OtoRhinoLaryngology News: 06/24/16

Παρασκευή 24 Ιουνίου 2016

Dynamics of Gut Microbiota According to the Delivery Mode in Healthy Korean Infants.

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Dynamics of Gut Microbiota According to the Delivery Mode in Healthy Korean Infants.

Allergy Asthma Immunol Res. 2016 Sep;8(5):471-7

Authors: Lee E, Kim BJ, Kang MJ, Choi KY, Cho HJ, Kim Y, Yang SI, Jung YH, Kim HY, Seo JH, Kwon JW, Kim HB, Lee SY, Hong SJ

Abstract
Microbial colonization of the infant gut is unstable and shows a wide range of diversity between individuals. Gut microbiota play an important role in the development of the immune system, and an imbalance in these organisms can affect health, including an increased risk of allergic diseases. Microbial colonization of young infants is affected by the delivery mode at birth and the consequent alterations of gut microbiota in early life affect the development of allergic diseases. We investigated the effects of the delivery mode on the temporal dynamics of gut microbiota in healthy Korean infants. Fecal samples were collected at 1-3 days, 1 month, and 6 months after birth in six healthy infants. Microbiota were characterized by 16S rRNA shotgun sequencing. At the first and third days of life, infants born by vaginal delivery showed a higher richness and diversity of gut microbiota compared with those born by cesarean section. However, these differences disappeared with age. The Bacteroides genus and Bacteroidetes phylum were abundant in infants born by vaginal delivery, whereas Bacilli and Clostridium g4 were increased in infants born by cesarean section. The Firmicutes phylum and Bacteroides genus showed convergent dynamics with age. This study demonstrated the effect of delivery mode on the dynamics of gut microbiota profiles in healthy Korean infants.

PMID: 27334787 [PubMed]

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Genes Involved in Interleukin-1 Receptor Type II Activities Are Associated With Asthmatic Phenotypes.

Genes Involved in Interleukin-1 Receptor Type II Activities Are Associated With Asthmatic Phenotypes.

Allergy Asthma Immunol Res. 2016 Sep;8(5):466-70

Authors: Madore AM, Vaillancourt VT, Bouzigon E, Sarnowski C, Monier F, Dizier MH, Demenais F, Laprise C

Abstract
PURPOSE: Interleukin-1 (IL-1) plays a key role in inflammation and immunity and its decoy receptor, IL-1R2, has been implicated in transcriptomic and genetic studies of asthma.
METHODS: Two large asthma family collections, the French-Canadian Saguenay-Lac-St-Jean (SLSJ) study and the French Epidemiological Study on the Genetics and Environment of Asthma (EGEA), were used to investigate the association of SNPs in 10 genes that modulate IL-1R2 activities with asthma, allergic asthma, and atopy. Gene-gene interactions were also tested.
RESULTS: One SNP in BACE2 was associated with allergic asthma in the SLSJ study and replicated in the EGEA study before statistical correction for multiple testing. Additionally, two SNPs in the MMP2 gene were replicated in both studies prior to statistical correction and reached significance in the combined analysis. Moreover, three gene-gene interactions also survived statistical correction in the combined analyses (BACE1-IL1RAP in asthma and allergic asthma and IL1R1-IL1RAP in atopy).
CONCLUSIONS: Our results highlight the relevance of genes involved in the IL-1R2 activity in the context of asthma and asthma-related traits.

PMID: 27334786 [PubMed]

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Soluble CD93 as a Novel Biomarker in Asthma Exacerbation.

Soluble CD93 as a Novel Biomarker in Asthma Exacerbation.

Allergy Asthma Immunol Res. 2016 Sep;8(5):461-5

Authors: Sigari N, Jalili A, Mahdawi L, Ghaderi E, Shilan M

Abstract
Asthma research is shifting from studying symptoms and lung functions to the narrow-focus cellular profiles protein analysis, biomarkers, and genetic markers. The transmembrane glycoprotein CD93 is involved in endothelial cell migration, angiogenesis, leukocytes extravasation, apoptosis, innate immunity and inflammation. Relationships between the serum level of soluble CD93 (sCD93) and acute myocardial infarction/premature MI/inflammatory arthritis/skin sclerosis have recently been reported. We hypothesized that sCD93 would be elevated during the acute phase of asthma. We measured the serum level of sCD93 in 57 patients with asthma exacerbation and 57 age-and gender-matched healthy controls. Additionally, sCD93 was reassessed at the time of discharge from the hospital. Clinical characteristics and peak expiratory flow (PEF) of the patients were assessed. The primary outcome was the comparison of serum level of sCD93 between asthmatics and healthy subjects. The sCD93 values ranged from 128 to 789 ng/mL in asthmatics (345.83±115.81) and from 31 to 289 ng/mL in control subjects (169.46±62.43). The difference between the 2 groups was statistically significant (P<0.001). The association between sCD93 and asthma remained significant after adjusting for age, sex, and BMI. The differences between asthmatics and controls remained significant on the last day of hospital stay. The association between sCD93 and PEF was not significant. In conclusion, the serum level of soluble CD93 is increased in patients with asthma exacerbation. It also showed that serum levels of sCD93 decreased with treatment of asthma attack. The clinical usefulness of determination of sCD93 as a biomarker of asthma requires further studies.

PMID: 27334785 [PubMed]

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Periostin and Interleukin-13 Are Independently Related to Chronic Spontaneous Urticaria.

Periostin and Interleukin-13 Are Independently Related to Chronic Spontaneous Urticaria.

Allergy Asthma Immunol Res. 2016 Sep;8(5):457-60

Authors: Bae Y, Izuhara K, Ohta S, Ono J, Hong GU, Ro JY, Park GH, Choi JH

Abstract
Chronic spontaneous urticaria (CSU) is a complex idiopathic disease of the skin with various cellular infiltrations. Although mast cells are key effector cells in the pathogenesis of CSU, CD4+ T helper 2 cells also have particular roles in the development and maintenance of CSU. Periostin is known as a downstream molecule of interleukin (IL)-4 and IL-13, key cytokines of type 2 immune responses. In this study, we examined periostin and IL-13 levels in the sera of patients with CSU (n=84) and healthy normal controls (NCs, n=43). Periostin levels were significantly lower in the CSU group than in NCs (71.4±21.8 vs 85.1±22.4 ng/mL, P=0.04). Periostin levels were also lower in the severe CSU group than those in mild CSU (59.7±18.0 vs 73.4±22.0 ng/mL, P=0.04). However, IL-13 levels were significantly higher in patients with CSU than in NCs (508.5±51.2 vs 200.7±13.3 pg/mL, P=0.001). In conclusion, periostin and IL-13 may be independently related to the pathogenesis of CSU.

PMID: 27334784 [PubMed]

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Synergistic Effect of Dermatophagoides farinae and Lipopolysaccharides in Human Middle ear Epithelial Cells.

Synergistic Effect of Dermatophagoides farinae and Lipopolysaccharides in Human Middle ear Epithelial Cells.

Allergy Asthma Immunol Res. 2016 Sep;8(5):445-56

Authors: Lee JE, Kim YH, Rhee CS, Kim DY

Abstract
PURPOSE: Although the concept of "one airway, one disease," which includes the middle ear space as part of the united airway is well recognized, the role of allergens in otitis media with effusion (OME) is not clearly understood. We aimed to investigate the effect of the interaction between Dermatophagoides farinae (Der f) and lipopolysaccharide (LPS) on the induction of epithelial inflammatory response in vitro.
METHODS: Primary human middle ear epithelial cells were exposed to Der f, LPS, or both in different sequences, and the magnitude of the immunologic responses was compared. The mRNA expressiona of mucin (MUC) 4, 5AC, 5B, 8, GM-CSF, TNF-α, TLR4, and MD-2 were evaluated using real-time PCR. MUC levels before and after siRNA-mediated knockout of TLR4 and MD-2 were assessed. Lastly, the involved cell signaling pathway was evaluated.
RESULTS: The expressiona of cytokines, and the MUC 4, 5AC, 5B, and 8 genes were augmented by pretreatment with Der f followed by LPS; however, reverse treatment or combined treatment did not induce the same magnitude of response. Increased MUC expression was decreased by TLR4 knockdown, but not by MD-2 knockdown. The signal intensity of MUC 8 was higher in MD-2 over-expressed cells than in those exposed to LPS only. The translocation of nuclear factor-κB was observed in cells pretreated with Der f followed by LPS.
CONCLUSIONS: When Der f treatment preceded LPS exposure, Der f and LPS acted synergistically in the induction of pro-inflammatory cytokines and the MUC gene, suggesting an important role in the development of OME in patients with concealed allergy airway sensitization.

PMID: 27334783 [PubMed]

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Vacuolar Serine Protease Is a Major Allergen of Fusarium proliferatum and an IgE-Cross Reactive Pan-Fungal Allergen.

Vacuolar Serine Protease Is a Major Allergen of Fusarium proliferatum and an IgE-Cross Reactive Pan-Fungal Allergen.

Allergy Asthma Immunol Res. 2016 Sep;8(5):438-44

Authors: Yeh CC, Tai HY, Chou H, Wu KG, Shen HD

Abstract
PURPOSE: Fusarium species are among prevalent airborne fungi and causative agents of human respiratory atopic disorders. We previously identified a 36.5-kDa F. proliferatum component recognized by IgE antibodies in 9 (53%) of the 17 F. proliferatum-sensitized atopic serum samples. The purpose of this study is to characterize the 36.5-kDa allergen of F. proliferatum.
METHODS: Characterization of allergens and determination of IgE cross-reactivity were performed by cDNA cloning/expression and immunoblot inhibition studies.
RESULTS: Based on the finding that the 36.5-kDa IgE-binding component reacted with the mouse monoclonal antibody FUM20 against fungal vacuolar serine protease allergens, the cDNA of F. proliferatum vacuolar serine protease (Fus p 9.0101) was subsequently cloned. Nine serum samples from respiratory atopic patients with IgE binding to the vacuolar serine protease allergen of Penicillium chrysogenum (Pen ch 18) also showed IgE-immunoblot reactivity to rFus p 9.0101. The purified rFus p 9.0101 can inhibit IgE and FUM20 binding to the 36.5-kDa component of F. proliferatum. Thus, a novel and important Fus p 9.0101 was identified. The rPen ch 18 can inhibit IgE binding to Fus p 9.0101. It indicates that IgE cross-reactivity between Fus p 9.0101 and Pen ch 18 also exists. Furthermore, neither rFus p 9.0101 K88A nor rPen ch 18 K89A mutants inhibited IgE binding to rFus p 9.0101. Lys88 was considered a critical core amino acid in IgE binding to r Fus p 9.0101 and a residue responsible for IgE cross-reactivity between Fus p 9.0101 and Pen ch 18 allergens.
CONCLUSIONS: Results obtained from this study indicate that vacuolar serine protease may be a major allergen of F. proliferatum and an important IgE cross-reactive pan-fungal allergen, and provide important bases for clinical diagnosis of fungal allergy.

PMID: 27334782 [PubMed]

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Orthologous Allergens and Diagnostic Utility of Major Allergen Alt a 1.

Orthologous Allergens and Diagnostic Utility of Major Allergen Alt a 1.

Allergy Asthma Immunol Res. 2016 Sep;8(5):428-37

Authors: Moreno A, Pineda F, Alcover J, Rodríguez D, Palacios R, Martínez-Naves E

Abstract
PURPOSE: Hypersensitivity to fungi is associated with rhinoconjunctivitis and asthma. For some fungi, such as Alternaria alternata (A. alternata), the symptoms of asthma are persistent, increasing disease severity and the risk of fatal outcomes. There are a large number of species of fungi but knowledge of them remains limited. This, together with the difficulties in obtaining adequate standardized extracts, means that there remain significant challenges in the diagnosis and immunotherapy of allergy associated with fungi. The type of indoor fungi related to asthma/allergy varies according to geographic, climatic, and seasonal factors, making their study difficult. The aim of this study was to determine hypersensitivity to indoor fungi in a population from Cuenca, Spain.
METHODS: Thirty-five patients with symptoms compatible with rhinitis or asthma who showed clear worsening of their symptoms in their homes or workplace were included. In vivo and in vitro tests were made with a battery of fungal allergens, including the species isolated in the home or workplace.
RESULTS: Ulocladium botrytis (U. botrytis) and A. alternata were the most representative species as a source of home sensitization. These species showed very high concordance in skin tests, specific IgE, and histamine release. The allergen Alt a 1, which was recognized in all patients, was detected in A. alternata, U. botrytis, and Stemphylium botryosum (S. botryosum).
CONCLUSIONS: U. botrytis and A. alternata were the most representative species as a source of home sensitization. Alt a 1 was recognized in all patients and may be considered a non-species-specific allergen that could be used as a diagnostic source of sensitization to some species of the Pleosporaceae family.

PMID: 27334781 [PubMed]

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Systemic Reactions to Dust Mite Subcutaneous Immunotherapy: A 3-Year Follow-up Study.

Systemic Reactions to Dust Mite Subcutaneous Immunotherapy: A 3-Year Follow-up Study.

Allergy Asthma Immunol Res. 2016 Sep;8(5):421-7

Authors: Dong X, Huang N, Li W, Hu L, Wang X, Wang Y, Xiang N, Liu G, Zhu R

Abstract
PURPOSE: The incidence of allergen specific immunotherapy-related systemic reactions (SRs) varies among different studies, and many factors are likely to contribute to SRs. This study aims to investigate the incidence, characteristics, and risk factors of SRs to standardize dust mite-specific subcutaneous immunotherapy (SCIT) in Central China.
METHODS: All patients receiving standardized dust mites (100-100,000 SQ-U/mL; Alutard SQ, Hørsholn, Denmark) immunotherapy were followed up. Recorded data included demographics, diagnosis, patient status, pulmonary function testing results before and after each injection, allergen dosage, and details of SRs.
RESULTS: From June 2011 to August 2014, a total of 208 patients received 4,369 injections; 27 (13.0%) patients experienced 48 (1.1%) systemic reactions. Most of the SRs were grade 2 reactions (n=30, 62.5%), followed by grade 1 (n=11, 22.9%), grade 3 (n=7, 14.6%), and no fatal reactions occurred. Forty-six SRs (95.8%) occurred within 30 minutes. Higher SR rates were associated with high concentration extracts (100,000 SQ-U/mL), injections with concomitant local reactions (LRs), children, asthma and high sensitivity (skin prick test 3+/4+ and/or sIgE≥17.5 kUA/L) (P<0.05). The estimated odds of SRs increased in children (OR=6.57; 95% CI: 1.88-22.97, P=0.003), asthmatic patients (OR=4.10; 95% CI: 1.72-9.80, P=0.002), and injections with LRs (OR=2.41; 95% CI: 1.33-4.36, P=0.004).
CONCLUSIONS: The incidence of SRs to dust mite SCIT was low, and multiple factors were associated with the increased incidence of SRs. Children, asthmatics and patients with concomitant LR may be prone to develop SRs.

PMID: 27334780 [PubMed]

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Short-, Intermediate-, and Long-Term Changes in Basophil Reactivity Induced by Venom Immunotherapy.

Short-, Intermediate-, and Long-Term Changes in Basophil Reactivity Induced by Venom Immunotherapy.

Allergy Asthma Immunol Res. 2016 Sep;8(5):412-20

Authors: Rodríguez Trabado A, Cámara Hijón C, Ramos Cantariño A, Romero-Chala S, García-Trujillo JA, Fernández Pereira LM

Abstract
PURPOSE: The basophil activation test (BAT) has been used to monitor venom immunotherapy (VIT) due to its high specificity. A previous study has reported a good correlation between a significant decrease in basophil activation during 5 years of VIT and clinical protection assessed by sting challenge. The following prospective study was performed to examine changes in basophil reactivity over a complete VIT period of 5 years.
METHODS: BAT in a dose-response curve was studied prospectively in 10 hymenoptera venom-allergic patients over 5 years of VIT. BAT was performed at the time of diagnosis, 1 month after finishing the VIT build-up phase, and 3, 6, 12, 24, and 60 months after beginning treatment. The repeated measures ANOVA was applied to evaluate basophil activation changes throughout VIT. A cross-sectional study was also performed in 6 patients who received treatment for more than 3 years, and in another 12 patients who followed immunotherapy for at least 5 years.
RESULTS: An early activation decrease was observed during the first 3 months of treatment, compared to pre-treatment values. This activation decrease was not maintained 6 to 18 months after treatment, but was observed again after 2 years of treatment, and maintained until the completion of the 5-year immunotherapy period. In cross-sectional analysis, the 6 patients who received treatment for 3 years, and 9 of the 12 patients who received treatment for 5 years, had negative BAT results. Three patients in this last group had positive BAT results and 2 patients had systemic reactions after field stings.
CONCLUSIONS: BAT appears to be an optimal non-invasive test for close monitoring of VIT.

PMID: 27334779 [PubMed]

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Does Spore Count Matter in Fungal Allergy?: The Role of Allergenic Fungal Species.

Does Spore Count Matter in Fungal Allergy?: The Role of Allergenic Fungal Species.

Allergy Asthma Immunol Res. 2016 Sep;8(5):404-11

Authors: Lin WR, Chen YH, Lee MF, Hsu LY, Tien CJ, Shih FM, Hsiao SC, Wang PH

Abstract
PURPOSE: Fungi have been known to be important aeroallergens for hundreds of years. Most studies have focused on total fungal concentration; however, the concentration of specific allergenic fungi may be more important on an individual basis.
METHODS: Ten fungal allergic patients and 2 non-fungal allergic patients were enrolled. The patients with a decrease in physician or patient global assessment by more than 50% of their personal best were considered to have an exacerbation of allergic symptoms and to be in the active stage. Those who maintained their physician and patient global assessment scores at their personal best for more than 3 months were considered to be in the inactive stage. The concentrations of dominant fungi in the patients' houses and outdoors were measured by direct and viable counts at active and inactive stages.
RESULTS: The exacerbation of allergic symptoms was not correlated with total fungal spore concentration or the indoor/outdoor ratio (I/O). Specific fungi, such as Cladosporium oxysporum (C. oxyspurum), C. cladosporioides, and Aspergillus niger (A. niger), were found to be significantly higher concentrations in the active stage than in the inactive stage. Presumed allergenic spore concentration threshold levels were 100 CFU/m³ for C. oxysporum, and 10 CFU/m³ for A. niger, Penicillium brevicompactum and Penicillium oxalicum.
CONCLUSIONS: The major factor causing exacerbation of allergic symptoms in established fungal allergic patients may be the spore concentration of specific allergenic fungi rather than the total fungal concentration. These results may be useful in making recommendations as regards environmental control for fungal allergic patients.

PMID: 27334778 [PubMed]

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Guideline of Chronic Urticaria Beyond.

Guideline of Chronic Urticaria Beyond.

Allergy Asthma Immunol Res. 2016 Sep;8(5):396-403

Authors: Fine LM, Bernstein JA

Abstract
Urticaria is a relatively common condition that if chronic can persist for weeks, months or years and affect quality of life significantly. The etiology is often difficult to determine, especially as it becomes chronic. Many cases of chronic urticaria are thought to be autoimmune, although there is no consensus that testing for autoimmunity alters the diagnostic or management strategies or outcomes. Many times, urticaria is easily managed with antihistamines and/or short courses of oral corticosteroids, but too often control is insufficient and additional therapies must be added. For years, immune modulating medications, such as cyclosporine and Mycophenolate Mofetil, have been used in cases refractory to antihistamines and oral corticosteroids, although the evidence supporting their efficacy and safety has been limited. Omalizumab was recently approved for the treatment of chronic urticaria unresponsive to H1-antagonists. This IgG anti-IgE monoclonal antibody has been well demonstrated to safely and effectively control chronic urticaria at least partially in approximately 2/3 of cases. However, the mechanism of action and duration of treatment for omalizumab is still unclear. It is hoped that as the pathobiology of chronic urticaria becomes better defined, future therapies that target specific mechanistic pathways will be developed that continue to improve the management of these often challenging patients.

PMID: 27334777 [PubMed]

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Climate Change and Air Pollution: Effects on Respiratory Allergy.

Climate Change and Air Pollution: Effects on Respiratory Allergy.

Allergy Asthma Immunol Res. 2016 Sep;8(5):391-5

Authors: D'Amato G, Pawankar R, Vitale C, Lanza M, Molino A, Stanziola A, Sanduzzi A, Vatrella A, D'Amato M

Abstract
A body of evidence suggests that major changes involving the atmosphere and the climate, including global warming induced by anthropogenic factors, have impact on the biosphere and human environment. Studies on the effects of climate change on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, such as meteorological variables, airborne allergens, and air pollution. Urbanization with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases and bronchial asthma observed over recent decades in most industrialized countries. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in the general population and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could also be an effect of air pollution and climate change. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last 5 decades. Pollen allergy is frequently used to study the relationship between air pollution and respiratory allergic diseases, such as rhinitis and bronchial asthma. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions, and westernized lifestyle are correlated with an increased frequency of respiratory allergy prevalently in people who live in urban areas in comparison with people living in rural areas. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc.) can affect both components (biological and chemical) of this interaction.

PMID: 27334776 [PubMed]

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Does Specific Fungal Allergen Really Matter?

Does Specific Fungal Allergen Really Matter?

Allergy Asthma Immunol Res. 2016 Sep;8(5):389-90

Authors: Yoo Y

PMID: 27334775 [PubMed]

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Book Review: The Nose-Revision & Reconstruction.

Book Review: The Nose-Revision & Reconstruction.

Ann Otol Rhinol Laryngol. 2016 Jun 22;

Authors: Fraioli RE

PMID: 27335050 [PubMed - as supplied by publisher]

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The development of a new questionnaire for cognitive complaints in vertigo: the Neuropsychological Vertigo Inventory (NVI).

The development of a new questionnaire for cognitive complaints in vertigo: the Neuropsychological Vertigo Inventory (NVI).

Eur Arch Otorhinolaryngol. 2016 Jun 22;

Authors: Lacroix E, Deggouj N, Salvaggio S, Wiener V, Debue M, Edwards MG

Abstract
Vertigo patients frequently complain of emotional and associated cognitive problems, yet currently, there is no satisfactory questionnaire to measure these associated problems. In the present paper, we propose a new internet-based Neuropsychological Vertigo Inventory (NVI; French) that evaluates attention, memory, emotion, space perception, time perception, vision, and motor abilities. The questionnaire was created using four steps: (1) open interviews with patients suffering from vertigo; (2) semi-structured interviews with an analysis grid to quantify and define the various cognitive and emotional problems reported by the patients; (3) a first version of an internet questionnaire tested on 108 vertigo participants; and (4) the selection of subscale items using principal component analyses (PCA). From the development phase, the revised NVI was composed of seven subscales, each with four items (28 items). In the validation phase, Cronbach's alphas were performed on the revised NVI for total and each subscale score, and to test extreme groups validity, the analyses of covariance (ANCOVAs) taking into account age were performed between 108 vertigo and 104 non-vertigo participants. The Cronbach's alphas showed good to satisfactory coefficients for the total and for all subscale scores, demonstrating acceptable reliability. The extreme groups validity analyses (ANCOVAs) were reliable for the total scale and for four subscales. Supplementary analyses showed no effect of hearing difficulties and an inverse age effect for attention and emotion subscales, with reduced problems with increased age in the vertigo participants. The NVI provides a useful new questionnaire to determine cognitive and emotional neuropsychological complaints that are associated with vertigo.

PMID: 27334526 [PubMed - as supplied by publisher]

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Laryngeal Manifestation of Forestier's Disease.

Laryngeal Manifestation of Forestier's Disease.

Open Access Maced J Med Sci. 2016 Jun 15;4(2):287-9

Authors: Stojanovic J, Zivanovic S, Sreckovic S, Jovanovic S, Belic B, Simovic S

Abstract
BACKGROUND: Forestier's disease is a rare disorder involving bony growths that can occur in various parts of the spinal column, mostly asymptomatic, but these osteophytes, very rarely have been associated with serious complications.
AIM: We report a 69-year-old man who was admitted at foniatric departement for evaluation of presenting hoarseness, dysphagia and laborious breathing.
CASE PRESENTATION: Noninvasive endolaryngeal imaging and radiological examination revealed distortion of left side of the larynx pushing to the right due to bony mass of the anterior part of cervical spine which was prominent at the left side. The symptoms of the patient presented were caused by Forestier's disease as found by the imiging.
CONCLUSIONS: In clinical practice it is advisable to take into consideration Forestier's disease as a possible cause of hoarseness and dysphagia in rare cases.

PMID: 27335602 [PubMed]

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Cricoid pressure impedes tracheal intubation with the Pentax-AWS Airwayscope®: a prospective randomized trial.

Cricoid pressure impedes tracheal intubation with the Pentax-AWS Airwayscope®: a prospective randomized trial.

Br J Anaesth. 2016 Mar;116(3):413-6

Authors: Komasawa N, Kido H, Miyazaki Y, Tatsumi S, Minami T

Abstract
BACKGROUND: It is unclear how cricoid pressure affects tracheal intubation with the Pentax-AWS Airwayscope(®) (AWS). We conducted a prospective randomized clinical trial in anaesthetized patients.
METHODS: Sixty patients were allocated to either the cricoid pressure (CP) group (n=30) or the sham group (n=30). We compared the two groups with regard to intubation time, number of attempts required for insertion of the Intlock blade (disposable blade of the AWS) and tracheal intubation, percentage of glottic opening (POGO) score, and subjective difficulty of both laryngoscopy and passage of a tube through the glottis.
RESULTS: Intubation time was significantly longer in the CP group (median 45[IQR40-59] s) than in the sham group (32[28-45] s) (P=0.003, 95% CI for median difference 5-24 s). The number required for insertion of the Intlock blade did not differ between the groups (P=0.08), but the number for tracheal intubation was significantly higher in the CP group (1 attempt in 14 patients, 2 in 7, 3 in 9) than in the sham group (1 attempt in 24 patients, 2 in 6; P=0.002). POGO score did not differ significantly between the groups (P=0.60), nor did the subjective difficulty of laryngoscopy (P=0.06). The visual analogue scale score for passage of a tube through the glottis was significantly higher in the CP group than in the sham group (P<0.001).
CONCLUSIONS: Cricoid pressure impedes tracheal intubation using the AWS, and is associated with longer intubation time, which can be attributed to increased difficulty in the passage of a tube through the glottis.
CLINICAL TRIAL REGISTRY NUMBER: UMIN000018209.

PMID: 26821697 [PubMed - indexed for MEDLINE]

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Epiglottic cyst as an etiological factor of globus sensation.

Epiglottic cyst as an etiological factor of globus sensation.

Turk J Gastroenterol. 2015 Sep;26(5):363-6

Authors: Polat B, Karahatay S, Gerek M

Abstract
BACKGROUND/AIMS: Globus is a subjective complaint that describes a sensation of a lump or a foreign body in the throat. Despite being a well-known and common clinical condition, the etiological factors have not been definitely elucidated yet. The study was set up to ascertain the relationship between epiglottic cysts and globus sensation.
MATERIALS AND METHODS: All patients undergoing investigation and treatments for globus sensation were included in the study. Patients with epiglottic cysts but no other possible causes of globus sensation were constituted the series of patients. Patients were asked to assess the levels of complaint before and after the carbon dioxide (CO2) laser excisions of the cysts.
RESULTS: Epiglottic cysts were found in 10 (5.4%) of the 182 patients. Three of these 10 patients who had concomitant diseases or conditions that may cause globus sensation and one patient who refused the surgery were excluded from the study. All the remaining six patients reported relief of the globus sensation after the CO2 laser excisions of the cysts.
CONCLUSION: Our results, obtained from this limited series, indicated that epiglottic cysts may be considered as one of the etiological factors of globus sensation.

PMID: 26350686 [PubMed - indexed for MEDLINE]

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Use of Extrathoracic Deposition Models for Patient-Specific Dose Estimation during Inhaler Design.

Use of Extrathoracic Deposition Models for Patient-Specific Dose Estimation during Inhaler Design.

Curr Pharm Des. 2015;21(27):3984-92

Authors: Carrigy NB, Martin AR, Finlay WH

Abstract
The lung dose of inhaled pharmaceutical aerosol that an individual will receive from an inhaler can now be more accurately estimated in light of recent extrathoracic deposition modeling that has correlated characteristic airway dimensions with deposition. This paper first summarizes the current state of extrathoracic deposition models, including recent developments that have quantified the effects of aerosol electrostatics and inhaler mouthpiece diameter on deposition. A generalized equation for predicting extrathoracic deposition in different subjects is then developed and average characteristic airway dimensions representative of different age groups are indicated. A methodology is then presented to predict the lung dose per unit body surface area individuals will receive from an inhaler. A sample calculation shows that a typical 10-year-old child subject would receive a lower lung dose per unit body surface area than an adult subject inhaling through the same inhaler at the same 90 L min-1 flow rate, due to greater extrathoracic deposition in the child. In order to provide an equivalent lung dose per unit body surface area to the child as to the adult, an inhaler particle size adjustment is specified. Finally, the use of idealized geometries for developing inhaler-specific empirical correlations and improving upon inhaler design is outlined.

PMID: 26290196 [PubMed - indexed for MEDLINE]

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Decompression illness treated in Denmark 1999-2013.

Decompression illness treated in Denmark 1999-2013.

Diving Hyperb Med. 2016 Jun;46(2):87-91

Authors: Svendsen Juhl C, Hedetoft M, Bidstrup D, Jansen EC, Hyldegaard O

Abstract
INTRODUCTION: The incidence, diver characteristics and symptomatology of decompression illness (DCI) in Denmark has not been assessed since 1982, and the presence of long-term residual symptoms among divers receiving hyperbaric oxygen therapy in Denmark has never been estimated to our knowledge.
METHODS: We undertook a retrospective study of the incidence and characteristics of DCI cases in Denmark for the period of 1999 to 2013. Medical records and voluntary questionnaires were reviewed, extracting data on age, gender, weight, height, diver certification level, diving experience, number of previous dives, type of diving, initial type of hyperbaric treatment and DCI symptoms. Trend in annual case numbers was evaluated using run chart analysis and Spearman's correlation. Age, height, weight, and BMI were evaluated using linear regression. The presence of long-term residual symptoms was investigated by phone interviewing the subgroup of divers treated in 2009 and 2010.
RESULTS: Two-hundred-and-five DCI cases were identified. The average annual case load was 14 with no significant trend during the study period (P = 0.081). Nor did we find any trend in age, weight, height or BMI. The most frequent symptoms were paraesthesia (50%), pain (42%) and vertigo (40%). Thirteen out of the subgroup of 30 divers had residual symptoms at discharge from hospital, and six out of 24 of these divers had residual symptoms at the time of follow-up.
CONCLUSIONS: We observed a more than ten-fold increase in DCI-cases since the period 1966-1980. In the subgroup of divers treated in 2009/2010, a quarter had long-term residual symptoms as assessed by telephone interview, which is in keeping with the international literature, but still a reminder that DCI can have life-long consequences.

PMID: 27334996 [PubMed - in process]

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Reply to the Comment on 'International Collegium of Rehabilitative Audiology (ICRA) recommendations for the constructor of multilingual speech test by Akeroyd et al' by Cas Smits.

Reply to the Comment on 'International Collegium of Rehabilitative Audiology (ICRA) recommendations for the constructor of multilingual speech test by Akeroyd et al' by Cas Smits.

Int J Audiol. 2016;55(4):269-71

Authors: Kollmeier B, Akeroyd MA, Arlinger S, Bentle RA, Boothroyd A, Dillier N, Dreschler WA, Gagné JP, Lutman ME, Wouters J, Wong L

PMID: 27336099 [PubMed - in process]

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Reply to the Comment on 'International Collegium of Rehabilitative Audiology (ICRA) recommendations for the constructor of multilingual speech test by Akeroyd et al' by Cas Smits.

Reply to the Comment on 'International Collegium of Rehabilitative Audiology (ICRA) recommendations for the constructor of multilingual speech test by Akeroyd et al' by Cas Smits.

Int J Audiol. 2016;55(4):269-71

Authors: Kollmeier B, Akeroyd MA, Arlinger S, Bentle RA, Boothroyd A, Dillier N, Dreschler WA, Gagné JP, Lutman ME, Wouters J, Wong L

PMID: 27336099 [PubMed - in process]

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Perilymphatic fistula after underwater diving: a series of 11 cases.

Perilymphatic fistula after underwater diving: a series of 11 cases.

Diving Hyperb Med. 2016 Jun;46(2):73-5

Authors: Morvan JB, Gempp E, Rivière D, Louge P, Vallee N, Verdalle P

Abstract
INTRODUCTION: Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced inner-ear damage. If this injury is ruled out, inner-ear barotrauma should be considered together with its underlying specific injury pattern, perilymphatic fistula.
METHODS: We report on a series of 11 cases of perilymphatic fistula following ear barotrauma between 2003 and 2015, eight after scuba diving and three after free diving. All patients underwent a series of laboratory investigations and first-line medical treatment.
RESULTS: Seven patients had a perilymphatic fistula in the left ear and four in the right. Eight cases underwent endaural surgical exploration. A fistula of the cochlear fenestra was visualised in seven cases with active perilymph leakage seen in six cases. After temporal fascia grafting, prompt resolution of dizziness occurred, with early, stable, subtotal recovery of hearing in seven. Of six patients in whom tinnitus occurred, this disappeared in two and improved in a further two. Two patients were not operated on because medical treatment had been successful, and one patient refused surgery despite the failure of medical treatment. Median follow-up time was 7.4 years (range 0.3 to 12).
CONCLUSION: The diagnosis of perilymphatic fistula is based on clinical assessments and various laboratory findings. When there was strong evidence of this condition, surgery yielded excellent functional outcomes in all patients treated early.

PMID: 27334993 [PubMed - in process]

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SPINE STEREOTACTIC RADIOSURGERY FOR PATIENTS WITH METASTATIC THYROID CANCER - Secondary analysis of Phase I/II trials.

SPINE STEREOTACTIC RADIOSURGERY FOR PATIENTS WITH METASTATIC THYROID CANCER - Secondary analysis of Phase I/II trials.

Thyroid. 2016 Jun 22;

Authors: Bernstein MB, Chang EL, Amini B, Pan H, Cabanillas M, Wang XA, Allen PK, Rhines LD, Tatsui C, Li J, Brown PD, Ghia AJ

Abstract
Background Metastatic deposits to the spine in thyroid cancer patients represent the most common site of bone involvement and can contribute to pain, neurologic deficits, and death. In this study, we sought to determine the efficacy and safety of spine stereotactic radiosurgery (SSRS) for thyroid cancer patients. Methods Thyroid cancer patients with spine metastases were selected and analyzed from a cohort of patients that were prospectively enrolled in two, single-institution Phase I/II studies. SSRS was delivered in single or multi-fraction schedules. Dose regimens ranged from 16-18 Gy in one fraction or 27-30 Gy in 3-5 fractions. Toxicity was graded according to the NCI-CTC toxicity scale. Local control was determined by serial post-treatment MRI scans showing no evidence of progressive disease. Patients were followed until date of death or date of last known visit for survival analyses. Local control and overall survival rates were carried out using Kaplan-Meier estimates. The log-rank test was used to assess the equality of the survivor function across groups. A p-value of 0.05 or less was considered to be statistically significant. Results A total of 27 spine lesions were treated in 23 patients over a six-year period. Median follow-up was 28.9 months (range 5-93 months). Local control was 88% at two years and 79% at three years. Patients requiring upfront surgical intervention and treated with adjuvant SSRS achieved sustained control rates of 86% at three years. Overall survival rates were 85% and 67% at one and two years, respectively. In patients classified with oligoprogression and controlled extra-spinal disease, overall survival was significantly higher than those with evidence of systemic progression, 81% versus 45% at two years (p=0.01). No patient experienced any grade 3-5 toxicity. Pain flare was reported in 30% of patients with only three patients (13%) requiring narcotics or short-course steroids. There was no evidence of vertebral body fracture in any patient that achieved local control in the treated area. Conclusions Spine stereotactic radiosurgery for thyroid metastases as a primary or adjuvant/salvage therapy is well-tolerated and yields high rates of local control. .

PMID: 27334245 [PubMed - as supplied by publisher]

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Contribution of molecular tools for the diagnosis and epidemiology of fungal chronic rhinosinusitis.

Contribution of molecular tools for the diagnosis and epidemiology of fungal chronic rhinosinusitis.

Med Mycol. 2016 Jun 22;

Authors: Comacle P, Belaz S, Jegoux F, Ruaux C, Le Gall F, Gangneux JP, Robert-Gangneux F

Abstract
Chronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp, A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS.

PMID: 27335058 [PubMed - as supplied by publisher]

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An Occupational Study in Nurses: Prevalence of Thyroid Nodules and Cancer in Comparison to Health Check-up Female.

An Occupational Study in Nurses: Prevalence of Thyroid Nodules and Cancer in Comparison to Health Check-up Female.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Kim KH, Woo SH

Abstract
Objectives: It is known that a great extent of radiation is emitted from the medical instruments used in hospitals and that radiation exposure can cause thyroid cancer. However, the correlation between occupational radiation exposure in hospitals and thyroid disease is not extensively recognized.
Methods: The subjects of the study were female nurses, who worked at a single hospital and female, who had undergone a health examination at the same hospital during the same period. The 1,024 nurses and 2,631 healthy women were enrolled for the present study. All the participants were screened using thyroid ultrasonography, and fine-needle aspiration & cytology was performed on potentially malignant nodules.
Results: Thyroid nodules were present in 315 nurses (30.8%) and 1,023 health check-up female (38.9%). Typically, 107 nurses (10.4%) and 201 health check-up female (7.6%) had suspicious nodule and were further tested with ultrasonography guided fine-needle aspiration & cytology. The 16 nurses (1.6%) and 38 health check-up female (1.4%) were diagnosed with thyroid cancer. The prevalence of thyroid nodules was enhanced in both the groups and a significant increase was noted in health check-up female group (P<0.05); however, no difference was seen in the incidence of thyroid cancer in both the groups (P>0.05).
Conclusion: In our study, working in a hospital does not increase the prevalence of thyroid nodules or thyroid cancer.

PMID: 27334518 [PubMed - as supplied by publisher]

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Preoperative Lymph Node Staging by FDG PET/CT With Contrast Enhancement for Thyroid Cancer: A Multicenter Study and Comparison With Neck CT.

Preoperative Lymph Node Staging by FDG PET/CT With Contrast Enhancement for Thyroid Cancer: A Multicenter Study and Comparison With Neck CT.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Chong A, Ha JM, Han YH, Kong E, Choi Y, Hong KH, Park JH, Kim SH, Park JM

Abstract
Objectives: The purpose of this study was to compare lymph node (LN) staging using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) with contrast-enhancement (CE) PET/CT and contrast-enhanced neck CT (neck CT) in patients with thyroid cancer with level-by-level comparison with various factors.
Methods: This was a retrospective multicenter study. A total of 85 patients were enrolled. Patients who underwent a preoperative evaluation by CE PET/CT and neck CT for thyroid cancer were enrolled. The gold standard for LN was the combination of surgical pathology and clinical follow-up. We compared CE PET/CT with neck CT using a level-by-level method. Factors, including age, sex, camera, arm position, tumor size, extra-thyroidal extension, tumor location, number of primary tumors, primary tumor maximum standardized uptake value, and the interval from scan to operation were also analyzed.
Results: Overall accuracy was 81.2% for CE PET/CT and 68.2% for neck CT. CE PET/CT was more sensitive than neck CT (65.8% vs. 44.7%). Also, CE PET/CT showed higher negative predictive value (77.2% vs. 66.1%). CE PET/CT showed good agreement with the gold standard (weighted kappa [κ], 0.7) for differentiating N0, N1a, and N1b, whereas neck CT showed moderate agreement (weighted κ, 0.5). CE PET/CT showed better agreement for the number of levels involved with the gold standard (weighted κ, 0.7) than that of neck CT with the gold standard (weighted κ, 0.5). The accuracies for differentiating N0, N1a, and N1b were 81.2% for CE PET/CT and 68.2% for neck CT. Level-by-level analysis showed that CE PET/CT was more sensitive and has higher negative predictive value for detecting ipsilateral level IV and level VI LNs than neck CT. Other analyzed factors were not related to accuracies of both modalities.
Conclusion: CE PET/CT was more sensitive and reliable than neck CT for preoperative LN staging in patients with thyroid cancer.

PMID: 27334517 [PubMed - as supplied by publisher]

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Changes in Oral Vowel Sounds and Hyoid Bone Movement After Thyroidectomy.

Changes in Oral Vowel Sounds and Hyoid Bone Movement After Thyroidectomy.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Hong KH, Yang WS, Park MJ, Oh JS, Han BH

Abstract
Objectives: Voice and speech alterations after total thyroidectomy may be associated with other extralaryngeal factors, such as neck muscle dysfunction and neck scar contracture. We evaluated the acoustic characteristics of oral vowel sounds and changes in hyoid bone movement before and after thyroidectomy.
Methods: Twenty-nine female patients undergoing total thyroidectomy were included. Fundamental frequencies (Fo), formants and vowel space areas were evaluated before surgery and 7 days and 3 months after surgery to acoustically analyze the oral vowel sounds. Videofluoroscopic images were taken at the same times to evaluate hyoid bone movement.
Results: The Fo levels of seven vowels decreased significantly after surgery. The vowel formant changes the F1 of vowel /[e]/ decreased significantly from baseline at 3 months postoperatively, and the F3 of vowel /[i]/ decreased significantly from baseline 7 days postoperatively. The change in the vowel space area was not observed. The Y coordinate of the vowels /[i]/ and /[e]/ decreased significantly from baseline 7 days postoperatively due to changes in hyoid movement.
Conclusion: The damage to the neck muscles after thyroidectomy changes in Fo, formant and hyoid bone position. These quantitative results could be used as basic data for voice management in patients who undergo thyroidectomy.

PMID: 27334516 [PubMed - as supplied by publisher]

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Age-Related Changes in Antioxidative Enzyme Capacity in Tongue of Fischer 344 Rats.

Age-Related Changes in Antioxidative Enzyme Capacity in Tongue of Fischer 344 Rats.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Baek MK, Kim KO, Kwon HJ, Kim YW, Woo JH, Kim DY

Abstract
Objectives: Antioxidative enzyme efficiency changes in some organs with age. However, no study has been conducted on age-related antioxidant enzyme changes in tongue. In the present study, the authors investigated the activities of four antioxidative enzymes and their protein expressions in the tongues of young and old Fischer 344 rats.
Methods: Age-dependent changes in the enzyme activities of total superoxide dismutase (SOD), Mn-SOD, Cu/Zn-SOD, catalase (CAT), and glutathione peroxidase (GPx) were determined using chemical kits, and the protein expressions levels of these enzymes by Western blotting. The study was conducted using rats aged 7 months (the young group, n=8) and 22 months (the old group, n=8).
Results: Total SOD, Cu/Zn-SOD, and GPx activities in the tongues of old rats were lower than in young rats, and similarly, corresponding protein expressions were downregulated in old rats. On the other hand, although the protein expressions of Mn-SOD and CAT were lower in old rats, their enzyme activities were not.
Conclusion: The results of this study provide a possible mechanism for the tongue aging process, as in old Fischer 344 rats the antioxidant defense system was diminished with respect to enzyme activity levels and protein abundances.

PMID: 27334515 [PubMed - as supplied by publisher]

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Initial Factors Influencing Duration of Hospital Stay in Adult Patients With Peritonsillar Abscess.

Initial Factors Influencing Duration of Hospital Stay in Adult Patients With Peritonsillar Abscess.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Liu YH, Su HH, Tsai YW, Hou YY, Chang KP, Chi CC, Lin MY, Wu PH

Abstract
Objectives: To review cases of peritonsillar abscess and investigate the initial clinical factors that may influence the duration of hospitalization. To determine the predictive factors of prolonged hospital stay in adult patients with peritonsillar abscess.
Methods: Subjects were adults hospitalized with peritonsillar abscess. We retrospectively reviewed 377 medical records from 1990 to 2013 in a tertiary medical center in southern Taiwan. The association between clinical characteristics and the length of hospital stay was analyzed with independent t-test, univariate linear regression and multiple linear regression analysis.
Results: The mean duration of hospitalization was 6.2±6.0 days. With univariate linear regression, a prolonged hospital stay was associated with several variables, including female gender, older ages, nonsmoking status, diabetes mellitus, hypertension, band forms in white blood cell (WBC) counts, and lower hemoglobin levels. With multiple linear regression analysis, four independent predictors of hospital stay were noted: years of age (P<0.001), history of diabetes mellitus (P<0.001), ratio of band form WBC (P<0.001), and hemoglobin levels (P<0.001).
Conclusion: In adult patients with peritonsillar abscess, older ages, history of diabetes mellitus, band forms in WBC counts and lower hemoglobin levels were independent predictors of longer hospitalization.

PMID: 27334514 [PubMed - as supplied by publisher]

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A New Surgical Approach for Direct Acoustic Cochlear Implant: A Temporal Bone Study.

A New Surgical Approach for Direct Acoustic Cochlear Implant: A Temporal Bone Study.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Bruschini L, Forli F, Vito A, Berrettini S

Abstract
Objectives: The direct acoustic cochlear implant (DACI) is among the latest developments in the field of implantable acoustic prostheses. The surgical procedure requires a mastoidectomy and a posterior-inferior tympanotomy, with access to the facial recess at the level of the oval window, in a complex and lengthy surgical approach. Here, we report a new and considerably shorter surgical approach.
Methods: The new approach involves positioning of artificial incus above the oval window through the superior-anterior tympanotomy. We performed DACI placement in temporal bone specimens (n=5) to assess the feasibility of the new approach.
Results: The average time for the DACI implant in the temporal bones was only 112 minutes (range, 94 to 142 minutes) and there was little clinical risk associated with the procedure. Access was easy and drilling was minimal.
Conclusion: Our approach simplified the surgical procedure and consequently reduced the time required for DACI placement.

PMID: 27334513 [PubMed - as supplied by publisher]

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Upper Airway Variation and Frequent Alcohol Consumption Can Affect Compliance With Continuous Positive Airway Pressure.

Upper Airway Variation and Frequent Alcohol Consumption Can Affect Compliance With Continuous Positive Airway Pressure.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Jeong JI, Kim HY, Hong SD, Ryu G, Kim SJ, Lee KE, Dhong HJ, Chung SK

Abstract
Objectives: Compliance with continuous positive airway pressure (CPAP) treatment remains a primary concern for improving treatment outcomes of obstructive sleep apnea. There are few studies that have considered the role of upper airway anatomy on the compliance with CPAP. We hypothesized that upper airway anatomy would influence the compliance with CPAP.
Methods: One hundred out of 161 consecutive patients were enrolled in this study. The following possible determinants were tested against CPAP use: demographic and anthropometric data, minimal cross-sectional area on acoustic rhinometry, cephalometric and polysomnographic data, questionnaires of Epworth sleepiness scale and Beck depression index, and histories of previous upper airway surgery, degree of nasal obstruction, daily cigarette consumption, and weekly frequency of alcohol intake.
Results: Univariate analysis showed that histories of previous upper airway surgery and less frequent alcohol consumption, and longer mandibular plane-hyoid length (MP-H) on cephalometry were associated with longer average daily CPAP use. After adjustment for the confounding factors with multiple linear regression analysis, alcohol consumption and MP-H were still associated with the compliance with CPAP significantly.
Conclusion: To improve compliance with CPAP, careful evaluations of upper airway problems and life style are important before initiating CPAP.

PMID: 27334512 [PubMed - as supplied by publisher]

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Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty.

Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Choi N, Noh Y, Park W, Lee JJ, Yook S, Choi JE, Chung WH, Cho YS, Hong SH, Moon IJ

Abstract
Objectives: This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty.
Methods: This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.
Results: The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group.
Conclusion: With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

PMID: 27334511 [PubMed - as supplied by publisher]

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Histopathologic Evaluations of the Lingual Artery in Healthy Tongue of Adult Cadaver.

Histopathologic Evaluations of the Lingual Artery in Healthy Tongue of Adult Cadaver.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Mun MJ, Lee CH, Lee BJ, Lee JC, Jang JY, Jung SH, Wang SG

Abstract
Objectives: To clarify the anatomical distribution of the lingual artery in normal adult subjects through histopathologic evaluations.
Methods: Eighteen healthy cadaveric tongues were used to produce 8 paraffin-embedded tissue sections each. Length from midline raphe, depth from dorsum of tongue and the whole transverse length tongue were measured. The lateral distance, depth, and proportion of lateral distance of deep lingual artery were determined from tip to base of tongue gradually. Lateral distance is length from median raphe to the center of deep lingual artery lumen. Depth is vertical distance from dorsal surface of tongue to the center of deep lingual artery. Proportion of lateral distance is obtained by dividing lateral distance with transverse length from median raphe to lateral border of tongue. The degree of symmetry between right and left sides and the difference between selected spots were evaluated.
Results: Right and left sides of the lingual artery were symmetric. The lingual artery was lateralized as it run posterior. The lingual artery runs gradually deeper from the surface as it goes near the base of tongue. Both length and depth of the lingual artery gradually increased between 0%-75% of the mobile tongue, but 75%-100% zone of the lingual artery showed no significant difference. There was no anastomosis between right and left side of the lingual arteries. The lingual artery was located within 50% of the transverse length of tongue from median raphe.
Conclusion: The present study reveals 3-dimensional information on the anatomical distributions of the lingual artery in normal adult subjects. These findings gives us beneficial information about the handling of the lingual artery during oral and base of tongue-related surgery.

PMID: 27334510 [PubMed - as supplied by publisher]

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Effect of Long-Term Antiorthostatic Suspension in a Murine Model of Acute Lung Injury.

Effect of Long-Term Antiorthostatic Suspension in a Murine Model of Acute Lung Injury.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Jang TY, Jung AY, Kim YH

Abstract
Objectives: Antiorthostatic suspension (AOS) is ground-based model of simulated microgravity. There is still no study about the effect of long-term microgravity on the clinical course of acute lung injury. We evaluated the effect of simulated microgravity using AOS in a murine model of acute lung injury by lipopolysaccharide (LPS).
Methods: Thirty BALB/c mice were used. During 4 weeks, mice were equally allocated to control (free movement), restraint (tail suspended, but hindlimbs not unloaded), and AOS group (hindlimb unloaded). After then, mice got intranasal challenge with LPS (20 mg/kg, 50 μL). We measured: weight gain before and after AOS, the number of inflammatory cells and titers of cytokines (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor-α, and interferon-γ) in bronchoalveolar lavage (BAL) fluid, titer of myeloperoxidase (MPO) in serum and lung homogenate, and histopathologic examination of lung tissue.
Results: AOS group had significant weight loss compared to control and restraint group (P<0.001). AOS group also showed significantly decreased lymphocytes (P=0.023) compared to control group. In AOS group, titer for IL-1β in BAL fluid was significantly lower than restraint group (P=0.049). Titer for serum MPO was significantly decreased in AOS group compared to restraint group (P=0.004). However, there was no significant difference of MPO titers in lung tissue between groups. Histopathologic examination of lung tissue revealed no significant difference in the degree of pulmonary infiltration between restraint and AOS group.
Conclusion: In spite of modest anti-inflammatory effect, prolonged AOS caused no significant change in LPS-induced pulmonary inflammation.

PMID: 27334509 [PubMed - as supplied by publisher]

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Tracheobronchial Angle Measurements in Children: An Anthropometric Retrospective Study With Multislice Computed Tomography.

Tracheobronchial Angle Measurements in Children: An Anthropometric Retrospective Study With Multislice Computed Tomography.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Herek D, Herek O, Ufuk F

Abstract
Objectives: The purpose of this study is to investigate if any change exists in the values of tracheal bifurcation angles (subcarinal angle [SCA] and interbronchial angle [IBA]), right and left bronchial angles (RBA and LBA) in different pediatric age groups.
Methods: Chest computed tomography (CT) images of children aged 18 years and younger were reviewed retrospectively by two radiologists who were blinded to each other's measurements. One hundred and eighteen children were involved. RBA, LBA, SCA, and IBA were measured on coronal reformatted images. Subjects were classified into three groups according to their age. Measurement of IBA was done by measuring the angle between the lines drawn along the central axis of right and left main bronchi over their length. RBA and LBA were measured at the intersection points of the lines drawn along the inferior borders of the right and left main bronchi and the line passing through the longitudinal axis of trachea. Sums of RBA and LBA gave SCA. Interobserver agreement was also analyzed.
Results: SCA, IBA, and RBA values were statistically significant between children of ages less than 10 years and over 10 years (P<0.01). Interobserver agreement was excellent with an intraclass correlation coefficient score of 0.87 (95% confidence interval) for RBA, SCA, and IBA measurements.
Conclusion: We concluded that tracheal bifurcation angles are wider in children of age 10 years and younger. As age increases values of SCA, IBA, and RBA decrease.

PMID: 27334508 [PubMed - as supplied by publisher]

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The Practicability of Transnasal Esophagoscopy and the Evaluation of Patient's Perception: A Prospective Study.

The Practicability of Transnasal Esophagoscopy and the Evaluation of Patient's Perception: A Prospective Study.

Clin Exp Otorhinolaryngol. 2016 Jun 18;

Authors: Polat B, Karahatay S, Birkent H, Gerek M

Abstract
Objectives: Transnasal esophagoscopy (TNE) is a relatively new diagnostic procedure in the evaluation of patients with globus sensation and dysphagia. Enabling doctors to examine all of the upper aerodigestive system without the need for sedation, this technique is becoming more popular among otolaryngology specialists. The aim of this study is to evaluate the practicability of TNE and tolerability of patients to the test.
Methods: The study group consisted of 314 patients who were admitted to the swallowing center of a tertiary medical institution with the symptoms of dysphagia and globus sensation. In addition to other diagnostic procedures, patients were informed of the TNE and the necessary consents were obtained. Before the examination, patients were asked to foresee the level of discomfort they would presumably feel, according to the information they had. After the TNE, patients were asked to score the real level of discomfort they experienced during the test. A visual analog scale was used to note the levels. The duration of the tests and any complications were also noted.
Results: We could not perform TNE in 12 of the 314 patients due to nasal obstruction, intractable retching and vasovagal syncope (7, 4, and 1 patients, respectively). The average discomfort score foreseen before the test was 4.7±1.4 (mean±standard deviation). The post-procedure discomfort score was 1.6±1.1, and the difference was statistically significant (P<0.001). The average time to perform the TNE was 5 minutes (range, 3 to 13 minutes). Except for minor epistaxis in 7 patients (2%), no complications occurred.
Conclusion: According to our results TNE is an easy and well-tolerated procedure, it may be logical to tell the patient that the procedure will be less annoying and irritating than they assume. It is also a time saving procedure with low complication rates.

PMID: 27334507 [PubMed - as supplied by publisher]

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Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

Eur Arch Otorhinolaryngol. 2016 Jun 22;

Authors: Ozcelik H, Kayar Y, Danalioglu A, Arabaci E, Uysal O, Yakar F, Kart L

Abstract
Obstructive sleep apnea (OSA) leads to upper respiratory tract obstruction, causing increased abdominal-gastric pressure and decreased lower esophageal sphincter (LES) pressure and thus gastroesophageal reflux (GER). Continuous positive airway pressure (CPAP) is known to be an effective method for OSA treatment, but its effect on GER is still controversial. There are a very few studies investigating CPAP and GER relationship and performed based on pre- and post-treatment objective parameters of GER in patients with OSA. The study investigated the effect of CPAP treatment in patients with moderate and severe OSA without GER complaints on pre- and post-treatment objective GER parameters. The study included 25 patients with respiratory disturbance indices >15 without reflux symptoms who had undergone polysomnography at sleep laboratory. Age, sex, body mass index (BMI), waist, and neck circumference of the patients were documented. DeMeester score, LES pressure, and polysomnography parameters were evaluated pre- and post-CPAP. The results were statistically evaluated, and p value <0.05 is considered significant. Out of 25 patients, 21 were male (84 %) and mean age was 49.2 ± 8.6 (range 31-66). At the pre-CPAP phase, mean sphincter pressure was 22.2 ± 1.2 (range 8-73), and mean DeMeester score was 18 ± 15.5 (range 0.2-57). At the post-CPAP, mean sphincter pressure was 22.9 ± 1.6 (range 9-95), and mean DeMeester score was 16.3 ± 14.8 (range 0.2-55). No significant difference (p > 0.05) was found comparing pre-CPAP and post-CPAP measurements. Objective criteria show that CPAP treatment does not cause reflux in patients with OSA. Unlike studies reported in the literature, this conclusion has been reached by pre- and post-CPAP assessments.

PMID: 27334527 [PubMed - as supplied by publisher]

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The development of a new questionnaire for cognitive complaints in vertigo: the Neuropsychological Vertigo Inventory (NVI).

The development of a new questionnaire for cognitive complaints in vertigo: the Neuropsychological Vertigo Inventory (NVI).

Eur Arch Otorhinolaryngol. 2016 Jun 22;

Authors: Lacroix E, Deggouj N, Salvaggio S, Wiener V, Debue M, Edwards MG

PMID: 27334526 [PubMed - as supplied by publisher]

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Calculating annoyance: an option to proof efficacy in ENT treatment of snoring?

Calculating annoyance: an option to proof efficacy in ENT treatment of snoring?

Eur Arch Otorhinolaryngol. 2016 Jun 22;

Authors: Fischer R, Kuehnel TS, Merz AK, Ettl T, Herzog M, Rohrmeier C

Abstract
To develop and validate an objective method for calculating the annoyance caused by snoring sounds. 53 subjects assessed 50 different snoring and breath sounds on a visual analog scale for level of annoyance. A linear regression analysis was used to correlate these subjective assessments with objectively calculated psychoacoustic parameters (loudness, roughness, sharpness, and fluctuation strength, calculating the maximum, mean, and 5th percentile in each case). The quality of the resulting formula was checked, and additional validation was performed using subjective assessments of 60 new snoring and breath sounds by 52 new subjects. Receiver operating characteristic (ROC) analysis was used to scale the annoyance ranges obtained with the formula. A score consisting of the 5th percentile of loudness and the mean of roughness was developed. The formula displays high goodness of fit (R (2) = 0.91) and quality. In the validation phase, a highly significant correlation (r s = 0.95; p < 0.01) was obtained between the scores calculated with the formula and the subjective assessments. ROC analysis was able to define the annoyance ranges with a discriminatory power between 52 and 73 % (optimum sensitivity/specificity). The subjective assessments made by the participants were distinctly scaled and were reflected in a psychophysical algorithm. In the setting of polygraphy and polysomnography, this means that a reliable annoyance score that is not dependent on the bed partner can be obtained to establish the indication for anti-snoring treatments and to review their utility.

PMID: 27334525 [PubMed - as supplied by publisher]

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Results with Expanded Endonasal Resection of Skull Base Meningiomas: Technical Nuances and Approach Selection Based on an Early Experience.

Results with Expanded Endonasal Resection of Skull Base Meningiomas: Technical Nuances and Approach Selection Based on an Early Experience.

Turk Neurosurg. 2016 Jan 25;

Authors: Sughrue M, Bonney P, Burks J, Hayhurst C, Gore P, Teo C

Abstract
AIM: Reconstruction technique advances have created renewed enthusiasm for the expanded endonasal approach (EEA). However, as with any new technique, early experiences inevitably lead to more selective use of these techniques. We review our experience of the expanded endonasal endoscopic approach for skull base meningiomas and place it in context of the literature.
MATERIAL AND METHODS: Material and Methods: We performed retrospective review of all endonasal cases performed at our center for histologically proven meningioma. Tumor locations in 26 patients included olfactory groove (n=9), tuberculum sellae (n=7), optic nerve sheath (n=1), planum sphenoidale (n=2), clival (n=1) petroclival (n=3), cavernous sinus (n=2) and extensive pan-basal meningioma (n=1).
RESULTS: Results: The median follow-up was 38.6 months. Excluding 3 patients with tumors found incidentally, pre-operative symptoms improved in 14 of 23 (61%), were the same in 8 of 23 (35%) and worsened in one of 23 patients (4%) at time of last follow-up. Of all 26 patients, 16 (62%) had complete macroscopic resection of their tumor, 5 (19%) underwent at least 90% resection, and 5 (19%) underwent subtotal resection. There were two neurological complications and one CSF leak.
CONCLUSION: This study presents outcomes of patients treated with endonasal endoscopic meningioma surgery. We believe that very low rates of morbidity can be achieved in carefully selected patients, thus avoiding brain manipulation.

PMID: 27337239 [PubMed - as supplied by publisher]

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Management of Calvarial Tumors - a retrospective analysis and literature review.

Management of Calvarial Tumors - a retrospective analysis and literature review.

Turk Neurosurg. 2015 Jul 6;

Authors: Özgiray E, Perumal K, Çinar C, Emre Çaliskan K, Ertan Y, Yurtseven T, Oktar N, Övül I, Öner K

Abstract
AIM: Tumors of various organs which metastasize to bone do not neglect calvarium as a target. The aim of this study is to characterize the calvarial tumors.
MATERIAL AND METHODS: We retrospectively reviewed 45 consecutive patients operated for calvarial masses from October 1996 till May 2012 at our hospital. Skull base tumors and patients â‰¤18 years were excluded.
RESULTS: Three groups of lesions were found - calvarial metastases (15/45), primary tumors (5/45) and tumor-like lesions (25/45). Malignant lesions were equitable by gender distribution, higher age of onset (median age of primary =55; secondary = 60 years) and benign lesions by younger age (median = 35) and female bias (18/25). Calvarial metastases mostly presented with local swelling (10/15), local pain (6/15) and rarely neurologic deficit. There was associated dural sinus thrombosis (4/20 of malignant; 1/25 of benign lesions) and osteolysis (3/5 primary malignant, 13/15 secondary and 18/25 of benign lesions). Complete surgical excision was possible with minimal morbidity in all except one patient and nil mortality.
CONCLUSION: Nearly half (20/45) of the calvarial lesions tend to be malignant with most of them presenting as silent painless masses. Surgical excision should be considered only after suitable investigation and appropriate neurosurgical set-up.

PMID: 27337230 [PubMed - as supplied by publisher]

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Does where you live influence how your vestibular schwannoma is managed? Examining geographical differences in vestibular schwannoma treatment across the United States.

Does where you live influence how your vestibular schwannoma is managed? Examining geographical differences in vestibular schwannoma treatment across the United States.

J Neurooncol. 2016 Jun 22;

Authors: Carlson ML, Glasgow AE, Grossardt BR, Habermann EB, Link MJ

Abstract
The management of small- to medium-sized vestibular schwannoma (VS) remains controversial. Despite a lack of compelling evidence supporting one treatment modality over others, many providers and institutions remain highly biased toward one particular therapy-microsurgery, radiation, or primary observation. The objective of the current study was to estimate the impact of geography on disease presentation and initial treatment of VS in the United States. An analysis of the Surveillance, Epidemiology, and End Results (SEER) database identified 9761 patients with VS that were managed across the 16 SEER geographic registry areas. Univariate analyses demonstrated strong associations between geographic location and tumor size at diagnosis (P < 0.0001). When analyzing the 6115 subjects with tumors between 0 and 3 cm in size, multivariable models identified strong associations between place of residence and treatment modality (P < 0.0001). These multivariable models demonstrated that in many cases the impact of place of residence on treatment selection was greater than other established variables such as tumor size and age. To our knowledge, this is the first study to evaluate geographic trends in VS patient demographics, tumor size and management in the United States. These data suggest that disease presentation and treatment modality are significantly influenced by regional referral patterns, provider or institutional treatment preferences, and regional availability of subspecialty expertise. Understanding geographic bias is important for patients, referring physicians, and treatment providers alike. Until there is clear evidence supporting one therapy over others, multidisciplinary consultation with a minimum of a neurotologist, neurosurgeon, and radiation oncologist or radiosurgeon should be offered in order to provide balanced counseling and accurate informed consent.

PMID: 27334903 [PubMed - as supplied by publisher]

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Temporal aneurysmal bone cyst: cost-effective method to achieve gross total resection.

Temporal aneurysmal bone cyst: cost-effective method to achieve gross total resection.

Acta Neurochir (Wien). 2016 Jun 22;

Authors: Sodhi HB, Salunke P, Agrawal P, Gupta K

Abstract
Aneurysmal bone cyst (ABC) is a vascular benign bony expansile lesion. The treatment is gross total resection. Surgery for a skull base aneurysmal bone cyst poses a significant challenge because of its vascularity and the adjacent neurovascular structures. We present the case of a young male with a temporal aneurysmal bone cyst who underwent gross total resection of the lesion. The external carotid artery (ECA) was temporarily clamped to cut off the vascular supply. There was no intraoperative event, and the patient made a good postoperative clinical recovery. This technique was used as an alternative to subselective endovascular embolization of the ECA branches. This case represents a simple yet cost-effective surgical technique to control bleeding for a highly vascular lesion such as ABCs, especially in resource-deficient countries.

PMID: 27334736 [PubMed - as supplied by publisher]

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Acoustic and tongue kinematic vowel space in speakers with and without dysarthria.

Acoustic and tongue kinematic vowel space in speakers with and without dysarthria.

Int J Speech Lang Pathol. 2016 Jun 23;:1-10

Authors: Lee J, Littlejohn MA, Simmons Z

Abstract
PURPOSE: The purpose is to investigate acoustic and tongue body kinematic vowel dispersion patterns and vowel space in speakers with and without dysarthria secondary to amyotrophic lateral sclerosis (ALS).
METHOD: Acoustic and tongue kinematic vowel spaces were examined at the same time sampling point using electromagnetic articulography in 11 speakers with dysarthria secondary to ALS and 11 speakers without dysarthria. Tongue kinematic data were collected from the tongue body sensor (∼25 mm posterior from the tongue apex). A number of acoustic and tongue body kinematic variables were tested.
RESULT: The result showed that the acoustic and tongue kinematic vowel dispersion patterns are different between the groups. Acoustic and tongue body kinematic vowel spaces are highly correlated; however, unlike acoustic vowel space, tongue body kinematic vowel space was not significantly different between the groups.
CONCLUSION: Both acoustic and tongue kinematic vowel dispersion patterns are sensitive to the group difference, especially with high vowels. The tongue kinematic vowel space approach is too crude to differentiate the speakers with dysarthria secondary to ALS from speakers without dysarthria. To examine tongue range of motion in speakers with dysarthria, a more refined articulatory kinematic approach needs to be examined in the future.

PMID: 27336197 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

Παρασκευή 24 Ιουνίου 2016