Prospective swallowing outcomes after IMRT for oropharyngeal cancer: Dosimetric correlations in a population-based cohort.

Prospective swallowing outcomes after IMRT for oropharyngeal cancer: Dosimetric correlations in a population-based cohort.

Oral Oncol. 2016 Oct;61:135-41

Authors: Guo GZ, Sutherland KR, Myers C, Lambert P, Loewen SK, Quon HC

Abstract
OBJECTIVES: To identify dose constraints to preserve swallowing after head and neck (H&N) radiotherapy using prospectively collected functional outcomes.
MATERIALS AND METHODS: Stage III-IV oropharyngeal cancer patients were prospectively evaluated using the Royal Brisbane Hospital Outcome Measure for Swallowing and Performance Status Scale for H&N Cancer Patients at pre-treatment and 3, 6, 12, and 24months after intensity-modulated radiotherapy. Dosimetric parameters were correlated with swallowing function.
RESULTS: Ninety-six patients were evaluated with median follow-up of 14.1months (interquartile range 9.9-26.3). Six patients (8.3%) remained feeding tube (FT) dependent at 12months. At 2years, 32.6% tolerated a normal diet without restrictions. Mean doses of 55Gy to supraglottic larynx, 44Gy to glottic larynx, 48Gy to cricopharyngeus, and 44Gy to esophageal inlet were associated with >25% risk of FT dependence at 6months.
CONCLUSION: Higher mean doses to the larynx and pharyngo-esophageal junction were associated with longer duration of FT dependence and dietary restrictions.

PMID: 27688116 [PubMed - in process]

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Low etiologic fraction for human papillomavirus in larynx squamous cell carcinoma.

Low etiologic fraction for human papillomavirus in larynx squamous cell carcinoma.

Oral Oncol. 2016 Oct;61:55-61

Authors: Taberna M, Resteghini C, Swanson B, Pickard RK, Jiang B, Xiao W, Mena M, Kreinbrink P, Chio E, Gillison ML

Abstract
BACKGROUND: Human Papillomavirus (HPV) is a cause of oropharyngeal squamous cell carcinoma (OPSCC), but its pathogenic role in larynx squamous cell carcinoma (LSCC) remains unclear.
MATERIAL AND METHODS: A single-institutional, retrospective case-series was performed to estimate the etiological fraction (EF) for HPV in LSCC. Eligible cases included 436 consecutive cases of LSCC diagnosed (2005-2014) at The Ohio State University Medical Center. HPV DNA presence was detected by consensus primer PCR (Inno-LiPa) and HPV type-specific qPCR. HPV E6/E7 mRNA expression was detected by type-specific qRT-PCR. Tumor p16 expression was evaluated by immunohistochemistry (IHC).
RESULTS: HPV DNA was detected by Inno-LiPa in 54 of 404 (13.4%, 95% CI 10.2-17.1) evaluable samples but was confirmed by HPV type-specific qPCR in only 14 (3.5%, 95% CI 1.9-5.7). Only 7 of 404 (1.7%, 95% CI 0.7-3.5) LSCC were positive for HPV E6/E7 mRNA expression, including HPV16 (n=4) and 1 each for 11, 26 and 33. In the HPV11-positive tumor, Sanger sequencing discovered 6 nucleotide mutations in the upstream regulation region, E6 and E7. Of 404 LSCC, 18 had strong and diffuse p16 expression. In comparison to a gold standard of HPV E6/E7 mRNA expression, p16 expression had a sensitivity of 71.4% (95% CI 29.0-96.3), specificity of 96.7% (95% CI 94.5-98.3), positive-predictive-value (PPV) of 27.8% (95% CI 9.7-53.5) and negative-predictive-value of 99.5% (95% CI 98.1-99.9).
CONCLUSION: The EF for HPV in LSCC is low (1.7%) in a geographic region with high EF for OPSCC. Low-risk HPV may rarely cause LSCC. Finally, p16 expression has poor PPV for HPV in LSCC.

PMID: 27688105 [PubMed - in process]

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nab-Paclitaxel, cisplatin, and 5-fluorouracil followed by concurrent cisplatin and radiation for head and neck squamous cell carcinoma.

nab-Paclitaxel, cisplatin, and 5-fluorouracil followed by concurrent cisplatin and radiation for head and neck squamous cell carcinoma.

Oral Oncol. 2016 Oct;61:1-7

Authors: Adkins D, Ley J, Michel L, Wildes TM, Thorstad W, Gay HA, Daly M, Rich J, Paniello R, Uppaluri R, Jackson R, Trinkaus K, Nussenbaum B

Abstract
OBJECTIVES: We previously reported the efficacy of nab-paclitaxel added to cisplatin, 5-FU, and cetuximab (APF-C) followed by concurrent high dose bolus cisplatin and radiation therapy (CRT) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). In this phase II trial, we determined the efficacy of APF (without cetuximab) followed by CRT in similar patients.
MATERIALS AND METHODS: Eligible patients had stage III-IV oropharynx (OP), larynx, or hypopharynx SCC and adequate organ function and performance status. T1 tumors were excluded. Patients were treated with three cycles of APF followed by CRT. Efficacy endpoints included two-year disease-specific survival (DSS), progression-free survival (PFS), overall survival (OS), and relapse rate.
RESULTS: Thirty patients were enrolled. Most patients were smokers (77%) with bulky T3/4 (73%) and N2/3 (83%) tumors. Analyses were stratified for human papilloma virus (HPV) status: HPV-related OPSCC (n=17; 57%) and HPV-unrelated HNSCC (n=13; 43%). With a minimum follow-up of 21months, relapse occurred in 1 (3%) patient. Two-year DSS was 94% in HPV-related OPSCC and 100% in HPV-unrelated HNSCC. Two-year PFS was 94% in HPV-related OPSCC and 100% in HPV-unrelated HNSCC. Two-year OS was 94% in HPV-related OPSCC and 92% in HPV-unrelated HNSCC. Causes of death were relapse (1), treatment-related mortality (1), and co-morbidity (1). Two patients with HPV-unrelated HNSCC treated with APF declined CRT and remained free of relapse at 36 and 28months of follow-up.
CONCLUSION: This phase II trial demonstrated favorable two-year DSS, PFS, and OS and a low relapse rate in HPV-unrelated HNSCC and HPV-related OPSCC treated with APF followed by CRT.

PMID: 27688097 [PubMed - in process]

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Confirmation of laryngeal mask airway placement by ultrasound examination: a pilot study.

Confirmation of laryngeal mask airway placement by ultrasound examination: a pilot study.

J Clin Anesth. 2016 Nov;34:638-46

Authors: Song K, Yi J, Liu W, Huang S, Huang Y

Abstract
STUDY OBJECTIVE: We sought to validate ultrasound against other established methods of confirming laryngeal mask airway (LMA) placement.
DESIGN: An observational study.
SETTING: A university teaching hospital, operating department.
PATIENTS: Fifty-eight patients undergoing general anesthesia using an LMA Supreme supraglottic airway device.
INTERVENTIONS: The position of the LMA was assessed by ultrasound in 3 planes: the pharynx, the larynx, and along the cranial-caudal axis in the midline. The leakage test at 20 cm H2O and fiberoptic examination were also undertaken independently, with the latter being used to detect suboptimal placement (in which case, the LMA was reinserted).
MEASUREMENTS: We scored the position of the LMA based on the location of the cuff and whether it had inflated correctly in each of the 3 planes. This score was converted to correspond with the leakage test grading system. We tested the strength of the correlation between the scores and the sensitivity and specificity for predicting reinsertion.
MAIN RESULTS: Seven patients (12.1%) required LMA reinsertion, and ventilation was inadequate in a further 6 (10.3%). Three patients (5.2%) developed laryngospasm and inspiratory stridor after insertion resulting in inadequate ventilation, but none needed reinsertion as optimal placement was confirmed by fiberscope. Spearman coefficient of rank correlation between the leakage test and ultrasound examination was 0.713 (P< .0001). The κ test and Bland-Altman analysis showed good agreement between the 2 scoring systems (weighted κ = 0.605, standard error = 0.086). An ultrasound examination score equating to grade 3 in the leakage test predicted the need for reinsertion with a sensitivity and specificity of 85.7% and 94.1%, respectively.
CONCLUSIONS: Ultrasound examination is a fast, noninvasive and reliable means of detecting LMA misplacement that agrees closely with the leakage test. Ultrasound is as effective as a fiberoptic examination to confirm LMA placement and indicate the need for reinsertion, but does not require ventilation to be interrupted.

PMID: 27687463 [PubMed - in process]

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Real-time MRI of swallowing: intraoral pressure reduction supports larynx elevation.

Real-time MRI of swallowing: intraoral pressure reduction supports larynx elevation.

NMR Biomed. 2016 Sep 30;

Authors: Olthoff A, Joseph AA, Weidenmüller M, Riley B, Frahm J

Abstract
The reduction in intraoral pressure during swallowing has previously been linked to bolus transport, although no such relation has yet been proven. The purpose of this work was to evaluate the time course of intraoral pressure during swallowing using simultaneous real-time magnetic resonance imaging (MRI) and dynamic pressure recordings. Real-time MRI based on highly undersampled radial fast low-angle shot (FLASH) and regularized nonlinear inverse reconstruction was performed at 3 T using a standard head coil and a mid-sagittal section covering the entire oral cavity. Voluntary swallowing (10 mL of pineapple juice or saliva) was monitored for about 30 s in 11 normal subjects at spatial and temporal resolution of 1.3 × 1.3 × 8 mm(3) and 40 ms, respectively. Simultaneously, the intraoral atmospheric pressure was recorded at a resolution of 10 ms during the entire course of deglutition. Quantitative measures of bolus transport, larynx elevation and submental muscle changes were obtained from the image series. As a key result, negative intraoral pressure accompanied laryngeal elevation during swallowing in all subjects. A reduction in submental muscle length during swallowing was also observed. No correlations of maximum negative pressure with larynx elevation and submental muscle change were found. In conclusion, intraoral pressure reduction during swallowing is not connected to oral bolus transport, but supports laryngeal elevation by palatal fixation of the tongue.

PMID: 27687293 [PubMed - as supplied by publisher]

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Induction of nasal polyps using house dust mite and Staphylococcal enterotoxin B in C57BL/6 mice.

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Induction of nasal polyps using house dust mite and Staphylococcal enterotoxin B in C57BL/6 mice.

Allergol Immunopathol (Madr). 2016 Jan-Feb;44(1):66-75

Authors: Khalmuratova R, Lee M, Kim DW, Park JW, Shin HW

Abstract
BACKGROUND: The murine polyp model was developed previously using ovalbumin and Staphylococcus aureus enterotoxin B (SEB). Here, we established a model mimicking key aspects of chronic eosinophilic rhinosinusitis with nasal polyps using the house dust mite (HDM), a clinically relevant aeroallergen, co-administered with SEB. We assessed the inflammatory response and formation of nasal polypoid lesions in an experimental murine model using intranasal delivery of HDM and ovalbumin.
METHODS: After induction of HDM-induced allergic rhinosinusitis in C57BL/6 mice, SEB (10ng) was instilled into the nasal cavity of mice for eight weeks. Phosphate-buffered saline-challenged mice served as control. Histopathological changes were evaluated using haematoxylin and eosin for overall inflammation, Sirius red for eosinophils, and periodic acid-Schiff stain for goblet cells. The distribution of mast cells in mouse nasal tissue was determined by immunohistochemistry. Serum total IgE was measured using enzyme-linked immunosorbent assay.
RESULTS: Compared to mice treated with HDM only, the HDM+SEB-treated mice demonstrated nasal polypoid lesion formation and a significant increase in the number of secretory cells and eosinophilic infiltration. Moreover, mice challenged intranasally with HDM showed highly abundant mast cells in the nasal mucosa. In contrast, OVA+SEB-challenged mice showed a significantly lower degree of mast cell infiltration.
CONCLUSION: We established an in vivo model of chronic allergic rhinosinusitis with nasal polypoid lesions using HDM aeroallergen. This study demonstrated that the HDM+SEB-induced murine polyp model could be utilised as a suitable model for nasal polyps, especially with both eosinophil and mast cell infiltration.

PMID: 26242569 [PubMed - indexed for MEDLINE]

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Functional swallowing outcomes in nasopharyngeal cancer treated with IMRT at 6 to 42 months post-radiotherapy.

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Functional swallowing outcomes in nasopharyngeal cancer treated with IMRT at 6 to 42 months post-radiotherapy.

Dysphagia. 2014 Dec;29(6):663-70

Authors: Patterson M, Brain R, Chin R, Veivers D, Back M, Wignall A, Eade T

Abstract
We sought to evaluate the swallowing function of 18 patients surviving nasopharyngeal cancer, who had been treated using an intensity-modulated radiotherapy (IMRT) protocol designed to minimise functional impairment. We compared the outcomes of a patient-reported oral function score with fiberoptic endoscopic examination of swallow (FEES), Australian Therapy Outcome Measures (AusTOMs) and a measure of trismus. While all patients returned to a fully oral diet, there was ongoing swallow dysfunction characterised by bolus residue and delay, but no aspiration. Dysphagia was of mild or moderate severity on all measures, generally because of the need for texture modification, impaired bolus transit or dysgeusia. There was xerostomia on self-reported measurement combined with reports of behaviours adaptive to xerostomia on AusTOMs; however, salivary functioning was less impaired on FEES. There was no trismus in this cohort. Our cohort lacked the morbidity experienced by cohorts reported in earlier studies, potentially due to the use of IMRT.

PMID: 25115856 [PubMed - indexed for MEDLINE]

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Associations between laryngeal and cough dysfunction in motor neuron disease with bulbar involvement.

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Associations between laryngeal and cough dysfunction in motor neuron disease with bulbar involvement.

Dysphagia. 2014 Dec;29(6):637-46

Authors: Britton D, Benditt JO, Merati AL, Miller RM, Stepp CE, Boitano L, Hu A, Ciol MA, Yorkston KM

Abstract
True vocal fold (TVF) dysfunction may lead to cough ineffectiveness. In individuals with motor neuron disease (MND), cough impairment in the context of dysphagia increases risk for aspiration and respiratory failure. This study characterizes differences and associations between TVF kinematics and airflow during cough in individuals with bulbar MND. Sequential glottal angles associated with TVF movements during volitional cough were analyzed from laryngeal video endoscopy examinations of adults with bulbar MND (n = 12) and healthy controls (n = 12) and compared with simultaneously collected cough-related airflow measures. Significant group differences were observed with airflow and TVF measures: volume acceleration (p ≤ 0.001) and post-compression abduction TVF angle average velocity (p = 0.002) were lower and expiratory phase rise time (p = 0.001) was higher in the MND group. Reductions in maximum TVF angle during post-compression abduction in the MND group approached significance (p = 0.09). All subjects demonstrated complete TVF and supraglottic closure during the compression phase of cough, except for incomplete supraglottic closure in 2/12 MND participants. A strong positive relationship between post-compression maximum TVF abduction angle and peak expiratory cough flow was observed in the MND group, though it was not statistically significant (r = 0.55; p = 0.098). Reductions in the speed and extent of TVF abduction are seen during the expulsion phase of cough in individuals with MND. This may contribute to cough impairment and morbidity.

PMID: 25037590 [PubMed - indexed for MEDLINE]

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Histomorphometric analysis of collagen and elastic fibres in the cranial and caudal fold of the porcine glottis.

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Histomorphometric analysis of collagen and elastic fibres in the cranial and caudal fold of the porcine glottis.

Anat Histol Embryol. 2015 Jun;44(3):186-99

Authors: Lang A, Koch R, Rohn K, Gasse H

Abstract
The porcine glottis differs from the human glottis in its cranial and caudal vocal folds (CraF, CauF). The fibre apparatus of these folds was studied histomorphometrically in adult minipigs. For object definition and quantification, the colour-selection tools of the Adobe-Photoshop program were used. Another key feature was the subdivision of the cross-sections of the folds into proportional subunits. This allowed a statistical analysis irrespective of differences in thickness of the folds. Both folds had a distinct, dense subepithelial layer equivalent to the basement membrane zone in humans. The subsequent, loose layer was interpreted - in principle - as being equivalent to Reinke's space of the human vocal fold. The next two layers were not clearly separated. Due to this, the concept of a true vocal ligament did not appear applicable to neither CauF nor CraF. Instead, the body-cover model was emphasized by our findings. The missing vocalis muscle in the CraF is substituted by large collagen fibre bundles in a proportional depth corresponding to the position of the muscle of the CauF. The distribution of elastic fibres made the CraF rather than the CauF more similar to the human vocal fold. We suggest that these data are useful for those wishing to use the porcine glottis as a model for studying oscillatory properties during phonation.

PMID: 24995486 [PubMed - indexed for MEDLINE]

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[Not Available].

[Not Available].

HNO. 2016 Oct;64(10):696-7

Authors:

PMID: 27689229 [PubMed - in process]

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[Speech audiometry in expert assessment of hearing impairment].

[Speech audiometry in expert assessment of hearing impairment].

HNO. 2016 Sep 29;

Authors: Batsoulis C, Lesinski-Schiedat A

Abstract
In the assessment process of hearing impairment the medical expert has to verify its causality and to quantify its severity as hearing loss in percentage. Based on the determined hearing loss in percentage, the degree of impairment/disability or, in the case of work-related noise-induced hearing loss, the reduction in earning capacity is estimated. In Germany the guideline for the expert assessment of work-related noise-induced hearing loss is the Königstein Guideline. Currently, the 5(th) edition from 2012 is used. Here, the hearing loss quantification depends mainly on the results of speech audiometry. Based on the Freiburg speech test, the hearing loss in percentage is determined using approved tables. For patients with a mild hearing loss, typically characterized by a high-frequency hearing loss, tone audiometry results are consulted additionally. Speech-in-noise tests are available and are frequently used to measure the benefit of hearing systems. They allow for the detection of these patients' hearing impairment, which generally occurs in noisy environments. The first suggestions for a table to determine hearing loss in noise in percent are available. In experimental studies it was shown that tests in quiet, other than the Freiburg speech test, can be used and the same tables can be applied. In this article the current use of speech audiometry for expert assessment is presented, and options of using further developed speech test material are discussed.

PMID: 27689228 [PubMed - as supplied by publisher]

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[Endoscopic ear surgery - complement to microscopic ear surgery].

[Endoscopic ear surgery - complement to microscopic ear surgery].

HNO. 2016 Sep 29;

Authors: Preyer S

Abstract
Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high definition, 4‑k, and 3‑dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragma can be visualized far better by using an endoscope rather than a microscope. Going through the external meatus surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handed, which is awkward. In case of extensive bone removal or excessive bleeding the view through the endoscope lense is obscured, the endoscope therefore cannot fully substitute the use of the microscope. It is however an interesting adjunct to microscopic ear surgery.

PMID: 27689227 [PubMed - as supplied by publisher]

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[Hypoglossal nerve stimulation in patients with CPAP failure : Evolution of an alternative treatment for patients with obstructive sleep apnea].

[Hypoglossal nerve stimulation in patients with CPAP failure : Evolution of an alternative treatment for patients with obstructive sleep apnea].

HNO. 2016 Sep 29;

Authors: Heiser C, Hofauer B

Abstract
Obstructive sleep apnea (OSA) is a common disease in western industrialized countries with increasing prevalence. Gold standard of therapy is nocturnal positive pressure ventilation by continuous positive airway pressure (CPAP). Due to complications and side effects of ventilation, therapy adherence is limited. Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep. The aim of this work is to provide an overview of the history and current state of scientific knowledge of this therapy in the treatment of OSA. Currently, two systems are available on the market: respiratory-driven hypoglossal nerve stimulation (Inspire Medical Systems) and continuous hypoglossal nerve stimulation (ImThera Medical). For respiratory-driven hypoglossal nerve stimulation, a solid body of evidence is available and the therapy has been investigated in numerous multicenter clinical studies with regard to safety and efficacy. Only a small number of publications is available for continuous hypoglossal nerve stimulation. At the end of the last century, promising clinical results were shown in the first patients treated with hypoglossal nerve stimulation. Consequent technological and scientific development of respiratory-driven hypoglossal nerve stimulation in recent years led to its implementation in today's clinical routine. This therapy significantly broadens the spectrum of therapies in the treatment of OSA, especially for patients with CPAP intolerance.

PMID: 27689226 [PubMed - as supplied by publisher]

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Tongue Strength is Associated with Grip Strength and Nutritional Status in Older Adult Inpatients of a Rehabilitation Hospital.

Tongue Strength is Associated with Grip Strength and Nutritional Status in Older Adult Inpatients of a Rehabilitation Hospital.

Dysphagia. 2016 Sep 29;

Authors: Sakai K, Nakayama E, Tohara H, Maeda T, Sugimoto M, Takehisa T, Takehisa Y, Ueda K

Abstract
The aim of this cross-sectional study was to investigate whether tongue strength observed in older adult inpatients of a rehabilitation hospital is associated with muscle function, nutritional status, and dysphagia. A total of 174 older adult inpatients aged 65 years and older in rehabilitation (64 men, 110 women; median age, 84 years; interquartile range, 80-89 years) who were suspected of having reduced tongue strength due to sarcopenia were included in this study. Isometric tongue strength was measured using a device fitted with a disposable oral balloon probe. We evaluated age, muscle function as assessed by the Barthel index and grip strength, nutritional status as measured by the Mini Nutritional Assessment-short form (MNA-SF), body mass index, serum albumin, controlling nutritional status, and calf circumference and arm muscle area to assess muscle mass. In addition, the functional oral intake scale (FOIS) was used as an index of dysphagia. Multivariate linear regression analysis revealed that isometric tongue strength was independently associated with grip strength (coefficient = 0.33, 95 % confidence interval (CI) 0.12-0.54, p = 0.002), MNA-SF (coefficient = 0.74, 95 % CI 0.12-1.35, p = 0.019), and FOIS (coefficient = 0.02, 95 % CI 0.00-0.15, p = 0.047). To maintain and improve tongue strength in association with sarcopenic dysphagia, exercise therapy and nutritional therapy interventions, as well as direct interventions to address tongue strength, may be effective in dysphagia rehabilitation in older adult inpatients.

PMID: 27687521 [PubMed - as supplied by publisher]

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Clients' perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) 'Audiology Care' for measuring client experiences.

Clients' perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) 'Audiology Care' for measuring client experiences.

Int J Audiol. 2016 Aug 17;:1-8

Authors: Hendriks M, Dahlhaus-Booij J, Plass AM

Abstract
OBJECTIVE: Clients' perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire 'Audiology Care' to systematically assess client experiences with audiology care.
DESIGN: The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n = 14), (2) two small-scale surveys assessing psychometric properties of the questionnaire (n = 188) and importance of quality aspects (n = 118), and (3) a large-scale survey (n = 1793) assessing psychometric properties and discriminatory power of the questionnaire.
STUDY SAMPLE: People with complex hearing impairments and/or balance and communicative disorders who visited an audiology care centre during the past year.
RESULTS: Important quality aspects were translated into seven reliable scales: accommodation and facilities, employees' conduct and expertise, arrangement of appointments, waiting times, client participation and effectiveness of treatment. Client experiences differed among the participating centres concerning accommodation and facilities, arrangement of appointments, waiting times and client participation.
CONCLUSION: The CQI Audiology Care is a valid and reliable instrument to assess clients' experiences with audiology care. Future implementation will reveal whether results can be used to monitor and improve the quality of audiology care.

PMID: 27686670 [PubMed - as supplied by publisher]

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[The thinking of clinical diagnosis and treatment of vertigo based on the international classification of vestibular disorders].

[The thinking of clinical diagnosis and treatment of vertigo based on the international classification of vestibular disorders].

Zhonghua Nei Ke Za Zhi. 2016 Oct 1;55(10):746-749

Authors: Tian JR, Zhao XQ

PMID: 27686430 [PubMed - as supplied by publisher]

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[Importance of clinical reasoning in diagnosis and treatment of vertigo/dizziness].

[Importance of clinical reasoning in diagnosis and treatment of vertigo/dizziness].

Zhonghua Nei Ke Za Zhi. 2016 Oct 1;55(10):745

Authors: Zhao XQ

PMID: 27686429 [PubMed - as supplied by publisher]

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Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases.

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Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases.

Neurosurg Rev. 2016 Jan;39(1):151-8; discussion 158

Authors: Lee MH, Jee TK, Lee JA, Park K

Abstract
Microvascular decompression (MVD) is an effective and safe treatment option that offers the prospect of definitive cure for hemifacial spasm (HFS). However, there are potential risks of complications for MVD associated with retromastoid suboccipital craniectomy (RmSOC) and cranial nerves in particular. The purpose of this study was to identify clinical characteristics of possible complications after MVD for HFS and to establish appropriate management concept of these complications. We retrospectively reviewed medical records of 2040 patients who underwent RmSOC with MVD for HFS at Samsung medical center between January 1998 and March 2013. Of 2040 patients, 2027 were followed (99.4%). Of the 2027 patients, 1841 (90.8%) exhibited complete relief or minimal symptoms, and 113 (5.6%) reported improved spasm but had mild remnant symptoms. After operation, the most frequently developed complications were facial nerve palsy (8.19%), followed by middle ear effusion (4.90%) and hearing loss (3.63%). There were two cases of supratentorial subdural hemorrhage, three cases of infarction. MVD was found to be safe and effective treatment for HFS, in consistent with previous reports. Some of the complications such as facial nerve palsy, middle ear effusion, and hearing loss are relatively common. However, they have mild clinical courses that are usually transient.

PMID: 26382646 [PubMed - indexed for MEDLINE]

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Repair and prevention of cerebrospinal fluid leakage in transsphenoidal surgery: a sphenoid sinus mucosa technique.

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Repair and prevention of cerebrospinal fluid leakage in transsphenoidal surgery: a sphenoid sinus mucosa technique.

Neurosurg Rev. 2016 Jan;39(1):123-31; discussion 131

Authors: Amano K, Hori T, Kawamata T, Okada Y

Abstract
Cerebrospinal fluid (CSF) leakage is a common but sometimes serious complication after transsphenoidal surgery (TSS). To avoid this postsurgical complication, we usually repair the CSF leaking area using an autologous material, such as fat, fascia, or muscle graft and sometimes nasonasal septal flap. In this report, we propose a technique using a novel autologous material, sphenoid sinus mucosa (SSM), to repair intraoperative CSF leakage or prevent it postoperatively. On 26 February 2007, we introduced the technique of using SSM to repair or prevent CSF leakage in TSS. Until 30th of June 2014, we performed 500 TSSs for patients with pituitary or parasellar lesions. They were 195 men and 305 women with a mean age of 48.5 years (range, 5-85 years). We used SSM for patching or suturing the arachnoid laceration or dural defect, in lieu of fat or fascia harvested from abdomen or thigh, or made pedicle flap of SSM instead of nasonasal septal flap to cover the sellar floor. Comparing the previous 539 cases not using these techniques before 26 February 2007, intraoperative CSF leakage increased from 49 to 69.4% (p < 0.0001) due to more aggressive surgical technique, mainly related to more extensive approaches and lesion removals, but the rate of using fat was reduced significantly from 35.5 to 19.4% (p = 0.00021) in small or moderate CSF leaks during TSS without increasing the reoperation rate for postoperative CSF leaks (1.86 vs 1.2%, p = 0.45). The technique of using SSM to repair intraoperative CSF leaks or prevent them postoperatively in TSS was considered useful, effective, less invasive, easier for graft harvesting (same surgical field), and providing natural anatomical reconstruction, without potential donor site morbidity. We can recommend it as a standard method for CSF leaks repair and prevention in TSS.

PMID: 26338198 [PubMed - indexed for MEDLINE]

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Corrigendum.

Corrigendum.

Int J Audiol. 2016 Aug 10;:1

Authors:

PMID: 27686800 [PubMed - as supplied by publisher]

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Clients' perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) 'Audiology Care' for measuring client experiences.

Clients' perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) 'Audiology Care' for measuring client experiences.

Int J Audiol. 2016 Aug 17;:1-8

Authors: Hendriks M, Dahlhaus-Booij J, Plass AM

Abstract
OBJECTIVE: Clients' perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire 'Audiology Care' to systematically assess client experiences with audiology care.
DESIGN: The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n = 14), (2) two small-scale surveys assessing psychometric properties of the questionnaire (n = 188) and importance of quality aspects (n = 118), and (3) a large-scale survey (n = 1793) assessing psychometric properties and discriminatory power of the questionnaire.
STUDY SAMPLE: People with complex hearing impairments and/or balance and communicative disorders who visited an audiology care centre during the past year.
RESULTS: Important quality aspects were translated into seven reliable scales: accommodation and facilities, employees' conduct and expertise, arrangement of appointments, waiting times, client participation and effectiveness of treatment. Client experiences differed among the participating centres concerning accommodation and facilities, arrangement of appointments, waiting times and client participation.
CONCLUSION: The CQI Audiology Care is a valid and reliable instrument to assess clients' experiences with audiology care. Future implementation will reveal whether results can be used to monitor and improve the quality of audiology care.

PMID: 27686670 [PubMed - as supplied by publisher]

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Knowledge and attitude of parents/caregivers towards hearing loss and screening in newborns - a systematic review.

Knowledge and attitude of parents/caregivers towards hearing loss and screening in newborns - a systematic review.

Int J Audiol. 2016 Aug 15;:1-8

Authors: Ravi R, Gunjawate DR, Yerraguntla K, Rajashekhar B, Lewis LE

Abstract
OBJECTIVE: The parents/caregivers of a newborn play a pivotal role in the process of hearing screening and intervention. The decisions taken by them depend on their knowledge and attitude. The purpose of this study was to review the literature systematically on knowledge and attitude of parents/caregivers towards infant hearing loss and newborn hearing screening.
DESIGN: A systematic search was conducted using electronic databases for the periods from 1990 to March 2016. Two authors scrutinized the studies and extracted the data based on predetermined criteria.
STUDY SAMPLE: Ten studies.
RESULTS: Ear discharge was correctly identified as a risk factor for hearing loss along with measles, drugs/medication, family history, congenital causes and noise exposure. The studies revealed mixed results for knowledge about newborn hearing screening. Overall, the parents/caregivers showed positive attitudes towards hearing screening and intervention options. However, due to heterogeneity in the studies, it's hard to derive a conclusion.
CONCLUSIONS: The present review sheds light on the common areas of misconception among parents/caregivers about risk factors of infant hearing loss and newborn hearing screening. The review also draws attention to the need to have more studies exploring this knowledge and attitude of parents/caregivers among diverse populations.

PMID: 27686575 [PubMed - as supplied by publisher]

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Analysis of the characteristics of persistent postural-perceptual dizziness: A clinical-based study in China.

Analysis of the characteristics of persistent postural-perceptual dizziness: A clinical-based study in China.

Int J Audiol. 2016 Aug 17;:1-5

Authors: Yan Z, Cui L, Yu T, Liang H, Wang Y, Chen C

Abstract
OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) is a common cause of chronic dizziness, but only a few studies have reported its clinical characteristics, and no related research has been performed in China. Therefore, the purpose of this study was to analyze the characteristics of PPPD for the first time in China.
DESIGN: Data was collected from all patients during standard clinical practice, and further to evaluate the characteristics of PPPD comparing with the control group.
STUDY SAMPLE: A total of 43 patients diagnosed with PPPD were selected as the study group for analysis.
RESULTS: Women were significantly more represented in the study group than men, and in the majority of cases the age of onset was in middle-age, and sleep quality was clearly decreased compared with controls, with more statistically significantly higher levels of anxiety. Personality analysis identified that neuroticism was significantly higher than in controls.
CONCLUSIONS: In this sample we showed that PPPD was more represented in female patients, the age of onset was 40-60 years old, the majority of patients had sleep disorders, anxiety was the main mood disorder to be identified, and personality analysis found that neurotic personality may be the risk factor for developing PPPD. Further large scale studies are suggested in China.

PMID: 27686369 [PubMed - as supplied by publisher]

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Usage of personal music players in adolescents and its association with noise-induced hearing loss: A cross-sectional analysis of Ohrkan cohort study data.

Usage of personal music players in adolescents and its association with noise-induced hearing loss: A cross-sectional analysis of Ohrkan cohort study data.

Int J Audiol. 2016 Aug 9;:1-8

Authors: Twardella D, Raab U, Perez-Alvarez C, Steffens T, Bolte G, Fromme H

Abstract
OBJECTIVE: To describe personal music player (PMP) usage among adolescents, sociodemographic determinants and association with audiometric notches.
DESIGN: Audiometric evaluation to assess hearing status, and standardized questionnaires to evaluate PMP listening behaviors, leisure noise exposures and self-reported hearing loss symptoms. Sociodemographic information was collected using a parent questionnaire. Noise exposure by PMP usage equivalent for a 40 h week was estimated based on self-reported volume and duration of use.
STUDY SAMPLE: A total of 2143 students (54% females) attending 9th grade in Regensburg, Germany, during 2009 to 2011.
RESULTS: Overall, 85% of the students reported using PMPs. Exposure level exceeded 80 dB(A) in approximately one third, and 85 dB(A) in one quarter, of those who used PMP. An audiometric notch was found in 2.3% of participants, but was not significantly associated with higher PMP exposure.
CONCLUSIONS: PMP exposure above the occupational limits of 80 and 85 dB(A) set by the Directive 2003/10/EC may be a risk factor for developing noise-induced hearing loss. Educational measures to ameliorate high risk behaviors in PMP usage are needed, particularly for socially disadvantaged groups.

PMID: 27686245 [PubMed - as supplied by publisher]

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Estimating audiometric thresholds using simultaneous acquisition of ASSR and ABR from QASSR in patients with sensorineural hearing loss.

Estimating audiometric thresholds using simultaneous acquisition of ASSR and ABR from QASSR in patients with sensorineural hearing loss.

Int J Audiol. 2016 Aug 9;:1-10

Authors: Lachowska M, Bohórquez J, Özdamar Ö, Niemczyk K

Abstract
OBJECTIVES: To evaluate the accuracy with which the innovative QASSR method predicts behavioral thresholds in adult patients with sensorineural hearing loss.
DESIGN: Subjects were tested at four carrier frequencies (500, 1000, 2000, and 4000 Hz).The resulting QASSR recordings were analyzed for thresholds and magnitude/phase characteristics. Tone-burst ABR was recovered from QASSR signal using CLAD method and analyzed in the time domain. The electrophysiological estimates were compared to hearing thresholds determined behaviorally.
STUDY SAMPLE: Sixteen ears of nine volunteer subjects recruited from a clinical population.
RESULTS: All mean threshold estimates differed less than 3 dB for QASSR and less than 5 dB for ABR at 1000, 2000 and 4000Hz (carrier or pure-tone test frequencies). The largest differences were observed for both at 500 Hz (5.63 and 11.56 dB respectively).The audiometric configurations of QASSR and ABR estimates followed those of the respective behaviorally determined configurations across ears tested.
CONCLUSIONS: QASSR method merges two dissimilar stimulation techniques, transient and steady-state, to create a hybrid stimulation-and-analysis paradigm that seems to improve the overall performance of the electrophysiological threshold estimation. The unique feature of the QASSR technique is the additional information afforded by the transient ABR, recovered from the same recording. The QASSR thus holds promise to be a very useful tool for practical clinical applications.

PMID: 27686167 [PubMed - as supplied by publisher]

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Simulated patients versus seminars to train case history and feedback skills in audiology students: A randomized controlled trial.

Simulated patients versus seminars to train case history and feedback skills in audiology students: A randomized controlled trial.

Int J Audiol. 2016 Aug 9;:1-7

Authors: Hughes J, Wilson WJ, MacBean N, Hill AE

Abstract
OBJECTIVE: To compare simulated patients (SP) versus seminars for training audiology students to take a case history and give feedback with adult patients.
DESIGN: A randomized controlled trial with cross-over.
STUDY SAMPLE: Twenty-four audiology students, five SPs, two clinical educators (CE) and three evaluators. Students were randomly allocated to Group 1 who completed SP then seminar training or Group 2 who completed seminar then SP training. The SP training saw each student work with an SP in a clinic room and receive individualized feedback. The seminar training saw the student group work with a single CE in a lecture room and receive group feedback. All students were assessed taking a case history and giving feedback to an SP before, between, and after the training blocks.
RESULTS: Mixed model analyses of derived factors for case history and feedback showed significant (p < 0.05) effects for assessment occasion (i.e. student skills improved with more training) but not for training sequence (i.e. order of training did not affect skill improvements) or training type (i.e. type of training did not affect skill improvements).
CONCLUSION: SP training provided no benefit over seminar training in audiology students learning case history and feedback skills with adult patients.

PMID: 27686138 [PubMed - as supplied by publisher]

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Practical considerations for the application of ear simulators in the calibration of audiometers in the extended high frequency region.

Practical considerations for the application of ear simulators in the calibration of audiometers in the extended high frequency region.

Int J Audiol. 2016 Aug 9;:1-6

Authors: Barham R

Abstract
OBJECTIVE: Calibration service providers for audiometric equipment often encounter impracticalities in fully implementing the International Electrotechnical Commission (IEC) guidelines for the extended high frequency region. This report evaluates some of the work-around solutions sometimes employed in practice and the implications these have for audiometer calibration results and uncertainties.
DESIGN: The impact of using four different microphone configurations on the ear simulator calibration in the frequency range 125 Hz to 20 kHz, and especially in the extended high frequency range from 10 kHz to 20 kHz, was investigated, at a range of temperatures.
RESULTS: Variations in the response of the ear simulator of up to 6 dB were observed with the different microphone configurations. In addition, using the microphone without its protection grid produced a dip in the high frequency response of approximately 15 dB.
CONCLUSION: While deviation from the practices required in IEC standards is not recommended, replacing the microphone protection grid with a specially fabricated collar (essentially a grid with the top removed) was found to constrain deviations in response to within ±2 dB. It was also concluded that simply removing the microphone protection grid resulted in a wholly unsatisfactory performance.

PMID: 27686113 [PubMed - as supplied by publisher]

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The effect of non-native and non-regional speech testing on a multi-lingual population.

The effect of non-native and non-regional speech testing on a multi-lingual population.

Int J Audiol. 2016 Aug 9;:1-7

Authors: Quar TK, Soli SD, Chan YF, Ishak WS, Abdul Wahat NH

Abstract
OBJECTIVE: This study was conducted to evaluate the speech perception of Malaysian Chinese adults using the Taiwanese Mandarin HINT (MHINT-T) and the Malay HINT (MyHINT).
DESIGN: The MHINT-T and the MyHINT were presented in quiet and noise (front, right and left) conditions under headphones. Results for the two tests were compared with each other and with the norms for each test.
STUDY SAMPLE: Malaysian Chinese native speakers of Mandarin (N = 58), 18-31 years of age with normal hearing.
RESULTS: On average, subjects demonstrated poorer speech perception ability than the normative samples for these tests. Repeated measures ANOVA showed that speech reception thresholds (SRTs) were slightly poorer on the MHINT-T than on the MyHINT for all test conditions. However, normalized SRTs were poorer by 0.6 standard deviations for MyHINT as compared with MHINT-T.
CONCLUSIONS: MyHINT and MHINT-T can be used as norm-referenced speech perception measures for Mandarin-speaking Chinese in Malaysia.

PMID: 27686009 [PubMed - as supplied by publisher]

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Discrimination and internalised feelings experienced by people who stutter in Jordan.

Discrimination and internalised feelings experienced by people who stutter in Jordan.

Int J Speech Lang Pathol. 2016 Aug 9;:1-10

Authors: Alqhazo M, Blomgren M, Roy N, Abu Awwad M

Abstract
PURPOSE: This study investigated the internalised feelings and discrimination experienced by people who stutter in Jordan.
METHOD: Five adult speakers who stutter were interviewed as a focus group. The participants were asked about their feelings related to stuttering and discrimination. The participants' responses in the focus group and items adapted from the extant literature formed the basis of a 20-item questionnaire. The questionnaire was administered to 20 additional adults who stutter to assess their internalised feelings about stuttering and their perceived rejecting behaviours (discrimination) associated with their impairment.
RESULT: Feeling "annoyed" was the item that received the highest percentage of negative internalised feelings, followed by "embarrassed," "shame," "disappointed," "nervous, "sad," "pessimistic," "fearful," "worried" and "lonely." The results of the discrimination experiences indicated that "getting a leadership position" was the item that most people who stutter reported being worried about, followed by "participation in the classroom," "getting a job," "getting married," "being fully paid in their jobs," "teased," "promoted" and "renting a house."
CONCLUSION: These findings provide further evidence of the universality that stuttering is more than the core surface features of speech, but also include aspects that exist below the surface such as negative internalised feelings and various discrimination experiences.

PMID: 27687010 [PubMed - as supplied by publisher]

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Screening patients for communication difficulty: The diagnostic accuracy of the IFCI staff questionnaire.

Screening patients for communication difficulty: The diagnostic accuracy of the IFCI staff questionnaire.

Int J Speech Lang Pathol. 2016 Aug 9;:1-11

Authors: O'Halloran R, Coyle J, Lamont S

Abstract
PURPOSE: Many patients have difficulty communicating about their healthcare. At present there is no tool to identify these patients. This research investigated whether the Inpatient Functional Communication Interview Staff Questionnaire (IFCI SQ) could detect patients who have difficulty communicating their healthcare needs by investigating the sensitivity, specificity and internal consistency of the IFCI SQ.
METHOD: Fifty patients and their nurses participated in this research. Every second consecutive admission on the general medical ward of a hospital was assessed for communication difficulty by a speech-language pathologist on the IFCI and screened for communication difficulty by a nurse using the IFCI SQ.
RESULT: At a cut off score of <2, the IFCI SQ had a sensitivity of 95% and a specificity of 77% compared with the IFCI. The IFCI SQ is a useful test in identifying patients who have communication difficulty and is an extremely good test at ruling out patients who do not have communication difficulty. The internal consistency of the IFCI SQ was also high at 0.954.
CONCLUSION: The IFCI SQ is a promising tool to detect patients in hospital with communication difficulty. Further research is required to explore the psychometric properties of the IFCI SQ in more detail.

PMID: 27686874 [PubMed - as supplied by publisher]

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Reliability for detecting oropharyngeal aspiration in children using cervical auscultation.

Reliability for detecting oropharyngeal aspiration in children using cervical auscultation.

Int J Speech Lang Pathol. 2016 Sep 29;:1-9

Authors: Frakking TT, Chang AB, O'Grady KF, David M, Weir KA

Abstract
PURPOSE: Limited data exist that support the reproducibility of cervical auscultation (CA) use in children. This study aimed to determine the reliability of CA in detecting oropharyngeal aspiration (OPA) in children within a controlled environment.
METHOD: This observational study included eight speech-language pathologists who rated clips of 40 normal and 40 OPA swallowing sounds on two separate occasions (i.e.160 sound clips rated by each speech-language pathologist) to comprise a total of 1280 swallow clips rated. Swallowing sound clips were collected from (1) a volunteer sample of 20 healthy children from the general community (mean 16.2 ± 10.7 months; 65% female); (2) a referred sample of 19 children with demonstrated OPA (mean 22.8 ± 25.5 months; 36.8% female), as determined on videofluoroscopic swallow studies (VFSS) using the Penetration-Aspiration Scale (PAS) (≥6 score).
RESULT: Inter-rater reliability was very good (kappa =0.81, 95%CI 0.79-0.84). Intra-rater reliability for each rater was good to very good (kappa range 0.72-0.98). Overall sensitivity was 93.9% (95%CI 91.8-95.6) and specificity was 94.5% (95%CI 92.5-96.2). High reliability values were found for the detection of OPA versus normal swallows using CA alone.
CONCLUSION: Future research should investigate the use of CA in a variety of clinical settings with less environmental control before CA can be advocated for use in routine clinical practice.

PMID: 27686754 [PubMed - as supplied by publisher]

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Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol.

Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol.

Int J Speech Lang Pathol. 2016 Sep 29;:1-11

Authors: Schwarz M, Coccetti A, Cardell E, Murdoch A, Davis J

Abstract
PURPOSE: There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case-control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012.
METHOD: Chart auditing was completed for 83 participants in three groups: pre-protocol (n = 12) (2011), post-protocol (n = 28) (2012-2014), and non-thrombolysed stroke patients (n = 43).
RESULT: Following the implementation of this clinical protocol, the average time patient remained nil by mouth reduced by 9.5 h, the percentage of patients who were malnourished or at risk reduced by 24% and the number of patients who developed aspiration pneumonia reduced by 11%. The cost of hospital stay reduced by $1505. Service compliance with best practice in dysphagia management in thrombolysed patients increased from 67% to 96% in the thrombolysed patient groups.
CONCLUSION: The outcomes suggest that a clinical protocol for dysphagia management in thrombolysed patients has the potential to improve service outcomes, reduce complications from dysphagia, have financial benefits for the hospital and increase service compliance. Furthermore, the results lend support for speech pathology services to manage dysphagia on weekends.

PMID: 27686633 [PubMed - as supplied by publisher]

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Finding the Right Treatment for Achalasia Treatment: Risks, Efficacy, Complications.

Finding the Right Treatment for Achalasia Treatment: Risks, Efficacy, Complications.

Curr Treat Options Gastroenterol. 2016 Sep 29;

Authors: Moonen A, Boeckxstaens G

Abstract
OPINION STATEMENT: Achalasia is a primary esophageal motor disorder of the esophagus that is characterized by the absence of esophageal peristalsis and a failure of the lower esophageal sphincter (LES) to relax upon swallowing. The defective relaxation leads to symptoms of dysphagia for solids and liquids, regurgitation, aspiration, chest pain, and weight loss. Achalasia is believed to result from a selective loss of enteric inhibitory neurons, most likely due to an autoimmune phenomenon in genetic susceptible individuals. As there is no curative treatment for achalasia, treatment is confined to disruption of the LES to improve bolus passage. The two most commonly used treatment modalities available are the endoscopic pneumodilation (PD) and the surgical laparoscopic Heller myotomy (LHM). A recent European randomized controlled trial showed that both treatment modalities have comparable success rates after a follow-up of at least 5 years. In view of these data, both treatments can be used as an initial therapy in achalasia and the choice should be based on the expertise available. Recently, a new endoscopic technique, peroral endoscopic myotomy (POEM), has been introduced with excellent short-term success rates. However, longer follow-up and data from randomized controlled trials are needed before accepting this technique as a new treatment option for achalasia in clinical practice.

PMID: 27687234 [PubMed - as supplied by publisher]

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Estill Voice Training and voice quality control in contemporary commercial singing: an exploratory study.

Estill Voice Training and voice quality control in contemporary commercial singing: an exploratory study.

Logoped Phoniatr Vocol. 2016 Sep 30;:1-7

Authors: Fantini M, Fussi F, Crosetti E, Succo G

Abstract
Estill Voice Training (EVT) is a widely known programme for developing vocal skills based on partitioning the process of vocal production in order to reach control of specific structures in the vocal mechanism. The present retrospective small-scale exploratory study aims at reporting preliminary data about the efficacy of EVT - in terms of voice quality control on a specific vocal exercise - in contemporary commercial singers with a Certificate of Figure Proficiency (CFP). Thirty-five contemporary commercial singers (professional or semi-professional pop and rock singers) with no vocal complaints were recruited. The experimental group was composed of twenty singers who studied EVT and had a CFP. The control group was composed of fifteen singers who studied in Italian contemporary popular music institutions but were not familiar with EVT. Voice quality control was assessed through acoustic and perceptual analysis on a specific vocal exercise requiring sound pitch, perturbation and spectral energy distribution control. The acoustic analysis showed some significant differences between the two groups of singers both in sound perturbation control and spectral energy distribution control, suggesting a higher voice quality control ability for the experimental group. The perceptual evaluation confirmed a higher ability for the experimental group to produce recognizable voice qualities in this specific task. The reported preliminary results seem to suggest EVT as an effective educational system for developing voice quality control ability in contemporary commercial singers.

PMID: 27686149 [PubMed - as supplied by publisher]

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Novel proteasome inhibitor ixazomib sensitizes neuroblastoma cells to doxorubicin treatment.

Novel proteasome inhibitor ixazomib sensitizes neuroblastoma cells to doxorubicin treatment.

Sci Rep. 2016;6:34397

Authors: Li H, Chen Z, Hu T, Wang L, Yu Y, Zhao Y, Sun W, Guan S, Pang JC, Woodfield SE, Liu Q, Yang J

Abstract
Neuroblastoma (NB) is the most common extracranial malignant solid tumor seen in children and continues to lead to the death of many pediatric cancer patients. The poor outcome in high risk NB is largely attributed to the development of chemoresistant tumor cells. Doxorubicin (dox) has been widely employed as a potent anti-cancer agent in chemotherapeutic regimens; however, it also leads to chemoresistance in many cancer types including NB. Thus, developing novel small molecules that can overcome dox-induced chemoresistance is a promising strategy in cancer therapy. Here we show that the second generation proteasome inhibitor ixazomib (MLN9708) not only inhibits NB cell proliferation and induces apoptosis in vitro but also enhances dox-induced cytotoxicity in NB cells. Ixazomib inhibits dox-induced NF-κB activity and sensitizes NB cells to dox-induced apoptosis. More importantly, ixazomib demonstrated potent anti-tumor efficacy in vivo by enhancing dox-induced apoptosis in an orthotopic xenograft NB mouse model. Collectively, our study illustrates the anti-tumor efficacy of ixazomib in NB both alone and in combination with dox, suggesting that combination therapy including ixazomib with traditional therapeutic agents such as dox is a viable strategy that may achieve better outcomes for NB patients.

PMID: 27687684 [PubMed - as supplied by publisher]

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To image or not to image? A cost-effectiveness analysis of MRI for patients with asymmetric sensorineural hearing loss.

To image or not to image? A cost-effectiveness analysis of MRI for patients with asymmetric sensorineural hearing loss.

Laryngoscope. 2016 Sep 30;

Authors: Hojjat H, Svider PF, Davoodian P, Hong RS, Folbe AJ, Eloy JA, A Shkoukani M

Abstract
OBJECTIVES/HYPOTHESIS: Our objective was to perform an economic analysis evaluating whether ordering a magnetic resonance imaging (MRI) is a cost-effective practice in the workup of undifferentiated asymmetric sensorineural hearing loss (ASNHL). Use of T1 gadolinium-weighted MR (GdT1W) and T2 weighted MR without contrast (T2MR) was each examined.
METHODS: The incremental cost-effectiveness ratio (ICER) of MR imaging among ASNHL patients was evaluated using a decision tree. We calculated what the probability of having a cerebellopontine angle/internal auditory canal lesion would have to be to make MR more cost-effective than observation. The decision pathways included observation, GdT1W, and T2MR. The probability of detecting a lesion and associated costs were employed in constructing our tree. Missing a mass in the observation branch was considered to have an effectiveness of 0. The costs and probabilities were extracted from previously published studies.
RESULTS: The ICERs of pursuing GdT1W and T2MR were $27,660 and $15,943, respectively, both below the widely accepted willingness to pay (WTP) thresholds of $30,000 and $50,000. Probabilistic sensitivity analysis with Monte Carlo simulations for GdT1W showed that it is more cost-effective than no imaging, with 54.4% and 83.5% certainty at $30,000 and $50,000 WTP thresholds. Probabilistic sensitivity analysis with Monte Carlo simulations for T2MR showed that it is more cost-effective than no imaging, with 75.2% and 92.6% certainty at $30,000 and $50,000 WTP thresholds.
CONCLUSION: This economic evaluation strongly supports pursuing MRI in patients with documented ASNHL as a cost-effective strategy. Both GdT1W and T2MR are more cost-effective than observation. Furthermore, noncontrast T2 imaging may be the more cost-effective modality of these two techniques.
LEVEL OF EVIDENCE: 2c. Laryngoscope, 2016.

PMID: 27686371 [PubMed - as supplied by publisher]

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Masses in the membranes.

Related Articles

Masses in the membranes.

Surv Ophthalmol. 2016 May-Jun;61(3):357-62

Authors: Suresh S, Abel AS, Younge BR, Bilyk JR, Lee MS

Abstract
A 24-year-old woman with systemic lupus erythematosus presented with a 1-year history of painless vision loss in the right eye. Examination was notable for a bitemporal hemianopia. Brain imaging revealed multiple contrast enhancing dural masses, including one along the planum sphenoidale. She underwent excisional biopsy for a presumed diagnosis of multiple meningiomas. Five years later, she developed worsening vision in the left eye, hypesthesia in the V1 distribution, and oculomotor nerve palsy. Repeat imaging showed an enhancing mass in the cavernous sinus and orbital apex. Biopsy demonstrated a lymphoplasmacyte rich infiltrate in dense extracellular material. She was diagnosed with lupus-induced hypertrophic pachymeningitis and started on immunosuppressive therapy. On further worsening of symptoms, her initial biopsy was reexamined and revealed a kappa light chain restricted B-cell and plasmacyte population. This led to the final diagnosis of central nervous system extranodal marginal zone lymphoma.

PMID: 26453797 [PubMed - indexed for MEDLINE]

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Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects--case series and review of the literature.

Related Articles

Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects--case series and review of the literature.

Neurosurg Rev. 2016 Jan;39(1):141-50; discussion 150

Authors: Gonen L, Handzel O, Shimony N, Fliss DM, Margalit N

Abstract
Increasing numbers of cases of idiopathic cerebrospinal fluid (CSF) leakage through temporal bone defects (TBD) have been recently reported, mainly in otolaryngologic journals. Those cases are referred to as spontaneous temporal bone encephaloceles (TBE). Three surgical approaches have been advocated for this condition: the transmastoid approach (TMA), the middle cranial fossa approach (MCFA), or a combination of both. We conducted a retrospective study of all 11 consecutive patients who underwent 12 middle cranial fossa craniotomies for the treatment of CSF leakage through TBD in our institution between 2011 and 2014. Neurosurgical and otologic data were collected from the patients' records. Nine of our cases had an idiopathic etiology. No CSF leaks recurred during an average follow-up of 19.5 months. There was one case of a postoperative expressive aphasia with complete recovery in a few weeks. A systematic literature search was conducted for all studies addressing the treatment of spontaneous TBE between 1986 and 2013. It revealed a trend favoring the use of the MCFA approach over the TMA approach, with an acceptable risk of less than 5% for craniotomy-related complications. We concluded that MCFA is an effective and safe technique for the repair of CSF leakage through TBD. A high percentage of complete resolution with a low complication rate can be achieved with this surgical technique.

PMID: 26342604 [PubMed - indexed for MEDLINE]

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Middle infratemporal fossa less invasive approach for radical resection of parapharyngeal tumors: surgical microanatomy and clinical application.

Related Articles

Middle infratemporal fossa less invasive approach for radical resection of parapharyngeal tumors: surgical microanatomy and clinical application.

Neurosurg Rev. 2016 Jan;39(1):87-96; discussion 96-7

Authors: Nonaka Y, Fukushima T, Watanabe K, Sakai J, Friedman AH, Zomorodi AR

Abstract
Surgery of the infratemporal fossa (ITF) and parapharyngeal area presents a formidable challenge to the surgeon due to its anatomical complexity and limited access. Conventional surgical approaches to these regions were often too invasive and necessitate sacrifice of normal function and anatomy. To describe a less invasive transcranial extradural approach to ITF parapharyngeal lesions and to determine its advantages, 17 patients with ITF parapharyngeal neoplasms who underwent tumor resection via this approach were enrolled in the study. All lesions located in the ITF precarotid parapharyngeal space were resected through a small operative corridor between the trigeminal nerve third branch (V3) and the temporomandibular joint (TMJ). Surgical outcomes and postoperative complications were evaluated. Pathological diagnosis included schwannoma in eight cases, paraganglioma in two cases, gangliocytoma in two cases, carcinosarcoma in one case, giant cell tumor in one case, pleomorphic adenoma in one case, chondroblastoma in one case, and juvenile angiofibroma in one case. Gross total resection was achieved in 12 cases, near-total and subtotal resection were in 3 and 2 cases, respectively. The most common postoperative complication was dysphagia. Surgical exposure can be customized from minimal (drilling of retrotrigeminal area) to maximal (full skeletonization of V3, removal of all structures lying lateral to the petrous segment of internal carotid artery) according to tumor size and location. Since the space between the V3 and TMJ is the main corridor of this approach, the key maneuver is the anterior translocation of V3 to obtain an acceptable surgical field.

PMID: 26160680 [PubMed - indexed for MEDLINE]

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Social support and substitute voice acquisition on psychological adjustment among patients after laryngectomy.

Social support and substitute voice acquisition on psychological adjustment among patients after laryngectomy.

Eur Arch Otorhinolaryngol. 2016 Sep 29;

Authors: Kotake K, Suzukamo Y, Kai I, Iwanaga K, Takahashi A

Abstract
The objective is to clarify whether social support and acquisition of alternative voice enhance the psychological adjustment of laryngectomized patients and which part of the psychological adjustment structure would be influenced by social support. We contacted 1445 patients enrolled in a patient association using mail surveys and 679 patients agreed to participate in the study. The survey items included age, sex, occupation, post-surgery duration, communication method, psychological adjustment (by the Nottingham Adjustment Scale Japanese Laryngectomy Version: NAS-J-L), and the formal support (by Hospital Patient Satisfaction Questionnaire-25: HPSQ-25). Social support and communication methods were added to the three-tier structural model of psychological adjustment shown in our previous study, and a covariance structure analysis was conducted. Formal/informal supports and acquisition of alternative voice influence only the "recognition of oneself as voluntary agent", the first tier of the three-tier structure of psychological adjustment. The results suggest that social support and acquisition of alternative voice may enhance the recognition of oneself as voluntary agent and promote the psychological adjustment.

PMID: 27687680 [PubMed - as supplied by publisher]

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Anatomical approach to surgery for intrathoracic goiter.

Anatomical approach to surgery for intrathoracic goiter.

Eur Arch Otorhinolaryngol. 2016 Sep 29;

Authors: Vaiman M, Bekerman I

Abstract
The anatomical approach to the intrathoracic goiter (ITG) was used to understand its etiology and to rationalize surgical technique of thyroidectomy. For a retrospective chart review, we selected cases of multinodular goiter with totally ITGs (n = 69; M 29, F 40), while 916 cases with cervical goiter were used for comparison. The topography of the thyroid gland was assessed against the tracheal rings and against the vertebrae. The regional anatomy of the thoracic inlet was assessed by its bony margins and the relations of structures traversing the area. Average tracheal-diameter-to-thoracic-inlet ratio was calculated. The ITG group consisted of 52 cases of retrosternal goiter (75.4 %), nine cases of retrotracheal goiter (13 %), and eight cases of retroesophageal goiter (11.6 %). In all but one analyzed cases, the goiters were removed via cervical incision. Mean weight of goiters was 183 g. The area of thoracic inlet in the cases of ITG had no difference in comparison with the cases of cervical goiter (F/M p = 0.11/0.15), but the tracheal-diameter-to-thoracic-inlet ratio was significantly smaller (F/M p = 0.06/0.04). In the ITG cases, the position of the upper edge of the isthmus of the thyroid was about 1.5 tracheal rings lower than in healthy individuals (p = 0.03). The area of the thoracic inlet, the neck size, and the anteroposterior diameter of the inlet do not affect the development of the ITG. The smaller tracheal-diameter-to-thoracic-inlet ratio and the lower position of the thyroid gland are the main indicators for the development of the ITG.

PMID: 27687679 [PubMed - as supplied by publisher]

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Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers.

Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers.

Eur Arch Otorhinolaryngol. 2016 Sep 29;

Authors: Rades D, Seidl D, Janssen S, Strojan P, Karner K, Bajrovic A, Hakim SG, Wollenberg B, Schild SE

Abstract
Radio-chemotherapy is a common treatment for locally advanced squamous cell head-and-neck cancers (LA-SCCHN). Cisplatin (100 mg/m(2)) every 3 weeks is very common but associated with considerable toxicity. Therefore, cisplatin programs with lower daily doses were introduced. There is a lack of studies comparing lower-dose programs. In this study, 85 patients receiving radio-chemotherapy with 20 mg/m(2) cisplatin on 5 days every 4 weeks (group A) were retrospectively compared to 85 patients receiving radio-chemotherapy with 30-40 mg/m(2) cisplatin weekly (group B). Groups were matched for nine factors including age, gender, performance score, tumor site, T-/N-category, surgery, hemoglobin before radio-chemotherapy, and radiation technique. One- and 3-year loco-regional control rates were 83 and 69 % in group A versus 74 and 63 % in group B (p = 0.12). One- and 3-year survival rates were 93 % and 73 % in group A versus 91 and 49 % in group B (p = 0.011). On multivariate analysis, survival was significantly better for group A (HR 1.17; p = 0.002). In groups A and B, 12 and 28 % of patients, respectively, did not receive a cumulative cisplatin dose ≥180 mg/m(2) (p = 0.016). Toxicity rates were not significantly different. On subgroup analyses, group A patients had better loco-regional control (p = 0.040) and survival (p = 0.005) than group B patients after definitive radio-chemotherapy. In patients receiving adjuvant radio-chemotherapy, outcomes were not significantly different. Thus, 20 mg/m(2) cisplatin on 5 days every 4 weeks resulted in better loco-regional control and survival in patients receiving definitive radio-chemotherapy and may be preferable for these patients. Confirmation of these results in a randomized trial is warranted.

PMID: 27687678 [PubMed - as supplied by publisher]

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