

Abstract
OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.
DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.
STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.
RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).
CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

PMID: 26878243 [PubMed - as supplied by publisher]

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Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Int J Audiol. 2016 Feb 15;:1-10

Authors: Wu YH, Ho HC, Hsiao SH, Brummet RB, Chipara O

Abstract
OBJECTIVE: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting.
DESIGN: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique.
STUDY SAMPLE: A total of 132 adults with hearing impairment.
RESULTS: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (∼18 dB) than first-time hearing-aid users (∼10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs.
CONCLUSIONS: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.

PMID: 26878163 [PubMed - as supplied by publisher]

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Role of endoscopic surgery in the management of sinonasal and skull base schwannomas.

Role of endoscopic surgery in the management of sinonasal and skull base schwannomas.

Head Neck. 2016 Feb 15;

Authors: Karligkiotis A, Turri-Zanoni M, Sica E, Facco C, Freguia S, Mercuri A, Pistochini A, Bignami M, Castelnuovo P

Abstract
BACKGROUND: The purpose of this study was to report our experience with the endoscopic management of sinonasal schwannomas, analyzing the advantages, limitations, and outcomes of the technique.
METHODS: A retrospective analysis was carried out on 11 patients treated endoscopically between 2000 and 2014 at a single institution.
RESULTS: Eight patients underwent an exclusive endoscopic endonasal approach, whereas, in 3 patients, an osteoplastic flap was combined because of massive or lateral frontal sinus involvement. The tumor extended into the orbit in 5 cases, and involved the skull base in 5 patients who required a concomitant endoscopic duraplasty. No evidence of disease was observed in 10 patients after a mean follow-up of 90.1 months (range, 14-189 months). One patient was alive with persistence of disease, although asymptomatic.
CONCLUSION: The endoscopic endonasal approach is a valid alternative for the vast majority of sinonasal schwannomas with minimal morbidity for the patient. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26876981 [PubMed - as supplied by publisher]

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How I do it: the combined petrosectomy.

How I do it: the combined petrosectomy.

Acta Neurochir (Wien). 2016 Feb 15;

Authors: Troude L, Carissimi M, Lavieille JP, Roche PH

Abstract
BACKGROUND: Petroclival and ventral brain stem tumors require a complex approach.
METHOD: The combined petrosectomy is an epidural transtentorial-transpetrosal otoneurosurgical approach to achieve a retrolabyrinthine presigmoidal approach and an anterior petrosectomy in one single procedure. The different steps of this approach are described and illustrated by figures and a video. The indications and limitations of the technique are presented.
CONCLUSION: The combined petrosectomy offers multiple corridors to the petroclival region and ventral brainstem while preserving the intrapetrous neurotological structures. Meticulous stepwise bony resection optimizing the dural opening and preservation of veins contributes to reducing the risk inherent to this technique.

PMID: 26876566 [PubMed - as supplied by publisher]

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Uncontrolled spread following radiosurgery for a skull base aspergilloma misdiagnosed as schwannoma: is radiosurgery responsible?

Uncontrolled spread following radiosurgery for a skull base aspergilloma misdiagnosed as schwannoma: is radiosurgery responsible?

Acta Neurochir (Wien). 2016 Feb 15;

Authors: Mukherjee KK, Salunke P

Abstract
BACKGROUND: Little is known about the natural history of skull base fungal lesions in immunocompetent individuals and the effect of high-dose radiation on fungal lesions.
METHOD AND RESULTS: We report a case where radiosurgery was given to a skull base aspergilloma, mistaking it to be a trigeminal schwannoma. There was dramatic spread of the lesion to periventricular region with significant increase in the skull base lesion. The patient never received steroids. A stereotactic biopsy established the diagnosis, and treatment with voriconazole helped.
CONCLUSIONS: It is possible that radiosurgery decreases local immunity due to vascular sclerosis and aids in spread of the fungal lesion, though it is only speculative. This again highlights the importance of establishing the diagnosis prior to radiosurgery.

PMID: 26876565 [PubMed - as supplied by publisher]

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Advantage of extended craniofacial resection for advanced malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and surgical management.

Advantage of extended craniofacial resection for advanced malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and surgical management.

World Neurosurg. 2016 Feb 11;

Authors: Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M

PMID: 26875653 [PubMed - as supplied by publisher]

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Endoscopic endonasal transmaxillary transpterygoid approach to meckel cave: anatomical study and preliminary clinical results.

Related Articles

Endoscopic endonasal transmaxillary transpterygoid approach to meckel cave: anatomical study and preliminary clinical results.

J Neurol Surg A Cent Eur Neurosurg. 2015 May;76(3):205-10

Authors: Gu Y, Yu Y, Zhang X, Hu F, Wang X, Xu W, Xie T

Abstract
OBJECTIVE: Tumors involving Meckel cave (MC) always present challenges to neurosurgeons. We performed an investigation of the anatomical characteristics of the endoscopic endonasal transmaxillary transpterygoid approach to MC as an alternative to routine transcranial approaches and further confirmed its efficacy in the clinical setting.
METHODS: Five adult fresh head specimens (10 sides) were studied to identify crucial anatomical landmarks and quantify the anatomical structures involved in the endoscopic endonasal transmaxillary transpterygoid approach. Two patients with a tumor involving the left MC were treated using the endoscopic endonasal transmaxillary transpterygoid approach.
RESULTS: The distance from the columella nasi to the choana, the sphenoid ostium, the anterior aperture of the palatosphenoidal canal (PSC), the sphenopalatine foramen, and the anterior aperture of the vidian canal (VC) was 66.5 ± 3.3 mm, 61.2 ± 1.6 mm, 64.6 ± 1.4 mm, 62.8 ± 2.3 mm, and 75.4 ± 3.3 mm, respectively. The distance from the anterior aperture of the VC to the anterior aperture of the PSC and the foramen rotundum (FR) was 2.1 ± 0.7 mm and 7.5 ± 0.7 mm, respectively; the length of the PSC and the VC was 6.4 ± 0.5 mm and 13.3 ± 1.2 mm, respectively. The landmarks of this route included the PSC, the VC, and the paraclival carotid prominence (CP). Subtotal resection and gross total resection were achieved in the first and second patients, respectively.
CONCLUSION: The anatomical landmarks of the endoscopic endonasal transmaxillary transpterygoid route are useful for clinical application. The endoscopic endonasal transmaxillary transpterygoid approach is an effective and minimally invasive route for certain tumors involving MC. Identifying the anatomical landmarks including the PSC, the VC, the FR, and the CP is crucial for safe manipulation.

PMID: 25539067 [PubMed - indexed for MEDLINE]

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Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):79-82

Authors: Izadi F, Ghanbari H, Azizi MR, Gasembaglou S, Manteghi MJ, Ghanbari A

Abstract
INTRODUCTION: Inflammatory myofibroblastic pseudotumors are initially described in the lung and various extrapulmonary sites such as the orbits, palatine tonsils, ears, gingiva, pterygomaxillary space, and periodontal tissues. These tumors rarely involve the larynx and predilection to the glottis occurs in an indolent manner.
CASE REPORT: This case describes a laryngeal myofibroblastic tumor in a 46-year-old woman who presented with an aggressive tumor that extended to the floor of the mouth and the base of the tongue. Extended supraglottic laryngectomy was undertaken for the patient. The diagnosis was spindle cell proliferation with dense lymphoplasma cell infiltration compatible with inflammatory myofibroblastic tumor (Inflammatory pseudotumor or plasma cell granuloma). Definitive diagnosis was achieved with immunohistochemical (IHC) staining.
CONCLUSION: We believe that further IHC studies are required to define the true nature of these tumors especially for those that behave in an aggressive pattern.

PMID: 26878008 [PubMed]

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Pleomorphic Adenoma of the Larynx: A Case Report.

Pleomorphic Adenoma of the Larynx: A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):73-7

Authors: Motahari SJ, Khavarinejad F, Salimi S, Bahari M

Abstract
INTRODUCTION: Pleomorphic adenomas are tumors mostly originating from salivary glands. These lesions in the larynx are very rare.
CASE REPORT: We report a rare case of pleomorphic adenoma that originated from the mucosal lining, just above the glottic area at the level of the laryngeal ventricle in a 55-year-old female patient. The tumor could not be palpated easily but was observed in the CT scan. We resected the large and firm tumor using trans hyoid pharyngotomy as the surgical approach.
CONCLUSION: Pleomorphic adenoma in the ventricle of the larynx is an extremely rare lesion. Trans-hyoid pharyngotomy can have good results as the surgical approach in removing such lesions.

PMID: 26878007 [PubMed]

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Relapsing polychondritis: A clinical update.

Relapsing polychondritis: A clinical update.

Autoimmun Rev. 2016 Feb 11;

Authors: Longo L, Greco A, Rea A, Vasco VR, De Virgilio A, De Vincentiis M

Abstract
Relapsing polychondritis (RP) is a rare connective tissue disease in which recurrent bouts of inflammation, involve the cartilage of the ears, nose, larynx, tracheobronchial tree and cardiovascular system. RP is generally observed in the fourth and fifth decade of life and occur with equal frequency in both sexes. The cause of RP is still unknown. It is considered an immune-mediated disease, as there is an overlap well documented RP with other rheumatic and autoimmune diseases. There is a significant association of RP with the antigen HLA-DR4. RP include loss of basophilic staining of cartilage matrix perichondral accompanied by inflammation of the cartilage. Cells are present perivascular mononuclear and polymorphonuclear cells infiltrated. The chondrocytes become vacuolated and necrotic and are replaced by fibrous tissue. Common symptoms are often absent in the early stages of the disease in almost half the cases, resulting in delay in diagnosis. The development of chondrite allows the diagnosis of RP in patients initially evaluated for joint abnormalities, ocular, cutaneous, or audio-vestibular. Diagnostic criteria for RP are based on characteristic clinical manifestations. According to Damiani and Levine, the diagnosis can be considered final when one or more of the clinical features are present in conjunction with biopsy confirmation. The course of symptoms for patients with relapsing polychondritis is often unpredictable. Patients with mild signs of acute inflammation are usually treated with non-steroidal anti-inflammatory drugs and small doses of prednisone. Patients with severe manifestations, such as airway compromise may require high doses of prednisone or even intravenous pulse methyl-prednisone.

PMID: 26876384 [PubMed - as supplied by publisher]

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The involvement of upper airway in Wegener's granulomatosis - about four cases.

Related Articles

The involvement of upper airway in Wegener's granulomatosis - about four cases.

Rom J Morphol Embryol. 2015;56(2):613-8

Authors: Sarău CA, Lighezan DF, Doroş IC, Ştefănescu EH, Iovănescu G, Balica NC, Horhat ID, Poenaru M

Abstract
The authors present four cases of Wegener's granulomatosis patients with multiorganic manifestation forms, but with a prevalent involvement in upper-airway. Granulomatosis diseases of the nose include bacterial infections (rhinoscleroma, tuberculosis, syphilis, lupus, and leprosy), fungal infections (rhinosporidiosis, aspergillosis, mucormycosis, candidosis, histoplasmosis, and blastomycosis) and diseases with unspecified etiology (Wegener's granulomatosis, mediofacial malignant granuloma, and sarcoidosis). We consider an interesting experience regarding Wegener's granulomatosis due to its rarity, being an autoimmune systemic disease, with continuous evolution and multiorganic involvement. The beginning of the disease is like upper airway affection, a kind of "persistent cold", being difficult to differentiate it from a common cold in the head, with a prolonged evolution. It is important to mention that we establish the diagnosis of Wegener's granulomatosis starting with Ear Nose and Throat (ENT) clinical exam, followed by other tests and investigations realized in our Clinic and completed with specialty tests (nephrology, internal medicine and dermatology), meaning that we need a close cooperation with these medical specialties. All the patients presented multiorganic involvement. Notably significant for our four cases is the prolonged evolution in a stable condition in one patient.

PMID: 26193239 [PubMed - indexed for MEDLINE]

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Chronic Invasive Fungal Granuloma-A Diagnostic Dilemma in an Immunocompetent Host.

Chronic Invasive Fungal Granuloma-A Diagnostic Dilemma in an Immunocompetent Host.

Iran J Otorhinolaryngol. 2016 Jan;28(84):83-8

Authors: S Chavan S, Bhople KS, Deshmukh SD, V Jain P, Sonavani M

Abstract
INTRODUCTION: Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, not only in immunocompromised patients but also in immunocompetent patients. The changing prevalence towards immunocompetent hosts is due to the indiscriminate usage of broad spectrum antibiotics, steroids, and immunosuppressive drugs. Diagnosing invasive fungal sinusitis should not pose any difficulty to both the clinician [a whitish colour secretion in elderly Diabetics, and CT Scan PNS showing concretion in the sinus along with destruction of the surrounding bone] and to the pathologist; however, when the invasive fungal sinus infection presents in a form of a granuloma then its diagnosis imposes a challenge to medical professionals.
CASE REPORT: We are presenting a case study,which consists of 3 cases of chronic invasive fungal sinus infection.Two patients were treated for tuberculoma and had completed a course of Anti Koch's Treatment and one patient was given a trial of broad spectrum antibiotics and steroids.Eventually all cases were diagnosed as a chronic invasive form of fungal granuloma (CIFG).
CONCLUSION: CIFG of the paranasal sinuses is seen in immunocompetent hosts, especially those that are in the 2nd and 3rd decades of their lives. Gradually progressive proptosis is the primary presenting symptom. MRI scanning is a better imaging modality compared to CT scanning. Routine H&E staining may prove inadequate and special stains such as the GMS stain should be employed in the slightest doubt of a fungal aetiology. A team approach towards patients is paramount for early diagnosis and timely medical and surgical intervention.

PMID: 26878009 [PubMed]

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Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):79-82

Authors: Izadi F, Ghanbari H, Azizi MR, Gasembaglou S, Manteghi MJ, Ghanbari A

Abstract
INTRODUCTION: Inflammatory myofibroblastic pseudotumors are initially described in the lung and various extrapulmonary sites such as the orbits, palatine tonsils, ears, gingiva, pterygomaxillary space, and periodontal tissues. These tumors rarely involve the larynx and predilection to the glottis occurs in an indolent manner.
CASE REPORT: This case describes a laryngeal myofibroblastic tumor in a 46-year-old woman who presented with an aggressive tumor that extended to the floor of the mouth and the base of the tongue. Extended supraglottic laryngectomy was undertaken for the patient. The diagnosis was spindle cell proliferation with dense lymphoplasma cell infiltration compatible with inflammatory myofibroblastic tumor (Inflammatory pseudotumor or plasma cell granuloma). Definitive diagnosis was achieved with immunohistochemical (IHC) staining.
CONCLUSION: We believe that further IHC studies are required to define the true nature of these tumors especially for those that behave in an aggressive pattern.

PMID: 26878008 [PubMed]

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Pleomorphic Adenoma of the Larynx: A Case Report.

Pleomorphic Adenoma of the Larynx: A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):73-7

Authors: Motahari SJ, Khavarinejad F, Salimi S, Bahari M

Abstract
INTRODUCTION: Pleomorphic adenomas are tumors mostly originating from salivary glands. These lesions in the larynx are very rare.
CASE REPORT: We report a rare case of pleomorphic adenoma that originated from the mucosal lining, just above the glottic area at the level of the laryngeal ventricle in a 55-year-old female patient. The tumor could not be palpated easily but was observed in the CT scan. We resected the large and firm tumor using trans hyoid pharyngotomy as the surgical approach.
CONCLUSION: Pleomorphic adenoma in the ventricle of the larynx is an extremely rare lesion. Trans-hyoid pharyngotomy can have good results as the surgical approach in removing such lesions.

PMID: 26878007 [PubMed]

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An Unusual Case of Cauda Equina Secondary to Spinal Metastasis of Thyroid Cancer.

An Unusual Case of Cauda Equina Secondary to Spinal Metastasis of Thyroid Cancer.

Iran J Otorhinolaryngol. 2016 Jan;28(84):67-71

Authors: Akhtar S, Adeel M

Abstract
INTRODUCTION: Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity.
CASE REPORT: We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of the chest wall lesion was undergone, which was diagnosed as a follicular carcinoma of the thyroid.
CONCLUSION: Metastatic workup of spinal metastasis should include evaluation of the thyroid gland.

PMID: 26878006 [PubMed]

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Effects of Tonsil size on Pulmonary Function test Results after Tonsillectomy in Children.

Effects of Tonsil size on Pulmonary Function test Results after Tonsillectomy in Children.

Iran J Otorhinolaryngol. 2016 Jan;28(84):61-6

Authors: Samareh Fekri M, Arabi Mianroodi A, Shakeri H, Khanjani N

Abstract
INTRODUCTION: Adenotonsillar hypertrophy is a typical cause of surgery in children. Evaluation and identification of patients as potential candidates tonsillectomy is a primary concern for otolaryngologists. This study focuses on the results of pulmonary function tests (PFTs) after tonsillectomy in children.
MATERIALS AND METHODS: This cross-sectional study examined 50 patients suffering from tonsillar hypertrophy in 2013. Full details and results of otolaryngology examinations were recorded. Moreover, patients were examined with respect to forced inspiratory flow at 50% of vital capacity (FIF50%), forced expiratory flow at 50% of vital capacity (FEF50%), forced expiratory volume in 1 second (FEV1)/peak expiratory flow rate (PEFR), and FEV1/forced expired volume in 0.5 seconds (FEV0.5) before and after surgery using spirometry. All data were analyzed using SPSS Software (version 19), and central descriptive measures, and data were compared by performing T-test and Chi-square tests.
RESULTS: According to tonsil size, patients were distributed as follows: 18 patients (36%) with +1 tonsil size, 18 patients (36%) with +2 tonsil size, and seven patients (14%) with +3 tonsil size, and seven patients (14%) with +4 tonsil size. Thirty-three (66%) and 17 patients (34%) were female and male, respectively, with a mean of age of 9.7[Formula: see text]2.97 years (range, 7-18 years). Seventy-eight percent of patients were aged 10 years or less. Moreover, 25 patients (50%), 17 patients (34%), and eight patients (16%), respectively, reported obstructive symptoms, recurrent tonsillitis, and both symptoms. In patients with +3 and +4 tonsil size, spirometric parameters indicated relief of symptoms of obstruction. Only in patients with +4 tonsil size were the changes statistically significant.
CONCLUSION: Tonsillectomy can relieve obstructive symptoms in patients with tonsils larger than +3 to a great extent. Additionally, spirometry can identify patients with +3 and +4 tonsils who do not have clinical signs of an obstructive upper airway.

PMID: 26878005 [PubMed]

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MTA1 Expression in Benign and Malignant Salivary gland Tumors.

MTA1 Expression in Benign and Malignant Salivary gland Tumors.

Iran J Otorhinolaryngol. 2016 Jan;28(84):51-9

Authors: Andisheh-Tadbir A, Dehghani-Nazhvani A, Ashraf MJ, Khademi B, Mirhadi H, Torabi-Ardekani S

Abstract
INTRODUCTION: Salivary gland tumors (SGTs) are important parts of human neoplasms. The most common SGT is pleomorphic adenoma and the most common malignant SGTs are mucoepidermoid carcinoma and adenoid cystic carcinoma (ACC). Metastasis-associated genes 1 (MTA1), a member of the nucleosome remodeling and histone deacetylation complex, is one newly discovered gene which recruits histone deacetylation, causing ATP-dependent chromosome remodeling, and regulating transcription. MTA1 had been shown to be overexpressed in malignant tumors with the enhancement of invasion and metastasis.
MATERIALS AND METHODS: Fifty-six samples of salivary gland tumors from the Khalili Hospital archive, including 20 cases of pleomorphic adenoma, 17 cases of mucoepidermoid carcinoma, 19 cases of ACC, and 23 cases of normal salivary gland tissues were chosen for immunohistochemical analysis of MTA1.
RESULTS: MTA1 expression in the malignant tumors was significantly higher than that in pleomorphic adenoma (P<0.001), and higher in pleomorphic adenoma than the normal salivary glands(P< 0.001). In total, 69.6% of normal salivary gland tissues showed MTA1, but all cases of salivary gland tumors were positive for MTA1. High nuclear expression of MTA1 was detected in 83.3% (30/36) of the malignant salivary gland tumors and 45% (9/20) of pleomorphic adenoma, while low MTA1 expression was seen in all of the normal salivary gland tissues. No statistically significant correlation was found between MTA1 protein expression and any clinicopathological features (P>0.05).
CONCLUSION: Our findings demonstrate that MTA1 was significantly overexpressed in malignant salivary gland neoplasm in comparison to a lower level in benign pleomorphic adenoma, suggesting that MTA1 protein might be involved in carcinogenesis.

PMID: 26878004 [PubMed]

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Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

J Laryngol Otol. 2016 Mar;130(3):321

Authors: Kouhi A, Vakili Zarch V

PMID: 26878378 [PubMed - as supplied by publisher]

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Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion.

Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion.

J Laryngol Otol. 2016 Mar;130(3):318

Authors: Bakshi SS

PMID: 26878377 [PubMed - as supplied by publisher]

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You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients.

You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients.

J Laryngol Otol. 2016 Mar;130(3):278-283

Authors: Ghosh A, Philiponis G, Bewley A, Ransom ER, Mirza N

Abstract
OBJECTIVE: A prospective randomised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population.
METHODS: Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period. They were randomised to a cash incentives or no incentive group. Subjects were offered enrolment in smoking cessation courses. Smoking by-product levels were assessed at 30 days, 3 months and 6 months. Subjects in the incentive group received $150 if smoking cessation was confirmed.
RESULTS: Over 2 years, 114 patients with an established diagnosis of head and neck cancer were offered enrolment. Twenty-four enrolled and 14 attended the smoking cessation classes. Only two successfully quit smoking at six months. Both these patients were in the financially incentivised group and received $150 at each test visit.
CONCLUSION: Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful.

PMID: 26878376 [PubMed - as supplied by publisher]

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Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

J Laryngol Otol. 2016 Mar;130(3):235-241

Authors: Harris AT, Mettias B, Lesser TH

Abstract
BACKGROUND: Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.
METHODS: A literature search for all types of cholesteatoma surgery in the PubMed, Google Scholar and Medline databases and in published conference proceedings was undertaken.
RESULTS: There was no level 1 evidence for the best method of primary cholesteatoma surgery. The highest evidence level found (level 2; 5366 patients) shows no difference in hearing change or discharge rate between open and combined approach surgery; however, these methods fail to cure the cholesteatomas in 16.0 per cent and 29.4 per cent of cases, respectively. In a total of 640 patients, reconstruction and/or repair mastoid surgery using a variety of non-comparable techniques had a failure rate of between 5.3 per cent and 20 per cent.
CONCLUSION: The available evidence suggests that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative. This technique appears to provide the lowest recidivism rate combined with a low post-operative ear discharge rate.

PMID: 26878375 [PubMed - as supplied by publisher]

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Medications for Ménière's disease?

Medications for Ménière's disease?

J Laryngol Otol. 2016 Mar;130(3):213

Authors: Youngs R, Fisher E, Hussain M, Fishman J

PMID: 26878374 [PubMed - as supplied by publisher]

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Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites.

Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites.

J Laryngol Otol. 2016 Feb 15;:1-5

Authors: Morand GB, Madana J, Da Silva SD, Hier MP, Mlynarek AM, Black MJ

Abstract
BACKGROUND: Merkel cell carcinoma is a rare, aggressive neurocutaneous malignancy. This study investigated whether patients with Merkel cell carcinoma in the head and neck had poorer outcomes than patients with Merkel cell carcinoma located elsewhere.
METHODS: A retrospective study was performed of patients with Merkel cell carcinoma treated at the Jewish General Hospital in Montréal, Canada, from 1993 to 2013. Associations between clinicopathological characteristics and disease-free and disease-specific survival rates were examined according to the Kaplan-Meier method.
RESULTS: Twenty-seven patients were identified. Although basic clinicopathological characteristics and treatments were similar between head and neck and non-head and neck Merkel cell carcinoma groups, disease-free and disease-specific survival rates were significantly lower in the head and neck Merkel cell carcinoma group (log-rank test; p = 0.043 and p = 0.001, respectively). Mortality was mainly due to distant metastasis.
CONCLUSION: Patients with head and neck Merkel cell carcinoma had poorer survival rates than patients with non-head and neck Merkel cell carcinoma in our study. The tendency to obtain close margins, a less predictable metastatic pattern, and/or intrinsic tumour factors related to the head and neck may explain this discrepancy.

PMID: 26875509 [PubMed - as supplied by publisher]

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