Comparative evaluation of craniofacial anthropometric measurements in Indian adult patients with and without obstructive sleep apnea: A pilot study.

Comparative evaluation of craniofacial anthropometric measurements in Indian adult patients with and without obstructive sleep apnea: A pilot study.

J Indian Prosthodont Soc. 2015 Oct-Dec;15(4):331-6

Authors: Dubey A, Upadhyay S, Mathur S, Kant S, Singh BP, Makwana R

Abstract
AIMS: The study aimed to compare the craniofacial features of North Indian patients suffering from obstructive sleep apnea (OSA) to that of normal North Indian population.
MATERIALS AND METHODS: Selected 25 North Indian subjects (age: 18-65 years) were divided into two groups (OSA group [n = 14] and non-OSA group [n = 9]) according to the results of full night polysomnographic sleep study. Body mass index (BMI), neck circumference (NC), and lateral cephalograms were recorded for each subject in both groups and total 22 parameters of craniofacial anthropometric features were measured on lateral cephalograms for each subject. The differences in BMI, NC, and craniofacial features between the OSA and non-OSA groups were compared statistically.
RESULTS: Independent sample t-test was used to compare the differences between OSA group and non-OSA group. The results showed that the BMI, NC, bulk of tongue (tongue length, tongue height, and tongue area) and length of the soft palate (PNS-U) were significantly higher in OSA group. OSA group was also found to have inferior positioning of hyoid bone (MP-H, ANS-H, PNS-H, ANS-Eb), narrower superior and middle airway space (SPAS and MAS), antero-inferior positioning of mandible (Gn-C3, ANS-Me, SNB, N-Me) and lower cranial base flexure angle (N-S-Ba).
CONCLUSION: Craniofacial features, which play an important role in the pathophysiology of OSA, differ significantly between North Indian patients suffering from OSA and normal North Indian population.

PMID: 26929536 [PubMed]

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Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis.

Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis.

BMJ Case Rep. 2016;2016

Authors: Harrison L, Mcnally J, Corbridge R

Abstract
A 53-year-old woman presented with right-sided otalgia radiating to the temporal region, angle of the mandible and upper neck. Otoscopy was unremarkable on examination and there were no signs of otitis externa. MRI revealed an infiltrative soft tissue mass to the right lateral aspect of the clivus. Transnasal and CT-guided biopsies were performed, however, these showed either inconclusive or benign tissue. Following multidisciplinary team assessment a diagnosis of spontaneous skull base osteomyelitis was made and treatment with intravenous antibiotics started. Failure to respond to antimicrobials and the development of cranial nerve palsies raised the possibility of a vasculitis. Subsequently, a clinical diagnosis of granulomatosis with polyangiitis (GPA) was made. Remission has now been maintained with cyclophosphamide and prednisolone. We discuss the rare presentation of GPA mimicking that of spontaneous skull base osteomyelitis as well as its management and related primary otolaryngological manifestations.

PMID: 26929226 [PubMed - as supplied by publisher]

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Reducing the risk of music-induced hearing loss from overuse of portable listening devices: understanding the problems and establishing strategies for improving awareness in adolescents.

Reducing the risk of music-induced hearing loss from overuse of portable listening devices: understanding the problems and establishing strategies for improving awareness in adolescents.

Adolesc Health Med Ther. 2016;7:27-35

Authors: Portnuff CD

Abstract
Hearing loss from the overuse of portable listening devices (PLDs), such as MP3 players or iPods, is of great concern in the popular media. This review aims to discuss the current state of scientific knowledge about music-induced hearing loss from PLD use. This report evaluates the literature on the risk to hearing from PLD use, the individual and psychological factors that influence PLD usage, and strategies for reducing exposure to music through PLDs. Specific interventions are reviewed, and several recommendations for designing interventions and for individual intervention in clinical practice are presented. Clinical recommendations suggested include the "80-90 rule" and the use of isolator-style earphones to reduce background noise.

PMID: 26929674 [PubMed]

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Assessment of voice quality after carbon dioxide laser and microdebrider surgery for Reinke edema.

Related Articles

Assessment of voice quality after carbon dioxide laser and microdebrider surgery for Reinke edema.

J Voice. 2015 Mar;29(2):256-9

Authors: Burduk PK, Wierzchowska M, Orzechowska M, Kaźmierczak W, Pawlak-Osińska K

Abstract
OBJECTIVES: Surgery of Reinke edema requires reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium.
MATERIAL AND METHODS: Sixteen patients were included for microdebrider and 10 patients for carbon dioxide (CO2) laser surgery. Vocal analysis was performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by the grade, roughness, breathiness, asthenia, and strain scale. The objective assessment was conducted by Multi-Dimensional Voice Program software.
RESULTS: We found consistent improvement in all parameters both in CO2 laser and microdebrider group. The normalization of all parameters were statistically better after microdebrider surgery. The most statistically significant improvements were accounted in reduction in grade of hoarseness, roughness, and asthenia and acoustic analysis.
CONCLUSIONS: Microdebrider is a useful and safe tool for Reinke edema treatment. The oscillatory cutting knife and low suction protect lamina propria resulting in better vibratory function.

PMID: 25261956 [PubMed - indexed for MEDLINE]

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Pre-reconstruction of cervical-to-petrous internal carotid artery: An improved technique for treatment of vascular lesions involving internal carotid artery at the lateral skull base.

Pre-reconstruction of cervical-to-petrous internal carotid artery: An improved technique for treatment of vascular lesions involving internal carotid artery at the lateral skull base.

Head Neck. 2016 Feb 29;

Authors: Li FD, Gao ZQ, Ren HL, Liu CW, Song XJ, Li YF, Zheng YH

Abstract
BACKGROUND: Reconstruction of the internal carotid artery (ICA) is an operative challenge for lesions involving the lateral skull base because of excessive blood loss, intraoperative cranial nerve injury, and difficulties in cerebral protection.
METHODS: Between January 2010 and October 2014, 9 patients with vascular lesions at the lateral skull base were treated with a "pre-reconstruction" technique, which means reconstruction of the ICA in advance of excising the lesions.
RESULTS: All operations were technically successful with no mortality or strokes. The mean blood loss was 921 ± 210 mL. The mean total clamping time was 18 ± 5 minutes. Among the 5 patients without invasion of specific cranial nerves, no long-term sequelae occurred during the follow-up period ranging from 11 to 54 months.
CONCLUSION: With less blood loss, slighter cranial nerve injuries, and shorter clamping time, the "pre-reconstruction" technique was safe and effective for the treatment of vascular lesions at the lateral skull base. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26929189 [PubMed - as supplied by publisher]

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Upper Nasopharyngeal Corridor for Transnasal Endoscopic Drainage of Petroclival Cholesterol Granulomas: Alternative Access in Conchal Sphenoid Patients.

Upper Nasopharyngeal Corridor for Transnasal Endoscopic Drainage of Petroclival Cholesterol Granulomas: Alternative Access in Conchal Sphenoid Patients.

J Neurol Surg Rep. 2016 Mar;77(1):e017-22

Authors: Turan N, Baum GR, Holland CM, Ahmad FU, Henriquez OA, Pradilla G

Abstract
Background Cholesterol granulomas arising at the petrous apex can be treated via traditional open surgical, endoscopic, and endoscopic-assisted approaches. Endoscopic approaches require access to the sphenoid sinus, which is technically challenging in patients with conchal sphenoidal anatomy. Clinical Presentation A 55-year-old woman presented with intermittent headaches and tinnitus. Formal audiometry demonstrated moderately severe bilateral hearing loss. CT of the temporal bones and sella revealed a well-demarcated expansile lytic mass. MRI of the face, orbit, and neck showed a right petrous apex mass measuring 22 × 18 × 19 mm that was hyperintense on T1- and T2-weighted images without enhancement, consistent with a cholesterol granuloma. The patient had a conchal sphenoidal anatomy. Operative Technique Herein, we present an illustrative case of a low-lying petroclival cholesterol granuloma in a patient with conchal sphenoidal anatomy to describe an alternative high nasopharyngeal corridor for endoscopic transnasal transclival access. Postoperative Course Postoperatively, the patient's symptoms recovered and no complications occurred. Follow-up imaging demonstrated a patent drainage tract without evidence of recurrence. Conclusion In patients with a conchal sphenoid sinus, endoscopic transnasal transclival access can be gained using a high nasopharyngeal approach. This corridor facilitates safe access to these lesions and others in this location.

PMID: 26929897 [PubMed]

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Resolution of Concussion Symptoms After Osteopathic Manipulative Treatment: A Case Report.

Resolution of Concussion Symptoms After Osteopathic Manipulative Treatment: A Case Report.

J Am Osteopath Assoc. 2016 Mar 1;116(3):e13-7

Authors: Guernsey DT, Leder A, Yao S

Abstract
A concussion is the result of a biomechanical force directed toward the head, causing neurologic dysfunction. The inflammatory response and the production of reactive oxygen species are proposed mechanisms for the symptoms and long-term sequelae of concussion. Osteopathic manipulative treatment (OMT) may help reduce inflammation by improving glymphatic flow. The authors describe the effect of OMT on a patient with mild concussion symptoms, including nausea, dizziness, tinnitus, and imbalance. The patient was evaluated with the Sensory Organization Test before and after undergoing a 25-minute session of OMT. After the session, the patient reported resolution of symptoms, and his sensory organization test score improved by 6 points. The role of OMT must be further investigated as an essential and cost-effective tool in the management of concussions.

PMID: 26927914 [PubMed - in process]

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Hearing protection devices: Use at work predicts use at play.

Hearing protection devices: Use at work predicts use at play.

Arch Environ Occup Health. 2015 Sep 11;:1-8

Authors: Beach EF, Gilliver M, Williams W

Abstract
Use of hearing protection devices (HPDs) at work is widespread and well researched, but less is known about HPD use in high-noise leisure activities. We investigated HPD use of 8,144 Australians in leisure settings. An online survey asked questions about HPD use at work and leisure and examined whether age, gender, HPD use at work, and tinnitus predicted HPD use in leisure activities. Leisure-based HPD use was most common during high-risk work-related activities. Use of HPDs at work was the most significant predictor of leisure-based use, with workplace users up to 5 times more likely to use HPDs at leisure. Men were significantly more likely than women to use HPDs in 10/20 leisure activities, and those with tinnitus were more likely than those without to use HPDs in 8/20 activities. Older participants were more likely to use HPDs at nightclubs and concerts, but younger participants were more likely to use HPDs playing e-games and musical instruments.

PMID: 26927729 [PubMed - as supplied by publisher]

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Triple-site rTMS for the treatment of chronic tinnitus: a randomized controlled trial.

Triple-site rTMS for the treatment of chronic tinnitus: a randomized controlled trial.

Sci Rep. 2016;6:22302

Authors: Lehner A, Schecklmann M, Greenlee MW, Rupprecht R, Langguth B

Abstract
Recent research indicates that tinnitus is related to alterations of neural networks including temporal, parietal, and prefrontal brain regions. The current study examines a rTMS protocol which targets three central nodes of these networks in a two-arm randomized parallel group trial. Overall, 49 patients with chronic tinnitus were randomized to receive either triple-site stimulation (left dorsolateral prefrontal stimulation, 1000 pulses, 20 Hz plus left and right temporoparietal stimulation, 1000 pulses each, 1 Hz) or single-site stimulation (left temporoparietal stimulation, 3000 pulses, 1 Hz). Both groups were treated in ten sessions. Tinnitus severity as measured by the tinnitus questionnaire was assessed before rTMS (day1), after rTMS (day12) and at two follow-up visits (day 90 and day 180). The triple-site protocol was well tolerated. There was a significant reduction in tinnitus severity for both treatment groups. The triple-site group tended to show a more pronounced treatment effect at day 90. However, the measurement time point x group interaction effect was not significant. The current results confirm former studies that indicated a significant reduction of tinnitus severity after rTMS treatment. No significant superiority of the multisite protocol was observed. Future approaches for the enhancement of treatment effects are discussed.

PMID: 26927363 [PubMed - as supplied by publisher]

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Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study.

Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study.

Laryngoscope. 2016 Mar 1;

Authors: Park S, Lee JM, Sim CS, Kim JG, Nam JG, Lee TH, Han MW, Kwon JK, Lee JC

Abstract
OBJECTIVES/HYPOTHESIS: To investigate the relationship between sleep-disordered breathing (SDB) and nocturnal enuresis (NE) in children and to prospectively evaluate the effectiveness of adenotonsillectomy on resolving enuresis in indicated SDB patients with NE.
METHODS: We prospectively collected data from 183 children (121 males, mean age 8.17 ± 2.84 years) who underwent adenotonsillectomy to treat SDB between July 2011 and July 2013, and analyzed the prevalence of NE. Before and 3 months after surgery, all parents were requested to answer a self-reported SDB scale questionnaire (22 questions, 0-22 points) and a NE questionnaire (episodes of enuresis per month). Paired t test, Student t test, and Chi-square test were used to analyze the data.
RESULTS: Overall prevalence of NE was 9.3% (17 patients) preoperatively and 1.5% postoperatively (four patients). After adenotonsillectomy, prevalence of NE and the mean SDB scale were significantly decreased (both P values < 0.001). After adenotonsillectomy, 13 of the 17 NE patients (76.5%) showed complete resolution. There was significantly higher prevalence of NE in patients with obstructive sleep apnea (OSA) than those without OSA (13.1%, 14 of 107 vs. 3.9%, 3 of 76; P = 0.036).
CONCLUSION: There is strong association between NE and SDB, and adenotonsillectomy can markedly improve enuresis in the majority of children with NE and SDB.
LEVELS OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 26928519 [PubMed - as supplied by publisher]

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Swallowing frequency: Impact of accumulated oropharyngeal secretion levels and gustatory stimulation.

Swallowing frequency: Impact of accumulated oropharyngeal secretion levels and gustatory stimulation.

Ear Nose Throat J. 2016 Feb;95(2):E7-E10

Authors: Brady SL, Wesling MW, Donzelli JJ, Kaszuba S

Abstract
We conducted a prospective, descriptive study of 27 individuals with known or suspected dysphagia to investigate the relationship between swallowing frequency, accumulated oropharyngeal secretion levels, and gustatory stimulation. Assessment of the secretion level was quantified with the use of a previously published 5-point rating scale using endoscopy. Overall, we found a moderate relationship between the baseline swallowing frequency at rest and the accumulated oropharyngeal secretion level (Pearson correlation 0.470; p = 0.01). The study sample was divided into two groups based on their secretion level. Group 1 (n = 19; mean age 59.7 ± 21.5 years) included patients whose accumulated oropharyngeal secretion level was rated as 1 (normal) or 2 (mild). Group 2 (n = 8; mean age 69.78 ± 8.35 years) included patients whose accumulated oropharyngeal secretion level was rated as 4 (severe) or 5 (profound). For Group 1, swallowing frequency increased from a baseline of 1.05 to 5.26 swallows over 2 minutes, following gustatory stimulation; for Group 2 it increased from a baseline of 0.125 swallows to 3.5 swallows. These results indicate that individuals with a lower baseline swallowing frequency at rest demonstrated a higher accumulated oropharyngeal secretion level as viewed by nasal endoscopy and that, regardless of secretion level, gustatory stimulation was effective at increasing swallowing frequency. Increasing swallowing frequency may be a functional dysphagia treatment objective in efforts to improve the efficiency of the swallow and may offer better management of accumulated oropharyngeal secretions.

PMID: 26930346 [PubMed - as supplied by publisher]

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Alleviating speech and deglutition: Role of a prosthodontist in multidisciplinary management of velopharyngeal insufficiency.

Alleviating speech and deglutition: Role of a prosthodontist in multidisciplinary management of velopharyngeal insufficiency.

J Indian Prosthodont Soc. 2015 Jul-Sep;15(3):281-3

Authors: Nanda A, Koli D, Sharma S, Suryavanshi S, Verma M

Abstract
Surgical resection of soft palate due to cancer affects the effective functioning of the velopharyngeal mechanism (speech and deglutition). With the loss of speech intelligibility, hyper resonance in voice and impaired function of swallowing (due to nasal regurgitation), there is a depreciation in the quality of life of such an individual. In a multidisciplinary setup, the role of a prosthodontist has been described to rehabilitate such patients by fabrication of speech aid prosthesis. The design and method of fabrication of the prosthesis are simple and easy to perform. The use of prosthesis, together with training (of speech) by a speech pathologist resulted in improvement in speech. Furthermore, an improvement in swallowing had been noted, resulting in an improved nutritional intake and general well-being of an individual. The take-home message is that in the treatment of oral cancer, feasible, and rapid rehabilitation should be endeavored in order to make the patient socially more acceptable. The onus lies on the prosthodontist to practise the same in a rapid manner before the moral of the patient becomes low due to the associated stigma of cancer.

PMID: 26929526 [PubMed]

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Prosthetic rehabilitation of large mid-facial defect with magnet-retained silicone prosthesis.

Prosthetic rehabilitation of large mid-facial defect with magnet-retained silicone prosthesis.

J Indian Prosthodont Soc. 2015 Jul-Sep;15(3):276-80

Authors: Shrivastava KJ, Shrivastava S, Agarwal S, Bhoyar A

Abstract
Rehabilitation of maxillofacial defect patients is a challenging task. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability, and support. In cases of large maxillofacial defect, movement of the prosthesis is inevitable. The primary objectives in rehabilitating the maxillofacial defect patients are to restore the function of mastication, deglutition, speech, and to achieve normal orofacial appearance. This clinical report describes maxillofacial prosthetic rehabilitation of large midfacial defect including orbit along with its contents, zygoma and soft tissues including half of the nose, cheeks, upper lip of left side, accompanying postsurgical microstomia and orofacial communication, which resulted from severe fungal infection mucormycosis. The defect in this case was restored with magnet retained two piece maxillofacial prosthesis having hollow acrylic resin framework and an overlying silicone facial prosthesis. The retention of prosthesis was further enhanced with the use of spectacles. This type of combination prosthesis enhanced the cosmesis and functional acceptability of prosthesis.

PMID: 26929525 [PubMed]

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Evaluation and Management of Chronic Aspiration in Children With Normal Upper Airway Anatomy.

Related Articles

Evaluation and Management of Chronic Aspiration in Children With Normal Upper Airway Anatomy.

JAMA Otolaryngol Head Neck Surg. 2015 Nov;141(11):1006-11

Authors: Adil E, Al Shemari H, Kacprowicz A, Perez J, Larson K, Hernandez K, Kawai K, Cowenhoven J, Urion D, Rahbar R

Abstract
IMPORTANCE: Chronic airway aspiration is a challenging problem for physicians and caregivers and can cause significant pulmonary morbidity in pediatric patients. Our knowledge regarding the causes and optimal management of these patients is in its infancy.
OBJECTIVE: To review our experience with the evaluation and management of pediatric patients with documented aspiration and normal upper airway anatomy.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective medical record review, we studied pediatric patients for airway disorders at a pediatric tertiary referral center who were diagnosed as having aspiration on modified barium swallow study during a 10-year period (June 1, 2002, through September 31, 2012).
INTERVENTIONS: Direct laryngoscopy and bronchoscopy performed with the patient under general anesthesia.
MAIN OUTCOMES AND MEASURES: Demographics, comorbidities, management, and swallowing outcomes were analyzed.
RESULTS: Forty-six patients met the inclusion criteria. The mean age at presentation was 1.56 years, and there was a male to female ratio of approximately 2:1. Eight patients (17%) were syndromic, 16 (35%) had developmental delay, and 12 (26%) had congenital heart disease. Fifteen patients (33%) underwent brain magnetic resonance imaging, and none had a brainstem or posterior fossa lesion that accounted for their aspiration. Patients were subdivided according to the consistency of the fluids that they aspirated: 25 (54%) aspirated thin liquids, 15 (33%) aspirated thickened liquids, and 6 (13%) aspirated purees. Of these patients, 21 (84%), 12 (80%), and 3 (50%) had resolution of their swallowing dysfunction with feeding and swallowing therapy, respectively. A total of 3 patients (7%) required a tracheostomy for their refractory aspiration.
CONCLUSIONS AND RELEVANCE: We recommend feeding and swallowing therapy for children with normal upper airway anatomy. Brain magnetic resonance imaging should be considered for patients with suspected brainstem or posterior fossa lesion based on neurologic examination findings. Most patients who aspirate thin and thickened liquids will have resolution of their swallowing dysfunction within 1 year of beginning therapy.

PMID: 26501239 [PubMed - indexed for MEDLINE]

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Dysphagia training after head and neck cancer fails to follow legislation and national recommendations.

Related Articles

Dysphagia training after head and neck cancer fails to follow legislation and national recommendations.

Dan Med J. 2015 May;62(5)

Authors: Fredslund SV, Høgdal N, Christensen MB, Wessel I

Abstract
INTRODUCTION: Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphagia is lacking, but several studies indicate that early initiation is crucial. The aim of this study was to map the existing dysphagia rehabilitation programmes for HNC patients in Denmark.
METHODS: Occupational therapists (OTs), oncologists and surgeons from five hospitals participated in a nationwide questionnaire-based survey, along with OTs from 39 municipal health centres.
RESULTS: HNC patients rarely receive preventive occupational therapy before treatment, and hospital-based OTs mainly attend to HNC patients undergoing surgery. Far from all oncology and surgical departments complete the required rehabilitation plans upon discharge which leaves many patients untreated. There are vast differences between the municipalities' rehabilitation programmes and between the expertise employed in municipalities and hospitals.
CONCLUSION: Existing HNC rehabilitation does not meet official Danish guidelines. Only a fraction of HNC patients are offered rehabilitation and often long after completing treatment. Municipal rehabilitation services vary considerably in terms of type, duration, intensity and expertise. Dysphagia-related rehabilitation requires an improved monitoration, possibly with an increase in the uptake of centralised dysphagia rehabilitation.
FUNDING: not relevant.
TRIAL REGISTRATION: not relevant.

PMID: 26050828 [PubMed - indexed for MEDLINE]

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Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

Muscle Nerve. 2016 Mar 1;

Authors: Munin MC, Heman-Ackah YD, Rosen CA, Sulica L, Maronian N, Mandel S, Carey BT, Craig E, Gronseth G

Abstract
INTRODUCTION: The purpose of this study was to develop an evidence-based consensus statement for use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN).
METHODS: Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy.
RESULTS: Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery. Positive sharp waves and/or fibrillation potentials did not predict outcome. The presence of electrical synkinesis may decrease the likelihood of recovery, based on 1 published study. LEMG altered clinical management by changing the initial diagnosis from RLN in 48% of cases. Cricoarytenoid fixation and superior laryngeal neuropathy were the most common other diagnoses observed.
CONCLUSIONS: If prognostic information is required in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, LEMG should be performed. LEMG may be performed to clarify treatment decisions for vocal fold immobility that is presumed to be caused by RLN. This article is protected by copyright. All rights reserved.

PMID: 26930512 [PubMed - as supplied by publisher]

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Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation.

Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation.

Radiol Bras. 2016 Jan-Feb;49(1):21-5

Authors: Reis I, Aguiar A, Alzamora C, Ferreira C, Castro V, Soares A, Lobão M

Abstract
OBJECTIVE: The present study was aimed at describing a single-institution experience in the curative treatment of patients diagnosed with locally advanced hypopharyngeal squamous cell carcinoma.
MATERIALS AND METHODS: Data concerning all patients treated for locally advanced hypopharyngeal squamous cell carcinoma between January 2006 and June 2012 were reviewed.
RESULTS: A total of 144 patients were included in the present study. The median follow-up period was 36.6 months. Median survival was 26 months, and 2-year and 5-year overall survival rates were, 51% and 30.5%, respectively. Median recurrence-free survival was 18 months and 2-year and 5-year recurrence-free survival rates were 42.8% and 28.5%, respectively.
CONCLUSION: The outcomes in the present series are in line with the literature.

PMID: 26929457 [PubMed]

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Are the interarytenoid muscles supplied by branches of both the recurrent and superior laryngeal nerves?

Are the interarytenoid muscles supplied by branches of both the recurrent and superior laryngeal nerves?

Laryngoscope. 2016 Mar 1;

Authors: Pascual-Font A, Cubillos L, Vázquez T, McHanwell S, Sañudo JR, Maranillo E

Abstract
OBJECTIVES/HYPOTHESIS: It has been generally accepted that the branches of the internal branch of the superior laryngeal nerve to the interarytenoid muscle are exclusively sensory. However, some experimental studies have suggested that these branches may contain motor axons, and therefore that the interarytenoid muscle is supplied by both the superior and recurrent laryngeal nerves. The aim of this work was to determine whether motor axons to the interarytenoid muscles are present in both laryngeal nerves.
STUDY DESIGN: Basic research.
METHODS: Twelve human internal branches of the superior laryngeal nerve were dissected, and its branches to the interarytenoid muscle were removed and processed for choline-acetyltransferase immunohistochemistry, a method not used previously in studying the nerve fiber composition of the laryngeal nerves.
RESULTS: The internal branch of the superior laryngeal nerve divided into two to five branches to the interarytenoid muscle. All branches contained motor axons, with the proportion of motor axons varying from 6% to 31%.
CONCLUSION: The present study confirms that the internal branch of the superior laryngeal nerve provides a motor innervation to the interarytenoid muscles.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2015.

PMID: 26927565 [PubMed - as supplied by publisher]

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Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer.

Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer.

J Vasc Surg. 2016 Feb 27;

Authors: Liang NL, Guedes BD, Duvvuri U, Singh MJ, Chaer RA, Makaroun MS, Sachdev U

Abstract
BACKGROUND: The purpose of this study was to examine outcomes of a patient cohort undergoing intervention for carotid blowout syndrome associated with head and neck cancer.
METHODS: Patients with head and neck cancer who presented with carotid distribution bleeding from 2000 to 2014 were identified in the medical record. Primary outcomes were short- and midterm mortality and recurrent bleeding. Standard statistical methods and survival analysis were used to analyze study population characteristics and outcomes.
RESULTS: Thirty-seven patients were included in the study. The mean age was 60.1 ± 11.4 years (74% male). All malignancies were squamous cell type, stage IV, in a variety of primary locations: 32% oral cavity, 24% larynx, 16% superficial neck, with the remainder in the oropharynx, nasopharynx, and hypopharynx. Fifty-one percent of bleeds were of common carotid, 29% external carotid, and 19% internal carotid origin. Among the patients, 68% presented with acute hemorrhage, 24% with impending bleed, and 8% with threatened bleed. All patients underwent intervention: 38% received endovascular coil embolization, 30% stent grafts, 22% surgical ligation, and 10% primary vessel repair or bypass grafting. Although major complications were rare, 10.8% of patients had perioperative stroke. Sixteen recurrent bleeding episodes involving 12 arteries occurred in 11 patients (29.73%). Median rebleeding time was 7 days (interquartile range, 6-49). Estimated recurrent bleeding risk at 30 days and 6 months was 24% and 34%, respectively. Of the patients, 91.9% survived to hospital discharge. The 90-day and 1-year estimated survivals were 60.9% and 36.6%, respectively.
CONCLUSIONS: Carotid blowout syndrome associated with head and neck cancer carries poor mid- and long-term prognoses; however, mortality may be related more to the advanced stage of disease rather than carotid involvement or associated intervention. Both surgical and endovascular approaches may be efficacious in cases of acute hemorrhage but carry a significant risk of periprocedural stroke and recurrent bleeding.

PMID: 26926937 [PubMed - as supplied by publisher]

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Successful application of endoscopic modified medial maxillectomy to orbital floor trapdoor fracture in a pediatric patient.

Successful application of endoscopic modified medial maxillectomy to orbital floor trapdoor fracture in a pediatric patient.

Auris Nasus Larynx. 2016 Feb 26;

Authors: Matsuda Y, Sakaida H, Kobayashi M, Takeuchi K

Abstract
Although surgical treatment of orbital floor fractures can be performed by many different approaches, the application of endoscopic modified medial maxillectomy (EMMM) for this condition has rarely been described in the literature. We report on a case of a 7-year-old boy with a trapdoor orbital floor fracture successfully treated with the application of EMMM. The patient suffered trauma to the right orbit floor and the inferior rectus was entrapped at the orbital floor. Initially, surgical repair via endoscopic endonasal approach was attempted. However, we were unable to adequately access the orbital floor through the maxillary ostium. Therefore, an alternative route of access to the orbital floor was established by EMMM. With sufficient visualization and operating space, the involved orbital content was completely released from the entrapment site and reduced into the orbit. To facilitate wound healing, the orbital floor was supported with a water-inflated urethral balloon catheter for 8 days. At follow-up 8 months later, there was no gaze restriction or complications associated with the EMMM. This case illustrates the efficacy and safety of EMMM in endoscopic endonasal repair of orbital floor fracture, particularly for cases with a narrow nasal cavity such as in pediatric patients.

PMID: 26926254 [PubMed - as supplied by publisher]

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AIRTRAQ8 OPTICAL LARYNGOSCOPE FOR TRACHEAL INTUBATION IN A PATIENT WITH AN UNCOMMON GIANT LIPOMA ON THE POSTERIOR ASPECT OF NECK AND ADDITIONAL RISK FACTORS OF ANTICIPATED DIFFICULT AIRWAY: A CASE REPORT.

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AIRTRAQ8 OPTICAL LARYNGOSCOPE FOR TRACHEAL INTUBATION IN A PATIENT WITH AN UNCOMMON GIANT LIPOMA ON THE POSTERIOR ASPECT OF NECK AND ADDITIONAL RISK FACTORS OF ANTICIPATED DIFFICULT AIRWAY: A CASE REPORT.

Middle East J Anaesthesiol. 2015 Oct;23(3):355-8

Authors: Dimitriou V, El Kouny A, Al Harbi M, Wambi F, Tawfeeq N, Tanweer A, Al Atassi A, Geldhof G

Abstract
Patients with restricted neck movement present a difficult airway situation because of improper positioning and inadequate extension of the atlanto-occipital joint. The Airtraq optical laryngoscope is a new single use device that permits an indirect view of the glottis without the need to achieve a direct line of sight by conventional use of the 'sniffing position'. We present and discuss a case of uncommon giant lipoma (16 x 12 x 10 cm) in the posterior aspect of the neck in addition with other independent factors of anticipated difficult airway, intubated successfully in the semi-lateral position with the use of Airtraq.

PMID: 26860029 [PubMed - indexed for MEDLINE]

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[Functional comparison of the voice quality after either open conservative surgery or only radiotherapy for early glottic carcinoma].

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[Functional comparison of the voice quality after either open conservative surgery or only radiotherapy for early glottic carcinoma].

Rev Laryngol Otol Rhinol (Bord). 2015;136(1):17-20

Authors: El Ouakif F, Veresezan O

Abstract
OBJECTIVES: The aim of this article is to compare the functional results after open conservative surgery versus radiotherapy alone in the management of early glottic carcinoma using the Voice Handicap Index questionnaire (VHI).
METHODS: Retrospective study was done using VHI for evaluation of 37 patients treated either by open conservative surgery or radiotherapy in T1-T2N0M0 glottic laryngeal carcinoma.
RESULTS: 19 patients were treated with radiotherapy. The overall survival rate and disease free after 5 years were 91.3%. The functional result was mild in 89%. 18 patients were treated surgically. The overall survival rate and disease free after 5 years were 93.1% and 95.4% respectively. The functional result was mild in 61% after surgery.
CONCLUSION: Radiotherapy alone seems to provide better functional results than partial surgery in T1-T2 glottic tumors.

PMID: 26749600 [PubMed - indexed for MEDLINE]

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The Effectiveness of Using Laryngeal Electromyography Guidelines for Injection Augmentation-Reply.

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The Effectiveness of Using Laryngeal Electromyography Guidelines for Injection Augmentation-Reply.

JAMA Otolaryngol Head Neck Surg. 2015 Nov;141(11):1030-1

Authors: Wang CC

PMID: 26583512 [PubMed - indexed for MEDLINE]

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The Effectiveness of Using Laryngeal Electromyography Guidelines for Injection Augmentation.

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The Effectiveness of Using Laryngeal Electromyography Guidelines for Injection Augmentation.

JAMA Otolaryngol Head Neck Surg. 2015 Nov;141(11):1030

Authors: Tang CG, Mor N, Blitzer A

PMID: 26583511 [PubMed - indexed for MEDLINE]

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Mechanical Modeling of the Human Cricoid Cartilage Using Computer-Aided Design: Applications in Airway Balloon Dilation Research.

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Mechanical Modeling of the Human Cricoid Cartilage Using Computer-Aided Design: Applications in Airway Balloon Dilation Research.

Ann Otol Rhinol Laryngol. 2016 Jan;125(1):69-76

Authors: Johnson CM, Howell JT, Mettenburg DJ, Rueggeberg FA, Howell RJ, Postma GN, Weinberger PM

Abstract
OBJECTIVES: Balloon dilation is generally considered first-line treatment for airway stenosis. Some dilation systems utilize a compliant balloon that can conform around rigid structures. Others use a noncompliant balloon that does not conform, allowing for dilation of more rigid stenoses. We hypothesized that subglottic dilation with a noncompliant balloon increases the likelihood of fracture of the cricoid when compared to a compliant balloon.
METHODS: Three fresh human cricoid cartilages were placed in a universal testing system to determine the expansile force necessary for cricoid fracture. Using these data, a 3D printer was used to construct a synthetic cricoid model possessing near identical physical characteristics to the human cricoid. Simulated dilation was then performed on the model using a compliant and a noncompliant balloon.
RESULTS: Human cricoid fracture occurred at 97.25 N (SD = 8.34), and the synthetic cricoid model fractured at 100.10 N (SD = 7.32). Both balloons fractured the model in every replicate experiment. Mean balloon internal pressure at fracture was 7.67 ATM (SD = 1.21) for the compliant balloon and 11.34 ATM (SD = 1.29) for the noncompliant balloon.
CONCLUSIONS: These data show that fracture of the cricoid is a valid concern in balloon dilation procedures where the balloon spans the subglottis. Furthermore, the hypothesis was rejected in that the compliant balloon system was at least as likely to fracture the cricoid model as the noncompliant.

PMID: 26256589 [PubMed - indexed for MEDLINE]

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Comparison of lyophilized glutaraldehyde-preserved bovine pericardium with different vascular prostheses for use as vocal cords implants: experimental study.

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Comparison of lyophilized glutaraldehyde-preserved bovine pericardium with different vascular prostheses for use as vocal cords implants: experimental study.

Biomed Res Int. 2015;2015:351862

Authors: Olmos-Zuñiga JR, Jasso-Victoria R, Gaxiola-Gaxiola M, Sotres-Vega A, Hernández-Jiménez C, Baltazares-Lipp M, Arredondo del Bosque F, Santillan-Doherty P

Abstract
This study compared the use of lyophilized glutaraldehyde-preserved bovine pericardium (LGPBP), polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), and Teflon felt (TF) as implants for vocal cords (VC) medialization and aimed to assess the endoscopic, macroscopic, and microscopic VC changes after medialization in a canine model. In 18 mongrel dogs, the right VC were medialized with LGPBP and the left were implanted as follows: Group I (n = 6): LGPBP and PTFE; Group II (n = 6): LGPBP and PET; Group III (n = 6): LGPBP and TF. Surgical handling of the implants was compared. Three months after surgery, macroscopic and microscopic changes of VC and implants were evaluated. LGPBP offered the best surgical handling (p = 0.005, Kruskal-Wallis). TF implants showed extrusion (p = 0.005, Kruskal-Wallis) and severe inflammation. All VC formed fibrous capsules around the implants; the ones developed by LGPBP implants were thinner (p = 0.001, ANOVA, Tukey). VC implanted with synthetic materials showed eosinophilic infiltration (p = 0.01, Kruskal-Wallis). We concluded that the LGPBP could be used as an implant for VC medialization because it is biocompatible, easy to handle and remove during surgical procedures, and nonabsorbable or extrudable and produces an inflammatory reaction similar to PTFE and PET.

PMID: 26075232 [PubMed - indexed for MEDLINE]

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Suicidal hanging in Istanbul, Turkey: 1979-2012 Autopsy results.

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Suicidal hanging in Istanbul, Turkey: 1979-2012 Autopsy results.

J Forensic Leg Med. 2015 Jul;33:44-9

Authors: Taktak S, Kumral B, Unsal A, Ozdes T, Buyuk Y, Celik S

Abstract
A retrospective study was carried out on 4549 which is the total number of hanging cases autopsied at Forensic Medicine Institute in Istanbul, Turkey. 4502 hanging cases of suicidal origin were detected and evaluated in terms of demographic features, the type of hanging material used for ligature, internal findings in neck organs, toxicological findings and microscopic findings. Of these suicides, 3295 (73.2%) were males and 1207 (26.8%) were females. The average age of the victims was 37.8 (SD 1.6). Crude suicidal hanging rate is approximately two-fold increase in women, while it is about five-to six-fold increase in men during 33 years. 1424 of the victims committed suicide by hanging themselves at home, and 441 of them in prison and indoor areas. The alcohol in the blood of all autopsy victims was tested and results were positive for 687 people. A drug active agent was detected in 108 (2.4%) victims: 70 (1.5%) of them were antidepressants, 20 (0.5%) of them were analgesic/anti-inflammatory/anti-histaminic and 18 (0.4%) of them were antipsychotic. In the examination of the psychoactive substances in blood and urine, any of such substances was not detected in 4146 of the victims. However, victims' blood and urine contained a sedative-hypnotic-anxiolytic with 74 (1.6%), a cannabinoid with 16 (0.4%) and an opioid with 12 (0.3%). Psychoactive substance examination was not carried out for 243 victims. Of these cases, 4060 (90.2%), ecchymosis in soft tissues and 2800 (62.1%) fracture in neck organs was found.

PMID: 26048496 [PubMed - indexed for MEDLINE]

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Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis.

Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis.

Eur Arch Otorhinolaryngol. 2016 Feb 29;

Authors: Faralli M, Lapenna R, Giommetti G, Pellegrino C, Ricci G

Abstract
Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.

PMID: 26926693 [PubMed - as supplied by publisher]

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Standardized pretreatment inflammatory laboratory markers and calculated ratios in patients with oral squamous cell carcinoma.

Standardized pretreatment inflammatory laboratory markers and calculated ratios in patients with oral squamous cell carcinoma.

Eur Arch Otorhinolaryngol. 2016 Feb 29;

Authors: Grimm M, Rieth J, Hoefert S, Krimmel M, Rieth S, Teriete P, Kluba S, Biegner T, Munz A, Reinert S

Abstract
Analyzing the inflammatory microenvironment has become an important issue in the management of oral squamous cell carcinoma (OSCC). Pretreatment C-reactive protein (CRP) levels, leucocytes, monocytes, lymphocytes, neutrophils, basophils, eosinophils, platelets, neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) derived from the peripheral blood were analyzed. Receiver operating characteristic (ROC) curves determined a cut-off value for each parameter in 146 patients with OSCC compared with 93 controls and the results were associated with clinicopathological characteristics. CRP expression of tumors was measured by immunohistochemistry. ROC analysis determined cut-off values for CRP levels, leucocytes, monocytes, lymphocytes, neutrophils, NLR, dNLR, LMR, PLR and showed significant differences between the OSCC and control group. Compared with single laboratory tests calculated ratios were superior in measuring sensitivity and specificity of OSCC disease. NLR was significant directly associated and correlated with PLR. LMR was significant inversely associated and correlated with NLR and PLR. Immunohistochemical analysis did not show CRP expression of OSCCs. This study highlights the first analysis for cut-off values of pretreatment single laboratory tests and calculated ratios, which are strongly needed for a follow-up of cancer patients. Additionally, the calculated baselines can be used as a goal for successful immunotherapies in the future. The links between NLR, LMR, and PLR might be helpful for the clinical course (monitoring) of cancer patients and have been first described for OSCC in this study. Taken together, analyzing these data provides an additional practical guideline of further postoperative OSCC management.

PMID: 26926692 [PubMed - as supplied by publisher]

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A different spin on mentoring.

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A different spin on mentoring.

Can Nurse. 2015 Nov;111(8):32-3

Authors: Sewell C

PMID: 26753240 [PubMed - indexed for MEDLINE]

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Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks.

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Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks.

BMJ Case Rep. 2015;2015

Authors: Gunaratne DA, Singh NP

Abstract
Spontaneous cerebrospinal fluid (CSF) leaks in the sphenoid sinus are an uncommon but potentially significant condition associated with thin pneumatised bone, obesity and raised intracranial pressure. Despite advances in endoscopic sinus surgery, successful repair remains problematic due to limitations in visualisation, access and management of underlying aetiological factors. Utilisation of vascularised tissue in the primary repair process of sphenoid CSF leaks is yet to be well explored in the literature. In this series, we describe our surgical approach and explore related clinical, pathological and operative factors in three cases of spontaneous sphenoid sinus CSF leaks, successfully repaired on first attempt with the use of a vascularised nasoseptal flap.

PMID: 25926586 [PubMed - indexed for MEDLINE]

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[Analysis of Perfusion Parameters within Salivary Gland Tumors using Contrast Enhanced Ultrasound].

[Analysis of Perfusion Parameters within Salivary Gland Tumors using Contrast Enhanced Ultrasound].

Laryngorhinootologie. 2016 Feb 29;

Authors: Küstermeyer J, Klingelhöfer G, Welkoborsky HJ

Abstract
Objective: Contrast-enhanced ultrasound (CEUS) allows analyzing perfusion of salivary gland tumors more precisely in addition to conventional sonography. The evaluation of tumor dignity can be improved by CEUS. Currently an analysis of comparing perfusion parameters of different regions of interest (ROI) inside salivary gland tumors has not been reported. Materials and Methods: In this study 25 patients with tumors of the salivary glands were examined by B-Mode- Sonography, Color Doppler Sonography and CEUS. The parameters diameter, echogenicity, demarcation and especially perfusion were measured. We describe a new method for analyzing perfusion in 6 peripheral and 2 central ROI which were standardized distributed in the entire salivary gland tumors. The parameters were compared between different tumor dignities and in particular between the standardized ROI inside the tumors. Results: The results showed a hotspot of perfusion in the deep peripheral ROI with special perfusion characteristics. The differences of perfusion between benign and malignant salivary gland tumors were significant. Conclusions: This new method seems to improve validity of CEUS in interpreting tumor dignity.

PMID: 26925572 [PubMed - as supplied by publisher]

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Assessment of acoustic characteristics of voice in patients after injection laryngoplasty with hyaluronan.

Assessment of acoustic characteristics of voice in patients after injection laryngoplasty with hyaluronan.

Otolaryngol Pol. 2016 Feb 29;70(1):15-23

Authors: Miaśkiewicz B, Szkiełkowska A, Piłka A, Skarżyński H

Abstract
BACKGROUND: Glottal incompetence is one of the most common contributing factors in patients who suffer from dysphonia. One of the different treatment approaches is injection laryngoplasty. The aim of the study was to assess the quality of voice in patients who were treated with hyaluronic acid injection into the vocal fold in the long-term follow-up.
MATERIAL AND METHODS: The material included 39 patients with dysphonia who were referred for injection augmentation. The studied group included patients with presbyphonia, scar, sulcus, unilateral vocal fold paralysis and with atrophy of the vocal fold. Preoperative and postoperative examination was based on laryngovideostroboscopy. Patients' voice was assessed using the subjective GRBAS scale, and objective evaluation provided by Multidimensional Voice Program (MDVP) was applied. All the patients underwent injection laryngoplasty with hyaluronic acid into the vocal folds. Follow-up examinations were conducted 6, 12 and 24 months postoperatively.
RESULTS: Perceptual voice quality assessed with the GRBAS scale was improved and the results were stable in the long-term follow-up periods. MDVP showed a significant statistical improvement within the group of frequency, amplitude and noise parameters. The differences in value between follow-up periods were not statistically significant.
CONCLUSIONS: Acoustic analysis of voice is a reliable method for objective assessment of voice quality after applied treatment. Injection of the hyaluronic acid into the vocal fold improves the quality of voice in patients suffering from glottic insufficiency.

PMID: 26926304 [PubMed - in process]

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A Submucosal True Vocal Fold Mass.

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A Submucosal True Vocal Fold Mass.

JAMA Otolaryngol Head Neck Surg. 2015 Nov;141(11):1025-6

Authors: Williams L, Allen C

PMID: 26447711 [PubMed - indexed for MEDLINE]

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Effects of Balloon Dilation for Idiopathic Laryngotracheal Stenosis on Voice Production.

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Effects of Balloon Dilation for Idiopathic Laryngotracheal Stenosis on Voice Production.

Ann Otol Rhinol Laryngol. 2016 Jan;125(1):12-9

Authors: Hoffman MR, Brand WT, Dailey SH

Abstract
OBJECTIVE: To evaluate the effects of balloon dilation for idiopathic laryngotracheal stenosis on voice production.
METHODS: Retrospective review of 10 female patients with idiopathic laryngotracheal stenosis undergoing balloon dilation. Voice outcomes were evaluated by comparing pre- and posttreatment patient-reported, perceptual, aerodynamic, and acoustic parameters. Complete data sets were not available for all subjects; sample size for each parameter is reported with the corresponding result.
RESULTS: Total Voice Handicap Index (VHI) decreased significantly (22.9 ± 13.5 to 6.8 ± 6.5; n = 8; p = .015), as did glottal function index (7.2 ± 4.9 to 1.5 ± 2.0; n = 6; p = .022). No changes were observed in the GRBAS (grade, roughness, breathiness, asthenia, strain) scale. Changes in aerodynamic parameters were not statistically significant. Percent jitter decreased (1.32 ± 1.37 to 0.60 ± 0.29; n = 7; P = .078), and fundamental frequency range was preserved (507 ± 325 to 612 ± 281; n = 7; P = .309).
CONCLUSIONS: Our sample of patients with idiopathic laryngotracheal stenosis had a mild-moderate dysphonia that improved with balloon dilation. Importantly, adverse effects on voice that can occur with open procedures were not observed. Patient perception of dysphonia improved while fundamental frequency range was maintained and aerodynamic parameters remained within or moved toward the normal range. Larger prospective studies are warranted to further evaluate changes in voice production associated with balloon dilation.

PMID: 26180179 [PubMed - indexed for MEDLINE]

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Surgical Management of Lateral Tentorial Meningiomas.

Surgical Management of Lateral Tentorial Meningiomas.

World Neurosurg. 2016 Feb 26;

Authors: Biroli A, Talacchi A

Abstract
OBJECTIVE: Tentorial meningiomas represent an heterogeneous group of tumors. Most of the published series deal with either a small number of patients or consider different locations as a whole, making indications for treatment and prognosis difficult to be drawn.We analysed the surgical management of the lateral tentorial meningiomas, a homogenous and rare sub-group.
METHODS: 52 later tentorial meningiomas were operated between 1990 and 2010. Clinical, radiological features and surgical management of these patients were reviewed. Tumors were further subcategorized in posterior/intermediate and in supra/infratentorial subgroups. Surgical outcome, long-term results and prognostic factors are described.
RESULTS: Mean age was 57 years(41 female,11 male). Mean tumor size was 46 mm; most had an infratentorial location(36vs16). Prevailing presenting symptoms were headache(n=28), vertigo/gait disturbances(n=25), confusion and visual disturbances(n=16). The infratentorial group presented with poorer clinical condition before as well as after operation. Extent of tumor resection was Simpson I in 10 patients, II in 26, III in 6 and IV in 10. Subtotal resection was statistically correlated with sinus invasion and tumor size. There was no surgical mortality. Permanent complications occurred in 3 patients. At latest follow-up(mean: 119 months)42/46 resumed their normal daily activity. Six cases recurred and remained stable after radiosurgery.
CONCLUSION: Lateral tentorial meningomas are an homogeneous entity characterized by simple surgical approaches and favourable outcome(no mortality and low overall morbidity).Infratentorial location was more frequent and characterized by poorer outcome.The limiting factors for surgical removal were tumor size and sinus invasion. The latter point strengths the rationale for their classification into posterior and intermediate.

PMID: 26926797 [PubMed - as supplied by publisher]

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Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis.

Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis.

Eur Arch Otorhinolaryngol. 2016 Feb 29;

Authors: Faralli M, Lapenna R, Giommetti G, Pellegrino C, Ricci G

Abstract
Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.

PMID: 26926693 [PubMed - as supplied by publisher]

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Audiological comparison between two different clips prostheses in stapes surgery.

Related Articles

Audiological comparison between two different clips prostheses in stapes surgery.

Rev Laryngol Otol Rhinol (Bord). 2015;136(1):33-6

Authors: Potena M, Portmann D, Guindi S

Abstract
OBJECTIVES: To compare audiometric results and complications of stapes surgery with two different types of piston prosthesis, the Portmann Clip Piston (Medtronic) (PCP) and the Soft Clip Piston (Kurz) (SCP).
MATERIAL AND METHODS: Study conducted on 64 patients who underwent primary stapedotomy from 2008 to 2011. We matched for each case of stapedotomy with the PCP (Medtronic Xomed Inc. Portmann Clip Piston Stainless Steel/Fluoroplastic) a case with the SCP (Heinz Kurz GmbH Medizintechnik Soft Piston Clip Titanium). Each group consisted of 32 patients, and patients in both groups were matched with respect to gender, age, bilateral or unilateral otosclerosis, otological symptoms (tinnitus, vertigo or dizziness), family history, operated side and the Portmann grading for otosclerosis. The length of the prosthesis used was reported. Post-operative complications such as tinnitus, vertigo, hearing loss and altered taste were documented. Each patient was subjected to a preoperative and postoperative audiogram (follow-up at the second month after the surgery). We used the Student test for statistical analysis. Statistical significance was set at < 0.01.
RESULTS: None of the patients experienced a post-operative hearing loss and none required a later revision surgery. No statistically significant difference was found between the two populations regarding demographic data (age, sex, side, bilaterality, family history, stage and lenght of piston) and hearing level (> 0.01) in the air, bone conduction and air-bone gap (ABG). Postoperative complications did not result to be significantly different between the two groups. Also, both groups showed a significant improvement (< 0.01) in the post-operative air, bone conduction and air-bone gap. There was no statistically significant difference (> 0.01) between the post-operative hearing results (bone conduction, air conduction, air-bone gap) using the two pistons. The mean ABG improvement was respectively 16.63 dB in the SCP group and 20.59 dB in the PCP group.
CONCLUSION: The titanium Soft clip piston (SCP) is a good alternative to the Portmann clip piston (PCP). Nevertheless there are some differences in the surgical fixing of these two pistons in the correct position.

PMID: 26749603 [PubMed - indexed for MEDLINE]

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