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| Related Articles |
[Neuronavigation-guided pure endoscopic endonasai transsphenoidal approach for pituitary adenomas].
Zhonghua Yi Xue Za Zhi. 2015 Feb 3;95(5):339-43
Authors: Hu C, Ji H, Zhang S, Hao X, Shen B, Su L
Abstract
OBJECTIVE: To explore the efficacies of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for removing pituitary adenomas.
METHODS: Retrospective analyses were conducted for the clinical data of 139 patients undergoing pure endoscopic endonasal transsphenoidal surgery for pituitary adenomas between July 2011 and July 2014. There were 55 males and 84 females with a mean age of 48. 9 (21 - 73) years. The classifications of Hardy-Wilson were I (n =16), II (n = 39), III (n = 48) and IV (n = 36). Neuronavigation was used in all patients. And neuro-ophthalmological, neuroimaging and endocrinological follow-ups were conducted postoperatively.
RESULTS: Total (n = 95, 68. 3%), subtotal (n = 33, 23. 7%) and partial (n = 11, 7. 9%) removals were achieved. For Hardy-Wilson I, gross total removal was achieved (n = 16, 100%); Hardy-Wilson II (n = 35, 89. 7%), Hardy-Wilson III (n = 34, 70. 8%) and Hardy-Wilson IV (n = 10, 27. 8%). Postoperative visual acuity improved (92. 1%, 70/76) and endocrine remission was observed (59. 6%, 53/89). The postoperative complications included cerebrospinal fluid (CSF) leakage (n = 8, 5. 8%), meningitis (n = 3), sellar hematoma (n = 5) and delayed carotid artery rupture (n = 1). And the patient of hemorrhagic shock underwent emergency interventional procedures and was discharged successfully.
CONCLUSION: Pure endoscopic endonasal transsphenoidal approach for removing pituitary adenoma is both safe and effective. And its efficacies may further increased through combined neuronavigation.
PMID: 26168667 [PubMed - indexed for MEDLINE]
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A new method to determine whether ossified posterior longitudinal ligament can be resected completely and safely: spinal canal "Rule of Nine" on axial computed tomography.
Eur Spine J. 2015 Aug;24(8):1673-80
Authors: Yang H, Lu X, Wang X, Chen D, Yuan W, Yang L, Liu Y
Abstract
PURPOSE: To introduce the new method of spinal canal "Rule of Nine" on axial computed tomography (CT) to determine whether ossified posterior longitudinal ligament (OPLL) can be resected completely and safely.
METHODS: From January 2008 to January 2013, we retrospectively analyzed 308 patients with cervical OPLL who underwent anterior corpectomy. Patients were examined by cervical plain X-ray, CT, and magnetic resonance imaging. The characteristics of OPLL on axial CT, dural mater adhesion and ossification, complete resection of the ossified mass, cerebrospinal fluid (CSF) leakage, spinal cord injury (SCI), and postoperative outcome were all studied. OPLL was characterized at the maximum ossified level using spinal canal "Rule of Nine" on axial CT.
RESULTS: OPLL was completely and safely resected in 129 patients, whose ossified mass was within the safety zone. No CSF leakage or SCI occurred. The most ossified material was resected when OPLL was within the danger zone in 21 patients. There were two cases of SCI and seven of CSF leakage. In the other 158 patients, the ossified mass was within the intermediate zone. In 96 patients the width of the ossified mass was <2 resection units. It was completely resected and one case had CSF leakage. In the other 62 cases, the ossified mass was >2 resection units and there were nine cases of CSF leakage. CSF leakage and SCI increased significantly when the ossified mass was ≥6 units. The inter- and intraobserver κ values were 0.76 and 0.84, respectively, showing a good reliability.
CONCLUSIONS: Our new method can be used to determine whether OPLL can be resected completely and safely, and identify potential risks and complications.
PMID: 25192727 [PubMed - indexed for MEDLINE]
Mobile Phone Usage and its Health Effects Among Adults in a Semi-Urban Area of Southern India.
J Clin Diagn Res. 2016 Jan;10(1):LC14-6
Authors: Stalin P, Abraham SB, Kanimozhy K, Prasad RV, Singh Z, Purty AJ
Abstract
INTRODUCTION: Worldwide, mobile phone usage has been increased dramatically which could affect the health of the people. India has the second largest number of mobile phone users. However there are only few studies conducted in India to assess its effects on health.
AIM: To determine the prevalence and pattern of mobile phone usage and to assess the relationship between certain selected health problems and mobile phone usage among adults.
SETTINGS AND DESIGN: Community-based cross-sectional study was conducted in Kottakuppam, a town panchayat in Villupuram district of Coastal Tamil Nadu, Southern India. It is a semi-urban area with a population of about 16,000. Majority of the residents are Muslim by religion and belong to different socio economic status.
MATERIALS AND METHODS: The study was approved by the Institutional Ethics Committee. A total of 2121 study participants were interviewed by the pre-final medical students through house-to-house survey using a pretested structured questionnaire. The questionnaire included the variables such as socio demographic profile, mobile phone usage and pattern, selected health problems, perceived benefits and threats and blood pressure. Selected health problems included headache, earache, neck pain, tinnitus, painful fingers, restlessness, morning tiredness, tingling fingers, fatigue, eye symptoms, sleep disturbance and hypertension.
STATISTICAL ANALYSIS USED: Only 2054 were included for data analysis using SPSS 17 version. Proportions were calculated. Chi-square test was used to measure the p-value. The p-value < 0.05 was considered as statistically significant.
RESULTS: The prevalence of mobile phone usage was 70%. Calling facility (94.2%) was used more than the SMS (67.6%). Health problems like headache, earache, tinnitus, painful fingers and restlessness etc., were found to be positively associated with mobile phone usage. There was negative association between hypertension and mobile phone usage.
CONCLUSION: The prevalence of mobile phone usage was high. There was significant association between selected health problems and mobile phone usage. In future, higher studies are required to confirm our findings.
PMID: 26894095 [PubMed]
Prevalence and nature of survivorship needs in patients with head and neck cancer.
Head Neck. 2016 Feb 19;
Authors: Giuliani M, McQuestion M, Jones J, Papadakos J, Le LW, Alkazaz N, Cheng T, Waldron J, Catton P, Ringash J
Abstract
BACKGROUND: The purpose of this study was to determine the number, type, and predictors of patients with head and neck cancer unmet survivorship needs.
METHODS: This study accrued patients with head and neck cancer at any time point in their survivorship course, and they completed a survey, including demographic information and the Cancer Survivors' Unmet Needs Measure (CaSUN).
RESULTS: The median age of the 158 participants was 64 years. Ninety-six patients (61%) reported at least one unmet need on the CaSUN and 6 patients had a very high number of needs between 31 and 35. The mean number of unmet needs was 5.8 ± 8.9. Comprehensive Cancer Care was the most common domain of unmet need (n = 69; 45%). Younger age, earlier survivorship phase, and worse quality of life were associated with increased survivorship unmet needs on multivariable analysis.
CONCLUSION: A high proportion of patients with head and neck cancer have unmet needs. These data can guide the development of head and neck survivorship programs. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 26894614 [PubMed - as supplied by publisher]
Anaplastic thyroid cancer: Prognostic factors, patterns of care, and overall survival.
Head Neck. 2016 Feb 19;
Authors: Glaser SM, Mandish SF, Gill BS, Balasubramani GK, Clump DA, Beriwal S
Abstract
BACKGROUND: Anaplastic thyroid cancer (ATC) represents a rare, aggressive malignancy. We analyzed factors predictive for overall survival (OS) and treatment modality utilization.
METHODS: Using the National Cancer Data Base, we identified 3552 patients with ATC. Factors associated with surgery, high-dose radiotherapy (RT; ≥59.4 Gy), and chemotherapy utilization were evaluated using multivariable logistic regression. From this, an inverse probability-weighted propensity score was incorporated into multivariable Cox regression analyses for OS.
RESULTS: Numerous factors predictive for high-dose RT, total thyroidectomy, and chemotherapy utilization are described. Factors associated with improved survival were absence of clinical or pathologic lymph node involvement, absence of metastasis, tumor size ≤6 cm, negative surgical margins, surgery, RT, and chemotherapy. On conditional landmark analysis, improved survival seen with chemotherapy and surgery other than total thyroidectomy was lost, but persisted for total thyroidectomy and high-dose RT.
CONCLUSION: Even after correction for selection and immortal time bias, high-dose RT resulted in improved survival. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 26894506 [PubMed - as supplied by publisher]
Cerebellar liponeurocytoma: A case report and review of the literature.
Oncol Lett. 2016 Feb;11(2):1061-1064
Authors: Wang KE, Ni M, Wang L, Jia G, Wu Z, Zhang L, Zhang J
Abstract
Cerebellar liponeurocytoma is rare, and the clinical characteristics and treatment strategy remain unclear. In the present study, a case of cerebellar liponeurocytoma was retrospectively reported and a literature review was performed. A 45-year-old female presented due to occipital headaches, exhibiting a hoarse voice and a broad-based gait. Pre-operative magnetic resonance images revealed a lesion occupying the right hemisphere of the cerebellum and the inferior vermis, compressing the medulla oblongata from the right side, and extending through the foramen magnum to the C2 level. A total resection was performed, and pathological analysis of the lesion showed positivity for synaptophysin, S-100 and neuronal nuclear antigen, partial positivity for Olig-2, and negativity for glial fibrillary acidic protein and epithelial membrane antigen. In addition, the Ki-67 index was low (<5%). Thus, a diagnosis of cerebellar liponeurocytoma was determined. Total resection was successful and the patient was followed up closely. A review of the literature showed that cerebellar liponeurocytoma is mainly located in the cerebellum, with rare extra-cerebellar cases. Certain studies have suggested that the tumor may be located supratentorially and subtentorially, and should be renamed as solely liponeurocytoma. Total resection of the tumor contributes to an improved prognosis, while a subtotal resection and high Ki-67 index lead to recurrence. The tumor is similar to a tumor of low malignancy, with long-term recurrence. Radiation is recommended when there is residual tumor, recurrence or when the Ki-67 is high.
PMID: 26893691 [PubMed - as supplied by publisher]
Radiation-induced anaplastic ependymoma mimicking a skull base meningioma: A case report.
Exp Ther Med. 2016 Feb;11(2):455-457
Authors: Spallone A, Marchione P, DI Capua M, Belvisi D
Abstract
The present study describes the case of a 63-year-old woman presenting with headache, dizziness and vomiting due to a an ovoid mass in the left pre-bulbar cistern, apparently arising from the lower clivus and the foramen magnum. The clinical history revealed the subtotal removal of a right cerebellar low-grade glioma 15 years previously and subsequent conventional 60-Gy radiotherapy. Notably, following gross total resection, histopathological examination showed microscopic features that resulted in a diagnosis of anaplastic ependymoma. The patient underwent surgery to remove the mass and post-operative chemotherapy with temozolomide. A progressive improvement of neurological signs and symptoms was observed during the postoperative course. At the 6-month follow-up, the patient was free from clinical and radiological recurrence. The unusual features of this rare secondary brain tumor were the extrassial location in the posterior fossa, the unusual age-associated location of the histological subtype and the fact that it closely mimicked a skull-base meningioma.
PMID: 26893630 [PubMed - as supplied by publisher]
Sphenoid sinus malignancies: a population-based comprehensive analysis.
Int Forum Allergy Rhinol. 2016 Feb 19;
Authors: Ghosh R, Dubal PM, Chin OY, Patel TD, Echanique KA, Baredes S, Liu JK, Eloy JA
Abstract
BACKGROUND: Sinonasal malignancies are rare, representing less than 1% of all cancers, with the sphenoid sinus accounting for 1% to 2% of these cases. Sphenoid sinus malignancies exhibit very poor outcomes. There is a paucity of literature describing their histopathological features, incidence trends, treatment, and survival. We seek to elucidate these factors using a national population-based resource.
METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify malignant sphenoid sinus tumors. The results were analyzed for demographics, incidence, and clinicopathologic trends. Survival was calculated using Kaplan-Meier analysis.
RESULTS: The search identified 472 cases. The mean and median age at diagnosis was 60.0 years. Males represented 54.9% of cases. By race/ethnicity, 82.4% were white and 8.5% were black. The four most common histopathologies were squamous cell neoplasms (29.4%), adenocarcinomas (14.4%), non-Hodgkin's mature B-cell lymphomas (13.1%), and unspecified epithelial neoplasms (11.0%). The overall incidence from 2000 to 2012 was 0.030 per 100,000. Kaplan-Meier analysis demonstrated an overall 5-year disease-specific survival (DSS) of 48.1%. Of the most common histopathological subtypes, 5-year DSS was best for mature B-cell NHL (64.0%) and worst for unspecified epithelial neoplasms (25.6%).
CONCLUSION: Sphenoid sinus malignancies are rare, with high prevalence in white males. The most common histopathology is squamous cell neoplasms. They exhibit significant locoregional extension. Of the common sphenoid sinus malignant subtypes, 5-year DSS is best for mature B-cell NHL and worst for unspecified epithelial neoplasms.
PMID: 26891865 [PubMed - as supplied by publisher]
Early experience in transoral robotic surgery (TORS) for non-oropharyngeal head and neck malignancies: a review of functional and oncologic outcomes.
B-ENT. 2015;Suppl 24:21-31
Authors: Meulemans J, Delaere P, Vander Poorten V
Abstract
OBJECTIVE: To review and summarize functional and oncologic outcomes after transoral robotic surgery (TORS) for non-oropharyngeal head and neck malignancies.
DATA SOURCES: The MEDLINE database and bibliographies of relevant studies were searched through December 2014.
METHODS: Search strategy was ((transoral) AND surgery) AND robotics) OR TORS. Abstracts and titles were screened for relevance and full articles of the selected records were evaluated and critically appraised after inclusion. Data concerning functional and oncologic outcomes as well as adverse effects were collected.
RESULTS: 22 records were eventually included in the review. For TORS in the treatment of glottic, hypopharyngeal ands supraglottic cancer we retained 3 case series (26 patients), 5 case series (36 patients) and 6 case series (67 patients) respectively. 8 case reports/series (14 patients) assessing safety and feasibility of TORS for tumours in the parapharyngeal space, nasopharynx and skull base were also evaluated. In general, treatment of laryngeal and hypopharyngeal cancer by means of TORS seems to be feasible and safe with satisfying functional and short-term oncologic results. For treatment of malignant tumours in the parapharyngeal space, nasopharynx and skull base, the benefits of TORS, when compared to classic surgical techniques, are still uncertain and are particularly based on theoretical advantages.
CONCLUSION: TORS offers an interesting new approach for treating non-oropharyngeal head and neck malignancies. However, long-term results are still not reported and TORS should be directly compared to existing therapeutic options in randomized controlled trials. Until then, its use should be subject to critical appraisal.
PMID: 26891528 [PubMed - in process]
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The Microsurgical Anatomy of the Modified Presigmoid Trans-Partial Bony Labyrinth Approach.
J Craniofac Surg. 2015 Jul;26(5):1619-23
Authors: Luo Z, Zhao P, Yang K, Liu Y, Zhang Y, Liu H
Abstract
OBJECTIVE: To investigate the surgical techniques of the modified presigmoid trans-partial bony labyrinth approach and the advantages in the exposure of the petroclival region and in the treatment of lesions in this area.
METHODS: Between April and October of 2012, a study on modification of the surgical approach was performed on 15 cadaveric heads. On the basis of the traditional presigmoid approach, semicircular canals, and the petrous apex were partially resected. The detailed conditions of the exposure of important structures of the petroclival region were recorded.
RESULTS: This approach provided a large operational space from the petroclival region to the posterior cavernous sinus. The range of presigmoid exposure (horizontal direction) was (19.41 ± 1.58) mm, the exposure range of the inferior temporal (vertical direction) was (14.18 ± 1.88) mm, the maximum exposure angle of the slope center depression was (60.54° ± 6.93°), and the depth of operation was (55.87 ± 4.34) mm. The vertebral-basilar artery, anterior inferior cerebellar artery, superior cerebellar artery, ipsilateral III-X cranial nerves, contralateral VI cranial nerve, Meckel cave, and posterior cavernous sinus were well exposed.
CONCLUSION: The modified presigmoid trans-partial bony labyrinth approach was able to achieve excellent exposure of deep surfaces of the petroclival region and the posterior part of the cavernous sinus and showed advantages including a large range of exposure, multiple axes of visualization, preservation of hearing and facial nerve function, and early devascularization of tumors.
PMID: 26114539 [PubMed - indexed for MEDLINE]
Exploration for an Algorithm for Deintensification to Exclude the Retropharyngeal Site From Advanced Oropharyngeal Squamous Cell Carcinoma Treatment.
JAMA Otolaryngol Head Neck Surg. 2016 Feb 18;
Authors: Spector ME, Chinn SB, Bellile E, Gallagher KK, Kang SY, Moyer JS, Prince ME, Wolf GT, Bradford CR, McHugh JB, Carey TE, Worden FP, Eisbruch A, Ibrahim M, Chepeha DB
Abstract
Importance: Understanding the drainage patterns to the retropharyngeal lymph nodes is an important consideration in oropharyngeal squamous cell carcinoma (OPSCC) because treatment of these nodes is related to increased morbidity. Prediction of these drainage patterns could not only help minimize treatment morbidity but also prevent failures in at-risk patients as deintensification trials are under way for this disease.
Objective: To evaluate the prevalence of pathologic retropharyngeal adenopathy (RPA) in OPSCC relative to involvement of the oropharyngeal subsite, number of metastatic neck nodes, T classification, and N classification.
Design, Setting, and Participants: We performed a retrospective review from January 1, 2003, through December 31, 2010, at an academic referral center of 205 previously untreated patients with pathologically confirmed, advanced-stage (III, IV) OPSCC. Data analysis was performed from January 1, 2013, through June 30, 2015.
Exposure: Concurrent chemoradiotherapy.
Main Outcomes and Measures: Radiologic evidence of pathologic RPA was tabulated and related to involvement of the oropharyngeal subsite, number of metastatic neck nodes, T classification, and N classification.
Results: Of the 205 previously untreated patients (183 men; mean age, 56.1 years), pathologic RPA was identified in 37 (18.0%) of the 205 patients. Pathologic retropharyngeal lymph nodes were found in 12 (13.5%) of 89 patients with base of tongue cancers, 24 (22.0%) of 109 patients with tonsil cancers, and 1 (14.3%) of 7 patients with other oropharyngeal subsite cancers. Increasing prevalence of RPA was positively correlated with closer proximity to the posterior tonsillar pillar. A multivariable logistic regression model using the oropharyngeal subsite, involvement of the posterior tonsillar pillar, number of metastatic neck nodes, T classification, and N classification revealed that the number of metastatic neck nodes was statistically significant (odds ratio, 1.44; 95% CI, 1.20-1.71; P < .001).
Conclusions and Relevance: The prevalence of pathologic RPA in this cohort was 18.0%, and patients with multiple nodes had the highest risk of pathologic RPA, followed by involvement of the posterior tonsillar pillar. However, these data suggest that there is no clear algorithm that can be used for deintensification to exclude the retropharyngeal site from the treatment volume using extent of disease gathered from pretreatment imaging for patients with advanced-stage OPSCC.
PMID: 26892642 [PubMed - as supplied by publisher]
Diagnostic and prognostic value of procalcitonin levels in patients with Bell's palsy.
Eur Arch Otorhinolaryngol. 2016 Feb 19;
Authors: Kilicaslan S, Uluyol S, Gur MH, Arslan IB, Yagiz O
Abstract
Inflammation is thought to play an important role in the pathogenesis of Bell's palsy (BP). Procalcitonin (PCT) is currently among the most frequently used proinflammatory biomarkers in clinical practice. In this study, we assessed the serum PCT levels for predicting the severity and prognosis of BP. In total, 32 patients with House-Brackmann (HB) grade II and III BP (low-grade group), 22 patients with HB grade IV and V (high-grade group) and 35 healthy individuals (control group) were included in this prospective study. PCT levels were compared among these three groups at the time of diagnosis. All patients received standard prednisolone and acyclovir treatment. The correlation between PCT levels and recovery was analyzed 3 months after treatment. The PCT levels for control, low-grade and high-grade BP groups were 0.01 ± 0.001, 0.35 ± 0.05, and 0.98 ± 0.41 ng/mL, respectively. The PCT level in low-grade group was significantly higher than that in control group (p < 0.001), and the PCT level in high-grade BP group was significantly higher than that in low-grade group (p = 0.01, p < 0.05). The complete recovery rate was 93.7 % in low-grade and 54.5 % in high-grade BP group (p = 0.015, p < 0.05). There was a strong negative correlation between PCT levels and recovery rates (r = -0.896, p < 0.001). PCT levels were significantly associated with the severity of BP and higher PCT levels were related with poor clinical outcome in terms of recovery. These results support the diagnostic and prognostic significance of PCT in patients with early BP.
PMID: 26894418 [PubMed - as supplied by publisher]
The laryngeal disease of the German Emperor Friedrich III: treatment failure or fateful course.
Eur Arch Otorhinolaryngol. 2016 Feb 19;
Authors: Rudert H, Werner JA
Abstract
BACKGROUND: Since the death of the Emperor Friedrich III in June 1888, there are still controversial discussions whether the Crown Prince could have been healed from his laryngeal cancer by a thyrotomy planned by his German physicians for May 21, 1887.
METHODS: In order to find an answer to this historical question, the Emperor's biographies, the literature on laryngology published in the late nineteenth and early twentieth century, German manuals on laryngology and ENT, the BMJ and Lancet were thoroughly studied where in particular not only Mackenzie but also Virchow had published several articles on the disease of Friedrich III.
RESULTS: Prof. Gerhardt had decided not to perform biopsies of the tumor. Furthermore, he did not perform iodine potassium treatment ex juvantibus as it was common practice at that time in order to confirm the diagnosis of carcinoma by excluding syphilitic gumma. So Mackenzie was perfectly right when insisting on performing excisional biopsy before surgery. It is tragedy that Virchow by making the diagnosis of pachydermia laryngis provided the justification for canceling the surgical intervention that had already been decided. It was also mistake that Prof. Gerhardt did not accompany the Crown Prince during his stay in England in summer 1887. The authority of the delegated medical officer Dr. Landgraf did not suffice to persuade Mackenzie to discuss again the matter of performing surgery together with Gerhardt and von Bergmann. The drawings made by Dr. Landgraf show an impressive tumor growth. The refusal of new consultations with Gerhardt and von Bergmann by Mackenzie can only be explained by the fact that Mackenzie was generally against such a surgical intervention. Regarding the question of the chances of such a surgery it can be said that thyrotomy and laryngectomy had been refused by the majority of laryngologists since the Congress of London in 1881 and the publication of P. v. Bruns in 1878. In Berlin, however, the improvement of surgical and anesthetic techniques by E. Hahn led to a positive opinion. F. Semon, who had strictly refused thyrotomy until 1886, supported the indication of thyrotomy of the Crown Prince since Hahn had successfully operated one of his patients in London. So the chance of healing a limited carcinoma of the vocal folds by thyrotomy was given. However, it may be questioned if partial resection had the desired outcome. The limited mobility of the left vocal fold that had been diagnosed already in May 1887 indicates that probably laryngectomy would have been necessary. The prognosis of this procedure, however, was extremely poor at that time. It is irony of history that T. Gluck who performed the separation of the airways from the digestive pathways in an animal model already in 1880 under von Langenbeck could not further develop his technique under von Bergmann.
CONCLUSIONS: The Crown Prince acquired his disease at a time when the acceptance of surgical treatment of laryngeal carcinomas had reached its lowest point. Ten years later, the technique of thyrotomy was successfully established by Hahn, Butlin, and Semon so that Morell Mackenzie would probably have agreed to the intervention. Ten years later, due to Gluck and Sörensen, even the technique of laryngectomy had reached the performance that is still valid today so that the Emperor could have been treated successfully even with an advanced laryngeal carcinoma.
PMID: 26894417 [PubMed - as supplied by publisher]
Bone-anchored hearing aids in conductive and mixed hearing losses: why do patients reject them?
Eur Arch Otorhinolaryngol. 2016 Feb 19;
Authors: Siau RT, Dhillon B, Siau D, Green KM
Abstract
This study aimed to report the bone-anchored hearing aid uptake rate and the reasons for their rejection by patients with conductive and mixed hearing losses. A retrospective review was performed of 113 consecutive patients with unilateral or bilateral conductive or mixed hearing loss referred to the Greater Manchester bone-anchored hearing aid (BAHA) programme between September 2008 and August 2011. 98 (86.7 %) patients were deemed audiologically suitable for BAHA implantation. Of these, 38 (38.8 %) had BAHA implanted; 60 (61.2 %) patients declined. Of those who declined, 27 (45 %) cited anxiety over surgery, 18 (30 %) cited cosmetic reasons, 16 (26.7 %) perceived limited benefit from the device and six (10 %) preferred conventional hearing aids. Our study highlights a 38.8 % BAHA uptake rate in audiologically suitable patients. The main reasons cited for rejection of BAHA were anxiety over surgery and cosmetic concerns. It is important that clinicians address these early during consultation with prospective BAHA recipients and avoid rushing to implant these patients with a bone-anchored hearing aid.
PMID: 26894416 [PubMed - as supplied by publisher]
Detection of eustachian tube openings by tubomanometry in adult otitis media with effusion.
Eur Arch Otorhinolaryngol. 2016 Feb 19;
Authors: Liu P, Su K, Zhu B, Wu Y, Shi H, Yin S
Abstract
Otitis media with effusion (OME) is a common disease and eustachian tube (ET) dysfunction is widely known to be related to the incidence of OME; however, objective evaluation tools for ET function are lacking. To evaluate ET openings by tubomanometry (TMM) in adult patients with otitis media with effusion (OME), the ET patency of 123 ears, including 63 ears of OME patients and 60 control ears, were tested using TMM and tympanometry. ET patency was evaluated by the R value and ET score, and was compared to the tympanogram results. The eustachian tube dysfunction questionnaire (ETDQ-7) was used to assess the severity of the symptoms in OME patients. The results showed that the rates of restricted opening or blocked ET under pressures of 30, 40, and 50 mbar by TMM testing were 10, 5, and 0 %, respectively (control group) and 76.19, 66.7, and 57.97 %, respectively (OME group) (p < 0.05 for all pressure groups). However, the rates were 77.42, 71.97, and 61.29 % in the type B tympanogram group, and 75, 62.5, and 46.87 % in the type C tympanogram group; no significant difference was found at each testing pressure (p = 0.821, 0.246, and 0.516; respectively) between these tympanogram groups. The mean ETDQ-7 score in OME patients was 16.40 ± 10.72, which was significantly negatively correlated with the ET score at 30 and 40 mbar (30 mbar: correlation coefficient -0.29, p = 0.025; 40 mbar: correlation coefficient -0.28; p = 0.030), but not at 50 mbar (correlation coefficient -0.013, p = 0.924). These findings showed that ET blockage or delayed opening were found in most adult patients with OME when evaluated by this innovative and semi objective TMM, testing pressures should be considered when assessing the results of TMM in OME patients.
PMID: 26894415 [PubMed - as supplied by publisher]
Treating Benign Paroxysmal Positional Vertigo in the Patient With Traumatic Brain Injury: Effectiveness of the Canalith Repositioning Procedure.
J Neurosci Nurs. 2016 Feb 18;
Authors: Ouchterlony D, Masanic C, Michalak A, Topolovec-Vranic J, Rutka JA
Abstract
OBJECTIVE: The aim of this study was to determine the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) among patients after mild-to-moderate traumatic brain injury.
METHODS: An unblinded, nonrandomized, case comparison interventional study with repeated measures (1, 5, 9, and 12 weeks postenrollment) of three groups of patients with traumatic brain injury (BPPV, n = 21; nonspecific dizziness, n = 23; no dizziness, n = 12) was conducted. Patients in the BPPV group received the CRP at baseline and repeatedly until a negative Dix-Hallpike Maneuver was observed. Participants in the other two groups did not receive the CRP.
RESULTS: Symptom resolution at the 12-week follow-up was observed in 75% of patients in the BPPV group versus 8.3% in the nonspecific dizziness group (p = .0006). A significant Group × Time interaction was observed for the Dizziness Handicap Inventory (F = 4.2, p = .003) and 36-item Short Form Health Questionnaire physical component scores (F = 2.16, p = .035) with the BPPV group showing significantly improved scores by the 12-week follow-up. Although there were between-group differences on the 36-item Short Form Health Questionnaire mental health component scores (F = 4.06, p = .022), changes over time were not significant in the groups.
CONCLUSIONS: Treatment with the CRP for posttraumatic BPPV resulted in significant symptom resolution and improvement in perceived physical health status.
PMID: 26895567 [PubMed - as supplied by publisher]
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Vocal fold nodules in school age children: attention deficit hyperactivity disorder as a potential risk factor.
J Voice. 2015 May;29(3):287-91
Authors: D'Alatri L, Petrelli L, Calò L, Picciotti PM, Marchese MR, Bussu F
Abstract
OBJECTIVE: To evaluate the presence of symptoms of inattention and hyperactivity/impulsivity in a population of school age children affected by vocal fold nodules.
METHODS: Parents and teachers of 18 children with vocal fold nodules (10 males, eight females; aged between 6 and 12 years) and 20 matched controls without dysphonia and/or vocal fold diseases (11 males, nine females; aged between 6 and 12 years) completed Attention-Deficit/Hyperactivity Disorder (ADHD) rating scale for parents (SDAG [Scala per i Disturbi di Attenzione/Iperattività per Genitori]) and teachers (SDAI [Scala per i Disturbi di Attenzione/Iperattività per Insegnanti) rating scales containing in two subscales items that specifically evaluate the symptoms of ADHD according to the DSM-IV. All children were subjected to videolaryngoscopy.
RESULTS: The group with vocal fold nodules scored significantly higher than the controls; the difference between the two groups was statistically significant for both the subscales of both questionnaires (SDAG and SDAI) (P < 0.05). Four children in the group with vocal fold nodules who scored higher than 14 in at least one subscale were referred for psychiatric evaluation. For two of the children, both male, a diagnosis of combined ADHD was formulated.
CONCLUSIONS: ADHD is a possible risk factor for the development of vocal fold nodules in childhood. SDAG and SDAI rating scales may supplement the diagnostic assessment of children with vocal fold nodules.
PMID: 25444156 [PubMed - indexed for MEDLINE]
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Voice outcomes after transoral laser microsurgery for early glottic cancer-considering signal type and smoothed cepstral peak prominence.
J Voice. 2015 May;29(3):370-81
Authors: Stone D, McCabe P, Palme CE, Heard R, Eastwood C, Riffat F, Madill C
Abstract
OBJECTIVES/HYPOTHESES: This study proposed the use of signal typing and acoustic measures experimentally validated for aperiodic voices to investigate voice outcomes after transoral laser microsurgery (TLM) for early glottic carcinoma. It was of interest whether signal type and pitch-tracking indicators would reveal unreliable perturbation and noise measures. As an alternative, smoothed cepstral peak prominence (CPPS) was used for the first time in this population.
STUDY DESIGN: A descriptive study of patients treated with TLM for early glottic carcinoma.
METHODS: All participants (n=14) performed a series of vocal tasks. Narrowband spectrograms were generated from voice recordings and classified into one of four signal types. The perturbation and noise measures of periodic or near-periodic signals only were reported. The CPPS for sustained vowel (CPPS-/a/) and connected speech (CPPS-s) were calculated for all participants. The relationship between voice outcomes and tumor and TLM factors was investigated.
RESULTS: Nine of 14 participants had an aperiodic type 3 signal. Three of 14 participants had voices considered reliable for perturbation analysis. Absolute jitter, %jitter, %shimmer, and signal-to-noise ratio were all low; however, CPPS-/a/ and CPPS-s amplitudes were below the normal range for most participants. Involvement of the anterior commissure, number of TLM episodes, and time post-surgery were associated with worse voice outcomes. There were strong correlations between signal type, CPPS-/a/, and pitch-tracking indicators.
CONCLUSIONS: The limitations of perturbation analysis should be considered when analyzing the voice after TLM. Signal type should be considered before conducting perturbation analysis. The CPPS-/a/ and CPPS-s may be more reliable acoustic outcome measures for this population.
PMID: 25301299 [PubMed - indexed for MEDLINE]
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Factors influencing botulinum toxin dose instability in spasmodic dysphonia patients.
J Voice. 2015 May;29(3):352-5
Authors: Rosow DE, Pechman A, Saint-Victor S, Lo K, Lundy DS, Casiano RR
Abstract
OBJECTIVE: Many patients with spasmodic dysphonia (SD) see consistent effects from botulinum toxin (BTX) injections of the same dose, whereas others require dosage changes over time. We sought to determine whether demographics (age and gender) or environmental factors (smoking) affect the long-term stability of BTX dosing in these patients.
STUDY DESIGN: Retrospective review.
METHODS: Charts of all patients undergoing BTX injection for adductor SD were reviewed. Dosage change, defined as whether there was any difference in total dosage used between two beneficial injections, was used as a measure of dosing stability. Beneficial injections were indicated by a voice rating score of at least three of four and any non-zero duration of improved voice. Logistic regression analysis was performed to determine whether age, gender, smoking status, or duration of treatment correlated with odds of having a dosage change.
RESULTS: A total of 211 patients were ultimately included. Age, gender, and smoking status were all found to have no correlative effect on dosing stability. The only factor that was predictive of dose stability was the number of previous beneficial injections, as every additional injection led to decreased odds of a change in dosage for the next injection (odds ratio=0.964; 95% confidence interval=0.947-0.981).
CONCLUSIONS: Dosage of BTX injections for long-term treatment of SD has a significant propensity to remain stable over time. Factors such as age, gender, and smoking status do not appear to influence the dosage stability. These findings should allow for better patient counseling regarding expectations for their long-term treatment.
PMID: 25242042 [PubMed - indexed for MEDLINE]
