Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

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Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Xu J, Yi H, Li X, Chen W, Xu J

Abstract
OBJECTIVE: To investigate the surgical treatment and related experience of lateral skull base lesions.
METHODS: In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair.
RESULTS: Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery.
CONCLUSION: Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.

PMID: 27577755 [PubMed - as supplied by publisher]

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Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Xu J, Yi H, Li X, Chen W, Xu J

Abstract
OBJECTIVE: To investigate the surgical treatment and related experience of lateral skull base lesions.
METHODS: In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair.
RESULTS: Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery.
CONCLUSION: Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.

PMID: 27577755 [PubMed - as supplied by publisher]

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Long-term observation of indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles as a dual mode CT/MR contrast agent for rabbit lingual sentinel lymph node identification.

Long-term observation of indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles as a dual mode CT/MR contrast agent for rabbit lingual sentinel lymph node identification.

Acta Otolaryngol. 2016 Aug 31;:1-8

Authors: Yang Y, Zhou J, Shi X, Sha Y, Wu H

Abstract
CONCLUSIONS: The rabbit lingual sentinel lymph node (SLN) could be long-term visualized by indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles (Gd-Au PENPs) as CT/MR dual-modal contrast agent.
OBJECTIVE: To investigate duration and intensity of rabbit lingual SLN enhancement using Gd-Au PENPs as a CT/MR dual-modal contrast agent.
METHODS: Twelve rabbits were randomly divided into indirect CT lymphography (CT-LG) and MR lymphography (MR-LG) groups. In each group, two rabbits received unilateral injection and four received bilateral injection of Gd-Au PENPs in the sub-mucosa of the tongue. Then the enhancement characteristics of SLN were investigated.
RESULTS: The enhanced SLNs were observed in 100% in all rabbits by indirect CT-LG and MR-LG simultaneously at 1 min after injection. Then SLN enhancement was improved rapidly and the first peaks were observed at 25 min for CT-LG and 1 h for MR-LG, respectively, then SLN enhancement decreased gradually to a minimum at 2 h for CT-LG and 3 h for MR-LG. Afterwards, the enhancement intensity increased again and second peaks were observed at 24 h for both CT-LG and MR-LG. Hereafter, the intensity dropped slowly and weak enhancement was also observed at the 40th week for CT-LG and 31st day for MR-LG. Black-stained SLNs were visualized in 100% at autopsy in all rabbits.

PMID: 27577609 [PubMed - as supplied by publisher]

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The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation.

The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation.

Acta Otolaryngol. 2016 Aug 31;:1-8

Authors: Liu YK, Qi CL, Tang J, Jiang ML, Du L, Li ZH, Tan SH, Tang AZ

Abstract
CONCLUSION: The cochlear length (CL) and cochlear height (CH) measured through MPR will provide for more accurate quantitative diagnosis of inner ear malformation, and are subsequently convenient for calculating cochlear duct length (CDL) before cochear implant.
OBJECTIVES: Qualitative and quantitative diagnosis of inner ear malformation in deaf patients through multiplanar reconstruction (MPR) was performed to provide a reference for cochlear implants.
METHODS: One hundred and two cases without sensorineural deafness and 560 patients with sensorineural deafness had MPR of temporal bone computed tomography performed to obtain the standardized cochlear-view and oblique coronal-view images. The inner ear radial lines were measured to formulate normal values for inner ear malformation diagnosing, and the CDL was estimated based on CL.
RESULTS: The normal range values of inner ear radial lines were measured and formulated, of which CL was 8.1-9.59 mm and CH was 3.28-3.90 mm. According to inner ear morphology and the normal values measured above, 61 cases of incomplete partition-type II (IP-II) and a high percentage (27/110, 24.5%) of hypoplasia of cochlea (HC) were diagnosed. The HC group was further divided into 1-turn, 1.5-turn, and 2-turn sub-groups, which had CDL of 15.98 ± 1.48 mm, 21.36 ± 0.96 mm, and 26.56 ± 0.60 mm, respectively.

PMID: 27577263 [PubMed - as supplied by publisher]

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Onset time of benign paroxysmal positional vertigo.

Onset time of benign paroxysmal positional vertigo.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Ichijo H

Abstract
CONCLUSION: Benign paroxysmal positional vertigo (BPPV) is strongly related to sleep. This study proposes a micro-otoconia accumulation theory in which the pathological debris is an aggregate of micro-otoconia over a long time period, and which begins to slide by its own weight during sleep.
OBJECTIVES: To examine the onset time of idiopathic BPPV and to investigate its etiology.
METHOD: Patients (n = 351) were classified as posterior canalolithiasis (PC), horizontal canalolithiasis (HC), and horizontal heavy cupula (HHC) according to nystagmus findings. This study examined the medical records, and categorized the onset times into the following four groups; (1) during sleep, (2) at the time of rising, (3) morning, and (4) afternoon.
RESULTS: PC (n = 135): In 33 patients, vertigo occurred during sleep, in 69 patients at rising, in 10 patients in the morning, and in 23 patients in the afternoon. HC (n = 87): In 38 patients, vertigo occurred during sleep, in 30 patients at rising, in eight patients in the morning, and in 11 patients in the afternoon. HHC (n = 129): In 27 patients, vertigo occurred during sleep, in 59 patients at rising, in 15 patients in the morning, and in 28 patients in the afternoon.

PMID: 27577049 [PubMed - as supplied by publisher]

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Relationship between (18)FDG-PET and different types of sinonasal malignancies.

Relationship between (18)FDG-PET and different types of sinonasal malignancies.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Felix-Ravelo M, Bey A, Arous F, Paris-Grandpierre S, Jankowski R, Nguyen DT

Abstract
CONCLUSION: The sensitivity and specificity of a (18)FDG-PET scan may be different according to the histology. The SUVmax and SUV ratio may reflect the tumor's aggressive behavior.
OBJECTIVES: To describe the characteristics of PET/CT scans, including the maximum standard uptake values (SUVmax), at initial diagnosis according to six main types of sinonasal malignancies: sinonasal adenocarcinoma (SNAC), sinonasal undifferentiated carcinoma (SNUC), adenoid cystic carcinoma (ACC), sinonasal malignant melanoma (SMM), olfactory neuroblastoma (ONB), and sinonasal neuroendocrine carcinoma (SNEC).
METHODS: A chart review of 50 patients who were diagnosed and treated for six sinonasal malignancy types over a period of 6 years was conducted. Any (18)F-FDG PET/CT scans for each patient were searched using the hospital's intranet. The SUVmax of the primary sinonasal site was recorded. The liver SUVs were utilized as reference SUVs. The SUV ratio was defined as the ratio of the SUVmax of the primary tumor and the SUVliver.
RESULTS: The most common malignancy was SNAC (32%), followed by SNUC (24%), ONB (14%), ACC (10%), SMM (10%), and SNEC (10%). The SUVmax and SUV ratio values were significantly different between tumor types (p = 0.002 and 0.012, respectively). SNUC had the highest mean SUVmax (14.2), followed by SNAC (9.9). A similar mean SUVmax was observed for SMM, ONB, and ACC (∼ 7.0). SNEC up-takes the least (18)FDG among these six tumor types (mean SUVmax = 4.7).

PMID: 27576899 [PubMed - as supplied by publisher]

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Deep neck cellulitis: limitations of conservative treatment with antibiotics.

Deep neck cellulitis: limitations of conservative treatment with antibiotics.

Acta Otolaryngol. 2016 Aug 31;:1-7

Authors: Hirasawa K, Tsukahara K, Motohashi R, Endo M, Sato H, Ueda Y, Nakamura K

Abstract
CONCLUSION: When the parapharyngeal space is infected, concurrent involvement of other spaces is likely, and involvement of multiple deep neck spaces is a key risk factor for abscess formation.
OBJECTIVES: Deep neck infection is treated with antibiotics when abscesses have not yet been formed. However, in some cases, abscesses will form later and surgical drainage is warranted. This study retrospectively examined which cases were less likely to achieve cure, to clarify the limitations of conservative treatment for deep neck cellulitis.
PATIENTS AND METHODS: Subjects comprised 19 patients with deep neck cellulitis who initially underwent conservative treatment with antibiotics. Patients were divided into two groups: Group A (n = 7), patients who recovered by conservative treatment; and Group B (n = 12), patients who did not recover and underwent surgical drainage. Age, state of DM control, etiology, treatment, spaces infected, and duration of hospitalization were investigated.
RESULTS: The number of infected spaces was one in all Group A patients, whereas Group B showed multiple infected spaces in all except two cases. In particular, among the 10 cases with parapharyngeal space infection, eight (80%) showed multiple lesions.

PMID: 27576733 [PubMed - as supplied by publisher]

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The groningen laryngomalacia classification system--based on systematic review and dynamic airway changes.

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The groningen laryngomalacia classification system--based on systematic review and dynamic airway changes.

Pediatr Pulmonol. 2015 Dec;50(12):1368-73

Authors: van der Heijden M, Dikkers FG, Halmos GB

Abstract
OBJECTIVE: Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the past, different classification systems have been introduced. Until now no classification system is widely accepted and applied. Our goal is to provide a simple and complete classification system based on systematic literature search and our experiences.
STUDY DESIGN: Retrospective cohort study with literature review.
METHODS: All patients with laryngomalacia under the age of 5 at time of diagnosis were included. Photo and video documentation was used to confirm diagnosis and characteristics of dynamic airway change. Outcome was compared with available classification systems in literature.
RESULTS: Eighty-five patients were included. In contrast to other classification systems, only three typical different dynamic changes have been identified in our series. Two existing classification systems covered 100% of our findings, but there was an unnecessary overlap between different types in most of the systems. Based on our finding, we propose a new a classification system for laryngomalacia, which is purely based on dynamic airway changes.
CONCLUSION: The groningen laryngomalacia classification is a new, simplified classification system with three types, based on purely dynamic laryngeal changes, tested in a tertiary referral center: Type 1: inward collapse of arytenoids cartilages, Type 2: medial displacement of aryepiglottic folds, and Type 3: posterocaudal displacement of epiglottis against the posterior pharyngeal wall.

PMID: 25825153 [PubMed - indexed for MEDLINE]

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Pseudoadenomatous Hyperplasia of the Inferior Forniceal Conjunctiva Due To Prosthetic Irritation in an Anophthalmic Socket.

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Pseudoadenomatous Hyperplasia of the Inferior Forniceal Conjunctiva Due To Prosthetic Irritation in an Anophthalmic Socket.

Ophthal Plast Reconstr Surg. 2016 Mar-Apr;32(2):e32-4

Authors: Jakobiec FA, Rashid A, Massoud V, Fay A

Abstract
Secondary complications in an anophthalmic socket can include late appearing shrinkage due to scarring and squamous cell carcinoma. This article reports a 51-year-old man who 27 years after an enucleation developed an inability to retain his ocular prosthesis due to an acquired multilobular fleshy mass in his inferior fornix. The patient had worn his prosthesis without removal for years at a time. Microscopic evaluation of the excised lesion disclosed a pseudoadenomatous (pseudoglandular) hyperplasia of the conjunctival epithelium with myriad goblet cells and accompanying chronic inflammation. In cross section, these structures microscopically resembled an adenoma but were found to display multifocal origins from the surface epithelium resembling exaggerated pseudoglands of Henle. Simple excision without recurrence 6 months later has permitted a new prosthesis to be comfortably worn with stability.

PMID: 24911539 [PubMed - indexed for MEDLINE]

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[Could it be a stroke?].

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[Could it be a stroke?].

MMW Fortschr Med. 2016 May 25;158(10):64-9; quiz 70

Authors: Jandl M, Marziniak M

PMID: 27221439 [PubMed - indexed for MEDLINE]

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A novel strategy for the discrimination of gelatinous Chinese medicines based on enzymatic digestion followed by nano-flow liquid chromatography in tandem with orbitrap mass spectrum detection.

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A novel strategy for the discrimination of gelatinous Chinese medicines based on enzymatic digestion followed by nano-flow liquid chromatography in tandem with orbitrap mass spectrum detection.

Int J Nanomedicine. 2015;10:4947-55

Authors: Yang H, Shen Y, Xu Y, Maqueda AS, Zheng J, Wu Q, Tam JP

Abstract
Gelatinous Chinese medicines made from mammalian skin or horn or reptile shell are a very important type of animal-derived Chinese medicine. They have been extensively used either as both hemopoietic and hemostatic agents to treat vertigo, palpitation, hematuria, and insomnia in traditional Chinese medicine clinics; consumed as a popular tonic for weaker persons such as the elderly or women after giving birth; or further manufactured to health supplements for certain populations. However, they cannot be discriminated from each other by only using the routine approach in the Chinese Pharmacopoeia, as it lacks enough specificity and, consequently, and the requirements can be met even by adding assayed ingredients. In this study, our efforts to differentiate three gelatinous Chinese medicines, Asini Corii Colla, Cervi Cornus Colla, and Testudinis Carapacis ET Plastri Colla, are presented, and a novel strategy based on enzymatic digestion followed by nano-flow liquid chromatography in tandem with orbitrap mass spectrum detector analysis is proposed herein. Fourteen diagnostic fragments identified from the digests of these medicines were exclusively selected for their discrimination. By taking advantage of the favorable features of this strategy, it is feasible and convenient to identify enzymatic-digested peptides originated from signature proteins in each medicine, which thus could be employed as potential biomarkers for their form of raw medicinal material, and the pulverized and the complex especially, that being the direct basis for authentication purpose.

PMID: 26345994 [PubMed - indexed for MEDLINE]

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Sinus floor elevation utilizing the transalveolar approach.

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Sinus floor elevation utilizing the transalveolar approach.

Periodontol 2000. 2014 Oct;66(1):59-71

Authors: Pjetursson BE, Lang NP

Abstract
A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as 'osteotome sinus floor elevation', the 'Summers technique' or the 'Crestal approach', may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra-oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3-year implant survival rate was 92.8% (95% confidence interval: 87.4-96.0%). Furthermore, a subject-based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥ 5 mm and the sinus floor anatomy was relatively flat.

PMID: 25123761 [PubMed - indexed for MEDLINE]

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Clinicopathology of Immunoglobulin G4-Related Chronic Sclerosing Sialadenitis: A Single-Center Study.

Clinicopathology of Immunoglobulin G4-Related Chronic Sclerosing Sialadenitis: A Single-Center Study.

Otolaryngol Head Neck Surg. 2016 Aug 30;

Authors: Chang DH, Wu PS, Wang YC, Lin CH, Li WY, Ma H, Perng CK

Abstract
OBJECTIVES: To investigate the clinicopathologic characteristics of patients with immunoglobulin G4-related chronic sclerosing sialadenitis (IgG4-RCSS), a recently recognized disease.
STUDY DESIGN: Case series with chart review and pathology study.
SETTINGS: Tertiary care hospital.
SUBJECTS AND METHODS: We evaluated chronic sialadenitis specimens obtained over 11 years using pathologic examination and IgG4 immunohistochemistry staining. The specimens were assigned a revised diagnosis of IgG4-RCSS or chronic sialadenitis not otherwise specified, and clinicopathologic data from each group were compared.
RESULTS: Of the 84 patients, 21 were diagnosed with IgG4-RCSS and 63 with chronic sialadenitis not otherwise specified. IgG4-RCSS patients were older (68.2 ± 13.9 vs 54.2 ± 15.8 years, P = .001), predominantly male (85.7% vs 61.9%, P = .036), and more likely to present with painless swelling (75% vs 44.3%, P = .001) and bilateral involvement (52.4% vs 6.3%, P < .001). Ratio of IgG4-positive plasma cells to IgG-positive plasma cells in IgG4-RCSS tissues was 0.81 ± 0.14. The mean value of serum IgG4 in IgG4-RCSS patients was 918.8 mg/dL.
CONCLUSION: IgG4-RCSS is more common in older male patients and frequently presents with bilateral involvement. Informing head and neck surgeons of the clinical features of IgG4-RCSS and promoting a combined approach of clinical evaluation, imaging, and biopsy can improve the accuracy of preoperative diagnoses.

PMID: 27576683 [PubMed - as supplied by publisher]

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Is There a Need for Repeat Radiologic Examination of Children with Esophageal Coin Foreign Body?

Is There a Need for Repeat Radiologic Examination of Children with Esophageal Coin Foreign Body?

Otolaryngol Head Neck Surg. 2016 Aug 30;

Authors: Dedhia K, Chang YF, Leonardis R, Chi DH

Abstract
OBJECTIVES: To determine factors associated with the passage of coins. To determine the need for repeat preoperative chest x-ray (CXR) for esophageal coin foreign body.
SETTING: Academic tertiary care center.
DESIGN: Case series with chart review.
SUBJECTS AND METHODS: Patient information was retrieved from an Institutional Review Board-approved database. We identified 1359 children with esophageal coin foreign bodies from 2001 to 2013. Patients with both initial diagnostic and immediate preoperative CXR were included.
RESULTS: A total of 406 patients met inclusion criteria. The average age was 47 months (range, 1.8-194 months). On preoperative CXR, the position changed in 29 patients (7%). Age, type of coin, and location of coin were all statistically significant factors affecting the passage of the coin (P < .0001). Coins in the distal esophagus were 9.3 times more likely to pass than coins in the proximal esophagus. The longer the object was in the esophagus, the less likely it was to pass.
CONCLUSIONS: This study characterizes when esophageal coins may pass. Age, type of coin, location of coin at initial x-ray, and length of time are all important considerations to determine if the coin will pass. This information may be used to counsel families about the likelihood of coins to pass and whether repeat x-ray is necessary prior to surgical removal. Additionally, it may be more cost-effective to obtain repeat films in select patients and prevent those from going to the operating theater who are more likely to pass the coin spontaneously.

PMID: 27576682 [PubMed - as supplied by publisher]

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Feeding Tube Utilization in Patients with Salivary Gland Malignancies.

Feeding Tube Utilization in Patients with Salivary Gland Malignancies.

Otolaryngol Head Neck Surg. 2016 Aug 30;

Authors: Chen DW, Lewin JS, Xu L, Lai SY, Gunn GB, Fuller CD, Mohamed AS, Kanwar A, Sturgis EM, Hutcheson KA

Abstract
OBJECTIVES: To evaluate feeding tube utilization in patients with salivary gland malignancies (SGMs).
STUDY DESIGN: Case series with planned data collection.
SETTING: The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
SUBJECTS AND METHODS: Patients (N = 287) were sampled from an epidemiologic SGM registry during a 12-year period. Feeding tube history was retrospectively reviewed. Patients with outside locoregional therapy or palliative treatment were excluded. Enteral feeding and length of dependence were analyzed as a function treatment modality and site of SGM.
RESULTS: Of 287 patients, 79 (28%) required temporary nasogastric tube feeding (median duration: 13 days, interquartile range: 6-21). Among those 79, 30 (10% of total cohort) required conversion to percutaneous gastrostomy tube (G-tube). Median G-tube duration was 4.8 months (interquartile range: 3.7-13.1). G-tube placement was necessary only in patients receiving multimodality therapy (P < .001), and among those, 50% with SGMs arising from pharyngeal/laryngeal sites required G-tube, as compared with 8% to 19% of SGMs arising from all other sites (P < .01). At a median follow-up of 2.4 years, 9 (3%) of all SGM patients were G-tube dependent, but 14% (3 of 22) with laryngeal/pharyngeal sites treated with multimodality therapy remained chronically G-tube dependent.
CONCLUSION: While almost 30% of SGM survivors require a temporary nasogastric tube, G-tube utilization is uncommon, in roughly 10% of SGM overall. G-tube utilization appears exclusive to patients treated with multimodality therapy, and chronic gastrostomy remains high (14%) in patients with minor gland cancers arising in the pharynx/larynx, suggesting impetus for dysphagia prophylaxis in these higher-risk subsets, similar to patients treated for squamous cancers.

PMID: 27576681 [PubMed - as supplied by publisher]

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Medications for Allergic Rhinitis: An Opportunity for Quality Improvement?

Medications for Allergic Rhinitis: An Opportunity for Quality Improvement?

Otolaryngol Head Neck Surg. 2016 Aug 30;

Authors: Roditi RE, Ishman S, Lee S, Lin S, Shin JJ

Abstract
OBJECTIVES: Adherence to the allergic rhinitis clinical practice guideline is being considered as a potential focus for national performance metrics. To help inform this discussion, we assessed patient- and clinician-reported medication administration among nationally representative populations of patients with allergic rhinitis.
STUDY DESIGN: Cross-sectional analyses.
SETTING AND SUBJECTS: Home health assessments, ambulatory visits.
METHODS: Participants in the National Health and Nutrition Examination Survey and the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey were assessed. The primary outcomes were the percentage of patients reporting receipt of antihistamines and/or nasal steroids among those with allergy-related symptoms and the percentage for whom a clinician administered these medications when diagnosing allergic rhinitis. Secondary outcomes included assessments of those with worse quality of life, confirmatory allergy testing, and leukotriene receptor antagonist use.
RESULTS: Within the National Health and Nutrition Examination Survey, an estimated 29.2 million patients were diagnosed with "hay fever," while 92.2 million were diagnosed with "allergies." Patients with symptoms of allergic rhinitis reported that antihistamines or nasal steroids were prescribed in 21.1% to 24.0% of cases. Leukotriene receptor antagonists were given to 1.7% of those without asthma or use of other allergy medications. Within the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey, observations representing 149.5 million visits for allergic rhinitis demonstrated that nasal steroids were administered in 29.6% of cases, while nonsedating and sedating antihistamines were given in 22.4% and 17.2%, respectively.
CONCLUSIONS: Despite a high prevalence of allergic rhinitis, per patient report and clinician entry, a substantial number of affected patients do not receive antihistamines and nasal steroids.

PMID: 27576680 [PubMed - as supplied by publisher]

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Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis.

Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis.

Otolaryngol Head Neck Surg. 2016 Aug 30;

Authors: Kohli P, Naik AN, Farhood Z, Ong AA, Nguyen SA, Soler ZM, Schlosser RJ

Abstract
OBJECTIVE: To use combined pre- and postsurgical olfactory outcomes to assess the impact of endoscopic sinus surgery on chronic rhinosinusitis-related olfactory impairment.
DATA SOURCES: CINAHL, Cochrane, OVID, EMBASE, PubMed, and SCOPUS. Each database was searched from inception up to October 2015.
REVIEW METHODS: Studies were included that reported subjective or objective olfactory data in chronic rhinosinusitis patients before and after endoscopic sinus surgery.
RESULTS: Thirty-one studies were used in the meta-analysis. Weighted mean differences of olfactory measures demonstrated significant improvement in mixed CRS patients (those with and without polyps) through visual analog scales (-0.83, P = .001), altered taste/smell item on Sinonasal Outcome Test (-1.32, P < .00001), 40-item Smell Identification Test (3.49, P = .0010), and Sniffin' Sticks identification (0.34, P = .03). Chronic rhinosinusitis mixed patients demonstrated nonsignificant improvements via Sniffin' Sticks threshold (1.60, P = .16) and Brief Smell Identification Test (0.20, P = .32). When separated, polyp patients and dysosmic patients experienced the highest levels of olfactory improvement. Polyp patients improved by 7.87 (P = .006) on the 40-item Smell Identification test, 11.54 (P < .0001) with the Sniffin' Sticks total score, and 2.57 (P < .00001) through Sniffin' Sticks identification. Dysosmic patients improved by 5.75 via the 40-item Smell Identification Test (P = .0001).
CONCLUSION: Endoscopic sinus surgery improves nearly all subjective and objective measures of olfaction in chronic rhinosinusitis patients. Patients with nasal polyposis or preoperative olfactory dysfunction improve to a greater degree.

PMID: 27576679 [PubMed - as supplied by publisher]

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Acoustic reflex patterns in amyotrophic lateral sclerosis.

Acoustic reflex patterns in amyotrophic lateral sclerosis.

Eur Arch Otorhinolaryngol. 2016 Aug 30;

Authors: Canale A, Albera R, Lacilla M, Canosa A, Albera A, Sacco F, Chiò A, Calvo A

Abstract
The aim of the study is to investigate acoustic reflex testing in amyotrophic lateral sclerosis patients. Amplitude, latency, and rise time of stapedial reflex were recorded for 500 and 1000 Hz contralateral stimulus. Statistical analysis was performed by the Wilcoxon test and the level of significance was set at 5 %. Fifty-one amyotrophic lateral sclerosis patients and ten sex- and age-matched control subjects were studied. Patients were further divided in two groups: amyotrophic lateral sclerosis-bulbar (38 cases, with bulbar signs at evaluation) and amyotrophic lateral sclerosis-spinal (13 cases, without bulbar signs at evaluation). Stapedial reflex was present in all patients. There was a statistically significant difference in the mean amplitude, latency, and rise time between the amyotrophic lateral sclerosis patients as compared with the controls. Amplitude was lower in both the amyotrophic lateral sclerosis-bulbar and the amyotrophic lateral sclerosis-spinal patients than in the controls (p < 0.05) and rise time was longer in both patient groups compared with the controls (p < 0.05). These results confirm the presence of abnormal acoustic reflex patterns in amyotrophic lateral sclerosis cases with bulbar signs and, moreover, suggesting a possible subclinical involvement of the stapedial motor neuron even in amyotrophic lateral sclerosis-spinal patients. Amplitude and rise time seem to be good sensitive parameters for investigating subclinical bulbar involvement.

PMID: 27577043 [PubMed - as supplied by publisher]

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Spontaneous multilevel airway haemorrhage in acquired haemophilia A.

Spontaneous multilevel airway haemorrhage in acquired haemophilia A.

Eur Arch Otorhinolaryngol. 2016 Aug 30;

Authors: See A, Sudirman SR, Huang XY

Abstract
BACKGROUND: Acquired haemophilia A is caused by the development of an autoantibody to factor VIII in a person with previously normal haemostasis. The most common clinical presentation in hereditary haemophilia is intra-articular bleeding. In contrast, acquired haemophilia more commonly presents with skin, soft tissue and mucosal haemorrhages.
METHODS: We present a case of a patient with idiopathic acquired haemophilia A, whose initial presentation was that of spontaneous submental and submandibular haematoma which rapidly progressed to involve multiple sites in the airway, ultimately necessitating an emergent tracheotomy. In view of the extremely rare occurrence of this phenomenon, a systematic review and summary of all previously reported cases is also presented.
RESULTS: The diagnostic and management dilemmas encountered in this case are presented from an otolaryngologist's perspective.
CONCLUSIONS: Otolaryngologists' awareness of underlying haematological pathologies and their natural course of disease in cases of severe airway haemorrhage is of paramount importance in anticipating evolving issues in management of these patients.

PMID: 27577042 [PubMed - as supplied by publisher]

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Osmophobia and olfactory functions in patients with migraine.

Osmophobia and olfactory functions in patients with migraine.

Eur Arch Otorhinolaryngol. 2016 Aug 30;

Authors: Kayabaşoglu G, Altundag A, Kotan D, Dizdar D, Kaymaz R

Abstract
Olfactory dysfunction and migraine has been associated for a long time. In this study, we planned to compare olfactory functions in patients with migraine and osmophobia with patients having migraine but no osmophobia, in addition with a normal control group using "Sniffin' Sticks" test. The main distinction of this study is that all qualitative and quantitative properties of olfactory functions; threshold, discrimination and identification, are evaluated separately and jointly. Thirty healthy person aged between 16 and 56 (18 women, 12 men) and 60 migraine patients aged between 15 and 54 (39 women, 21 man) were included in the study. All patients have been inquired about osmophobia and have been assessed with Hedonic tone assessment. Osmophobia has been tested for perfume, cigarette smoke, leather, stale food, soy sauce, fish, spices and coffee smells. Olfactory functions has been assessed with "Sniffin' Sticks" smell test. Thresholds, discrimination and identification have been determined for each patient. In migraine patients with osmophobia, threshold was 7.75 ± 2.3, in migraine patients without osmophobia threshold was 8.25 ± 1.5 and threshold was 10.75 ± 1.3 for the control group. Discrimination score was 6 ± 1.2 in migraine patients with osmophobia, 9 ± 0.8 in patients without osmophobia and was 12 ± 1.4 in the control group. In migraine patient with or without osmophobia Threshold/Discrimination/Identification (TDI) scores were lower than the control group. The most important parameter in our study is that discrimination scores were especially lower in patients with osmophobia. We believe that this decrease in discrimination in migraine patients with osmophobia; who claim that they smell everything and they are sensitive to all smells, is significant. Further studies about smell discrimination will help better understand some conditions; especially anosmia and hyposmia after upper respiratory tract infections and parosmia.

PMID: 27577041 [PubMed - as supplied by publisher]

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Cerebrospinal Fluid-Cutaneous Fistula After Continuous Spinal Catheter in an Obstetric Patient.

Cerebrospinal Fluid-Cutaneous Fistula After Continuous Spinal Catheter in an Obstetric Patient.

A A Case Rep. 2016 Sep 1;7(5):103-107

Authors: Lenart MJ, Carness JM

Abstract
A 23-year-old woman at 41 weeks and 6 days estimated gestational age underwent continuous spinal analgesia for labor after a recognized, unintended dural puncture. Excellent analgesia was maintained throughout labor and vaginal delivery, the intrathecal catheter was left in situ for 24 hours postpartum, and the catheter was subsequently removed without apparent complication. On physical examination during her anesthesia postoperative visit, clear fluid was noted to be slowly draining from the catheter insertion site. Although she denied all symptoms associated with a dural puncture, including headache, a cerebrospinal fluid-cutaneous fistula was diagnosed. An epidural blood patch was placed, which terminated the cerebrospinal fluid leak. No long-term complications were evident. Subsequent literature review revealed a rare incidence of this type of complication and varied recommendations for intervention and optimal management. We review the literature with regard to this complication and offer discussion regarding the various suggested means of diagnosis and therapy.

PMID: 27580408 [PubMed - as supplied by publisher]

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Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.

Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.

Int Forum Allergy Rhinol. 2016 Aug 31;

Authors: Shahangian A, Soler ZM, Baker A, Wise SK, Rereddy SK, Patel ZM, Oyesiku NM, DelGaudio JM, Hadjipanayis CG, Woodworth BA, Riley KO, Lee J, Cusimano MD, Govindaraj S, Khan MN, Psaltis A, Wormald PJ, Santoreneos S, Sindwani R, Trosman S, Stokken JK, Woodard TD, Recinos PF, Vandergrift Iii WA, Boling C, Schlosser RJ

Abstract
BACKGROUND: The impact of failed cerebrospinal fluid leak (CSF) leak repair in endoscopic skull base surgery has not been adequately studied.
METHODS: In this investigation we reviewed patients who had undergone endoscopic skull base surgery between 2002 and 2014 at 7 international centers. Demographic variables, comorbidities, tumor characteristics, and repair techniques were evaluated to determine association with successful repair of CSF leak. Postoperative complications and length of stay were compared among groups.
RESULTS: Data were collected on 2097 patients who were divided into 3 groups: (1) those with no intraoperative leak (n = 1533); (2) those with successful repair of their intraoperative leak (n = 452); and (3) those with failed repair (n = 112). Compared with successful repair, failed repair was associated with an increased risk of intracranial infection (odds ratio [OR], 5.6; 95% confidence interval [CI], 5.3-13.15), pneumocephalus (OR, 16; 95% CI, 5.8-44.4), 30-day readmission (OR, 8.4; 95% CI, 5.3-13.5), reoperation (OR, 115.4; 95% CI, 56.3-236.8), and prolonged hospital stay (14.9 vs 7.0 days, p < 0.01). Outcomes in patients who had successful repairs of intraoperative leaks were similar to those who never had leakage. Intraoperative use of pedicled nasoseptal flaps was associated with successful repair (OR, 0.60; 95% CI, 0.34-0.92).
CONCLUSION: Intraoperative CSF leaks are a frequent and expected occurrence during endoscopic skull base surgery. Failed CSF leak repair has a significant impact on patient outcomes, with increased rates of postoperative pneumocephalus, intracranial infections, reoperation, deep vein thrombosis, readmission, and prolonged hospital stay. Recognition and repair of intraoperative CSF leaks reduces postoperative complications. Use of pedicled nasoseptal flaps improves outcomes in reconstructing defects at higher risk for postoperative leak.

PMID: 27579523 [PubMed - as supplied by publisher]

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Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Xu J, Yi H, Li X, Chen W, Xu J

Abstract
OBJECTIVE: To investigate the surgical treatment and related experience of lateral skull base lesions.
METHODS: In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair.
RESULTS: Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery.
CONCLUSION: Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.

PMID: 27577755 [PubMed - as supplied by publisher]

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Frequency and specific characteristics of the incomplete partition type III anomaly in children.

Frequency and specific characteristics of the incomplete partition type III anomaly in children.

Laryngoscope. 2016 Aug 31;

Authors: Kanno A, Mutai H, Namba K, Morita N, Nakano A, Ogahara N, Sugiuchi T, Ogawa K, Matsunaga T

Abstract
OBJECTIVES/HYPOTHESIS: To determine the frequency of the incomplete partition type III anomaly and the genetic and clinical features associated with POU3F4 mutations in children with hearing loss.
STUDY DESIGN: Retrospective case series from 2000 to 2014 at the National Hospital Organization Tokyo Medical Center and collaborating hospitals.
METHODS: A total of 1,004 patients (from 938 families) who had hearing loss by 10 years of age and had undergone computed tomography scanning of their temporal bones were enrolled in this genetic, clinical, and radiological study.
RESULTS: The incomplete partition type III anomaly was identified in six patients (0.6%), each of whom had an enlargement of the vestibular aqueduct at the end close to the vestibule. The six patients also had POU3F4 variants, and a genetic analysis revealed frameshift deletions in three patients, a missense variant in two patients of the same family, and a large deletion in one patient. Three of the six patients with POU3F4 variants were sporadic cases, and in one patient the genetic mutation occurred de novo.
CONCLUSIONS: It was indicated that POU3F4 mutations can be predicted by incomplete partition type III anomaly by radiological examination of the inner ear. All six of the patients showed mixed hearing loss, but none showed fluctuations in hearing, which may be related to the lack of vestibular aqueduct enlargement at the operculum.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27577114 [PubMed - as supplied by publisher]

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Safety of IV amikacin in the treatment of pulmonary non-tuberculous mycobacterial disease.

Related Articles

Safety of IV amikacin in the treatment of pulmonary non-tuberculous mycobacterial disease.

Respirology. 2016 Feb;21(2):357-62

Authors: Ellender CM, Law DB, Thomson RM, Eather GW

Abstract
BACKGROUND AND OBJECTIVE: Pulmonary non-tuberculous mycobacterial (NTM) disease has a high mortality rate and often requires treatment with intravenous amikacin. We report on safety data in patients treated with intravenous amikacin for pulmonary.
METHODS: A retrospective observational study (2002-2012) was performed including 45 patients that met American Thoracic Society criteria for pulmonary NTM disease and were treated with intravenous amikacin at three hospitals in Brisbane, Australia. The aim was to define the rates of common adverse effects, the patient and regimen factors associated with these adverse effects and describe the rates of treatment success and associated factors.
RESULTS: Forty-five patients (34 women; median age 63 years) were treated for Mycobacterium intracellulare (25), Mycobacterium abscessus (13), Mycobacterium avium (6) and Mycobacterium fortuitum (1) using multi-drug therapy that included IV amikacin. Transient ototoxicity was seen in eight (18%) but long-term ototoxicity was seen in only three (7%). There were no cases of nephrotoxicity and no long-term vestibulotoxicity. Sustained culture conversion at 6 months was only found in 17 (38%), however, the majority (34 patients, 76%) had a clinical response to treatment determined by an improvement in symptoms.
CONCLUSION: Carefully selected and closely monitored patients with pulmonary NTM can be treated using IV amikacin safely with low rates of toxicity. No pretreatment patient or regimen factors were predictive of toxicity or treatment success in this small cohort. Lower treatment success rates were found than previous trials suggest there is a difficult balance in this patient group between treatment success and toxicities.

PMID: 26581837 [PubMed - indexed for MEDLINE]

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A case of falciparum malaria: Acute hearing loss as the initial symptom.

A case of falciparum malaria: Acute hearing loss as the initial symptom.

J Infect Chemother. 2016 Aug 28;

Authors: Tada T, Hitani A, Honda NH, Haruna S, Yoshimura T, Haruki K, Tanaka Y

Abstract
A 49-year-old healthy woman, who returned from Burkina Faso, visited an ear, nose, and throat clinic with complaints of left hearing loss, tinnitus, and dizziness. Pure tone audiometry demonstrated bilateral mild sensorineural hearing loss. Three days later, she was transported in an ambulance to a general hospital due to high fever and disturbance of consciousness. Plasmodium falciparum was found in the peripheral blood smear. After diagnosing severe falciparum malaria with cerebral involvement, quinine hydrochloride, clindamycin, and artemether/lumefantrine were administered. After recovery of consciousness, she was followed up at our department with bilateral hearing loss. After taking prednisolone for 10 days, there was improvement to normal hearing level. Furthermore, no neurologic sequelae were observed. In this case, acute sensorineural hearing loss occurred before administration of the antimalarial drug. Therefore, hearing loss was not drug-induced, but was caused by the malaria itself. In patients with acute hearing loss and who have history of travel to tropical regions, physicians should include malaria and other causes of acute deafness in the differential diagnoses.

PMID: 27578030 [PubMed - as supplied by publisher]

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Improving medical students' knowledge and skill in communicating with people with acquired communication disorders.

Improving medical students' knowledge and skill in communicating with people with acquired communication disorders.

Int J Speech Lang Pathol. 2016 Aug 31;:1-10

Authors: Forsgren E, Hartelius L, Saldert C

Abstract
PURPOSE: To explore the effects of an interactive workshop on medical students' knowledge and skill in communicating with people with acquired communication disorders.
METHOD: Sixty-nine medical students received a lecture on acquired communication disorders. Thirty-six of these students also participated in a workshop where they practised using supportive strategies in interaction with a simulated patient with aphasia. All students completed a questionnaire exploring attitudes, confidence in knowledge and ability to suggest suitable supportive strategies pre- and post-lecture/workshop and 15 students were video recorded when interacting with a simulated patient pre- and post-workshop.
RESULT: The results show no change in attitude in either student group, but both groups rated their confidence in knowledge as higher post-lecture/workshop. The students' ability to suggest supportive strategies post training was significantly higher only in the workshop group. Comparing post training results regarding knowledge and ability to suggest supportive strategies between the groups, higher ratings were found for the workshop group. The analysis of video recordings indicated that the students also used new supportive strategies and used strategies more frequently after the workshop.
CONCLUSION: An interactive workshop can improve medical students' knowledge and skills in communicating with people with acquired communication disorders.

PMID: 27576788 [PubMed - as supplied by publisher]

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Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Xu J, Yi H, Li X, Chen W, Xu J

Abstract
OBJECTIVE: To investigate the surgical treatment and related experience of lateral skull base lesions.
METHODS: In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair.
RESULTS: Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery.
CONCLUSION: Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.

PMID: 27577755 [PubMed - as supplied by publisher]

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Long-term observation of indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles as a dual mode CT/MR contrast agent for rabbit lingual sentinel lymph node identification.

Long-term observation of indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles as a dual mode CT/MR contrast agent for rabbit lingual sentinel lymph node identification.

Acta Otolaryngol. 2016 Aug 31;:1-8

Authors: Yang Y, Zhou J, Shi X, Sha Y, Wu H

Abstract
CONCLUSIONS: The rabbit lingual sentinel lymph node (SLN) could be long-term visualized by indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles (Gd-Au PENPs) as CT/MR dual-modal contrast agent.
OBJECTIVE: To investigate duration and intensity of rabbit lingual SLN enhancement using Gd-Au PENPs as a CT/MR dual-modal contrast agent.
METHODS: Twelve rabbits were randomly divided into indirect CT lymphography (CT-LG) and MR lymphography (MR-LG) groups. In each group, two rabbits received unilateral injection and four received bilateral injection of Gd-Au PENPs in the sub-mucosa of the tongue. Then the enhancement characteristics of SLN were investigated.
RESULTS: The enhanced SLNs were observed in 100% in all rabbits by indirect CT-LG and MR-LG simultaneously at 1 min after injection. Then SLN enhancement was improved rapidly and the first peaks were observed at 25 min for CT-LG and 1 h for MR-LG, respectively, then SLN enhancement decreased gradually to a minimum at 2 h for CT-LG and 3 h for MR-LG. Afterwards, the enhancement intensity increased again and second peaks were observed at 24 h for both CT-LG and MR-LG. Hereafter, the intensity dropped slowly and weak enhancement was also observed at the 40th week for CT-LG and 31st day for MR-LG. Black-stained SLNs were visualized in 100% at autopsy in all rabbits.

PMID: 27577609 [PubMed - as supplied by publisher]

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The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation.

The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation.

Acta Otolaryngol. 2016 Aug 31;:1-8

Authors: Liu YK, Qi CL, Tang J, Jiang ML, Du L, Li ZH, Tan SH, Tang AZ

Abstract
CONCLUSION: The cochlear length (CL) and cochlear height (CH) measured through MPR will provide for more accurate quantitative diagnosis of inner ear malformation, and are subsequently convenient for calculating cochlear duct length (CDL) before cochear implant.
OBJECTIVES: Qualitative and quantitative diagnosis of inner ear malformation in deaf patients through multiplanar reconstruction (MPR) was performed to provide a reference for cochlear implants.
METHODS: One hundred and two cases without sensorineural deafness and 560 patients with sensorineural deafness had MPR of temporal bone computed tomography performed to obtain the standardized cochlear-view and oblique coronal-view images. The inner ear radial lines were measured to formulate normal values for inner ear malformation diagnosing, and the CDL was estimated based on CL.
RESULTS: The normal range values of inner ear radial lines were measured and formulated, of which CL was 8.1-9.59 mm and CH was 3.28-3.90 mm. According to inner ear morphology and the normal values measured above, 61 cases of incomplete partition-type II (IP-II) and a high percentage (27/110, 24.5%) of hypoplasia of cochlea (HC) were diagnosed. The HC group was further divided into 1-turn, 1.5-turn, and 2-turn sub-groups, which had CDL of 15.98 ± 1.48 mm, 21.36 ± 0.96 mm, and 26.56 ± 0.60 mm, respectively.

PMID: 27577263 [PubMed - as supplied by publisher]

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Onset time of benign paroxysmal positional vertigo.

Onset time of benign paroxysmal positional vertigo.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Ichijo H

Abstract
CONCLUSION: Benign paroxysmal positional vertigo (BPPV) is strongly related to sleep. This study proposes a micro-otoconia accumulation theory in which the pathological debris is an aggregate of micro-otoconia over a long time period, and which begins to slide by its own weight during sleep.
OBJECTIVES: To examine the onset time of idiopathic BPPV and to investigate its etiology.
METHOD: Patients (n = 351) were classified as posterior canalolithiasis (PC), horizontal canalolithiasis (HC), and horizontal heavy cupula (HHC) according to nystagmus findings. This study examined the medical records, and categorized the onset times into the following four groups; (1) during sleep, (2) at the time of rising, (3) morning, and (4) afternoon.
RESULTS: PC (n = 135): In 33 patients, vertigo occurred during sleep, in 69 patients at rising, in 10 patients in the morning, and in 23 patients in the afternoon. HC (n = 87): In 38 patients, vertigo occurred during sleep, in 30 patients at rising, in eight patients in the morning, and in 11 patients in the afternoon. HHC (n = 129): In 27 patients, vertigo occurred during sleep, in 59 patients at rising, in 15 patients in the morning, and in 28 patients in the afternoon.

PMID: 27577049 [PubMed - as supplied by publisher]

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Relationship between (18)FDG-PET and different types of sinonasal malignancies.

Relationship between (18)FDG-PET and different types of sinonasal malignancies.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Felix-Ravelo M, Bey A, Arous F, Paris-Grandpierre S, Jankowski R, Nguyen DT

Abstract
CONCLUSION: The sensitivity and specificity of a (18)FDG-PET scan may be different according to the histology. The SUVmax and SUV ratio may reflect the tumor's aggressive behavior.
OBJECTIVES: To describe the characteristics of PET/CT scans, including the maximum standard uptake values (SUVmax), at initial diagnosis according to six main types of sinonasal malignancies: sinonasal adenocarcinoma (SNAC), sinonasal undifferentiated carcinoma (SNUC), adenoid cystic carcinoma (ACC), sinonasal malignant melanoma (SMM), olfactory neuroblastoma (ONB), and sinonasal neuroendocrine carcinoma (SNEC).
METHODS: A chart review of 50 patients who were diagnosed and treated for six sinonasal malignancy types over a period of 6 years was conducted. Any (18)F-FDG PET/CT scans for each patient were searched using the hospital's intranet. The SUVmax of the primary sinonasal site was recorded. The liver SUVs were utilized as reference SUVs. The SUV ratio was defined as the ratio of the SUVmax of the primary tumor and the SUVliver.
RESULTS: The most common malignancy was SNAC (32%), followed by SNUC (24%), ONB (14%), ACC (10%), SMM (10%), and SNEC (10%). The SUVmax and SUV ratio values were significantly different between tumor types (p = 0.002 and 0.012, respectively). SNUC had the highest mean SUVmax (14.2), followed by SNAC (9.9). A similar mean SUVmax was observed for SMM, ONB, and ACC (∼ 7.0). SNEC up-takes the least (18)FDG among these six tumor types (mean SUVmax = 4.7).

PMID: 27576899 [PubMed - as supplied by publisher]

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Deep neck cellulitis: limitations of conservative treatment with antibiotics.

Deep neck cellulitis: limitations of conservative treatment with antibiotics.

Acta Otolaryngol. 2016 Aug 31;:1-7

Authors: Hirasawa K, Tsukahara K, Motohashi R, Endo M, Sato H, Ueda Y, Nakamura K

Abstract
CONCLUSION: When the parapharyngeal space is infected, concurrent involvement of other spaces is likely, and involvement of multiple deep neck spaces is a key risk factor for abscess formation.
OBJECTIVES: Deep neck infection is treated with antibiotics when abscesses have not yet been formed. However, in some cases, abscesses will form later and surgical drainage is warranted. This study retrospectively examined which cases were less likely to achieve cure, to clarify the limitations of conservative treatment for deep neck cellulitis.
PATIENTS AND METHODS: Subjects comprised 19 patients with deep neck cellulitis who initially underwent conservative treatment with antibiotics. Patients were divided into two groups: Group A (n = 7), patients who recovered by conservative treatment; and Group B (n = 12), patients who did not recover and underwent surgical drainage. Age, state of DM control, etiology, treatment, spaces infected, and duration of hospitalization were investigated.
RESULTS: The number of infected spaces was one in all Group A patients, whereas Group B showed multiple infected spaces in all except two cases. In particular, among the 10 cases with parapharyngeal space infection, eight (80%) showed multiple lesions.

PMID: 27576733 [PubMed - as supplied by publisher]

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Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.

Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.

Int Forum Allergy Rhinol. 2016 Aug 31;

Authors: Shahangian A, Soler ZM, Baker A, Wise SK, Rereddy SK, Patel ZM, Oyesiku NM, DelGaudio JM, Hadjipanayis CG, Woodworth BA, Riley KO, Lee J, Cusimano MD, Govindaraj S, Khan MN, Psaltis A, Wormald PJ, Santoreneos S, Sindwani R, Trosman S, Stokken JK, Woodard TD, Recinos PF, Vandergrift Iii WA, Boling C, Schlosser RJ

Abstract
BACKGROUND: The impact of failed cerebrospinal fluid leak (CSF) leak repair in endoscopic skull base surgery has not been adequately studied.
METHODS: In this investigation we reviewed patients who had undergone endoscopic skull base surgery between 2002 and 2014 at 7 international centers. Demographic variables, comorbidities, tumor characteristics, and repair techniques were evaluated to determine association with successful repair of CSF leak. Postoperative complications and length of stay were compared among groups.
RESULTS: Data were collected on 2097 patients who were divided into 3 groups: (1) those with no intraoperative leak (n = 1533); (2) those with successful repair of their intraoperative leak (n = 452); and (3) those with failed repair (n = 112). Compared with successful repair, failed repair was associated with an increased risk of intracranial infection (odds ratio [OR], 5.6; 95% confidence interval [CI], 5.3-13.15), pneumocephalus (OR, 16; 95% CI, 5.8-44.4), 30-day readmission (OR, 8.4; 95% CI, 5.3-13.5), reoperation (OR, 115.4; 95% CI, 56.3-236.8), and prolonged hospital stay (14.9 vs 7.0 days, p < 0.01). Outcomes in patients who had successful repairs of intraoperative leaks were similar to those who never had leakage. Intraoperative use of pedicled nasoseptal flaps was associated with successful repair (OR, 0.60; 95% CI, 0.34-0.92).
CONCLUSION: Intraoperative CSF leaks are a frequent and expected occurrence during endoscopic skull base surgery. Failed CSF leak repair has a significant impact on patient outcomes, with increased rates of postoperative pneumocephalus, intracranial infections, reoperation, deep vein thrombosis, readmission, and prolonged hospital stay. Recognition and repair of intraoperative CSF leaks reduces postoperative complications. Use of pedicled nasoseptal flaps improves outcomes in reconstructing defects at higher risk for postoperative leak.

PMID: 27579523 [PubMed - as supplied by publisher]

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Does formal research training lead to academic success in otolaryngology?

Does formal research training lead to academic success in otolaryngology?

Laryngoscope. 2016 Aug 31;

Authors: Bobian MR, Shah N, Svider PF, Hong RS, Shkoukani MA, Folbe AJ, Eloy JA

Abstract
OBJECTIVES/HYPOTHESIS: To evaluate whether formalized research training is associated with higher researcher productivity, academic rank, and acquisition of National Institutes of Health (NIH) grants within academic otolaryngology departments.
METHODS: Each of the 100 civilian otolaryngology program's departmental websites were analyzed to obtain a comprehensive list of faculty members credentials and characteristics, including academic rank, completion of a clinical fellowship, completion of a formal research fellowship, and attainment of a doctorate in philosophy (PhD) degree. We also recorded measures of scholarly impact and successful acquisition of NIH funding.
RESULTS: A total of 1,495 academic physicians were included in our study. Of these, 14.1% had formal research training. Bivariate associations showed that formal research training was associated with a greater h-index, increased probability of acquiring NIH funding, and higher academic rank. Using a linear regression model, we found that otolaryngologists possessing a PhD had an associated h-index of 1.8 points higher, and those who completed a formal research fellowship had an h-index of 1.6 points higher. A PhD degree or completion of a research fellowship was not associated with a higher academic rank; however, a higher h-index and previous acquisition of an NIH grant were associated with a higher academic rank. The attainment of NIH funding was three times more likely for those with a formal research fellowship and 8.6 times more likely for otolaryngologists with a PhD degree.
CONCLUSION: Formalized research training is associated with academic success in otolaryngology. Such dedicated research training accompanies greater scholarly impact, acquisition of NIH funding, and a higher academic rank.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.

PMID: 27578559 [PubMed - as supplied by publisher]

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Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases.

Acta Otolaryngol. 2016 Aug 31;:1-5

Authors: Xu J, Yi H, Li X, Chen W, Xu J

Abstract
OBJECTIVE: To investigate the surgical treatment and related experience of lateral skull base lesions.
METHODS: In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair.
RESULTS: Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery.
CONCLUSION: Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.

PMID: 27577755 [PubMed - as supplied by publisher]

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Two-session tumor and retrogasserian trigeminal nerve-targeted gamma knife radiosurgery for secondary trigeminal neuralgia associated with benign tumors.

Two-session tumor and retrogasserian trigeminal nerve-targeted gamma knife radiosurgery for secondary trigeminal neuralgia associated with benign tumors.

World Neurosurg. 2016 Aug 27;

Authors: Park SC, Lee DH, Lee JK

Abstract
OBJECTIVE: To investigate gamma knife radiosurgery (GKS) for benign tumor-associated secondary trigeminal neuralgia.
METHODS: From 2006 to 2015, 21 patients with secondary trigeminal neuralgia from meningioma were treated using GKS. Their mean age was 56.5 ± 12.2 years. The 50% isodose was 12.5±1.1 Gy for the first GKS for the meningioma. Retrogasserian targeting of the trigeminal nerve at 90 Gy with a 4-mm collimator was used for the second GKS.
RESULTS: The pain duration until GKS was 1.9± 1.9 years. The meningiomas were located in the cisternal space in 13 patients (56.5%) and involved the skull base in 8 patients (43.5%). The mean follow-up duration was 3.7±2.7 years. The pain control outcomes were Marseilles pain scale (MPS) scores of I-IV in 15 patients (71%). In six patients (29%), the pain control outcome was a score of V. For these patients, we performed a second GKS targeting the trigeminal nerve and resulting in MPS scores of I-IV. The tumor size did not increase in any patient and decreased >10% in 12 (80%) of the 15 patients who were followed for at least 1 year. Trigeminal nerve visibility may improve after tumor shrinkage. Retrogasserian trigeminal nerve targets may be used even with invisible trigeminal nerves using Meckel's cave as an anatomical marker.
CONCLUSIONS: Here we show the reproducible feasibility of a two-session GKS procedure using higher radiation doses: the first to treat the tumor, and the second to treat the trigeminal nerves using retrogasserian targeting.

PMID: 27576768 [PubMed - as supplied by publisher]

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Unique extrancranial-to-intracranial neovascularization found on diagnostic angiography prior to skull base atypical grade 2 meningioma resection: a case report and hypothesis.

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Unique extrancranial-to-intracranial neovascularization found on diagnostic angiography prior to skull base atypical grade 2 meningioma resection: a case report and hypothesis.

World Neurosurg. 2016 Aug 26;

Authors: Feng R, Oermann EK, Oxley T, Shrivastava R

Abstract
Meningiomas are common intracranial tumors that can have complex arterial supply. A patient with a recurrent large left clinoid aypical grade 2 meningioma was found to have left proximal middle cerebral artery (MCA) occlusion, and reconstitution of her MCA circulation from her left middle meningeal artery on diagnostic angiography. The planned surgical approach consequently adjusted to preserve the left external carotid artery circulation in a difficult meningioma resection. This case illustrates a role for preoperative angiography in surgical planning of patients with complex skull base tumors involving intracranial vascular structures and highlights the unique neovascularization that can often take place as meningiomas parasitize the exracranial blood supply.

PMID: 27576195 [PubMed - as supplied by publisher]

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Olfaction preservation after removal of large tuberculum sellae meningiomas via a superior interhemispheric approach. A quantitative and qualitative study.

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Olfaction preservation after removal of large tuberculum sellae meningiomas via a superior interhemispheric approach. A quantitative and qualitative study.

Neurochirurgie. 2015 Oct;61(5):318-23

Authors: Hannequin P, Paviot A, Chaussy O, Gilard V, Cébula H, Marie JP, Proust F

Abstract
INTRODUCTION: We present a prospective series of tuberculum sellae meningioma (TSM) resected via a superior interhemispheric (IH) approach in 10 patients who preoperatively and postoperatively underwent extensive olfaction testing using a standardised test battery.
PATIENTS AND METHODS: This prospective longitudinal study evaluated the olfactory function after TSM resection. The resection was performed via a superior interhemispheric (IH) approach. The quantitative and qualitative analyses of the olfactory function were assessed with the Biolfa(®) olfactory test (at 6 months).
RESULTS: Between November 2009 and April 2012, 10 consecutive patients with symptomatic TSM and preserved olfactory function were operated via a superior IH approach. For the self-evaluation criteria of the olfactory function, the mean preoperative visual analog scale score was 8.8. The mean preoperative total quantitative (/27) scored 18.2 ± 6.3 for this cohort of 10 patients. In the postoperative period, the mean total score decreased non-significantly to 15.8 ± 8.8 (Wilcoxon test, P = 0.085). The mean preoperative qualitative score (/8) was 5.5 ± 1.7 and in the postoperative period decreased, non-significantly, to 4.7 ± 2.6 (Wilcoxon test, P = 0.12). The olfactory function was quantitatively and qualitatively preserved in 6 patients (60%), but a postoperative deterioration occurred in 2 (20%) and an anosmia in 2 (20%). Size and invasive characteristics of the meningioma determined the post-surgical deterioration.
CONCLUSION: Olfaction is an important factor of emotional and social life, which needs to be integrated into the challenge regarding the resection of TSM. The risks of nerve damage are reviewed.

PMID: 26271401 [PubMed - indexed for MEDLINE]

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