Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia.

Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia.

Dysphagia. 2015 Nov 21;

Authors: Seo HG, Oh BM, Han TR

Abstract
The purpose of this study was to investigate swallowing kinematics and explore kinematic factors related with penetration-aspiration in patients with post-stroke dysphagia. Videofluoroscopic images of 68 patients with post-stroke dysphagia and 34 sex- and age-matched healthy controls swallowing a thin liquid were quantitatively analyzed using two-dimensional motion digitization. The measurements included the movement distances and velocities of the hyoid and larynx, and the maximal tilt angles and angular velocities of the epiglottis. All velocity variables were significantly decreased in the stroke patients compared to the controls. There was a significant difference in the maximal horizontal displacement of the larynx, but there were no significant differences in other displacements of the larynx, the maximal displacements of the hyoid bone, and the maximum tilt angle of the epiglottis between the two groups. The maximal tilt angle of the epiglottis was lower in the aspiration subgroup than in the no penetration/aspiration and penetration subgroups as well as the controls. The maximal tilt angle from the y axis showed a dichotomous pattern at 90° of the angle, and all 11 patients with an angle <90° showed either penetration or aspiration. In the ROC curve of the angle for prediction of aspiration, the area under the curve was 0.725 (95 % CI 0.557-0.892, P = 0.008). This study suggested that sluggish rather than decreased hyolaryngeal movements during swallowing are a remarkable feature of post-stroke dysphagia. The association of reduced epiglottic movement with the risk of aspiration in patients with post-stroke dysphagia was supported by the quantitative analysis.

PMID: 26590571 [PubMed - as supplied by publisher]

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Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia.

Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia.

Dysphagia. 2015 Nov 21;

Authors: Seo HG, Oh BM, Han TR

Abstract
The purpose of this study was to investigate swallowing kinematics and explore kinematic factors related with penetration-aspiration in patients with post-stroke dysphagia. Videofluoroscopic images of 68 patients with post-stroke dysphagia and 34 sex- and age-matched healthy controls swallowing a thin liquid were quantitatively analyzed using two-dimensional motion digitization. The measurements included the movement distances and velocities of the hyoid and larynx, and the maximal tilt angles and angular velocities of the epiglottis. All velocity variables were significantly decreased in the stroke patients compared to the controls. There was a significant difference in the maximal horizontal displacement of the larynx, but there were no significant differences in other displacements of the larynx, the maximal displacements of the hyoid bone, and the maximum tilt angle of the epiglottis between the two groups. The maximal tilt angle of the epiglottis was lower in the aspiration subgroup than in the no penetration/aspiration and penetration subgroups as well as the controls. The maximal tilt angle from the y axis showed a dichotomous pattern at 90° of the angle, and all 11 patients with an angle <90° showed either penetration or aspiration. In the ROC curve of the angle for prediction of aspiration, the area under the curve was 0.725 (95 % CI 0.557-0.892, P = 0.008). This study suggested that sluggish rather than decreased hyolaryngeal movements during swallowing are a remarkable feature of post-stroke dysphagia. The association of reduced epiglottic movement with the risk of aspiration in patients with post-stroke dysphagia was supported by the quantitative analysis.

PMID: 26590571 [PubMed - as supplied by publisher]

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Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula.

Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula.

Dysphagia. 2015 Nov 21;

Authors: Leder SB, Siner JM, Bizzarro MJ, McGinley BM, Lefton-Greif MA

Abstract
Use of high-flow oxygen via nasal cannula (HFO2-NC) is increasingly common in intensive care unit (ICU) settings. Despite the critical interface between respiration and swallowing, and the high acuity of patients in ICUs, the impact of HFO2-NC on feeding and swallowing is unknown. The present prospective, single-center, cohort study investigated the impact of HFO2-NC use on oral alimentation in neonatal and adult ICU patients. Oral alimentation status was evaluated in 100 consecutive ICU inpatients (50 neonatal and 50 adult) requiring HFO2-NC. Participant characteristics, respiratory support, successful initiation of oral feeding in neonates, and successful resumption of oral feeding in adults were recorded. Seventeen of 50 (34 %) neonates requiring HFO2-NC were deemed developmentally and medically appropriate by the neonatologist and nursing to begin oral alimentation. All 17 (100 %) were successful with initiation of oral feedings. Thirty-three of 50 (66 %) continued nil per os due to prematurity or medical conditions precluding oral alimentation at time of data collection. Thirty-nine of 50 (78 %) adults requiring HFO2-NC were deemed medically appropriate by the intensivist and nursing to resume oral alimentation (n = 34) or with a functional swallow without aspiration on FEES (n = 5). All 39 (100 %) resumed oral alimentation successfully. Eleven of 50 (22 %) continued nil per os due to severe respiratory issues precluding both swallow testing and oral alimentation at time of data collection. All developmentally and medically appropriate neonatal and adult patients requiring HFO2-NC were successful with either the introduction or resumption of oral alimentation. Patients requiring HFO2-NC who are identified as having feeding or swallowing issues should be referred for swallowing evaluations using the same criteria as patients who do not require HFO2-NC, as it is not the use of HFO2-NC but rather patient-specific determinants of feeding and swallowing readiness and their underlying medical conditions that impact readiness for oral alimentation status.

PMID: 26590570 [PubMed - as supplied by publisher]

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Repeated Surgical or Endoscopic Myotomy for Recurrent Dysphagia in Patients After Previous Myotomy for Achalasia.

Repeated Surgical or Endoscopic Myotomy for Recurrent Dysphagia in Patients After Previous Myotomy for Achalasia.

J Gastrointest Surg. 2015 Nov 20;

Authors: Fumagalli U, Rosati R, De Pascale S, Porta M, Carlani E, Pestalozza A, Repici A

Abstract
AIM: Surgical myotomy of the lower esophageal sphincter has a 5-year success rate of approximately 91 %. Peroral endoscopic myotomy can provide similar results for controlling dysphagia. Some patients experience either persistent or recurrent dysphagia after myotomy. We present here a retrospective analysis of our experience with redo myotomy for recurrent dysphagia in patients with achalasia.
METHODS: From March 1996 to February 2015, 234 myotomies for primary or recurrent achalasia were performed in our center. Fifteen patients (6.4 %) had had a previous myotomy and were undergoing surgical redo myotomy (n = 9) or endoscopic redo myotomy (n = 6) for recurrent symptoms.
RESULTS: Patients presented at a median of 10.4 months after previous myotomy. Median preoperative Eckardt score was 6. Among the nine patients undergoing surgical myotomy, three esophageal perforations occurred intraoperatively (all repaired immediately). Surgery lasted 111 and 62 min on average (median) in the surgical and peroral endoscopic myotomy (POEM) groups, respectively. No postoperative complications occurred in either group. Median postoperative stay was 3 and 2.5 days in the surgical and POEM groups, respectively. In the surgical group, Eckardt score was <3 for seven out of nine patients after a mean follow-up of 19 months; it was <3 for all six patients in the POEM group after a mean follow-up of 5 months.
CONCLUSIONS: A redo myotomy should be considered in patients who underwent myotomy for achalasia and presenting with recurrent dysphagia. Preliminary results using POEM indicate that the technique can be safely used in patients who have undergone previous surgical myotomy.

PMID: 26589525 [PubMed - as supplied by publisher]

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Some unpublished documents and unusual portraits of Anton von Tröltsch (1828-1890), one of the founders of this journal.

Some unpublished documents and unusual portraits of Anton von Tröltsch (1828-1890), one of the founders of this journal.

Eur Arch Otorhinolaryngol. 2015 Nov 20;

Authors: Mudry A, von Deuster C, Peinhardt J

Abstract
Anton Friedrich Baron von Tröltsch (1829-1890) was a very famous German otologist in Würzburg in the second part of the 19th century. The aim of this study is to present some unpublished documents related to his biography: a 4-page autobiographical unsigned text probably written for his habilitation in 1861, a 4-page autobiographical letter sent by von Tröltsch to the editors of the Brockhaus-Conversations-Lexikon in 1872, a unique album of portraits of the main otologists of the second part of the 19th century, collected for his 1886 Privat Docent jubilee anniversary, and a portrait of unknown origin. They are discussed with other unusual portraits. These new documents demonstrate at least two major points. One, von Tröltsch was aware of his qualities and the importance of his work in otology but he was not boastful. Two, he was really loved and respected by its colleagues, nearly 150 of them came just for a one-day ovation in Würzburg for his 25th Privat Docent Jubilee and his retirement from his otological practice. Von Tröltsch was and remains an example for all otologists.

PMID: 26589899 [PubMed - as supplied by publisher]

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Quantification of lymph nodes in the central compartment of the neck: a cadaveric study.

Quantification of lymph nodes in the central compartment of the neck: a cadaveric study.

Eur Arch Otorhinolaryngol. 2015 Nov 20;

Authors: Ofo E, Thavaraj S, Cope D, Barr J, Kapoor K, Jeannon JP, Oakley R, Lock C, Odell E, Simo R

Abstract
Differentiated thyroid cancer (DTC) accounts for over 90 % of thyroid malignancies, and is frequently associated with central neck compartment nodal metastasis that requires a therapeutic central compartment neck dissection (CCND) for clinically evident nodes. Current knowledge on the expected lymph node yield from a CCND is limited, compared with data on the lateral neck. The aim of our study was to accurately quantify nodal yield from the cadaveric central neck compartment. Twenty-eight cadaveric necks were dissected and the central neck compartment was subdivided into four regions: pre-laryngeal (delphian), pre-tracheal, right and left para-tracheal regions. Each cadaver had a thyroid gland, which was also removed, and the CCND tissue in each compartment was processed and examined by a consultant histopathologist. Only lymphoid tissue with a defined microscopic fibrous capsule and subcapsular sinus was included in the node count. The median total lymph node count per cadaver was four (range 1-16), with a median of one node detectable in each para-tracheal region (range 0-7) and the pre-tracheal region (range 0-8). The median pre-laryngeal node count was 0 (range 0- 2). The average lymph node size across all compartments was 2.9 mm. This is the first European study to assess cadaveric central neck lymph nodes and establish baseline counts for nodal yield. If a prophylactic or therapeutic CCND is required during thyroid surgery, those involved in DTC management must recognise that there is a wide range, and low median yield of central neck compartment lymph nodes.

PMID: 26589898 [PubMed - as supplied by publisher]

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[Computer Assisted Surgery around the Head (CASH) : Interdisciplinary symposium and hands-on workshop, Ulm, 25-26 September 2015].

[Computer Assisted Surgery around the Head (CASH) : Interdisciplinary symposium and hands-on workshop, Ulm, 25-26 September 2015].

HNO. 2015 Nov 20;

Authors: Hoffmann TK, Sommer F

PMID: 26589600 [PubMed - as supplied by publisher]

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[Obituary on Prof. Dr. med. Dietrich Plester (1922-2015) : Director of the Department of Otolaryngology, University of Tübingen from 1966 to 1988].

[Obituary on Prof. Dr. med. Dietrich Plester (1922-2015) : Director of the Department of Otolaryngology, University of Tübingen from 1966 to 1988].

HNO. 2015 Nov 20;

Authors: Zenner HP

PMID: 26589599 [PubMed - as supplied by publisher]

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Dysphagia in the elderly: focus on rehabilitation strategies.

Dysphagia in the elderly: focus on rehabilitation strategies.

Aging Clin Exp Res. 2015 Nov 20;

Authors: Di Pede C, Mantovani ME, Del Felice A, Masiero S

Abstract
Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental exams, and identification of the risk of aspiration. Long-standing individual abilities and impairments determine the goals of an ad hoc rehabilitation program. Currently there are no standard algorithmic approaches for the management of dysphagia in the elderly. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. This narrative review summarizes the current rehabilitation approaches for dysphagia in the elderly. The aim is to inform the treating health care professionals, whether caring physician, physical medicine doctor, speech/swallowing therapist or nurse, on the state-of-the-art and stimulate discussion in the scientific community.

PMID: 26589905 [PubMed - as supplied by publisher]

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Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Int J Pediatr Otorhinolaryngol. 2015 Nov 4;

Authors: Moreddu E, Pereira J, Vaz R, Lena G, Triglia JM, Nicollas R

Abstract
OBJECTIVES: This study reports a patient with a large teratoma involving the oropharynx, the nasopharynx and the left orbit, with intracranial extension. This case represents one of the first reported instances of such an association. A literature review reporting head and neck teratomas with intracranial involvement is also presented.
CASE REPORT: The authors describe a case of a neonate presenting with a huge teratoma causing respiratory distress due to upper airway obstruction. The child was operated on at 3 months of age with a combined neurosurgical and endonasal endoscopic-assisted approach. After more than 1-year follow-up, the child has no recurrence and no complications of surgery.
DISCUSSION: This type of teratoma is very rare and surgical morbidity is common. The diagnosis may be apparent before birth, which will facilitate the planning of respiratory management. The combined neurosurgical and otolaryngologic approach for a neonatal teratoma has not previously been described. Using an endoscopic-assisted approach for intranasal tumors removal in neonates and infants is a very rare surgical challenge.
CONCLUSION: Large nasopharyngeal teratomas of infancy with sinonasal and intracranial extension may be managed using a combined endoscopic-assisted endonasal and neurosurgical procedure.

PMID: 26590006 [PubMed - as supplied by publisher]

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Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?

Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?

Int J Oral Maxillofac Surg. 2015 Nov 14;

Authors: Stephens JR, Holmes S, Evans BT

Abstract
The skull base is uniquely placed to absorb anteriorly directed forces imparted either via the midfacial skeleton or cranial vault. A variety of skull base fracture classifications exist. Less well understood, however, is fracture extension beyond the anterior cranial fossa (ACF) into the middle and posterior cranial fossae. The cases of 81 patients from two UK major trauma centres were studied to examine the distribution of fractures across the skull base and any relationship between the vector of force and extent of skull base injury. It was found that predominantly lateral force to the craniofacial skeleton produced a fracture that propagated beyond the ACF into the middle cranial fossa in 77.4% of cases, significantly more (P<0.001) than for predominantly anterior force (12.0%). Fractures were significantly more likely to propagate into the posterior fossa with a lateral vector of impact compared to an anterior vector (P=0.049). This difference in energy transfer across the skull base may, in part, be explained by the local anatomy. The more delicate central ACF acts as a 'crumple zone' in order to absorb force. Conversely, no collapsible interface exists in the lateral aspect of the ACF, thus the lateral ACF behaves like a 'buttress', resulting in increased energy transfer.

PMID: 26589135 [PubMed - as supplied by publisher]

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The MAO-B inhibitor deprenyl reduces the oral tremor and the dopamine depletion induced by the VMAT-2 inhibitor tetrabenazine.

The MAO-B inhibitor deprenyl reduces the oral tremor and the dopamine depletion induced by the VMAT-2 inhibitor tetrabenazine.

Behav Brain Res. 2015 Nov 15;

Authors: Podurgiel SJ, Yohn SE, Dortche K, Correa M, Salamone JD

Abstract
Tetrabenazine (TBZ) is prescribed for the treatment of chorea associated with Huntington's disease. Via inhibition of the vesicular monoamine transporter (VMAT-2), TBZ blocks dopamine (DA) storage and depletes striatal DA; this drug also has been shown to induce Parkinsonian motor side effects in patients. Recently, TBZ was shown to induce tremulous jaw movements (TJMs) in rats and mice. TJMs are an oral tremor that has many of the characteristics of Parkinsonian tremor in humans. The present study focused upon the ability of the well-estabilished anti-Parkinsonian agent deprenyl to attenuate the behavioral and neurochemical effects of 2.0mg/kg TBZ. Deprenyl is a selective and irreversible inhibitor of monoamine oxidase-B, and administration of deprenyl produced a dose-related suppression of TBZ-induced TJMs. A second experiment employed in vivo microdialysis to examine extracellular DA levels in the ventrolateral striatum, the neostriatal region most closely associated with the production of TJMs, after administration of TBZ and deprenyl. Consistent with the behavioral data, TBZ alone produced a biphasic effect on extracellular DA, with an initial increases followed by a prolonged decrease during the period in which TJMs are displayed. Co-administration of deprenyl with TBZ increased DA levels compared to rats treated with TBZ alone. These results provide support for use of TBZ as a rodent model of Parkinsonism, and future studies should utilize this model to evaluate putative anti-Parkinsonian agents.

PMID: 26590367 [PubMed - as supplied by publisher]

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Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Int J Pediatr Otorhinolaryngol. 2015 Nov 4;

Authors: Moreddu E, Pereira J, Vaz R, Lena G, Triglia JM, Nicollas R

Abstract
OBJECTIVES: This study reports a patient with a large teratoma involving the oropharynx, the nasopharynx and the left orbit, with intracranial extension. This case represents one of the first reported instances of such an association. A literature review reporting head and neck teratomas with intracranial involvement is also presented.
CASE REPORT: The authors describe a case of a neonate presenting with a huge teratoma causing respiratory distress due to upper airway obstruction. The child was operated on at 3 months of age with a combined neurosurgical and endonasal endoscopic-assisted approach. After more than 1-year follow-up, the child has no recurrence and no complications of surgery.
DISCUSSION: This type of teratoma is very rare and surgical morbidity is common. The diagnosis may be apparent before birth, which will facilitate the planning of respiratory management. The combined neurosurgical and otolaryngologic approach for a neonatal teratoma has not previously been described. Using an endoscopic-assisted approach for intranasal tumors removal in neonates and infants is a very rare surgical challenge.
CONCLUSION: Large nasopharyngeal teratomas of infancy with sinonasal and intracranial extension may be managed using a combined endoscopic-assisted endonasal and neurosurgical procedure.

PMID: 26590006 [PubMed - as supplied by publisher]

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Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management.

Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management.

Int J Pediatr Otorhinolaryngol. 2015 Nov 5;

Authors: Zanoletti E, Cazzador D, Faccioli C, Sari M, Bovo R, Martini A

Abstract
OBJECTIVES: Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations.
METHODS: At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years.
RESULTS: All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029).
CONCLUSION: LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.

PMID: 26590005 [PubMed - as supplied by publisher]

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Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy.

Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy.

Int J Pediatr Otorhinolaryngol. 2015 Oct 24;

Authors: Oremule B, Johnson M, Sanderson L, Lutz J, Dodd J, Hans P

Abstract
OBJECTIVES: The withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen.
METHODS: A 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (C1, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0-10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups.
RESULTS: More than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (C1=54%, C2C=74%, p=0.003, C2D=84%, p=0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7 (C1 1.6, C2C 3.59, p=0.017, C2D 3.90, p=0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (C1 24%, C2C 7%, p=0.0014, C2D 5%, p=0.0002). There was no difference in measured outcomes between the 2nd cycle groups.
CONCLUSION: This service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less pharmacological intervention when contacting the GP after surgery.

PMID: 26590004 [PubMed - as supplied by publisher]

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Fetal distress and circulatory disturbance in monochorionic twins: Possible risk factors for sialadenitis?

Fetal distress and circulatory disturbance in monochorionic twins: Possible risk factors for sialadenitis?

Int J Pediatr Otorhinolaryngol. 2015 Nov 9;

Authors: Korček P, Straňák Z

Abstract
Neonatal sialadenitis is a rare condition. The vast majority of cases are caused by Staphylococcus aureus with predominant involvement of the parotid gland and need for long-term antimicrobial therapy. We reviewed three distinct cases of submandibular sialadenitis in preterm infants from monochorionic pregnancies. The association with neonatal sialadenitis is unproven. We speculate about the role of fetal distress and circulatory compromise in monochorionic twins as a risk factor in the development of this serious condition.

PMID: 26590003 [PubMed - as supplied by publisher]

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Cochlear sensitivity in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis.

Cochlear sensitivity in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis.

Int J Pediatr Otorhinolaryngol. 2015 Nov 10;

Authors: Renda R, Renda L, Selçuk ÖT, Eyigör H, Yılmaz MD, Osma Ü

Abstract
OBJECTIVES: Auditory system abnormalities commonly occur in patients with chronic renal disease and end-stage renal disease undergoing hemodialysis. The aim of this study was to determine the relationship between cochlear sensitivity and hemodialysis in dialytic and non-dialytic chronic kidney disease patients.
METHODS: The study included children aged 6-18 years that were divided into 3 groups: 36 non-dialytic patients with chronic kidney disease, 16 end-stage renal disease patients undergoing hemodialysis, and 30 healthy controls. Blood urea nitrogen, serum cystatin C levels, duration of chronic kidney disease, and the duration of hemodialysis were compared between the chronic kidney disease patients and end-stage renal disease patients undergoing hemodialysis. Hearing health was measured via tympanometry, pure-tone audiometry and distortion product otoacoustic emissions testing.
RESULTS: Distortion product otoacoustic emission amplitudes and signal-to-noise ratios were significantly lower at all frequencies tested in the non-dialytic and dialytic groups than in the control group (p<0.05). Patients with normal hearing had significantly lower distortion product otoacoustic emission amplitudes and signal-to-noise ratios than the healthy controls (p<0.05). The duration of CKD, the cystatin C level, and the blood urea level were not associated with hearing loss. The present findings suggest that there was a significant association between the duration of HD and hearing loss.
CONCLUSION: The present findings show that there was impaired cochlear function in the dialytic and non-dialytic patient groups, regardless of hearing loss, as compared to the control group. Patients with chronic renal disease-both dialytic and non-dialytic-should be monitored to prevent any further deterioration by avoiding potential ototoxic agents, even if their hearing thresholds are within normal limits.

PMID: 26590002 [PubMed - as supplied by publisher]

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A novel predictive marker for the viscosity of otitis media with effusion.

A novel predictive marker for the viscosity of otitis media with effusion.

Int J Pediatr Otorhinolaryngol. 2015 Nov 5;

Authors: Boztepe OF, Demir M, Gün T, Bilal N, Ensari NA, Doğru H

Abstract
OBJECTIVES: To evaluate the significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the prediction of the viscosity of otitis media with effusion.
METHODS: This retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic.The patients were divided into two groups according to their effusion type, as serous or mucoid, which was defined intraoperatively after myringotomy. The NLR and PLR were calculated as a simple ratio between the absolute neutrophil/platelet and absolute lymphocyte counts.Tympanostomy tube insertion was performed for all cases.Under direct visualization, the effusion was aspirated and classified as serous or mucous.
RESULTS: We postulated that an NLR value of less than 1.38 may show mucoid effusion and if the PLR value is less than 97.96, the effusion is mucoid.
CONCLUSIONS: We speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Additional studies are needed to confirm our results.

PMID: 26590001 [PubMed - as supplied by publisher]

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Primary glottic malignant melanoma of the larynx (PGMML): a very rare entity.

Primary glottic malignant melanoma of the larynx (PGMML): a very rare entity.

BMJ Case Rep. 2015;2015

Authors: Aggarwal S, Kaushal V, Singla S, Sen R

Abstract
Primary glottic malignant melanoma of the larynx (PGMML) is a very rare clinical entity with less than 20 cases reported in the literature so far. The most frequently reported subsite in primary malignant melanomas of the larynx is the supraglottic larynx. The vocal cord as a subsite for primary malignant melanoma is very rare. The present case is a primary glottic malignant melanoma involving both vocal cords. PGMML may present early due to associated hoarseness of voice, unlike other non-cutaneous melanomas in the head and neck. Non-cutaneous malignant melanomas in the head and neck are historically very aggressive in nature and known for poor outcomes and survival. Most non-cutaneous melanomas described in the literature have been superficial spreading or ulcerative in nature, unlike the present case, in which proliferative, polypoidal growth was seen. No associated risk factor was present in this case. Every reported case of this rare entity further adds to the better understanding of tumour biology and expression.

PMID: 26590185 [PubMed - as supplied by publisher]

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Mixed primary squamous cell carcinoma, follicular carcinoma, and micropapillary carcinoma of the thyroid gland: A case report.

Mixed primary squamous cell carcinoma, follicular carcinoma, and micropapillary carcinoma of the thyroid gland: A case report.

Auris Nasus Larynx. 2015 Nov 14;

Authors: Dong S, Song XS, Chen G, Liu J

Abstract
Primary squamous cell carcinoma of the thyroid gland is rare, and mixed squamous cell and follicular carcinoma is even rarer still, with only a few cases reported in the literature. The simultaneous presentation of three primary cancers of the thyroid has not been reported previously. Here we report a case of primary squamous cell carcinoma of the thyroid, follicular thyroid carcinoma, and micropapillary thyroid carcinoma. A 62-year-old female patient presented with complaints of pain and a 2-month history of progressively increased swelling in the anterior region of the neck. Fine-needle-aspiration cytology of both lobes indicated the possibility of the presence of a follicular neoplasm. Total thyroidectomy with left-sided modified radical neck dissection was performed. Postoperative pathological examination confirmed the diagnosis of thyroid follicular carcinoma with squamous cell carcinoma and micropapillary carcinoma of the thyroid. Thyroid-stimulating hormone suppressive therapy with l-thyroxine was administered. Radioiodine and radiotherapy also were recommended, but the patient did not complete treatment as scheduled. The patient remained alive more than 9 months after operation. The present case report provides an example of the coexistence of multiple distinct malignancies in the thyroid.

PMID: 26589365 [PubMed - as supplied by publisher]

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Pseudoadenoid dysplasia in proliferative verrucous leukoplakia.

Pseudoadenoid dysplasia in proliferative verrucous leukoplakia.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 13;

Authors: Ide F, Ito Y, Saito I

PMID: 26589076 [PubMed - as supplied by publisher]

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Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis.

Related Articles

Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis.

Expert Opin Drug Saf. 2015 Nov 19;

Authors: Klimek L, Jean B, David P

Abstract
INTRODUCTION: As a chronic disease, allergic rhinitis (AR) requires regular use of allergy medications for the effective management of symptoms. It is therefore imperative that AR treatments not only provide adequate symptom control, but are also well-tolerated. Area covered: MP29-02 (Dymista, Meda, Solna, Sweden) is the first new class of AR medication (WHO ATC R01AD58) since the introduction of intranasal corticosteroids (INS) almost 50 years ago. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray. Here we review all the safety information relevant to MP29-02, from the initial Phase I bioavailability and disposition data, to the Phase III 14-day and 52-week data, to Phase IV safety data collected during MP29-02 use in routine clinical practice. Expert Opinion: MP29-02 is the first real therapeutic advance in AR since the introduction of INS and has the potential to change the way this disease is managed, simplifying AR treatment regimens to a single puff in each nostril twice a day. Patients will benefit from superior symptom relief MP29-02 compared to INS with the added assurance that the safety of MP29-02 has been confirmed in the short- and long-term as well as in real life.

PMID: 26581312 [PubMed - as supplied by publisher]

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Processing complex pseudo-words in mild cognitive impairment: The interaction of preserved morphological rule knowledge with compromised cognitive ability.

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Processing complex pseudo-words in mild cognitive impairment: The interaction of preserved morphological rule knowledge with compromised cognitive ability.

Clin Linguist Phon. 2015 Nov 20;:1-19

Authors: Manouilidou C, Dolenc B, Marvin T, Pirtošek Z

Abstract
Mild cognitive impairment (MCI) affects the cognitive performance of elderly adults. However, the level of severity is not high enough to be diagnosed with dementia. Previous research reports subtle language impairments in individuals with MCI specifically in domains related to lexical meaning. The present study used both off-line (grammaticality judgment) and on-line (lexical decision) tasks to examine aspects of lexical processing and how they are affected by MCI. 21 healthy older adults and 23 individuals with MCI saw complex pseudo-words that violated various principles of word formation in Slovenian and decided if each letter string was an actual word of their language. The pseudo-words ranged in their degree of violability. A task effect was found, with MCI performance to be similar to that of healthy controls in the off-line task but different in the on-line task. Overall, the MCI group responded slower than the elderly controls. No significant differences were observed in the off-line task, while the on-line task revealed a main effect of Violation type, a main effect of Group and a significant Violation × Group interaction reflecting a difficulty for the MCI group to process pseudo-words in real time. That is, while individuals with MCI seem to preserve morphological rule knowledge, they experience additional difficulties while processing complex pseudo-words. This was attributed to an executive dysfunction associated with MCI that delays the recognition of ungrammatical formations.

PMID: 26588013 [PubMed - as supplied by publisher]

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Methods for quantifying tongue shape and complexity using ultrasound imaging.

Related Articles

Methods for quantifying tongue shape and complexity using ultrasound imaging.

Clin Linguist Phon. 2015 Nov 20;:1-17

Authors: Dawson KM, Tiede MK, Whalen DH

Abstract
Quantification of tongue shape is potentially useful for indexing articulatory strategies arising from intervention, therapy and development. Tongue shape complexity is a parameter that can be used to reflect regional functional independence of the tongue musculature. This paper considers three different shape quantification methods - based on Procrustes analysis, curvature inflections and Fourier coefficients - and uses a linear discriminant analysis to test how well each method is able to classify tongue shapes from different phonemes. Test data are taken from six native speakers of American English producing 15 phoneme types. Results classify tongue shapes accurately when combined across quantification methods. These methods hold promise for extending the use of ultrasound in clinical assessments of speech deficits.

PMID: 26587871 [PubMed - as supplied by publisher]

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Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center.

Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center.

Acta Otolaryngol. 2015 Nov 20;:1-6

Authors: Iglesias-Moreno MC, López-Salcedo MA, Gómez-Serrano M, Gimeno-Hernández J, Poch-Broto J

Abstract
CONCLUSIONS: Pre-operative planning for parapharyngeal tumors must include meticulous analysis. Factors such as tumor size, distance to cranial base, and relation to neurovascular structures must guide the selection of a surgical approach.
OBJECTIVE: To summarize experience in diagnosis and surgical management of parapharyngeal tumors, analyzing the frequencies of various tumoral types, clinical presentation, choice of surgical approach and outcomes. This study also compares the results with the most relevant case series in the literature.
METHODS: A retrospective review was performed of the records of 51 patients treated by the team, from 1984-2012. Only primary tumors were included, excluding invasion from adjacent spaces and metastatic disease. All patients underwent imaging studies and surgical resection of the neoplasm. Cytological analysis and arteriography were used on an individualized basis. Surgical excision was performed via different approaches, predominantly through a cervicoparotid route.
RESULTS: Benign neoplasms were predominant (80%), and the most frequent tumor was pleomorphic adenoma. FNAC had a 100% accuracy to differentiate benign vs malignant tumors. The most common post-operative sequel was compromise of a cranial nerve, and three patients presented local complications after surgery. After follow-up, only three of 41 patients with benign tumors had recurring disease.

PMID: 26588771 [PubMed - as supplied by publisher]

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A correlation analysis between HDAC1 over-expression and clinical features of laryngeal squamous cell carcinoma.

A correlation analysis between HDAC1 over-expression and clinical features of laryngeal squamous cell carcinoma.

Acta Otolaryngol. 2015 Nov 20;:1-5

Authors: Zhao R, Chen K, Cao J, Yu H, Tian L, Liu M

Abstract
CONCLUSION: HDAC1 may be a prognostic biomarker for LSCC malignant potency and a potent factor resulting in decreased sensitivity of LSCC in radiotherapy.
OBJECTIVE: The aim of this study was to evaluate the correlation between histone deacetylase 1 (HDAC1) over-expression and clinical features in laryngeal squamous cell carcinoma (LSCC).
METHODS: This study assessed the HDAC1 expressions in 90 formalin-fixed paraffin-embedded LSCC samples, 30 adjacent non-neoplastic tissues, and 30 laryngeal polyp tissues by immunohistochemistry (IHC). In addition, another 40 LSCC samples were collected that were divided into two groups after 3-month radiotherapy: the high radio-sensitive group (HRS) and low radio-sensitive group (LRS). Overall survival curves of all the LSCC patients were constructed by Kaplan-Meier method and long-rank test.
RESULTS: All ninety samples were positively immunostained for HDAC1. The expression of HDAC1 was up-regulated and significantly associated with T classification, lymph node metastases, tumor location and clinical stage. HDAC1 was mainly labeled in the epithelial cells of laryngeal polyp tissues and adjacent non-neoplastic tissues. In addition, the expression of HDAC1 was significantly higher in LRS than that in HRS. The positive rates for stage III-IV tumor were significantly higher than those for stage II. LSCC patients with HDAC1 over-expression and LRS presented a shorter 5-year overall survival rate.

PMID: 26588579 [PubMed - as supplied by publisher]

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The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss.

The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss.

Acta Otolaryngol. 2015 Nov 20;:1-7

Authors: Niu X, Zhang Y, Zhang Q, Xu X, Han P, Cheng Y, Gao Y, Zhang R, Yang Y, Chen Z, Hu J, Chen Y, Xu M

Abstract
OBJECTIVE: To investigate the relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss (SSHL).
METHODS: Clinical data including the symptom of vertigo of 149 SSHL patients were investigated retrospectively. Pure tone audiometry, ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) evoked by air-conducted sound (ACS), and caloric test were employed for cochlear and vestibular function assessment. The relationship between hearing level and vestibular dysfunction was analyzed.
RESULTS: The pure tone averages (PTAs) (mean ± SD) of SSHL patients with and without vertigo were 88.81 ± 21.74 dB HL and 72.49 ± 21.88 dB HL (Z = -4.411, p = 0.000), respectively. The PTAs of SSHL patients with abnormal and normal caloric test were 84.71 ± 22.54 dB HL and 70.41 ± 24.07 dB HL (t = -2.665, p = 0.009), respectively. Conversely, vertigo and abnormal caloric results also happened more frequently in patients with profound hearing loss. However, no consistent tendency could be found among vestibular evoked myogenic potentials (VEMPs) responses or hearing loss.
CONCLUSIONS: SSHL patients with vertigo or abnormal caloric test displayed worse hearing loss; and vice versa, vertigo and abnormal caloric results happened more frequently in SSHL patients with profound hearing loss.

PMID: 26587580 [PubMed - as supplied by publisher]

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Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

J Neurosurg Spine. 2015 Nov 20;:1-5

Authors: Bonow RH, Bales JW, Morton RP, Levitt MR, Zhang F

Abstract
Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

PMID: 26588496 [PubMed - as supplied by publisher]

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Cancer stem cells in laryngeal cancer: what we know.

Cancer stem cells in laryngeal cancer: what we know.

Eur Arch Otorhinolaryngol. 2015 Nov 19;

Authors: Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Pagliuca G, Martellucci S, Turchetta R, De Vincentiis M

Abstract
Cancer stem cells (CSCs) are a group of cells with eternal life or infinite self-renewal ability, which have high migrating, infiltrative, and metastatic abilities. Though CSCs only account for a small proportion in tumors, the high resistance to traditional therapy exempts them from therapy killing and thus they can reconstruct tumors. Previous studies found that heterogeneity of cancer cells extensively exists in head and neck cancers. Our current knowledge, about CSCs in the laryngeal cancer (LC), largely depends on head and neck studies. Given the lack of systematic data about CSCs in LC, we propose a review of the literature, reporting the evidences of CSCs in tumorigenesis of LC, with the purpose to provide new insights into the prevention and/or treatment of laryngeal carcinoma.

PMID: 26585332 [PubMed - as supplied by publisher]

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[Thyroidectomy performed under local anesthesia at the University Hospital of Antananarivo].

[Thyroidectomy performed under local anesthesia at the University Hospital of Antananarivo].

Pan Afr Med J. 2015;21:278

Authors: Razafindrakoto RM, Razafindranaivo MN, Valisoa HA, Schammirah MR, Randriamboavonjy R

PMID: 26587128 [PubMed - as supplied by publisher]

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Speech task effects on acoustic measure of fundamental frequency in Cantonese-speaking children.

Speech task effects on acoustic measure of fundamental frequency in Cantonese-speaking children.

Int J Pediatr Otorhinolaryngol. 2015 Nov 3;

Authors: Ma EP, Lam NL

Abstract
OBJECTIVES: Speaking fundamental frequency (F0) is a voice measure frequently used to document changes in vocal performance over time. Knowing the intra-subject variability of speaking F0 has implications on its clinical usefulness. The present study examined the speaking F0 elicited from three speech tasks in Cantonese-speaking children. The study also compared the variability of speaking F0 elicited from different speech tasks.
METHODS: Fifty-six vocally healthy Cantonese-speaking children (31 boys and 25 girls) aged between 7.0 and 10.11 years participated. For each child, speaking F0 was elicited using speech tasks at three linguistic levels (sustained vowel /a/ prolongation, reading aloud a sentence and passage). Two types of variability, within-session (trial-to-trial) and across-session (test-retest) variability, were compared across speech tasks.
RESULTS AND CONCLUSIONS: Significant differences in mean speaking F0 values were found between speech tasks. Mean speaking F0 value elicited from sustained vowel phonations was significantly higher than those elicited from the connected speech tasks. The variability of speaking F0 was higher in sustained vowel prolongation than that in connected speech.

PMID: 26586246 [PubMed - as supplied by publisher]

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Polymorphic variants near 1p22 and 20q11.2 loci and the risk of non-syndromic cleft lip and palate in South Indian population.

Polymorphic variants near 1p22 and 20q11.2 loci and the risk of non-syndromic cleft lip and palate in South Indian population.

Int J Pediatr Otorhinolaryngol. 2015 Nov 4;

Authors: Babu Gurramkonda V, Hussain Syed A, Murthy J, Chaubey G, Bhaskar Lakkakula VK

Abstract
BACKGROUND: Recent genome-wide association studies (GWAS) have reported multiple genetic risk loci for non-syndromic orofacial clefts (NSOFCs) in many populations. However, the contribution of these loci to NSOFC in India, which comprises one-fifth of the global population, is completely lacking. Our aim was to replicate the association of the SNPs located on 1p22 chromosomal loci (rs540026, rs481931) and 20q11.2 (rs13041247, rs11696257) in the aetiology of NSOFCs, in South Indian populations.
METHODS: The SNPs were genotyped by using KBiosciences KASPar SNP genotyping chemistry in 173 cases and 176 controls for NSOFCs in South India. To estimate the association between these SNPs and NSOFCs, chi-square test was adopted. Odds ratios (OR) with 95% confidence intervals (CI) were also calculated in order to assess the risk.
RESULTS: Single nucleotide polymorphisms located at chromosomal region 1p22 are not found to be associated with cleft lip with or without non-syndromic cleft palate (NSCL/P) and non-syndromic cleft palate only (NSCPO) at either the genotype or allele levels. Further, there is no LD observed between these variants. The polymorphic variants near 20q11.2 (rs13041247, rs11696257) are in complete linkage disequilibrium (LD) and are significantly associated with only NSCL/P in genotypic (p=0.013) and allelic models (p=0.029). In the genotypic model significance persisted even after Bonferroni correction (p<0.016).
CONCLUSION: These results suggest that 20q11.2 SNPs could play a contributory role in the pathophysiology and risk of NSCL/P, while the variations in 1p22 do not underlie the pathophysiology of NSOFCs in South Indian populations.

PMID: 26586245 [PubMed - as supplied by publisher]

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Investigation of pepsin in tears of children with laryngopharyngeal reflux disease.

Investigation of pepsin in tears of children with laryngopharyngeal reflux disease.

Int J Pediatr Otorhinolaryngol. 2015 Oct 30;

Authors: Iannella G, Di Nardo G, Plateroti R, Rossi P, Plateroti AM, Mariani P, Magliulo G

Abstract
OBJECTIVES: Numerous investigations postulated that laryngopharyngeal reflux (LPR) is implicated in the pathogenesis of various upper airway inflammatory diseases as sinusitis or dacryostenosis. The presence of pepsin in tears might be confirmed the presuntive hypothesis of the arrival in the nasolacrimal ducts and precorneal tears film through the laryngopharyngeal reflux of either gastric acid or stomach secretions (pepsin) with inflammatory potentialities. The aim of this preliminary study was to identify the presence or absence of pepsin in the tears collected from children with a high suspicion of LPR who underwent 24-h pH (MII-pH) monitoring to confirm the disease.
METHODS: This study enrolled 20 patients suffering from symptoms of laryngopharyngeal reflux that underwent 24-h multichannel intraluminal impedance (MII)-pH monitoring to confirm the disease. The findings of the study group were compared with those of a control group of patients with negative pH monitoring. The quantitative analysis of human pepsin concentration in the tear samples was performed by ELISA method in both groups.
RESULTS: Four children (20%) of the study group showed pepsin in the tears. All of the subjects belonging to the control group were negative for its presence. No difference differences in the total number of reflux episodes and the number of weakly basic reflux in the pepsin positive patients vs. pepsin negative children were present.
CONCLUSIONS: 20% of the children with diagnosed LPR showed pepsin in the tears. Our specific investigation might provide information regarding sinusitis or dacryostenosis.

PMID: 26586244 [PubMed - as supplied by publisher]

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Rabbit model of tracheal stenosis induced by prolonged endotracheal intubation using a segmented tube.

Rabbit model of tracheal stenosis induced by prolonged endotracheal intubation using a segmented tube.

Int J Pediatr Otorhinolaryngol. 2015 Nov 3;

Authors: Lee HS, Kim SW, Oak C, Ahn YC, Kang HW, Chun BK, Lee KD

Abstract
OBJECTIVE: Animal model of tracheal stenosis based on pathophysiology of prolonged endotracheal intubation has been rarely reported. We sought to verify the feasibility of inducing an animal model of tracheal stenosis by segmented endotracheal tube insertion in the New Zealand white rabbit model.
METHODS: Tracheal stenosis was induced by inserting a segmented endotracheal tube of 1.5cm length which was wrapped with a commercialized absorbable hemostat in 15 New Zealand white rabbits, while sham surgery controls (n=3) underwent tracheotomy and direct closure of tracheal exposure. The tube was removed transorally, 1 week after tube insertion. All rabbits were evaluated endoscopically at 1 week, 2 weeks and 3 weeks after the tube insertion. The rabbits were sacrificed 3 weeks after the surgery, and the excised tissue of trachea was processed along with the procedure of standard hematoxylin eosin staining and observed under a microscope.
RESULTS: Tracheal stenosis was induced in all rabbits (range 32-84% stenosis) with no death of rabbits during the study. The histological features of tracheal stenosis demonstrated thickening and fibrosis of lamina propria and submucosa with relatively intact cartilage framework.
CONCLUSIONS: We developed a rabbit model of tracheal stenosis induced by endotracheal intubation using a segmented tracheal tube. Since the model is based on the physiologic condition of prolonged endotracheal intubation, it may be used in variable studies related to tracheal stenosis.

PMID: 26586243 [PubMed - as supplied by publisher]

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[On the Differential Diagnosis of Intractable Psychogenic Chronic Cough: Neuropathic Larynx Irritable - Gabapentin's Antitussive Action].

[On the Differential Diagnosis of Intractable Psychogenic Chronic Cough: Neuropathic Larynx Irritable - Gabapentin's Antitussive Action].

Fortschr Neurol Psychiatr. 2015 Oct;83(10):568-577

Authors: Bonnet U, Ossowski A, Schubert M, Gall H, Steinkamp I, Richter LE, Khalil-Boutros Y, Nefedev A, Kuhlmann R

Abstract
We present the case of a 76 year old female inpatient who suffered from a chronic intractable cough which arose simultaneously to a severe major depression and was secondary to an exorbitant psychological distress. Chronic cough had never been experienced before and was initially considered to have a mere psychogenic origin since a comprehensive and guideline-based diagnostic screening did not reveal any underlying somatic cause. However, several factors cast doubt on the solitary psychic genesis of the chronic cough: i) occurrence immediately after a penetrant cold, ii) embedding in other complaints of laryngeal hyperreagibility (larynx irritable), such as persistent globus pharyngeus sensation, throat clearing and episodic dysphonia, iii) first occurrence on old life, iv) erupting from sleep as well, v) persistence despite remission of the major depression, and v) no sustaining benefit from specific psychotherapy and speech therapy. Therefore, diagnostics were extended to apparative tools for objective evaluation of swallowing by using fiberoptic videoendoscopic (FEES) and videofluoroscopic (VFS) techniques, which revealed signs of laryngeal neuropathy but without evidence of penetration or aspiration. A co-existing small goiter and an impaired glucose tolerance along with a putative intracellular vitamin B12 or folate deficiency (as indirectly derived from an apparent hyperhomocysteinemia) were assumed to be responsible for the neuropathy and underwent specific treatments. The impaired glucose tolerance and putative vitamin deficit were compatible with a distal symmetric sensorimotoric, even subclinical polyneuropathy of the lower extremities. The larynx irritable improved under gabapentin being confirmed by drug removals several times, and finally calmed down almost completely under gabapentin, which was in line with the scant literature of this topic. Re-examination of the larynx per FEES nine months later showed no deficits any more under the well-tolerated treatment (gabapentin, levothyroxine, vitamin B12 and folic acid substitution, weight reduction and physical training). All in all, the larynx irritable as well as the chronic cough were most probably induced by a laryngeal neuropathy and were not solely of psychic origin. Due to good treatment options a larynx irritable should be regularly taken into consideration of the investigation of intractable chronic cough. Therefore, an apparative evaluation of deglutition is recommended in the diagnostic toolbox of chronic cough - even if embedded in a psychiatric disorder or distress - before diagnosing a sole psychic origin. An hypothetical scheme of the development of a larynx irritable caused by neuropathic and non-neuropathic ("nociceptive") conditions is proposed.

PMID: 26588720 [PubMed - as supplied by publisher]

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Familial Sulcus Vergeture: Further Evidence for Congenital Origin of Type 2 Sulcus.

Familial Sulcus Vergeture: Further Evidence for Congenital Origin of Type 2 Sulcus.

J Voice. 2015 Nov 13;

Authors: Husain S, Sulica L

Abstract
A 29-year-old otherwise healthy woman presented with a lifetime history of hoarseness because it had begun to interfere with her career. Examination of both the woman and her 60-year-old father revealed bilateral sulcus vergeture, without inflammation or lesions attributable to phonotrauma. The woman responded well to injection augmentation; the father declined treatment. Combined with existing descriptions of other family groupings, all with sulcus vergeture without signs of inflammation, clinical progression, and little or no apparent behavioral component, this report further suggests that sulcus vergeture (Ford type 2) and sulcus vocalis (Ford type 3) are entirely different entities, despite architectural similarity.

PMID: 26584518 [PubMed - as supplied by publisher]

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Pathology of Tinnitus and Hyperacusis-Clinical Implications.

Pathology of Tinnitus and Hyperacusis-Clinical Implications.

Biomed Res Int. 2015;2015:608437

Authors: Moller AR, Salvi R, De Ridder D, Kleinjung T, Vanneste S

PMID: 26587541 [PubMed - as supplied by publisher]

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Effects of Noise Exposure on Development of Tinnitus and Hyperacusis: Prevalence rates 12 months after exposure in Middle-Aged Rats.

Effects of Noise Exposure on Development of Tinnitus and Hyperacusis: Prevalence rates 12 months after exposure in Middle-Aged Rats.

Hear Res. 2015 Nov 13;

Authors: Turner JG, Larsen D

Abstract
Fischer Brown Norway (FBN) rats (n=233) were unilaterally exposed to 12 different combinations of noise intensity, duration, and spectrum, while 46 rats served as sham-exposed controls. Rats were behaviorally tested for tinnitus and hyperacusis using gap-induced inhibition of the acoustic startle reflex (Gap) and prepulse inhibition (PPI) using 60-dB SPL before noise-exposure and at regular intervals for 12 mo. 12-mo after noise exposure the middle-aged rats were then tested again for tinnitus and hyperacusis before collecting Auditory Brainstem Response (ABR) thresholds. Collapsing across all noise exposure conditions a significant tinnitus-like deficit in responding to silent gaps was observed, with the most likely tinnitus pitch around 16 kHz. Rates of tinnitus 12-mo after noise exposure were greatest in groups receiving the four least intense noise doses (110-dB for 30, 60 and 120 mins, and 116-dB for 30 min), while some of the greatest rates of hyperacusis occurred in groups receiving more intense or longer exposures. The results suggest that rates for developing tinnitus in animal models may not be easily predicted based upon noise exposure dose, but that low-to-moderate noise exposures may result in the greatest likelihood for producing tinnitus.

PMID: 26584761 [PubMed - as supplied by publisher]

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Whole scalp resting state EEG of oscillatory brain activity shows no parametric relationship with psychoacoustic and psychosocial assessment of tinnitus: a repeated measures study.

Whole scalp resting state EEG of oscillatory brain activity shows no parametric relationship with psychoacoustic and psychosocial assessment of tinnitus: a repeated measures study.

Hear Res. 2015 Nov 13;

Authors: Pierzycki RH, McNamara AJ, Hoare DJ, Hall DA

Abstract
Tinnitus is a perception of sound that can occur in the absence of an external stimulus. A brief review of electroencephalography (EEG) and magnetoencephalography (MEG) literature demonstrates that there is no clear relationship between tinnitus presence and frequency band power in whole scalp or source oscillatory activity. Yet a preconception persists that such a relationship exists and that resting state EEG could be utilised as an outcome measure for clinical trials of tinnitus interventions, e.g. as a neurophysiological marker of therapeutic benefit. To address this issue, we first examined the test-retest correlation of EEG band power measures in tinnitus patients (n = 42). Second we examined the evidence for a parametric relationship between numerous commonly used tinnitus variables (psychoacoustic and psychosocial) and whole scalp EEG power spectra, directly and after applying factor reduction techniques. Test-retest correlation for both EEG band power measures and tinnitus variables were high. Yet we found no relationship between whole scalp EEG band powers and psychoacoustic or psychosocial variables. We conclude from these data that resting state whole scalp EEG should not be used as a biomarker for tinnitus and that greater caution should be exercised in regard to reporting of findings to avoid confirmation bias. The data was collected during a randomised controlled trial registered at ClinicalTrials.gov (Identifier: NCT01541969).

PMID: 26584760 [PubMed - as supplied by publisher]

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The impact of tinnitus characteristics and associated variables on tinnitus-related handicap.

The impact of tinnitus characteristics and associated variables on tinnitus-related handicap.

J Laryngol Otol. 2015 Nov 20;:1-7

Authors: Degeest S, Corthals P, Dhooge I, Keppler H

Abstract
OBJECTIVE: This study aimed to determine the characteristics of tinnitus and tinnitus-related variables and explore their possible relationship with tinnitus-related handicap.
METHODS: Eighty-one patients with chronic tinnitus were included. The study protocol measured hearing status, tinnitus pitch, loudness, maskability and loudness discomfort levels. All patients filled in the Tinnitus Sample Case History Questionnaire, the Hyperacusis Questionnaire and the Tinnitus Handicap Inventory. The relationship of each variable with the Tinnitus Handicap Inventory score was evaluated by univariate and multivariate analyses.
RESULTS: Five univariables were associated with the Tinnitus Handicap Inventory score: loudness discomfort level, subjective tinnitus loudness, tinnitus awareness, noise intolerance and Hyperacusis Questionnaire score. Multiple regression analysis showed that the Hyperacusis Questionnaire score and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score.
CONCLUSION: Hyperacusis and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score. Questionnaires on tinnitus and hyperacusis are especially suited to providing additional insight into tinnitus-related handicap and are therefore useful for evaluating tinnitus patients.

PMID: 26584711 [PubMed - as supplied by publisher]

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A Double-Blind Placebo-Controlled Trial of Liquid Thyroxine Ingested at Breakfast: Results of the TICO study.

A Double-Blind Placebo-Controlled Trial of Liquid Thyroxine Ingested at Breakfast: Results of the TICO study.

Thyroid. 2015 Nov 20;

Authors: Cappelli C, Pirola I, Daffini L, Formenti A, Iacobello C, Cristiano A, Gandossi E, Agabiti Rosei E, Castellano M

Abstract
BACKGROUND: Levothyroxine (L-T4) is the recommended treatment for millions of hypothyroid patients. Current guidelines recommend that L-T4 tablets be taken in a fasting state, but inability to adhere to this often leads to poor therapy compliance.
METHODS: We conducted a randomized, double-blind, placebo-controlled, crossover trial in previously untreated hypothyroid patients randomly assigned to receive an oral solution of L-T4 either at least 30 minutes before breakfast or directly at breakfast time. Each patient completed two 6-week treatment periods, with different timing of active L-T4 administration: placebo before breakfast and active L-T4 at breakfast, or vice versa. At the end of each period, TSH, fT4 and fT3 were measured. The primary endpoint was to verify any difference in serum TSH levels whether consuming liquid L-T4 at breakfast or 30 minutes prior to breakfast.
RESULTS: A total of 77 patients (64/13 female/male, median age 45.4 ±13.7) completed the study. No statistically significant difference of serum TSH, fT4 and fT3 levels was observed whether L-T4 was taken at breakfast or 30 minutes before, in a fasting state. No significant effect from the sequence of regimens, breakfast composition and/or concomitantly administered drugs was observed on the dose of L-T4 administered, or on the post-treatment serum TSH values.
CONCLUSIONS: The TICO study suggests that a liquid L-T4 formulation can be ingested directly at breakfast, thus potentially improving therapeutic compliance. This observation is of considerable clinical relevance, since non-adherence to L-T4therapy requirements is more likely to cause variability in serum TSH concentrations.

PMID: 26586610 [PubMed - as supplied by publisher]

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EFFECTS OF MATERNAL IODINE NUTRITION AND THYROID STATUS ON COGNITIVE DEVELOPMENT IN OFFSPRING: A PILOT STUDY.

EFFECTS OF MATERNAL IODINE NUTRITION AND THYROID STATUS ON COGNITIVE DEVELOPMENT IN OFFSPRING: A PILOT STUDY.

Thyroid. 2015 Nov 20;

Authors: Moleti M, Trimarchi F, Tortorella G, Candia Longo A, Giorgianni GM, Sturniolo G, Alibrandi A, Vermiglio F

Abstract
BACKGROUND AND OBJECTIVE: Maternal iodine nutrition and thyroid status may influence neurocognitive development in offspring. This study investigated the effects on the Intelligence Quotient (IQ) of children born to mothers with different levels of iodine supplementation, with or without the administration of levothyroxine (LT4), prior to and during pregnancy .
PATIENTS AND METHODS: This pilot, prospective, observational study included four study groups, each comprising 15 mother-child pairs, identified on the basis of maternal histories of iodized salt consumption and LT4 treatment prior to and during pregnancy. The groups were labeled as follows: iodine (I), no-iodine (no-I), iodine+LT4 (I+T4), and no-iodine+LT4 (no-I+T4). IQ tests were administered to children at age 6-12 years with the Wechsler Intelligence Scale for Children-3rd-Edition (WISC-III) and full-scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ) being evaluated.
RESULTS: Children of I and I+T4 mothers had similar verbal, performance, and FSIQs, which were 14, 10, and 13 points higher, respectively, than children born to no-I and no I+T4 mothers. A positive association was found between VIQ and maternal urinary iodine [() = 1.023, 95% CI 1.003-1.043; p = 0.028], but not with maternal free -thyroxine (FT4) concentrations at any stage of pregnancy. Overall, the prevalence of borderline or defective cognitive function was more than 3-fold higher in the children of unsupplemented mothers than of supplemented mothers (76.9% vs. 23.1%, OR 7.667, 95%CI 2.365-24.856, χ2 = 12.65; p = 0.0001).
CONCLUSIONS: Neuro-intellectual outcomes in children appear to be more dependent on their mothers' nutritional iodine status than on maternal thyroid function. These results support the growing body of evidence that prenatal, mild-to-moderate iodine deficiency adversely affects cognitive development later in life, with a seemingly greater impact on verbal abilities.

PMID: 26586553 [PubMed - as supplied by publisher]

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[Caloric irrigation of the vestibular organ using near infrared: A device for use in clinical practice].

[Caloric irrigation of the vestibular organ using near infrared: A device for use in clinical practice].

Laryngorhinootologie. 2015 Nov;94(11):735-737

Authors: Walther LE

PMID: 26587672 [PubMed - as supplied by publisher]

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Natural and surgical history of Chiari malformation Type I in the pediatric population.

Natural and surgical history of Chiari malformation Type I in the pediatric population.

J Neurosurg Pediatr. 2015 Nov 20;:1-10

Authors: Pomeraniec IJ, Ksendzovsky A, Awad AJ, Fezeu F, Jane JA

Abstract
OBJECT The natural and surgical history of Chiari malformation Type I (CM-I) in pediatric patients is currently not well described. In this study the authors discuss the clinical and radiological presentation and outcomes in a large cohort of pediatric CM-I patients treated with either conservative or surgical management. METHODS The authors retrospectively reviewed 95 cases involving pediatric patients with CM-I who presented between 2004 and 2013. The patients ranged in age from 9 months to 18 years (mean 8 years) at presentation. The cohort was evenly split between the sexes. Twenty-five patients underwent posterior fossa decompression (PFD) with either dural splitting or duraplasty. Seventy patients were managed without surgery. Patients were followed radiologically (mean 44.8 months, range 1.2-196.6 months) and clinically (mean 66.3 months, range 1.2-106.5 months). RESULTS Seventy patients were treated conservatively and followed with serial outpatient neurological and radiological examinations, whereas 25 patients were treated with PFD. Of these 25 surgical patients, 11 were treated with duraplasty (complete dural opening) and 14 were treated with a dura-splitting technique (incomplete dural opening). Surgical intervention was associated with better clinical resolution of symptoms and radiological resolution of tonsillar ectopia and syringomyelia (p = 0.0392). Over the course of follow-up, 20 (41.7%) of 48 nonsurgical patients who were symptomatic at presentation experienced improvement in symptoms and 18 (75%) of 24 symptomatic surgical patients showed clinical improvement (p = 0.0117). There was no statistically significant difference in resolution of symptoms between duraplasty and dura-splitting techniques (p = 0.3572) or between patients who underwent tonsillectomy and tonsillopexy (p = 0.1667). Neither of the 2 patients in the conservative group with syrinx at presentation showed radiological evidence of resolution of the syrinx, whereas 14 (87.5%) of 16 patients treated with surgery showed improvement or complete resolution of syringomyelia (p = 0.0392). In the nonsurgical cohort, 3 patients (4.3%) developed new or increased syrinx. CONCLUSIONS The overwhelming majority of CM-I patients (92.9%) managed conservatively do not experience clinical or radiological progression, and a sizeable minority (41.7%) of those who present with symptoms improve. However, appropriately selected symptomatic patients (sleep apnea and dysphagia) and those presenting with syringomyelia should be considered surgical candidates because of the high rates of clinical (75%) and radiological improvement (87.5%).

PMID: 26588459 [PubMed - as supplied by publisher]

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Conceiving a national head and neck cancer screening programme.

Conceiving a national head and neck cancer screening programme.

J Laryngol Otol. 2015 Nov 20;:1-7

Authors: Gogarty DS, Shuman A, O'Sullivan EM, Sheahan P, Kinsella J, Timon C, O'Neill JP

Abstract
BACKGROUND: This study was undertaken to determine the optimum approach to screening for head and neck cancer based on international experiences.
OBJECTIVE: To determine whether or not head and neck cancer is suitable for screening, and, if so, what the ideal approach should be.
METHODS: An electronic search of online databases up to and including May 2014 was conducted. Key search terms included 'head and neck', 'cancer', 'screening', 'larynx', 'oropharynx' and 'oral'.
RESULTS: Subset analysis of high-risk cohorts showed statistically significant improvements in early detection of head and neck cancer via screening.
CONCLUSION: Current levels of public awareness regarding head and neck cancers are suboptimal, despite increased incidence and mortality. Scheduled and opportunistic screening, coupled with efforts to enhance education and health behaviour modification, are highly recommended for pre-defined, high-risk, targeted populations. This can enable early detection and therefore improve morbidity and mortality.

PMID: 26585180 [PubMed - as supplied by publisher]

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Top-cited articles of the last 30 years (1985-2014) in otolaryngology - head and neck surgery.

Top-cited articles of the last 30 years (1985-2014) in otolaryngology - head and neck surgery.

J Laryngol Otol. 2015 Nov 20;:1-7

Authors: Lenzi R, Fortunato S, Muscatello L

Abstract
BACKGROUND: The frequency with which a scientific article is cited by other studies is one way to measure its academic influence.
METHODS: A comprehensive search was performed to identify journal articles in the otorhinolaryngology subject category of the 2013 Journal Citation Report Science Edition over the last 30 years (1985-2014). The 100 most cited articles were reviewed and basic information including the publication year, country of origin, source journal, article type and research field was collected.
RESULTS: The 100 most cited articles were published in 15 of the 44 otorhinolaryngology journals. The number of citations per article ranged between 208 and 1559. The leading research field was otology and neurotology (n = 50), followed by rhinology (n = 23) and head and neck surgery (n = 11). Most papers originated in the USA (n = 64).
CONCLUSION: The possibility of an article being cited is influenced by the publication language, country of origin and source journal.

PMID: 26584956 [PubMed - as supplied by publisher]

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The great mimicker: a rare case of head and neck inflammatory pseudotumour in the presence of human immunodeficiency virus.

The great mimicker: a rare case of head and neck inflammatory pseudotumour in the presence of human immunodeficiency virus.

J Laryngol Otol. 2015 Nov 20;:1-4

Authors: Ramotar H, Cheung L, Pitkin L

Abstract
BACKGROUND: Inflammatory pseudotumours of the head and neck are rare. A connection has been made between inflammatory pseudotumours and human immunodeficiency virus positivity.
CASE REPORT: This paper reports a case of an inflammatory pseudotumour presenting with a lesion in the left tonsil and left cervical lymph node in a 49-year-old human immunodeficiency virus positive patient. A histological diagnosis was obtained after biopsy and serial radiological imaging.
CONCLUSION: Diagnostic uncertainties can lead to unnecessary surgery. It is important to recognise the clinical, radiological and histological indicators of an inflammatory pseudotumour to enable a timely diagnosis and arrange appropriate treatment. In patients with co-morbidities causing immunocompromise, the potential diagnosis of an inflammatory pseudotumour should be considered. This is especially the case in human immunodeficiency virus patients, as inflammatory pseudotumours have been associated with immune reconstitution inflammatory syndrome, which can manifest up to several years after the initiation of, or change in, antiretroviral therapies.

PMID: 26584834 [PubMed - as supplied by publisher]

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The impact of tinnitus characteristics and associated variables on tinnitus-related handicap.

The impact of tinnitus characteristics and associated variables on tinnitus-related handicap.

J Laryngol Otol. 2015 Nov 20;:1-7

Authors: Degeest S, Corthals P, Dhooge I, Keppler H

Abstract
OBJECTIVE: This study aimed to determine the characteristics of tinnitus and tinnitus-related variables and explore their possible relationship with tinnitus-related handicap.
METHODS: Eighty-one patients with chronic tinnitus were included. The study protocol measured hearing status, tinnitus pitch, loudness, maskability and loudness discomfort levels. All patients filled in the Tinnitus Sample Case History Questionnaire, the Hyperacusis Questionnaire and the Tinnitus Handicap Inventory. The relationship of each variable with the Tinnitus Handicap Inventory score was evaluated by univariate and multivariate analyses.
RESULTS: Five univariables were associated with the Tinnitus Handicap Inventory score: loudness discomfort level, subjective tinnitus loudness, tinnitus awareness, noise intolerance and Hyperacusis Questionnaire score. Multiple regression analysis showed that the Hyperacusis Questionnaire score and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score.
CONCLUSION: Hyperacusis and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score. Questionnaires on tinnitus and hyperacusis are especially suited to providing additional insight into tinnitus-related handicap and are therefore useful for evaluating tinnitus patients.

PMID: 26584711 [PubMed - as supplied by publisher]

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[On the Differential Diagnosis of Intractable Psychogenic Chronic Cough: Neuropathic Larynx Irritable - Gabapentin's Antitussive Action].

[On the Differential Diagnosis of Intractable Psychogenic Chronic Cough: Neuropathic Larynx Irritable - Gabapentin's Antitussive Action].

Fortschr Neurol Psychiatr. 2015 Oct;83(10):568-577

Authors: Bonnet U, Ossowski A, Schubert M, Gall H, Steinkamp I, Richter LE, Khalil-Boutros Y, Nefedev A, Kuhlmann R

Abstract
We present the case of a 76 year old female inpatient who suffered from a chronic intractable cough which arose simultaneously to a severe major depression and was secondary to an exorbitant psychological distress. Chronic cough had never been experienced before and was initially considered to have a mere psychogenic origin since a comprehensive and guideline-based diagnostic screening did not reveal any underlying somatic cause. However, several factors cast doubt on the solitary psychic genesis of the chronic cough: i) occurrence immediately after a penetrant cold, ii) embedding in other complaints of laryngeal hyperreagibility (larynx irritable), such as persistent globus pharyngeus sensation, throat clearing and episodic dysphonia, iii) first occurrence on old life, iv) erupting from sleep as well, v) persistence despite remission of the major depression, and v) no sustaining benefit from specific psychotherapy and speech therapy. Therefore, diagnostics were extended to apparative tools for objective evaluation of swallowing by using fiberoptic videoendoscopic (FEES) and videofluoroscopic (VFS) techniques, which revealed signs of laryngeal neuropathy but without evidence of penetration or aspiration. A co-existing small goiter and an impaired glucose tolerance along with a putative intracellular vitamin B12 or folate deficiency (as indirectly derived from an apparent hyperhomocysteinemia) were assumed to be responsible for the neuropathy and underwent specific treatments. The impaired glucose tolerance and putative vitamin deficit were compatible with a distal symmetric sensorimotoric, even subclinical polyneuropathy of the lower extremities. The larynx irritable improved under gabapentin being confirmed by drug removals several times, and finally calmed down almost completely under gabapentin, which was in line with the scant literature of this topic. Re-examination of the larynx per FEES nine months later showed no deficits any more under the well-tolerated treatment (gabapentin, levothyroxine, vitamin B12 and folic acid substitution, weight reduction and physical training). All in all, the larynx irritable as well as the chronic cough were most probably induced by a laryngeal neuropathy and were not solely of psychic origin. Due to good treatment options a larynx irritable should be regularly taken into consideration of the investigation of intractable chronic cough. Therefore, an apparative evaluation of deglutition is recommended in the diagnostic toolbox of chronic cough - even if embedded in a psychiatric disorder or distress - before diagnosing a sole psychic origin. An hypothetical scheme of the development of a larynx irritable caused by neuropathic and non-neuropathic ("nociceptive") conditions is proposed.

PMID: 26588720 [PubMed - as supplied by publisher]

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Conceiving a national head and neck cancer screening programme.

Conceiving a national head and neck cancer screening programme.

J Laryngol Otol. 2015 Nov 20;:1-7

Authors: Gogarty DS, Shuman A, O'Sullivan EM, Sheahan P, Kinsella J, Timon C, O'Neill JP

Abstract
BACKGROUND: This study was undertaken to determine the optimum approach to screening for head and neck cancer based on international experiences.
OBJECTIVE: To determine whether or not head and neck cancer is suitable for screening, and, if so, what the ideal approach should be.
METHODS: An electronic search of online databases up to and including May 2014 was conducted. Key search terms included 'head and neck', 'cancer', 'screening', 'larynx', 'oropharynx' and 'oral'.
RESULTS: Subset analysis of high-risk cohorts showed statistically significant improvements in early detection of head and neck cancer via screening.
CONCLUSION: Current levels of public awareness regarding head and neck cancers are suboptimal, despite increased incidence and mortality. Scheduled and opportunistic screening, coupled with efforts to enhance education and health behaviour modification, are highly recommended for pre-defined, high-risk, targeted populations. This can enable early detection and therefore improve morbidity and mortality.

PMID: 26585180 [PubMed - as supplied by publisher]

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Familial Sulcus Vergeture: Further Evidence for Congenital Origin of Type 2 Sulcus.

Familial Sulcus Vergeture: Further Evidence for Congenital Origin of Type 2 Sulcus.

J Voice. 2015 Nov 13;

Authors: Husain S, Sulica L

Abstract
A 29-year-old otherwise healthy woman presented with a lifetime history of hoarseness because it had begun to interfere with her career. Examination of both the woman and her 60-year-old father revealed bilateral sulcus vergeture, without inflammation or lesions attributable to phonotrauma. The woman responded well to injection augmentation; the father declined treatment. Combined with existing descriptions of other family groupings, all with sulcus vergeture without signs of inflammation, clinical progression, and little or no apparent behavioral component, this report further suggests that sulcus vergeture (Ford type 2) and sulcus vocalis (Ford type 3) are entirely different entities, despite architectural similarity.

PMID: 26584518 [PubMed - as supplied by publisher]

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The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss.

The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss.

Acta Otolaryngol. 2015 Nov 20;:1-7

Authors: Niu X, Zhang Y, Zhang Q, Xu X, Han P, Cheng Y, Gao Y, Zhang R, Yang Y, Chen Z, Hu J, Chen Y, Xu M

Abstract
OBJECTIVE: To investigate the relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss (SSHL).
METHODS: Clinical data including the symptom of vertigo of 149 SSHL patients were investigated retrospectively. Pure tone audiometry, ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) evoked by air-conducted sound (ACS), and caloric test were employed for cochlear and vestibular function assessment. The relationship between hearing level and vestibular dysfunction was analyzed.
RESULTS: The pure tone averages (PTAs) (mean ± SD) of SSHL patients with and without vertigo were 88.81 ± 21.74 dB HL and 72.49 ± 21.88 dB HL (Z = -4.411, p = 0.000), respectively. The PTAs of SSHL patients with abnormal and normal caloric test were 84.71 ± 22.54 dB HL and 70.41 ± 24.07 dB HL (t = -2.665, p = 0.009), respectively. Conversely, vertigo and abnormal caloric results also happened more frequently in patients with profound hearing loss. However, no consistent tendency could be found among vestibular evoked myogenic potentials (VEMPs) responses or hearing loss.
CONCLUSIONS: SSHL patients with vertigo or abnormal caloric test displayed worse hearing loss; and vice versa, vertigo and abnormal caloric results happened more frequently in SSHL patients with profound hearing loss.

PMID: 26587580 [PubMed - as supplied by publisher]

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Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network.

Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network.

J Pediatric Infect Dis Soc. 2015 Dec;4(4):297-304

Authors: Gerber JS, Prasad PA, Russell Localio A, Fiks AG, Grundmeier RW, Bell LM, Wasserman RC, Keren R, Zaoutis TE

Abstract
BACKGROUND: Outpatient respiratory tract infections are the most common reason for antibiotic prescribing to children. Although prior studies suggest that antibiotic overuse occurs, patient-specific data or data exploring the variability and determinants of variability across practices and practitioners is lacking.
METHODS: This study was conducted from a retrospective cohort of encounters to 25 diverse pediatric practices with 222 clinicians, from January 1 to December 31, 2009. Diagnoses, medications, comorbid conditions, antibiotic allergy, and demographic data were obtained from a shared electronic health record and validated by manual review. Practice-specific antibiotic prescription and acute respiratory tract infection diagnosis rates were calculated to assess across-practice differences after adjusting for patient demographics and clustering of encounters within clinicians.
RESULTS: A total of 102 102 (28%) of 399 793 acute visits by 208 015 patients resulted in antibiotic prescriptions. After adjusting for patient age, sex, race, and insurance type, and excluding encounters by patients with chronic conditions, antibiotic prescribing by practice ranged from 18% to 36% of acute visits, and the proportion of antibiotic prescriptions that were broad-spectrum ranged from 15% to 58% across practices, despite additional exclusion of patients with antibiotic allergies or prior antibiotic use. Diagnosis of (Dx) and broad-spectrum antibiotic prescribing (Broad) for acute otitis media (Dx: 8%-20%; Broad: 18%-60%), sinusitis (Dx: 0.5%-9%; Broad: 12%-78%), Streptococcal pharyngitis (Dx: 1.8%-6.4%; Broad: 2%-30%), and pneumonia (Dx: 0.4%-2%; Broad: 1%-70%) also varied by practice (P < 0.001 for all comparisons).
CONCLUSIONS: Antibiotic prescribing for common pediatric infections varied substantially across practices. This variability could not be explained by patient-specific factors. These data suggest the need for and provide high-impact targets for outpatient antimicrobial stewardship interventions.

PMID: 26582868 [PubMed - as supplied by publisher]

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Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss.

Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss.

Biomed Res Int. 2015;2015:621845

Authors: Parietti-Winkler C, Lion A, Montaut-Verient B, Grosjean R, Gauchard GC

Abstract
Many studies were interested in the consequence of vestibular dysfunction related to cochlear implantation on balance control. This pilot study aimed to assess the effects of unilateral cochlear implantation on the modalities of balance control and sensorimotor strategies. Posturographic and vestibular evaluations were performed in 10 patients (55 ± 20 years) with profound hearing loss who were candidates to undergo unilateral multichannel cochlear implantation. The evaluation was carried out shortly before and one year after surgery. Posturographic tests were also performed in 10 age-matched healthy participants (63 ± 16 years). Vestibular compensation was observed within one year. In addition, postural performances of the patients increased within one year after cochlear implantation, especially in the more complex situations, in which sensory information is either unavailable or conflicting. Before surgery, postural performances were higher in the control group compared to the patients' group. One year after cochlear implantation, postural control was close to normalize. The improvement of postural performance could be explained by a mechanism of vestibular compensation. In addition, the recovery of auditory information which is the consequence of cochlear implantation could lead to an extended exploration of the environment possibly favoring the development of new balance strategies.

PMID: 26583121 [PubMed - as supplied by publisher]

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RNA-Seq and microarray analysis of the Xenopus inner ear transcriptome discloses orthologous OMIM(®) genes for hereditary disorders of hearing and balance.

RNA-Seq and microarray analysis of the Xenopus inner ear transcriptome discloses orthologous OMIM(®) genes for hereditary disorders of hearing and balance.

BMC Res Notes. 2015;8(1):691

Authors: Ramírez-Gordillo D, Powers TR, van Velkinburgh JC, Trujillo-Provencio C, Schilkey F, Serrano EE

Abstract
BACKGROUND: Auditory and vestibular disorders are prevalent sensory disabilities caused by genetic and environmental (noise, trauma, chemicals) factors that often damage mechanosensory hair cells of the inner ear. Development of treatments for inner ear disorders of hearing and balance relies on the use of animal models such as fish, amphibians, reptiles, birds, and non-human mammals. Here, we aimed to augment the utility of the genus Xenopus for uncovering genetic mechanisms essential for the maintenance of inner ear structure and function.
RESULTS: Using Affymetrix GeneChip(®) X. laevis Genome 2.0 Arrays and Illumina-Solexa sequencing methods, we determined that the transcriptional profile of the Xenopus laevis inner ear comprises hundreds of genes that are orthologous to OMIM(®) genes implicated in deafness and vestibular disorders in humans. Analysis of genes that mapped to both technologies demonstrated that, with our methods, a combination of microarray and RNA-Seq detected expression of more genes than either platform alone.
CONCLUSIONS: As part of this study we identified candidate scaffold regions of the Xenopus tropicalis genome that can be used to investigate hearing and balance using genetic and informatics procedures that are available through the National Xenopus Resource (NXR), and the open access data repository, Xenbase. The results and approaches presented here expand the viability of Xenopus as an animal model for inner ear research.

PMID: 26582541 [PubMed - as supplied by publisher]

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Fragen für die Facharztprüfung.

Fragen für die Facharztprüfung.

Laryngorhinootologie. 2015 Nov;94(11):790

Authors:

PMID: 26584214 [PubMed - as supplied by publisher]

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[From the Expert's Office: How to Simplify the Calculation of the Hearing Loss in the Speechaudiogram According to the Scale of Boenninghaus and Röser].

[From the Expert's Office: How to Simplify the Calculation of the Hearing Loss in the Speechaudiogram According to the Scale of Boenninghaus and Röser].

Laryngorhinootologie. 2015 Nov;94(11):772-774

Authors: Brusis T

PMID: 26584213 [PubMed - as supplied by publisher]

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