Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma.

Related Articles

Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma.

Am J Otolaryngol. 2015 Sep-Oct;36(5):710-4

Authors: Goepfert RP, Liu C, Ryan WR

Abstract
BACKGROUND: Retropharyngeal metastases are uncommon but a well-known location for regional spread of well-differentiated thyroid carcinoma (WDTC). Surgeon-performed, trans-oral ultrasound (SP-TO-US) and trans-oral robot-assisted surgical (TORS) excision represent a unique combination of technology and techniques in the treatment of isolated retropharyngeal thyroid metastases.
PATIENT FINDINGS: A patient with a history of T3N1b papillary thyroid carcinoma (PTC) previously treated with total thyroidectomy, left central and lateral neck dissection, and radioactive iodine presented with progressive elevations in serum thyroglobulin (Tg) from baseline of 0.2 to 0.6 μg/L. She was found to have an isolated 2.6 cm left retropharyngeal nodal metastasis on MRI that was confirmed to be PTC on fine needle aspiration biopsy. She underwent SP-TO-US for identification of the node in the operating room immediately prior to TORS excision. There were no complications. Additional radioactive iodine was administered. Post-treatment iodine scans revealed resolution of avid uptake in left retropharynx and return of Tg to 0.2 μg/L.
SUMMARY: The combination of SP-TO-US and TORS represents a novel combination of technology and technique for treatment of isolated retropharyngeal metastasis in WDTC. Trans-oral ultrasound allows for rapid localization of the lesion in relation to the adjacent neurovascular structures in the parapharynx while the robot-assisted approach affords a safe and effective dissection through the improved visualization and dexterity in a small working space. Our patient had no complications and only short-term dysphagia that resolved after temporary diet alteration. Risks and long-term morbidities associated with classical approaches to the retropharynx including trans-cervical and trans-mandibular, particularly in a previously dissected field, are avoided through this trans-oral approach.
CONCLUSIONS: Retropharyngeal metastases are a known location for regional spread of WDTC and are amenable to evaluation and biopsy using TO-US by both surgical and non-surgical providers. In cases where lateral neck dissection has already been performed or when traditional transcervical or transmandibular approaches to the retropharynx represent a comparatively extensive procedure for isolated metastases, SP-TO-US and TORS are safe and effective combination for surgical management of disease.

PMID: 25964171 [PubMed - indexed for MEDLINE]

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Phenotyping, endotyping and clinical decision-making.

Phenotyping, endotyping and clinical decision-making.

Rhinology. 2016 May 29;

Authors: Fokkens WJ

Abstract
We have exiting times in the treatment of chronic rhinosinusitis (CRS). The last year has brought us a number of new ideas and publications to help in decision-making in daily practice. In the first issue of this year, Claire Hopkins and co-authors identified the most important outcomes for patients, public and practitioners that should be evaluated in studies on health interventions for CRS. In this issue of the journal, a group of experts tried to define appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis. Appropriate indications for endoscopic sinus surgery (ESS) are currently poorly defined and the lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates. Using the Delphi method a total of 624 clinical scenarios (half CRSsNP and half CRSwNP) were ranked. The study clearly states that this group of experts indicates that ESS can only be indicated after medical treatment has failed with patients still having significant symptoms (SNOT-22 over 20) and at least some abnormalities at CT scan.

PMID: 27236249 [PubMed - as supplied by publisher]

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Laryngeal and phrenic nerve involvement in a patient with hereditary neuropathy with liability to pressure palsies (HNPP).

Laryngeal and phrenic nerve involvement in a patient with hereditary neuropathy with liability to pressure palsies (HNPP).

Neuromuscul Disord. 2016 May 12;

Authors: Cortese A, Piccolo G, Lozza A, Schreiber A, Callegari I, Moglia A, Alfonsi E, Pareyson D

Abstract
Lower cranial and phrenic nerve involvement is exceptional in hereditary neuropathy with liability to pressure palsies (HNPP). Here we report the occurrence of reversible laryngeal and phrenic nerve involvement in a patient with HNPP. The patient recalled several episodes of reversible weakness and numbness of his feet and hands since the age of 30 years. His medical history was uneventful, apart from chronic obstructive pulmonary disease (COPD). At age 44, following severe weight loss, he presented with progressive dysphonia and hoarseness. EMG of cricoarytenoid and thyroarytenoid muscles and laryngeal fibroscopy confirmed vocal cord paralysis. These speech disturbances gradually regressed. Two years later, he reported rapidly worsening dyspnea. Electroneurography showed increased distal latency of the right phrenic nerve and diaphragm ultrasonography documented reduced right hemi-diaphragm excursion. Six months later and after optimization of CODP treatment, his respiratory function had improved and both phrenic nerve conduction and diaphragm excursion were completely restored. We hypothesize that chronic cough and nerve stretching in the context of CODP, together with severe weight loss, may have triggered the nerve paralysis in this patient. Our report highlights the need for optimal management of comorbidities such as CODP as well as careful control of weight in HNPP patients to avoid potentially harmful complications.

PMID: 27241821 [PubMed - as supplied by publisher]

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Bilateral cochlear implantation under local anaesthesia in a young adult - A case report.

Bilateral cochlear implantation under local anaesthesia in a young adult - A case report.

Cochlear Implants Int. 2016 Jun 2;:1-4

Authors: Vaid N, Jana JJ, Kothadiya A, Deshpande S, Vaid S

Abstract
OBJECTIVE: Cochlear implantation is routinely performed under general anaesthesia in most centres in the world. There have been reports of this surgery being performed under local anaesthesia and sedation for unilateral cochlear implantation. Our case study reports the first bilateral cochlear implantation carried out under local anaesthesia with sedation. This paper outlines the protocol used and discusses the challenges and advantages of the procedure being performed under local anaesthesia.
CASE STUDY: A 28-year-old female with a history of multidrug-resistant tuberculosis presented with bilateral severe to profound sensorineural hearing loss. On evaluation, she was found to be a suitable candidate for cochlear implantation. However, she was clinically unfit to undergo the surgery under general anaesthesia. After counselling the patient, the decision to undertake the procedure under local anaesthesia was made. The procedure took 105 min and was uneventful. The patient was discharged the next day Conclusion: In the hands of an experienced surgeon and anaesthesiology team, bilateral cochlear implantation is possible under local anaesthesia. Patient motivation and cooperation are extremely important for the procedure to be done under local anaesthesia. This is an option for patients needing cochlear implantation who are medically unfit for general anaesthesia.

PMID: 27251776 [PubMed - as supplied by publisher]

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Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma.

Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma.

Head Neck. 2016 Jun 1;

Authors: Charbonnier Q, Thisse AS, Sleghem L, Mouawad F, Chevalier D, Page C, Mortuaire G

Abstract
BACKGROUND: The oncologic impact of surgical margins after transoral laser microsurgery (TLM) for T1 and T2 glottic carcinoma is controversial. The purpose of this study was to assess the prognostic value of margin status in terms of local control.
METHODS: Records of 266 patients treated from 1990 to 2013 were evaluated. Patients with previous cordectomy or without preoperative CT scan were excluded from the study.
RESULTS: A total 110 patients (85 T1a, 8 T1b, and 17 T2) were enrolled. A local recurrence was observed in 23 patients. Five-year disease-free survival was significantly impaired in patients with positive margins (p = .009) and in patients with deep involvement of the vocal muscle (p = .004).
CONCLUSION: The present study shows that invaded margin is a factor of poor local control even though laser vaporization was systematically applied after resection. In case of deep vocal fold involvement, TLM should be extended beyond the vocal muscle to improve local control. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27248845 [PubMed - as supplied by publisher]

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Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma.

Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma.

Head Neck. 2016 Jun 1;

Authors: Liskamp CP, Janssens GO, Bussink J, Melchers WJ, Kaanders JH, Verhoef CG

Abstract
BACKGROUND: The purpose of this retrospective study was to identify prognostic factors in a cohort of patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT).
METHODS: Medical records of 142 patients treated with (chemo)radiotherapy between September 2005 and September 2011 were reviewed and the human papillomavirus (HPV) status was determined by polymerase chain reaction (PCR) analysis. Potential prognostic factors for 3-year locoregional control and overall survival (OS) were evaluated.
RESULTS: HPV-positive patients (n = 82) had locoregional control and OS of 78% and 79%, respectively. Significant prognostic factors on multivariate analysis were smoking (p = .03) for locoregional control and OS, and comorbidity (p = .04) for OS. Further stratification was done according to smoking behavior in HPV-positive patients. Locoregional control in current smokers was 67% compared to 86% in never smokers and former smokers, respectively (p = .02).
CONCLUSION: Smoking was the only modifiable prognostic factor in HPV-positive patients. Therefore, active stop-smoking programs must be integrated in the routine management of patients to maximize treatment results. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27248701 [PubMed - as supplied by publisher]

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Sacrificing the buccal branch of the facial nerve during parotidectomy.

Sacrificing the buccal branch of the facial nerve during parotidectomy.

Head Neck. 2016 Jun 1;

Authors: Dhiwakar M, Khan ZA

Abstract
BACKGROUND: The need for and consequence of sacrificing the buccal branch of the facial nerve during parotidectomy is unknown. We sought to determine the indication, frequency, and functional outcome of buccal branch sacrifice.
METHODS: We conducted a prospective study of all cases of parotidectomy at a tertiary referral center.
RESULTS: Of 100 consecutive cases of parotidectomy, the buccal branch was sacrificed in 23 cases. This subgroup was more likely to have anterior or deep lesions (p < .001), retrograde facial nerve dissection (p = .037), and immediate postoperative upper and lower facial weakness (p = .051 and .002, respectively). However, if the temporozygomatic and cervicomandibular branches were anatomically preserved, full facial (including buccal) function was restored.
CONCLUSION: Deep or anterior lesions may warrant sacrifice of the buccal branch for adequate access and excision. However, this does not result in long-term impairment of facial function. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27248506 [PubMed - as supplied by publisher]

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Predictors of Difficult Intubation Among Malay Patients in Indonesia.

Predictors of Difficult Intubation Among Malay Patients in Indonesia.

Anesth Pain Med. 2016 Apr;6(2):e34848

Authors: Tantri AR, Firdaus R, Salomo ST

Abstract
BACKGROUND: Failure to maintain an adequate airway can lead to brain damage and death. To reduce the risk of difficulty in maintaining an airway during general anesthesia, there are several known predictors of difficult intubation. People with a Malay background have different craniofacial structures in comparison with other individuals. Therefore, different predictors should be used for patients of Malay race.
OBJECTIVES: The aim of this study was to determine the ability to predict difficult visualization of the larynx (DVL) in Malay patients based on several predictors, such as the modified Mallampati test (MMT), thyromental distance (TMD), and hyomental distance ratio (HMDR).
PATIENTS AND METHODS: This cross-sectional study included 277 consecutive patients requiring general anesthesia. All subjects were evaluated using the MMT, TMD, and HMDR, and the cut-off points for the airway predictors were Mallampati III and IV, < 6.5 cm, and < 1.2, respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack-Lehane (CL) classification. CL grades III and IV were considered difficult visualization. The area under the curve (AUC), sensitivity, and specificity for each predictor were calculated both as sole and combined predictors. Logistic regression analysis was used to determine independent predictors of DVL.
RESULTS: Difficulty in visualizing the larynx was found in 28 (10.1%) patients. The AUC, sensitivity, and specificity for the three airway predictors were as follows: MMT: 0.614, 10.7%, and 99.2%; HMDR: 0.743, 64.2%, and 74%; and TMD: 0.827, 82.1%, and 64.7%. The combination providing the best prediction in our study involved the MMT, HMDR, and TMD with an AUC, sensitivity, and specificity of 0.835, 60.7%, and 88.8%, respectively. Logistic regression analysis showed that the MMT, HMDR, and TMD were independent predictors of DVL.
CONCLUSIONS: The TMD, with a cut-off point of 65 mm, had superior diagnostic value compared with the HMDR and Mallampati score. Therefore, the TMD could be used in Malay patients to predict the difficulty of larynx visualization during laryngoscopy.

PMID: 27252905 [PubMed]

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Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves.

Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves.

Langenbecks Arch Surg. 2016 Jun 2;

Authors: Henry BM, Vikse J, Graves MJ, Sanna S, Sanna B, Tomaszewska IM, Tubbs RS, Tomaszewski KA

Abstract
INTRODUCTION: The recurrent laryngeal nerves (RLN) are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. Historically, the RLN has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extralaryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. We aimed to assess the anatomical characteristics of ELB comprehensively.
METHODS: Articles on the ELB of the RLN were identified by a comprehensive database search. Relevant data were extracted and pooled into a meta-analysis of the prevalence of branching, branching pattern, distance of ELB point from the larynx, and presence of positive motor signals in anterior and posterior ELB branches.
RESULTS: A total of 69 articles (n = 28,387 nerves) from both intraoperative and cadaveric modalities were included in the meta-analysis. The overall pooled prevalence of ELB was 60.0 % (95 % CI 52.0-67.7). Cadaveric and intraoperative subgroups differed with prevalence rates of 73.3 % (95 % CI 61.0-84.0) and 39.2 % (95 % CI 29.0-49.9), respectively. Cadavers most often presented with a ELB pattern of bifurcation, with a prevalence of 61.1 %, followed by no branching at 23.4 %. Branching of the RLN occurred most often at a distance of 1-2 cm (74.8 % of cases) prior to entering the larynx. A positive motor signal was most often noted in anterior RLN branches (99.9 %) but only in 1.5 % of posterior branches.
CONCLUSIONS: The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications.

PMID: 27251487 [PubMed - as supplied by publisher]

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Change in the Quality of Life in Oropharyngeal, Laryngeal and Hypopharyngeal Cancer Patients treated with Volumetric Modulated Arc-Based Concomitant Boost Radiotherapy.

Change in the Quality of Life in Oropharyngeal, Laryngeal and Hypopharyngeal Cancer Patients treated with Volumetric Modulated Arc-Based Concomitant Boost Radiotherapy.

Gulf J Oncolog. 2016 May;1(21):36-45

Authors: Kannan P, Mukherji A, Saravanan K, Reddy KS, Vivekanandam S, Shamsudheen C, Santhosh V

Abstract
OBJECTIVE: To assess the change in the quality of life (QOL) in Oropharyngeal, Laryngeal and Hypopharyngeal cancer patients treated with concomitant boost radiotherapy by Volumetric Intensity Modulated Arc Therapy (VMAT) technique.
METHODS: Thirty patients with oropharynx, larynx or hypopharynx cancers of stage II to IVA were treated with an Accelerated fractionation schedule using Concomitant boost. The dose given was 1.8Gy/fraction daily, 5 days a week to the large field for 28 fractions and a daily concomitant boost of 1.5Gy/fraction to the boost field over the last 12 treatment days for a total dose of 68.4Gy/40 fractions/5½weeks by VMAT technique with concurrent chemotherapy (in stage III and IV patients) using Cisplatin 100mg/m2 IV three weekly during week 1 and week 4 of irradiation. QOL was assessed using the European Organization of Research and Treatment of Cancer Quality of Life Core Questionnaire, version 3.0 (EORTC QLQC30) and EORTC head and neck module (EORTC QLQ-HN35) before treatment, at the end of treatment, 1 month, 3 months and 6 months post treatment. The QOL scores and their evolution over the five measurements were calculated.
RESULTS: The change in the QOL scores was acceptable in general. There was a significant reduction in quality of life scores at the end of treatment. The QOL improved in the followup period; and by 3 months post irradiation, there was a return of QOL scores to the baseline value.
CONCLUSION: The QOL scores indicate that concomitant boost radiotherapy by VMAT is well tolerated and helps in rapid return to baseline quality of life scores. We believe that this is one of the first papers which have combined concomitant boost radiotherapy with VMAT technique in head and neck cancers. VMAT based concomitant boost radiotherapy helps in rapid return to baseline quality of life.

PMID: 27250886 [PubMed - in process]

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Dynamic vocal fold parameters with changing adduction in ex-vivo hemilarynx experiments.

Dynamic vocal fold parameters with changing adduction in ex-vivo hemilarynx experiments.

J Acoust Soc Am. 2016 May;139(5):2372

Authors: Döllinger M, Berry DA, Kniesburges S

Abstract
Ex-vivo hemilarynx experiments allow the visualization and quantification of three-dimensional dynamics of the medial vocal fold surface. For three excised human male larynges, the vibrational output, the glottal flow resistance, and the sound pressure during sustained phonation were analyzed as a function of vocal fold adduction for varying subglottal pressure. Empirical eigenfunctions, displacements, and velocities were investigated along the vocal fold surface. For two larynges, an increase of adduction level resulted in an increase of the glottal flow resistance at equal subglottal pressures. This caused an increase of lateral and vertical oscillation amplitudes and velocity indicating an improved energy transfer from the airflow to the vocal folds. In contrast, the third larynx exhibited an amplitude decrease for rising adduction accompanying reduction of the flow resistance. By evaluating the empirical eigenfunctions, this reduced flow resistance was assigned to an unbalanced oscillation pattern with predominantly lateral amplitudes. The results suggest that adduction facilitates the phonatory process by increasing the glottal flow resistance and enhancing the vibrational amplitudes. However, this interrelation only holds for a maintained balanced ratio between vertical and lateral displacements. Indeed, a balanced vertical-lateral oscillation pattern may be more beneficial to phonation than strong periodicity with predominantly lateral vibrations.

PMID: 27250133 [PubMed - in process]

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Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature.

Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar 17;

Authors: Draenert FG, Kämmerer PW, Berthold M, Neff A

Abstract
OBJECTIVES: Vertical bone augmentation in dental implantology is an indication for cancellous allogeneic bone blocks (ABB). However, these materials may lead to adverse reactions, which are known well in orthopedics but rarely published. Therefore, in this study, we performed an evaluation of the use of ABB in vertical bone augmentation in clinical dental implantology.
STUDY DESIGN: The prospective clinical study included 20 cases with vertical augmentation using ABB and subsequent or simultaneous placement of implants in the lateral maxilla and mandible. Follow-up included panoramic radiography, tissue healing, and peri-implantitis. Because of the limited number of patients, the report was planned to be descriptive only. Loss of ABB or peri-implantitis of more than 30% of the intraosseous implant length was deemed to indicate failure.
RESULTS: The study was cancelled after six cases because of an unexpectedly high number of complications (5 of 6; 83%). The average surveillance time was 1460 days. Three types of unsatisfying outcome were observed: type I, early complete loss of the augmentation with soft tissue defects after 3 to 8 weeks (n = 2); type II, early soft tissue maceration (up to 8 weeks) without loss of coverage and complete early bone healing with later peri-implantitis and bone loss after prosthetic loading (6 months or later; n = 2); and type III, complication-free bone healing with subsequent peri-implantitis after prosthetic loading (6 months or later; n = 1).
CONCLUSIONS: Complications were observed in vertical augmentation with ABB and implant placement. After careful consideration, literature data were found to support these results and also suggest that tissue level implants may be advantageous in vertical bone augmentation with ABB.

PMID: 27236830 [PubMed - as supplied by publisher]

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Hydrops of the organ of Corti.

Hydrops of the organ of Corti.

Acta Otolaryngol. 2016 May 31;:1-3

Authors: Nomura Y, Kimura Y, Kobayashi H

Abstract
OBJECTIVES: The authors would like to confirm a fluid pathway from the scala tympani to the organ of Corti, and to observe its morphological changes.
METHODS: A staining solution for succinic dehydrogenase was perfused with phenazine methosulfate in the scala tympani of living guinea pigs (n = 5) under deep anesthesia. After fixation, the cochleas were eventually embedded in epon. Sections were observed under a light microscope.
RESULTS: Blue-stained tissue is indicative of the pathway taken by the solution. The staining solution entered the organ of Corti through Hensen-Deiters' slit. The slit widened and Hensen's cells were pushed laterally. A new space was formed medial to Hensen's cells. Cortilymphatic hydrops developed.
CONCLUSION: The Hensen-Deiters' slit is a pathway of a certain staining solution from the scala tympani to inside the organ of Corti of the guinea pig. The influx of the fluid pushes Hensen's cells laterally and upward, resulting in a formation of hydrops of the organ of Corti or cortilymphatic hydrops. The hydrops is observed in animals with experimental perilymphatic fistula and with viral labyrinthitis. At the end stage of the hydrops, only the surface of the organ of Corti remains as a thin layer without any cellular elements.

PMID: 27241920 [PubMed - as supplied by publisher]

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Cochlear implantation in Pendred syndrome and non-syndromic enlarged vestibular aqueduct - clinical challenges, surgical results, and complications.

Cochlear implantation in Pendred syndrome and non-syndromic enlarged vestibular aqueduct - clinical challenges, surgical results, and complications.

Acta Otolaryngol. 2016 May 31;:1-5

Authors: Mey K, Bille M, Cayé-Thomasen P

Abstract
OBJECTIVE: To explore specific clinical issues, surgical results, and complications of 80 cochlear implantations (CI) in 55 patients with Pendred syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA).
BACKGROUND: Previous studies have focused either on unselected case series or on populations with mixed cochlear malformations. PS/NSEVA accounts for up to 10% of congenital SNHL, rendering this a large group of cochlear implant candidates. The abnormal inner ear anatomy of these patients may be associated with a lower surgical success rate and a higher rate of complications.
STUDY DESIGN: Retrospective review of patients' medical records and CT/MRI.
SETTING: Tertiary referral center.
MATERIALS AND METHODS: The medical records and CT/MRI images of 55 PS/NSEVA patients receiving 80 cochlear implantations from 1982-2014 were reviewed. Demographic data, surgical results, intra-operative incidents, and post-operative complications were retrieved.
RESULTS: Complications occurred in 36% of implantations; 5% hereof major complications. Gushing/oozing from the cochleostoma occurred in 10% of implantations and was related to transient, but not prolonged post-operative vertigo.
CONCLUSION: Intra-operative risks of gushing/oozing and post-operative vertigo are the primary clinical issues in PS/NSEVA patients regarding CI. Nonetheless, the surgical success rate is high and the major complication rate is low; similar to studies of unselected series of CI recipients.

PMID: 27241825 [PubMed - as supplied by publisher]

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[Medical examination: Preparation for ENT specialisation : Part 25].

[Medical examination: Preparation for ENT specialisation : Part 25].

HNO. 2016 May 30;

Authors: Kemper M, Neudert M

PMID: 27240794 [PubMed - as supplied by publisher]

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[Laryngeal and larynx-associated reflexes].

[Laryngeal and larynx-associated reflexes].

HNO. 2016 May 30;

Authors: Ptok M, Kühn D, Miller S, Jungheim M, Schroeter S

Abstract
The laryngeal adductor reflex and the pharyngoglottal closure reflex protect the trachea and lower respiratory tract against the entrance of foreign material. The laryngeal expiration reflex and the cough reflex serve to propel foreign material, which has penetrated in the cranial direction. The inspiration reflex, the sniff reflex, and the swallowing reflex are further larynx-associated reflexes. In patients with dysphagia the laryngeal adductor reflex can be clinically tested with air pulses. The water swallow test serves to show the integrity of the cough reflex. The sniff reflex is useful to test the abduction function of the vocal folds. Future studies should address laryngeal reflexes more specifically, both for a better understanding of these life-supporting mechanisms and to improve diagnostic procedures in patients with impaired laryngeal function.

PMID: 27240793 [PubMed - as supplied by publisher]

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[Concretions and iatrogenic foreign bodies in the lacrimal system : Treatment recommendations].

[Concretions and iatrogenic foreign bodies in the lacrimal system : Treatment recommendations].

HNO. 2016 May 30;

Authors: Heichel J, Sandner A, Siebolts U, Bethmann D, Struck HG

Abstract
BACKGROUND: Deposits (dacryoliths or foreign bodies) inside the lacrimal system can cause chronic inflammation and recurrent lacrimal stenosis. Furthermore, dacryoliths can occur due to chronic inflammation.
OBJECTIVE: Considering typical clinical courses, the different localizations and surgical options for removing deposits from the lacrimal system are demonstrated.
MATERIALS AND METHODS: A retrospective analysis of 1451 lacrimal surgeries in 1131 patients was performed. Fourteen representative lacrimal surgeries of 11 patients were retrospectively analyzed in terms of current complaints, prior surgery, and the performed surgical intervention. In three cases, histologic findings of removed dacryoliths were assessed. The surgical approaches are described using precise photodocumentation.
RESULTS: In 220 lacrimal surgeries (15.2 %), dacryoliths were detected. Iatrogenic foreign bodies were found in 0.8 % (n = 12). All chosen patients suffered painful chronic inflammation of the lacrimal system. Localization was either intrasaccular or intracanalicular. In 10 eyes, surgery was performed using a transcanalicular dacryoendoscope, either alone or in combination with another method. An external approach (transcutaneous/transconjunctival) was performed in 4 patients. Regarding the whole study population, dacryoliths were found in 16.9 % (n = 91) of dacryocystorhinostomies, in 14.6 % (n = 77) of dacryoendoscopies, and in 35.6 % (n = 52) of canaliculotomies.
CONCLUSION: Foreign bodies and dacryoliths are important differential diagnoses in the treatment of chronic dacryocystitis. Different surgical approaches are possible and should be available for treatment. Patients' history often reports prior lacrimal surgery.

PMID: 27240792 [PubMed - as supplied by publisher]

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[Anatomy and physiology of the nasolacrimal ducts].

[Anatomy and physiology of the nasolacrimal ducts].

HNO. 2016 May 30;

Authors: Paulsen F, Garreis F, Schicht M, Bräuer L, Ali MJ, Sel S

Abstract
Ophthalmologists and interventional radiologists are not the only professionals for whom diseases of the efferent tear duct system occupy centre stage; this applies also to ENT specialists involving endonasal conservative or surgical treatment. On the basis of current knowledge and taking account of results yielded by own research in recent years and of clinical aspects, we here give an overview of basic knowledge on the anatomy and physiology of the nasolacrimal system. In doing so functional aspects regarding tear transport as well as embryological and pathophysiological issues are integrated.

PMID: 27240791 [PubMed - as supplied by publisher]

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The impact of tinnitus upon cognition in adults: A systematic review.

The impact of tinnitus upon cognition in adults: A systematic review.

Int J Audiol. 2016 May 31;:1-8

Authors: Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM

Abstract
OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus.
DESIGN: A systematic and descriptive review.
STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function.
RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention.
CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

PMID: 27240696 [PubMed - as supplied by publisher]

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The clival canal.

Related Articles

The clival canal.

Arq Neuropsiquiatr. 2015 Dec;73(12):1047

Authors: Campos Dd, Jotz GP, Goulart GR, Malysz T

PMID: 26465285 [PubMed - indexed for MEDLINE]

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Endotoxemia-mediated inflammation potentiates aminoglycoside-induced ototoxicity.

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Endotoxemia-mediated inflammation potentiates aminoglycoside-induced ototoxicity.

Sci Transl Med. 2015 Jul 29;7(298):298ra118

Authors: Koo JW, Quintanilla-Dieck L, Jiang M, Liu J, Urdang ZD, Allensworth JJ, Cross CP, Li H, Steyger PS

Abstract
The ototoxic aminoglycoside antibiotics are essential to treat severe bacterial infections, particularly in neonatal intensive care units. Using a bacterial lipopolysaccharide (LPS) experimental model of sepsis, we tested whether LPS-mediated inflammation potentiates cochlear uptake of aminoglycosides and permanent hearing loss in mice. Using confocal microscopy and enzyme-linked immunosorbent assays, we found that low-dose LPS (endotoxemia) greatly increased cochlear concentrations of aminoglycosides and resulted in vasodilation of cochlear capillaries without inducing paracellular flux across the blood-labyrinth barrier (BLB) or elevating serum concentrations of the drug. Additionally, endotoxemia increased expression of both serum and cochlear inflammatory markers. These LPS-induced changes, classically mediated by Toll-like receptor 4 (TLR4), were attenuated in TLR4-hyporesponsive mice. Multiday dosing with aminoglycosides during chronic endotoxemia induced greater hearing threshold shifts and sensory cell loss compared to mice without endotoxemia. Thus, endotoxemia-mediated inflammation enhanced aminoglycoside trafficking across the BLB and potentiated aminoglycoside-induced ototoxicity. These data indicate that patients with severe infections are at greater risk of aminoglycoside-induced hearing loss than previously recognized.

PMID: 26223301 [PubMed - indexed for MEDLINE]

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Sunitinib as Neoadjuvant Chemotherapy in the Management of Metastatic Renal Cell Carcinoma Mimicking a Glomus Vagale Tumor in the Head and Neck: A Case Report and Review of Literature.

Sunitinib as Neoadjuvant Chemotherapy in the Management of Metastatic Renal Cell Carcinoma Mimicking a Glomus Vagale Tumor in the Head and Neck: A Case Report and Review of Literature.

J Neurol Surg Rep. 2016 Jun;77(2):e77-82

Authors: Erkan S, Somner J, Rajan GP

Abstract
Background Metastatic renal cell carcinoma (RCC) of the head and neck with intracranial extension is rare and may pose difficulties to the diagnosis and management. Method We describe a unique case of a 76-year-old man with a metastatic RCC to the neck and lateral skull base with intracranial extension presenting with Collet-Sicard syndrome 8 years after initial diagnosis. The radiologic features were consistent with the diagnosis of a glomus vagale tumor on the basis of clinical and radiologic features. Results Despite radiotherapy, the intracranial extension progressed in size, resulting in early hydrocephalus. Sunitinib, a novel tyrosine kinase inhibitor, was instituted to treat the glomus vagale tumor with a marked reduction in tumor volume and resolution of the early hydrocephalus. The surgical resection of the tumor with its intracranial extension was achieved without additional postoperative morbidity. The histopathologic diagnosis surprisingly demonstrated metastatic RCC. Conclusion We present a case of metastatic RCC to the head and neck region mimicking a glomus vagale tumor and describe the first use of sunitinib as a neoadjuvant chemotherapy to achieve a single-stage radical en bloc resection of the tumor mass.

PMID: 27247912 [PubMed]

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Subjective and Objective Analyses of Voice Improvement After Phonosurgery in Professional Voice Users.

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Subjective and Objective Analyses of Voice Improvement After Phonosurgery in Professional Voice Users.

Med Probl Perform Art. 2016 Mar;31(1):18-24

Authors: do Amaral Catani GS, Hamerschmidt R, Moreira AT, Timi JR, Wiemes GR, Ido J, Macedo E

Abstract
OBJECTIVES: To evaluate voice improvement after phonosurgery by subjective and objective voice analysis.
DESIGN: Prospective observational analytic group study.
METHODS: This study was conducted from January 2012 to December 2013. Two hundred forty professional voice users (patients), classified as Koufman level I or II with benign vocal fold lesions, were divided in two groups. Patients in group 1 had a diagnosis of superficial vocal fold lesions, and patients in group 2 had deep lesions on the vocal folds. All patients completed the Vocal Performance Questionnaire (VPQ) and underwent acoustic voice tests using the Praat program. Subjective and objective voice analyses were performed before phonosurgery and at 1, 2, and 3 months after phonosurgery. A control group of 100 volunteers was created and underwent the same voice metrics that were applied to the patients.
RESULTS: Jitter, shimmer, harmonic-to-noise ratio, and VPQ scores significantly differentiated patients with vocal fold lesions from individuals in the control group. All of the analyzed parameters improved significantly after phonosurgery. Additionally, patients with superficial vocal fold lesions achieved normal voice parameters 1 month after surgery, and patients with deep lesions achieved normal voice parameters 3 months after surgery.
CONCLUSIONS: Analysis of vocal parameters using the VPQ and acoustic tests revealed voice improvement after phonosurgery for both patient groups.

PMID: 26966960 [PubMed - indexed for MEDLINE]

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Phenotype of a Belgian Family With 6p25 Deletion Syndrome.

Phenotype of a Belgian Family With 6p25 Deletion Syndrome.

Ann Otol Rhinol Laryngol. 2016 May 30;

Authors: Weegerink NJ, Swinnen FK, Vanakker OM, Casselman JW, Dhooge IJ

Abstract
BACKGROUND: The 6p25 deletion syndrome is one of the many syndromes with both hearing impairment as well as vision impairment. However, the audiometric characteristics and radiological findings of patients with 6p25 deletions are only scarcely described in literature. This study focused on characterizing the audiometric and radiological features of a Belgian family with a chromosome 6p25 deletion.
OBJECTIVE: To evaluate the hearing impairment, audiometric testing and radiological examination of the temporal bones in 3 family members with a 3.4 Mb deletion in chromosome band 6p25.
RESULTS: All 3 family members demonstrated slowly progressive sensorineural or mixed hearing impairment. Radiologic examination revealed thickened and sclerotic stapes in all patients and a minor internal partition type II of the cochlea in 2 patients.
CONCLUSION: There is a significant phenotypic variability within and among families with the 6p25 deletion syndrome. A thorough genotype-phenotype correlation is difficult because of the small number of affected patients and the limited clinical data available. More clinical data of families with 6p25 deletions need to be published in order to create a reliable and precise phenotypic characterization. However, our findings can facilitate counseling of hearing impairment caused by 6p25 deletions.

PMID: 27242366 [PubMed - as supplied by publisher]

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Middle Cranial Fossa Dehiscence as an Incidental Finding on CT.

Middle Cranial Fossa Dehiscence as an Incidental Finding on CT.

Ann Otol Rhinol Laryngol. 2016 May 30;

Authors: Valika T, Redleaf M

Abstract
OBJECTIVES: This retrospective chart review demonstrates that the prevalence of middle cranial fossa (MCF) dehiscence on computed tomography (CT) scans increases with age.
METHODS: High-resolution temporal bone CT scans, which had been obtained for any otologic complaint, were reviewed independent of all clinical history. Scans showing soft tissue, fluid, trauma, or previous operations were excluded. The CTs from 183 patients (296 ears) were reviewed, blinded for age and body mass index (BMI). The MCF floor was divided into 7 regions and systematically inspected. Ages and BMIs of the patients were subsequently extracted from the medical record.
RESULTS: Logistic regression analysis confirmed increasing MCF dehiscence with age (P < .05, odds ratio [OR] = 1.07, R = .584). Over all ages (range, 1-88 years; average, 38.5), 32% of MCF floors were dehiscent at any 1 site. For age 60 and over, 55% were dehiscent. The most common sites of MCF dehisence were directly above the malleus head and above the additus ad antrum (35% and 28%, respectively). Superior canal dehiscence (SCD) was seen in 7% of all patients and only in the context of MCF dehiscence. The prevalence of MCF dehiscence increased with age when patients were analyzed by BMI <25, BMI = 25-30, and BMI >30 (P < .003, P < .04, P = .03).
CONCLUSION: The increase of middle cranial fossa dehiscence with respect to age is statistically significant. Over all ages, approximately 32% of ears show dehiscence. Over 60 years, approximately 55% show dehiscence. The odds of having dehiscence double with a 10-year difference in age. The most common sites along the MCF floor are in the epitympanum over the malleus head and the additus ad antrum. There was a statistically significant increase in MCF dehiscence with age when patients with equivalent BMIs are compared.

PMID: 27242365 [PubMed - as supplied by publisher]

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Liberatory vertigo: a new prognostic factor for repositioning maneuvers.

Liberatory vertigo: a new prognostic factor for repositioning maneuvers.

Am J Emerg Med. 2016 May 19;

Authors: Tirelli G, Boscolo Nata F, Gardenal N, Ghirardo G, Tofanelli M

Abstract
OBJECTIVE: This study suggests the new concept of liberatory vertigo to facilitate emergency department treatment of benign paroxysmal positional vertigo.
METHODS: The present prospective nonrandomized study enrolled 535 patients with typical forms of positional vertigo, who were treated following clinical practice guidelines. We observed the onset of liberatory vertigo during the maneuver as a prognostic factor, and we tested the correlation between that symptom and therapeutic effectiveness. A subjective evaluation of vertigo was made by way of a questionnaire. Data analysis was performed that made use of statistical software.
RESULTS: Complete recovery occurred in 287 patients (76.5%) with posterior semicircular canal positional vertigo and in 67 patients (80%) with horizontal semicircular canal positional vertigo; liberatory vertigo occurred in 195 (67.9%) and 59 (88%) of those cases, respectively. Differences in terms of recovery probability resulted regardless of the canal involved. Positive predictive value ranged from 93% to 97%.
CONCLUSIONS: In our sample, liberatory vertigo could predict the effectiveness of the maneuver regardless of the canal involved.

PMID: 27241562 [PubMed - as supplied by publisher]

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Simultaneous cochlear implantation and labyrinthectomy for advanced Ménière's disease.

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Simultaneous cochlear implantation and labyrinthectomy for advanced Ménière's disease.

J Laryngol Otol. 2016 Feb;130(2):204-6

Authors: Heywood RL, Atlas MD

Abstract
BACKGROUND: Patients with Ménière's disease can develop unaidable sensorineural hearing loss. Cochlear implantation has recently been utilised in this group with favourable results. A more challenging group are those with intractable vertigo, and they have traditionally posed a significant management dilemma.
CASE REPORT: Two female patients with unaidable hearing and recurrent incapacitating vertigo attacks despite conservative management underwent simultaneous labyrinthectomy and cochlear implantation. There was complete resolution of vertigo in both patients. Speech perception in quiet conditions and the ability to hear in background noise improved considerably.
CONCLUSION: Surgical labyrinthectomy is effective for the elimination of vertigo in Ménière's disease patients. The major disadvantage in the past was loss of residual hearing. Cochlear implantation is now an option in these patients. The benefits of simultaneous labyrinthectomy with cochlear implantation include the prevention of implantation of a fibrosed or ossified cochlea, a decrease in the duration of deafness, and a single operative procedure.

PMID: 26672392 [PubMed - indexed for MEDLINE]

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Hydrops of the organ of Corti.

Hydrops of the organ of Corti.

Acta Otolaryngol. 2016 May 31;:1-3

Authors: Nomura Y, Kimura Y, Kobayashi H

Abstract
OBJECTIVES: The authors would like to confirm a fluid pathway from the scala tympani to the organ of Corti, and to observe its morphological changes.
METHODS: A staining solution for succinic dehydrogenase was perfused with phenazine methosulfate in the scala tympani of living guinea pigs (n = 5) under deep anesthesia. After fixation, the cochleas were eventually embedded in epon. Sections were observed under a light microscope.
RESULTS: Blue-stained tissue is indicative of the pathway taken by the solution. The staining solution entered the organ of Corti through Hensen-Deiters' slit. The slit widened and Hensen's cells were pushed laterally. A new space was formed medial to Hensen's cells. Cortilymphatic hydrops developed.
CONCLUSION: The Hensen-Deiters' slit is a pathway of a certain staining solution from the scala tympani to inside the organ of Corti of the guinea pig. The influx of the fluid pushes Hensen's cells laterally and upward, resulting in a formation of hydrops of the organ of Corti or cortilymphatic hydrops. The hydrops is observed in animals with experimental perilymphatic fistula and with viral labyrinthitis. At the end stage of the hydrops, only the surface of the organ of Corti remains as a thin layer without any cellular elements.

PMID: 27241920 [PubMed - as supplied by publisher]

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Cochlear implantation in Pendred syndrome and non-syndromic enlarged vestibular aqueduct - clinical challenges, surgical results, and complications.

Cochlear implantation in Pendred syndrome and non-syndromic enlarged vestibular aqueduct - clinical challenges, surgical results, and complications.

Acta Otolaryngol. 2016 May 31;:1-5

Authors: Mey K, Bille M, Cayé-Thomasen P

Abstract
OBJECTIVE: To explore specific clinical issues, surgical results, and complications of 80 cochlear implantations (CI) in 55 patients with Pendred syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA).
BACKGROUND: Previous studies have focused either on unselected case series or on populations with mixed cochlear malformations. PS/NSEVA accounts for up to 10% of congenital SNHL, rendering this a large group of cochlear implant candidates. The abnormal inner ear anatomy of these patients may be associated with a lower surgical success rate and a higher rate of complications.
STUDY DESIGN: Retrospective review of patients' medical records and CT/MRI.
SETTING: Tertiary referral center.
MATERIALS AND METHODS: The medical records and CT/MRI images of 55 PS/NSEVA patients receiving 80 cochlear implantations from 1982-2014 were reviewed. Demographic data, surgical results, intra-operative incidents, and post-operative complications were retrieved.
RESULTS: Complications occurred in 36% of implantations; 5% hereof major complications. Gushing/oozing from the cochleostoma occurred in 10% of implantations and was related to transient, but not prolonged post-operative vertigo.
CONCLUSION: Intra-operative risks of gushing/oozing and post-operative vertigo are the primary clinical issues in PS/NSEVA patients regarding CI. Nonetheless, the surgical success rate is high and the major complication rate is low; similar to studies of unselected series of CI recipients.

PMID: 27241825 [PubMed - as supplied by publisher]

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The G534E variant in HABP2 and Nonmedullary Thyroid Cancer.

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The G534E variant in <i>HABP2</i> and Nonmedullary Thyroid Cancer.

Thyroid. 2016 Jun 1;

Authors: Ruiz-Ferrer M, Fernández RM, Navarro E, Antinolo G, Borrego S

Abstract
Not required.

PMID: 27245704 [PubMed - as supplied by publisher]

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Resolution of Chronic Aspiration Pneumonitis Following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Fistula of the Skull Base.

Resolution of Chronic Aspiration Pneumonitis Following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Fistula of the Skull Base.

J Neurol Surg Rep. 2016 Jun;77(2):e73-6

Authors: Seltzer J, Babadjouni A, Wrobel BB, Zada G

Abstract
Spontaneous cerebrospinal fluid (CSF) rhinorrhea due to a skull base defect requires prompt diagnosis and treatment. Multiple surgical options are available for repairing the fistula, including the two-layer "fascial apposition" method and use of a pedicled nasal-septal flap. A 44-year-old obese woman presented with 4 months of progressive cough, exertional dyspnea, hoarseness, and intermittent fluid drainage from the right nostril. Chest computed tomography (CT) imaging and bronchoscopy showed chronic pneumonitis, which was confirmed by pulmonary wedge resection. CT and magnetic resonance imaging of the skull base, as well as laboratory analysis of the nasal fluid for β2-transferrin, confirmed a skull base defect causing CSF rhinorrhea. During surgery, insertion of a lumbar drain with the intrathecal fluorescein administration was performed, followed by endoscopic endonasal repair using an autologous fascial apposition graft and pedicled nasal-septal flap. Both the CSF leak and the pulmonary complications resolved following the operation with no symptoms at 11-month follow-up. This is the first reported case of spontaneous CSF rhinorrhea complicated by chronic aspiration and pneumonitis. Increased diagnostic complexity due to chronic pulmonary complications resulted in unnecessary interventions and treatment delays. Prompt recognition of spontaneous CSF leaks is essential to prevent potentially harmful complications.

PMID: 27247911 [PubMed]

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Dissociable cerebellar activity during spatial navigation and visual memory in bilateral vestibular failure.

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Dissociable cerebellar activity during spatial navigation and visual memory in bilateral vestibular failure.

Neuroscience. 2015 Oct 1;305:257-67

Authors: Jandl NM, Sprenger A, Wojak JF, Göttlich M, Münte TF, Krämer UM, Helmchen C

Abstract
OBJECTIVE: Spatial orientation and navigation depends on information from the vestibular system. Previous work suggested impaired spatial navigation in patients with bilateral vestibular failure (BVF). The aim of this study was to investigate event-related brain activity by functional magnetic resonance imaging (fMRI) during spatial navigation and visual memory tasks in BVF patients.
METHODS: Twenty-three BVF patients and healthy age- and gender matched control subjects performed learning sessions of spatial navigation by watching short films taking them through various streets from a driver's perspective along a route to the Cathedral of Cologne using virtual reality videos (adopted and modified from Google Earth). In the scanner, participants were asked to respond to questions testing for visual memory or spatial navigation while they viewed short video clips. From a similar but not identical perspective depicted video frames of routes were displayed which they had previously seen or which were completely novel to them.
RESULTS: Compared with controls, posterior cerebellar activity in BVF patients was higher during spatial navigation than during visual memory tasks, in the absence of performance differences. This cerebellar activity correlated with disease duration.
CONCLUSIONS: Cerebellar activity during spatial navigation in BVF patients may reflect increased non-vestibular efforts to counteract the development of spatial navigation deficits in BVF. Conceivably, cerebellar activity indicates a change in navigational strategy of BVF patients, i.e. from a more allocentric, landmark or place-based strategy (hippocampus) to a more sequence-based strategy. This interpretation would be in accord with recent evidence for a cerebellar role in sequence-based navigation.

PMID: 26255675 [PubMed - indexed for MEDLINE]

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[Research progress of the lymph node dissection posterior to fight recurrent laryngeal nerve of papillary thyroid carcinoma].

Related Articles

[Research progress of the lymph node dissection posterior to fight recurrent laryngeal nerve of papillary thyroid carcinoma].

Zhonghua Wai Ke Za Zhi. 2015 Mar;53(3):233-6

Authors: Peng Y, Ding J, Zhang W, Pan G, Ding Z, Luo D

Abstract
Central neck lymph node is the main site of metastasis of papillary thyroid cancer. However, the central area of dissection scope and integrity are still issues and controversies. The vast majority of papillary thyroid cancer in central lymph node dissection process, ignoring the lymph node posterior to fight recurrent laryngeal nerve (LN-prRLN), strictly speaking, does not do the central area of lymphatic adipose tissue intact, completely removed. This paper summarizes the recent literature on the LN-prRLN clinical dissection scope, the incidence of LN-prRLN transfer, LN-prRLN dissection impact on the incidence of complications, recurrence rate, mortality and survival rate were reviewed analysis, summarized the LN-prRLN dissection indications, clinical significance and importance.

PMID: 26269020 [PubMed - indexed for MEDLINE]

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Sustained Aftereffect of α-tACS Lasts Up to 70 min after Stimulation.

Sustained Aftereffect of α-tACS Lasts Up to 70 min after Stimulation.

Front Hum Neurosci. 2016;10:245

Authors: Kasten FH, Dowsett J, Herrmann CS

Abstract
Transcranial alternating current stimulation (tACS) has been repeatedly demonstrated to increase power of endogenous brain oscillations in the range of the stimulated frequency after stimulation. In the alpha band this aftereffect has been shown to persist for at least 30 min. However, in most experiments the aftereffect exceeded the duration of the measurement. Thus, it remains unclear how the effect develops beyond these 30 min and when it decays. The current study aimed to extend existing findings by monitoring the physiological aftereffect of tACS in the alpha range for an extended period of 90 min post-stimulation. To this end participants received either 20 min of tACS or sham stimulation with intensities below their individual sensation threshold at the individual alpha frequency (IAF). Electroencephalogram (EEG) was acquired during 3 min before and 90 min after stimulation. Subjects performed a visual vigilance task during the whole measurement. While the enhanced power in the individual alpha band did not return back to pre-stimulation baseline in the stimulation group, the difference between stimulation and sham diminishes after 70 min due to a natural alpha increase of the sham group.

PMID: 27252642 [PubMed]

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Annexin A5 is the Most Abundant Membrane-Associated Protein in Stereocilia but is Dispensable for Hair-Bundle Development and Function.

Annexin A5 is the Most Abundant Membrane-Associated Protein in Stereocilia but is Dispensable for Hair-Bundle Development and Function.

Sci Rep. 2016;6:27221

Authors: Krey JF, Drummond M, Foster S, Porsov E, Vijayakumar S, Choi D, Friderici K, Jones SM, Nuttall AL, Barr-Gillespie PG

Abstract
The phospholipid- and Ca(2+)-binding protein annexin A5 (ANXA5) is the most abundant membrane-associated protein of ~P23 mouse vestibular hair bundles, the inner ear's sensory organelle. Using quantitative mass spectrometry, we estimated that ANXA5 accounts for ~15,000 copies per stereocilium, or ~2% of the total protein there. Although seven other annexin genes are expressed in mouse utricles, mass spectrometry showed that none were present at levels near ANXA5 in bundles and none were upregulated in stereocilia of Anxa5(-/-) mice. Annexins have been proposed to mediate Ca(2+)-dependent repair of membrane lesions, which could be part of the repair mechanism in hair cells after noise damage. Nevertheless, mature Anxa5(-/-) mice not only have normal hearing and balance function, but following noise exposure, they are identical to wild-type mice in their temporary or permanent changes in hearing sensitivity. We suggest that despite the unusually high levels of ANXA5 in bundles, it does not play a role in the bundle's key function, mechanotransduction, at least until after two months of age in the cochlea and six months of age in the vestibular system. These results reinforce the lack of correlation between abundance of a protein in a specific compartment or cellular structure and its functional significance.

PMID: 27251877 [PubMed - in process]

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The Contribution of Hearing and Hearing Loss to Balance Control.

The Contribution of Hearing and Hearing Loss to Balance Control.

Audiol Neurootol. 2016 Jun 2;21(4):195-202

Authors: Vitkovic J, Le C, Lee SL, Clark RA

Abstract
This study investigated the hypothesis that a hearing 'map' of our surroundings is used to maintain balance control. We investigated the effects of sound on postural sway using centre of pressure analysis in 50 subjects with normal hearing, 28 with hearing loss and 19 with vestibular dysfunction. The acoustic environments utilized sound cues that were either present or absent. It was found that auditory cues are utilized by subjects with normal hearing to improve postural sway. The ability to utilize sound for postural control is diminished when there is a hearing loss, but this appears to be overcome by the use of a hearing aid. Patients with additional vestibular deficits exploit auditory cues to a greater degree, suggesting that sensory weighting to enhance the use of auditory cues may be applied when there is diminished sensory redundancy.

PMID: 27251708 [PubMed - as supplied by publisher]

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The impact of tinnitus upon cognition in adults: A systematic review.

The impact of tinnitus upon cognition in adults: A systematic review.

Int J Audiol. 2016 May 31;:1-8

Authors: Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM

Abstract
OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus.
DESIGN: A systematic and descriptive review.
STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function.
RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention.
CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

PMID: 27240696 [PubMed - as supplied by publisher]

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Effect of Septoplasty on Voice Quality: A Prospective-Controlled Trial.

Effect of Septoplasty on Voice Quality: A Prospective-Controlled Trial.

Clin Exp Otorhinolaryngol. 2016 May 27;

Authors: Gulec S, Kulahli I, Sahin MI, Kokoğlu K, Gunes MS, Avci D, Arli T

Abstract
Objectives: The purpose is to investigate effect of septoplasty and widened nasal patency on voice quality.
Methods: Fifty patients who undergone septoplasty were included in the study. Thirty-three people who had similar age and distribution were enrolled as control group. Before and 1 and 3 months after surgery, anterior rhinomanometry, voice analysis by Multi-Dimensional Voice Program, and spectrographic analysis were performed to patients. The recordings of /a/ vowel were used to evaluate average fundamental frequency (F0), jitter percent, and shimmer percent. In spectrographic analyses, F3-F4 values for the vowels /i, e, a, o, and u/, nasal formant frequencies of the consonants /m/ and /n/ in the word /mini/, and 4 formant frequencies (F1, F2, F3, and F4) for nasalized /i/ vowel following a nasal consonant /n/ in the word /mini/ were compared. The differences in nasal resonance were evaluated. All patients were asked whether change in their voices after the surgery. Preoperative and postoperative voice parameters and anterior rhinomanometry.
Results.: were compared separately with the control group as well as in the patient group itself.
Results: Preoperative total nasal resistance (TNR) values of patients were higher than the control group (P=0.001). TNR values of patients measured one day before surgery and after surgery in the 1st and 3rd months were different and these differences were significant statistically (P=0.001). There was no significant difference between the voice analysis parameters in preoperative, postoperative 1st, and 3rd months. As a result of their subjective reviews, 12 patients (36.4%) noted their voices were better than before surgery and 20 patients (60.6%) noted no change before and after surgery.
Conclusion: Providing widened nasal cavity has no effect on voice quality.

PMID: 27230274 [PubMed - as supplied by publisher]

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Efficacy of Trimetazidine Dihydrochloride for Relieving Chronic Tinnitus: A Randomized Double-Blind Study.

Efficacy of Trimetazidine Dihydrochloride for Relieving Chronic Tinnitus: A Randomized Double-Blind Study.

Clin Exp Otorhinolaryngol. 2016 May 27;

Authors: Kumral TL, Yıldırım G, Berkiten G, Saltürk Z, Ataç E, Atar Y, Uyar Y

Abstract
Objectives: To evaluate the efficacy of trimetazidine dihydrochloride as a treatment for chronic tinnitus.
Methods: A total of 97 chronic tinnitus patients were evaluated in this randomized, prospective, double-blind, placebo-controlled trial. After assessing for eligibility, 82 patients were randomly assigned into placebo or trimetazidine groups according to the medication. The trimetazidine group received 20×3 mg/day per oral trimetazidine dihydrochloride and the placebo group received 20×3 mg/day per oral placebo for 3 months. Tinnitus handicap inventory (THI), visual analogue scale (VAS) questionnaires and audiometric.
Results.: were used to determine the effectiveness of trimetazidine treatment.
Results: The study group comprised 82 tinnitus subjects, 42 (51.2%) of whom received trimetazidine dihydrochloride and 40 (48.8%) who received placebo. There was no significant difference between placebo and trimetazidine groups in THI grade and VAS (both pre- and posttreatment scores) (P>0.05) and no significant improvement was observed in subjective loudness score in either group (P>0.05). Additionally there was no significant difference between groups in pre- and posttreatment pure tone hearing thresholds at all measured frequencies (P>0.05).
Conclusion: Trimetazidine dihydrochloride therapy was ineffective for relieving chronic tinnitus.

PMID: 27230273 [PubMed - as supplied by publisher]

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New Web-Based Tool for Generating Scattergrams to Report Hearing Results.

New Web-Based Tool for Generating Scattergrams to Report Hearing Results.

Otolaryngol Head Neck Surg. 2016 Jun;154(6):981

Authors: Oghalai JS, Jackler RK

PMID: 27251009 [PubMed - in process]

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Highlights from the Current Issue: June 2016.

Highlights from the Current Issue: June 2016.

Otolaryngol Head Neck Surg. 2016 Jun;154(6):979-80

Authors: Krouse JH

PMID: 27251008 [PubMed - in process]

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Predisposing factors for adverse skin reactions with percutaneous bone anchored hearing devices implanted with skin reduction techniques.

Predisposing factors for adverse skin reactions with percutaneous bone anchored hearing devices implanted with skin reduction techniques.

Eur Arch Otorhinolaryngol. 2016 Jun 1;

Authors: Candreia C, Birrer R, Fistarol S, Kompis M, Caversaccio M, Arnold A, Stieger C

Abstract
We present an analysis of adverse events after implantation of bone anchored hearing device in our patient population with focus on individual risk factors for peri-implant skin reactions. The investigation involved a chart review of adult Baha patients (n = 179) with 203 Bahas implanted with skin reduction techniques between 1993 and 2009, a questionnaire (n = 97) and a free clinical examination (n = 47). Skin reactions were graded by severity from 0 (no skin reaction) to 4 (implant loss resulting from infection) according to Holgers. We analyzed the skin reaction rate (SRR) defined as the number of skin reactions per year and the worst Holgers grade (WHG), which indicates the grade of the worst skin reaction per implant. We defined 20 parameters including the demographic characteristics, surgery details, subjective benefits, handling and individual factors. The most frequent adverse events (85 %) were skin reactions. The average SRR was 0.426 per Baha year. Six parameters showed an association with the SRR or the WHG. The clinically most relevant factors are an elevated Body Mass Index (BMI, p = 0.02) and darker skin type (p = 0.03). The SRR increased with the distance between the tragus and the implant (p = 0.02). Regarding the identified risk factors, the SRR might be reduced by selecting a location for the implant near the pinna and by specific counseling regarding post-operative care for patients with darker skin type or an elevated Body Mass Index (BMI). Few of the factors analyzed were found to influence the SRR and WHG. Since most adverse skin reactions could be treated easily with local therapy, our results suggest that in adult patients, individual risk factors for skin reactions are not a contraindication for Baha implantation. Thus, patients can be selected purely on audiological criteria.

PMID: 27250841 [PubMed - as supplied by publisher]

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Incidental Finding in a Man With Objective Tinnitus.

Incidental Finding in a Man With Objective Tinnitus.

JAMA Otolaryngol Head Neck Surg. 2016 Jun 2;

Authors: Kong DK, Schutt CA, Michaelides E

PMID: 27253910 [PubMed - as supplied by publisher]

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Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults.

Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults.

Trials. 2016;17(1):270

Authors: Hall DA, Haider H, Szczepek AJ, Lau P, Rabau S, Jones-Diette J, Londero A, Edvall NK, Cederroth CR, Mielczarek M, Fuller T, Batuecas-Caletrio A, Brueggemen P, Thompson DM, Norena A, Cima RF, Mehta RL, Mazurek B

Abstract
BACKGROUND: There is no evidence-based guidance to facilitate design decisions for confirmatory trials or systematic reviews investigating treatment efficacy for adults with tinnitus. This systematic review therefore seeks to ascertain the current status of trial designs by identifying and evaluating the reporting of outcome domains and instruments in the treatment of adults with tinnitus.
METHODS: Records were identified by searching PubMed, EMBASE CINAHL, EBSCO, and CENTRAL clinical trial registries (ClinicalTrials.gov, ISRCTN, ICTRP) and the Cochrane Database of Systematic Reviews. Eligible records were those published from 1 July 2006 to 12 March 2015. Included studies were those reporting adults aged 18 years or older who reported tinnitus as a primary complaint, and who were enrolled into a randomised controlled trial, a before and after study, a non-randomised controlled trial, a case-controlled study or a cohort study, and written in English. Studies with fewer than 20 participants were excluded.
RESULTS: Two hundred and twenty-eight studies were included. Thirty-five different primary outcome domains were identified spanning seven categories (tinnitus percept, impact of tinnitus, co-occurring complaints, quality of life, body structures and function, treatment-related outcomes and unclear or not specified). Over half the studies (55 %) did not clearly define the complaint of interest. Tinnitus loudness was the domain most often reported (14 %), followed by tinnitus distress (7 %). Seventy-eight different primary outcome instruments were identified. Instruments assessing multiple attributes of the impact of tinnitus were most common (34 %). Overall, 24 different patient-reported tools were used, predominantly the Tinnitus Handicap Inventory (15 %). Loudness was measured in diverse ways including a numerical rating scale (8 %), loudness matching (4 %), minimum masking level (1 %) and loudness discomfort level (1 %). Ten percent of studies did not clearly report the instrument used.
CONCLUSIONS: Our findings indicate poor appreciation of the basic principles of good trial design, particularly the importance of specifying what aspect of therapeutic benefit is the main outcome. No single outcome was reported in all studies and there was a broad diversity of outcome instruments.
PROSPERO REGISTRATION: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525 . Registered on 12 March 2015 revised on 15 March 2016.

PMID: 27250987 [PubMed - in process]

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Auditory localization by subjects with unilateral tinnitus.

Auditory localization by subjects with unilateral tinnitus.

J Acoust Soc Am. 2016 May;139(5):2280

Authors: Hyvärinen P, Mendonça C, Santala O, Pulkki V, Aarnisalo AA

Abstract
Tinnitus is associated with changes in neural activity. How such alterations impact the localization ability of subjects with tinnitus remains largely unexplored. In this study, subjects with self-reported unilateral tinnitus were compared to subjects with matching hearing loss at high frequencies and to normal-hearing subjects in horizontal and vertical plane localization tasks. Subjects were asked to localize a pink noise source either alone or over background noise. Results showed some degree of difference between subjects with tinnitus and subjects with normal hearing in horizontal plane localization, which was exacerbated by background noise. However, this difference could be explained by different hearing sensitivities between groups. In vertical plane localization there was no difference between groups in the binaural listening condition, but in monaural listening the tinnitus group localized significantly worse with the tinnitus ear. This effect remained when accounting for differences in hearing sensitivity. It is concluded that tinnitus may degrade auditory localization ability, but this effect is for the most part due to the associated levels of hearing loss. More detailed studies are needed to fully disentangle the effects of hearing loss and tinnitus.

PMID: 27250123 [PubMed - in process]

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Anti-inflammatory and anti-oxidative effects of alpha-lipoic acid in experimentally induced acute otitis media.

Anti-inflammatory and anti-oxidative effects of alpha-lipoic acid in experimentally induced acute otitis media.

J Laryngol Otol. 2016 May 30;:1-8

Authors: Tatar A, Korkmaz M, Yayla M, Gozeler MS, Mutlu V, Halici Z, Uslu H, Korkmaz H, Selli J

Abstract
OBJECTIVES: To investigate the anti-inflammatory, anti-oxidative and tissue protective effects, as well as the potential therapeutic role, of alpha-lipoic acid in experimentally induced acute otitis media.
METHODS: Twenty-five guinea pigs were assigned to one of five groups: a control (non-otitis) group, and otitis-induced groups treated with saline, penicillin G, alpha-lipoic acid, or alpha-lipoic acid plus penicillin G. Tissue samples were histologically analysed, and oxidative parameters in tissue samples were measured and compared between groups.
RESULTS: The epithelial integrity was better preserved, and histological signs of inflammation and secretory metaplasia were decreased, in all groups compared to the saline treated otitis group. In the alpha-lipoic acid plus penicillin G treated otitis group, epithelial integrity was well preserved and histological findings of inflammation were significantly decreased compared to the saline, penicillin G and alpha-lipoic acid treated otitis groups. The most favourable oxidative parameters were observed in the control group, followed by the alpha-lipoic acid plus penicillin G treated otitis group.
CONCLUSION: Alpha-lipoic acid, with its antioxidant, anti-inflammatory and tissue protective properties, may decrease the clinical sequelae and morbidity associated with acute otitis media.

PMID: 27238225 [PubMed - as supplied by publisher]

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Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function.

Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function.

World J Gastroenterol. 2016 May 28;22(20):4918-25

Authors: Sanaka MR, Hayat U, Thota PN, Jegadeesan R, Ray M, Gabbard SL, Wadhwa N, Lopez R, Baker ME, Murthy S, Raja S

Abstract
AIM: To assess and compare the esophageal function after peroral endoscopic myotomy (POEM) vs other conventional treatments in achalasia.
METHODS: Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy (LHM) or pneumatic dilation (PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow (TBE) and high-resolution esophageal manometry (HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo post-treatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter (LES) pressures and LES-integrated relaxation pressures (IRP). Data are presented as mean ± SD, median [25(th), 75(th) percentiles] or frequency (percent). Analysis of variance, Kruskal-Wallis test, Pearsons χ(2) test and Fishers Exact tests were used for analysis.
RESULTS: A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older (55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM (29.1 ± 5.9 kg/m(2) vs 26 ± 5.1 kg/m(2), P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group (72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups (P = 0.01 to P < 0.001) except the column height at 1 min in PD group (P = 0.11) . At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM (40.5 mmHg vs 14.5 mmHg and 24 mmHg vs 7.1 mmHg respectively, P < 0.001) and POEM groups (38.7 mmHg vs 11.4 mmHg and 23.6 mmHg vs 6.6 mmHg respectively, P < 0.001). However, when the efficacy of three treatments were compared to each other in terms of improvement in TBE or HREM parameters at 2 mo, there was no significant difference (P > 0.05).
CONCLUSION: POEM, PD and LHM were all effective in improving esophageal function in achalasia at short-term. There was no difference in efficacy between the three treatments.

PMID: 27239118 [PubMed - in process]

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Trials of a Contralateral Hearing Aid After Long-Term Unilateral Cochlear Implant Use in Early-Onset Deafness

Purpose

The purpose of this study was to evaluate the practicability of binaural hearing by adding a contralateral hearing aid (HA) after long-term cochlear implant (CI) use in prelingually deaf adults.

Method

Five individuals with 1 CI volunteered for a 3-week bimodal (CI + HA) trial. HA gain was set low until sound was tolerable, then increased as listeners acclimated. Participants logged their daily listening experiences and were closely monitored by the audiologist. Measures included pre- and posttrial consonant-nucleus-consonant (CNC) word and phoneme scores and self-reports of satisfaction and listening ability in difficult situations.

Results

Acoustic stimulation was initially unpleasant, but approached comfort at target gain within the 3-week period. Benefit was demonstrated in continued voluntary HA use and higher bimodal phoneme scores compared to CI alone (8%–31% increases) for 4 of the participants.

Conclusions

When a second CI is not a consideration, a contralateral HA should be pursued as the standard of care for prelingually deaf adults despite substantial auditory deprivation in the previously unaided ear, unpleasant sensations at initial HA fit, or lack of dramatic objective test gains. Frequent audiologist contact, repeated HA adjustments, and client journals are valuable in promoting favorable outcomes with bimodal hearing (adaptation, acceptance, and benefit) for this population.

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An Application of Item Response Theory and the Rasch Model in Speech Recognition Test Materials

Purpose

The purpose of this study was to describe an attempt to apply item-response theory (IRT) and the Rasch model to construction of speech-recognition tests. A set of word-recognition test items applicable to children as young as 3 years old—with any level of hearing sensitivity, with or without using hearing devices—was developed.

Method

Test items were constructed through expert consultation and by reference to some established language corpora, validated with 121 participants with various degrees of hearing loss and 255 with typical hearing. IRT and the Rasch model were applied to evaluate item quality.

Results

Eighty disyllabic word items were selected in accordance with IRT. The speech-recognition abilities of the 376 young participants are reported. The IRT analyses on this set of data are also discussed.

Conclusions

A new set of speech-recognition test materials in Cantonese Chinese has been developed. Construction of short equivalent lists may be performed in accordance with IRT item qualities. Clinical applications of this test tool in the particular language population are discussed.

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