Variants in the KCNE1 or KCNE3 gene and risk of Ménière's disease: A meta-analysis.

Variants in the KCNE1 or KCNE3 gene and risk of Ménière's disease: A meta-analysis.

J Vestib Res. 2016 Jan 28;25(5-6):211-218

Authors: Li YJ, Jin ZG, Xu XR

Abstract
BACKGROUND: Ménière's disease (MD) is defined as an idiopathic disorder of the inner ear characterized by the triad of tinnitus, vertigo, and sensorineural hearing loss. Although many studies have evaluated the association between variants in the KCNE1 or KCNE3 gene and MD risk, debates still exist.
OBJECTIVE: Our aim is to evaluate the association between KCNE gene variants, including KCNE1 rs1805127 and KCNE3 rs2270676, and the risk of MD by a systematic review.
METHODS: We searched the literature in PubMed, SCOPUS and EMBASE through May 2015. We calculated pooled odds ratios (OR) and 95% confidence intervals (CIs) using a fixed-effects model or a random-effects model for the risk to MD associated with different KCNE gene variants. The heterogeneity assumption decided the effect model.
RESULTS: A total of three relevant studies, with 302 MD cases and 515 controls, were included in this meta-analysis. The results indicated that neither the KCNE1 rs1805127 variant (for G vs. A: OR = 0.724, 95%CI 0.320, 1.638, P= 0.438), nor the KCNE3 rs2270676 variant (for T vs. C: OR = 0.714, 95%CI 0.327, 1.559, P = 0.398) was associated with MD risk.
CONCLUSIONS: Based on current evidence from published studies, neither of the two variants from KCNE was significantly associated with the risk of MD. Larger studies with mixed ethnicity subjects and stratified by clinical and sub-clinical characteristics are needed to validate our findings.

PMID: 26890422 [PubMed - as supplied by publisher]

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Neuronavigated left temporal continuous theta burst stimulation in chronic tinnitus.

Neuronavigated left temporal continuous theta burst stimulation in chronic tinnitus.

Restor Neurol Neurosci. 2016 Jan 30;

Authors: Schecklmann M, Giani A, Tupak S, Langguth B, Raab V, Polak T, Várallyay C, Harnisch W, Herrmann MJ, Fallgatter AJ

Abstract
PURPOSE: Clinical effects of repetitive transcranial magnetic stimulation (rTMS) in chronic tinnitus are moderate. More precise coil localisation strategies, innovative stimulation protocols, and identification of predictors for treatment response were proposed as promising attempts to enhance treatment efficacy. In this pilot study we investigated neuronavigated continuous theta burst TMS (cTBS).
METHODS: Twenty-three patients received neuronavigated cTBS over the left primary auditory cortex in a randomized sham-controlled trial (verum = 12; sham = 11). Treatment response was evaluated with tinnitus questionnaires and numeric rating scales. Immediate change in numeric rating scales during the first session was used as predictor for treatment response.
RESULTS: Tinnitus was significantly reduced after treatment, but there were no superior effects between verum vs. sham treatment. Immediate change in the first treatment session predicted the response to treatment only in the verum group.
CONCLUSIONS: In our study, verum cTBS was not superior to sham which highlights the persistent need for improving non-invasive brain stimulation techniques for the treatment of tinnitus. Future research should focus on the transfer of positive single session effects to daily treatment trials.

PMID: 26890094 [PubMed - as supplied by publisher]

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[Middle ear adenoma: clinical and pathologic analysis].

[Middle ear adenoma: clinical and pathologic analysis].

Zhonghua Bing Li Xue Za Zhi. 2015 Dec;44(12):900-4

Authors: Bai Y, Yue C, Yang D, Han Y, Zhang Y, Liu H

Abstract
OBJECTIVE: To investigate the clinical and pathologic features of middle ear adenoma (MEA).
METHODS: Eight cases of MEA were collected from Beijing Tongren Hospital, Capital Medical University between 2004 and 2014, and immunohistochemical staining was performed.
RESULTS: The patients included five women and three men (mean age, 37.5 years; median 37 years; range, 21-51 years). All patients had unilateral lesions. Five MEA occurred on the left side, and three on the right. In seven patients the MEA was primary, and they presented with hearing loss (6 cases), tinnitus (5 cases), sense of ear blockage (3 cases), otalgia (1 case) and facial nerve paralysis (1 case). The remaining patient had recurrent MEA, and presented with otorrhea, aural fullness and tinnitus. Histologically, the tumor cells were arranged in a variety of patterns, including solid sheets, nests, glands, ribbons or trabeculae. Glandular structures were prominent in one case only. Immunohistochemically, the tumor cells were diffusely positive for keratin (8/8) and vimentin (8/8), and focally positive for CK 7(8/8) and CK5/6(8/8). CK7 and CK5/6 were predominantly positive in tumor cells with glandular growth pattern; CK7 was positive in the luminal cells while CK5/6 was positive in the abluminal cells. Both were also expressed focally in scattered tumor cells with non-glandular pattern. The tumor cells were also diffusely positive for synaptophysin(8/8), diffusely but weakly positive for NSE (5/8), and were diffusely or focally positive for chromogranin A (4/8). Both S-100 protein and calponin were negative in all cases. The proliferation rate was low, about 1%-2%. Six cases were followed up for one year and three months to ten years and six months, with an average follow-up period of four years and two months. Two patients developed recurrence, but there were no regional or distant metastases.
CONCLUSIONS: Diagnosis of MEA requires pathologic confirmation since the clinical symptoms are non-specific. MEA can show a variety of histologic patterns, and should be distinguished from other space-occupying lesions at this site. Immunohistochemical staining has greatly contributed to the diagnosis and differential diagnosis of MEA. The prognosis of this tumor is good. Patients with MEA require long-term follow-up for recurrences.

PMID: 26888509 [PubMed - in process]

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[Clinical features of sudden sensorineural hearing loss accompanied with inner ear hemorrhage].

[Clinical features of sudden sensorineural hearing loss accompanied with inner ear hemorrhage].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Dec;50(12):996-1000

Authors: Chen X, Lin C, Fang Z, Chen X, Ye S, Cheng J, Zhang R

Abstract
OBJECTIVE: To investigate the clinical features, diagnosis and prognosis of sudden sensorineural hearing loss accompanied with inner ear hemorrhage.
METHODS: Eleven cases of sudden sensorineural hearing loss accompanied with inner ear hemorrhage were retrospectively analyzed, including clinical manifestation, hematological and audiological examinations, as well as characteristics of inner ear three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).
RESULTS: Eleven cases of sudden hearing loss with inner ear hemorrhage were accompanied by varying degrees of vertigo, lasting from several minutes to several hours, nine of whom had persistent tinnitus. The audiometry curves of the 11 cases included total deafness or flat descending type. The inner ear 3D-FLAIR MRI studies revealed abnormal high signals at different positions of the inner ear, one case with endolymphatic hydrops. After the treatment, seven cases were invalid, two cases had notable effect, and two cases were effective.
CONCLUSIONS: Abnormal high signals in the inner ear were sensitively detected by 3D-FLAIR MRI sequence, which was applied for the diagnosis of the sudden hearing loss accompanied with inner ear hemorrhage. The effect of conventional treatment was not good and the appropriate treatments for this type of sudden hearing loss need further investigation.

PMID: 26888129 [PubMed - in process]

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[Cinical and genetic characteristics of familial Meniere's disease: three families report].

[Cinical and genetic characteristics of familial Meniere's disease: three families report].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;50(11):915-24

Authors: Gao Y, Wang D, Wang H, Guan J, Lan L, Wu Z, Xie L, Yu L, Zhang S, Shan X, Wang Q

Abstract
OBJECTIVE: To investigate the clinical and genetic characteristics of three Chinese Meniere's disease(MD) families and decipher the mechanism of MD further.
METHODS: Personal and family medical evidence of hearing loss, vestibular symptoms, and other clinical abnormalities of the participants were identified, clinical and genetic features were analyzed. Targeted 307 genes capture and high-throughput sequencing were performed on the two ascertained members of family 1007184.
RESULTS: Eight patients from these three families showed post-lingual sensorineural hearing loss, six women and two men were involved. Age of onset in these affected members concentrated in the middle age, with the average age of 39.3 years old. Among them, patients from 1407278 were accompanied by migraine. All of the three probands presented as recurrent vertigo firstly, and then fluctuated hearing loss showed up, accompanying by tinnitus and ear fullness feeling. The hearing loss manifested as late-onset, low frequency-involved pattern, with subsequent gradual progression from moderate to severe level. Some of the patients progressed to severe level involving all frequencies at higher ages. In addition, most of the cases showed revitalization. Four cases received vestibular function tests, three of which had varying dysfunction of vestibular function, while the other one had normal vestibular function. Patients who had abnormal vestibular function showed much more severe hearing impairment. The three-generation family 1007193 had an autosomal recessive genetic characteristics, family 1007184 showed autosomal dominant inheritance of characteristics, family 1407278 were either autosomal dominant or X-linked dominant pattern. Through target genes capture high-throughput sequencing technology, we identified two candidate variants in the two members of family 1007184, named c. 2057G>A in EGFLAM and c. 1961C>T in ITGA8.
CONCLUSION: Meniere's disease has some genetic and familial aggregation in Chinese population, but its complex genetic pathogenic mechanisms need further study.

PMID: 26887996 [PubMed - in process]

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A Critical Approach to Evaluating Clinical Efficacy, Adverse Events and Drug Interactions of Herbal Remedies.

A Critical Approach to Evaluating Clinical Efficacy, Adverse Events and Drug Interactions of Herbal Remedies.

Phytother Res. 2016 Feb 17;

Authors: Izzo AA, Hoon-Kim S, Radhakrishnan R, Williamson EM

Abstract
Systematic reviews and meta-analyses represent the uppermost ladders in the hierarchy of evidence. Systematic reviews/meta-analyses suggest preliminary or satisfactory clinical evidence for agnus castus (Vitex agnus castus) for premenstrual complaints, flaxseed (Linum usitatissimum) for hypertension, feverfew (Tanacetum partenium) for migraine prevention, ginger (Zingiber officinalis) for pregnancy-induced nausea, ginseng (Panax ginseng) for improving fasting glucose levels as well as phytoestrogens and St John's wort (Hypericum perforatum) for the relief of some symptoms in menopause. However, firm conclusions of efficacy cannot be generally drawn. On the other hand, inconclusive evidence of efficacy or contradictory results have been reported for Aloe vera in the treatment of psoriasis, cranberry (Vaccinium macrocarpon) in cystitis prevention, ginkgo (Ginkgo biloba) for tinnitus and intermittent claudication, echinacea (Echinacea spp.) for the prevention of common cold and pomegranate (Punica granatum) for the prevention/treatment of cardiovascular diseases. A critical evaluation of the clinical data regarding the adverse effects has shown that herbal remedies are generally better tolerated than synthetic medications. Nevertheless, potentially serious adverse events, including herb-drug interactions, have been described. This suggests the need to be vigilant when using herbal remedies, particularly in specific conditions, such as during pregnancy and in the paediatric population. Copyright © 2016 John Wiley & Sons, Ltd.

PMID: 26887532 [PubMed - as supplied by publisher]

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Streptolysin S Promotes Programmed Cell Death and Enhances Inflammatory Signaling in Epithelial Keratinocytes during Group A Streptococcus Infection.

Related Articles

Streptolysin S Promotes Programmed Cell Death and Enhances Inflammatory Signaling in Epithelial Keratinocytes during Group A Streptococcus Infection.

Infect Immun. 2015 Oct;83(10):4118-33

Authors: Flaherty RA, Puricelli JM, Higashi DL, Park CJ, Lee SW

Abstract
Streptococcus pyogenes, or group A Streptococcus (GAS), is a pathogen that causes a multitude of human diseases from pharyngitis to severe infections such as toxic shock syndrome and necrotizing fasciitis. One of the primary virulence factors produced by GAS is the peptide toxin streptolysin S (SLS). In addition to its well-recognized role as a cytolysin, recent evidence has indicated that SLS may influence host cell signaling pathways at sublytic concentrations during infection. We employed an antibody array-based approach to comprehensively identify global host cell changes in human epithelial keratinocytes in response to the SLS toxin. We identified key SLS-dependent host responses, including the initiation of specific programmed cell death and inflammatory cascades with concomitant downregulation of Akt-mediated cytoprotection. Significant signaling responses identified by our array analysis were confirmed using biochemical and protein identification methods. To further demonstrate that the observed SLS-dependent host signaling changes were mediated primarily by the secreted toxin, we designed a Transwell infection system in which direct bacterial attachment to host cells was prevented, while secreted factors were allowed access to host cells. The results using this approach were consistent with our direct infection studies and reveal that SLS is a bacterial toxin that does not require bacterial attachment to host cells for activity. In light of these findings, we propose that the production of SLS by GAS during skin infection promotes invasive outcomes by triggering programmed cell death and inflammatory cascades in host cells to breach the keratinocyte barrier for dissemination into deeper tissues.

PMID: 26238711 [PubMed - indexed for MEDLINE]

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Diagnostic value of vestibular-evoked myogenic potentials in Ménière's disease and vestibular migraine.

Diagnostic value of vestibular-evoked myogenic potentials in Ménière's disease and vestibular migraine.

J Vestib Res. 2016 Jan 28;25(5-6):261-266

Authors: Salviz M, Yuce T, Acar H, Taylan I, Yuceant GA, Karatas A

Abstract
Overlaps can be seen between vestibular migraine (VM) Ménière's Disease (MD) and diagnosis is difficult if hearing is normal. We aimed to investigate the sacculo-collic pathway in VM patients, MD patients, and healthy controls to define the diagnostic role of cervical VEMP (cVEMP). VEMP testing in response to 500 Hz and 1000 Hz air-conducted tone burst (TB) stimulation was studied prospectively in 22 subjects with definite VM (according to Bárány nomenclature), 30 subjects with unilateral definite MD, and 18 volunteers matched healthy controls. In VM subjects, response rate, p13 and n23 latencies were similar to healthy controls, but peak-to-peak amplitudes were bilaterally reduced at 500 Hz TBs (p= 0.005). cVEMP differentiated MD patients from VM and healthy controls with asymmetrically reduced amplitudes on affected ears with low response rates at 500 Hz TBs, and alteration of frequency dependent responses at 500 and 1000 Hz TBs. These findings suggest that cVEMP can be used as a diagnostic test to differentiate MD from VM. On the other hand, VEMP responses are symmetrically reduced on both sides in VM patients, suggesting that otolith organs might be affected by migraine-induced ischemia.

PMID: 26890427 [PubMed - as supplied by publisher]

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Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study.

Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study.

J Vestib Res. 2016 Jan 28;25(5-6):241-251

Authors: Schlick C, Schniepp R, Loidl V, Wuehr M, Hesselbarth K, Jahn K

Abstract
BACKGROUND: Vertigo and dizziness are among the most prevalent symptoms in neurologic disorders. Although many of these patients suffer from postural instability and gait disturbances, there is only limited data on their risk of falling.
METHODS: We conducted a controlled cross-sectional study at the tertiary care outpatient clinic of the German Center for Vertigo and Balance Disorders using a self-administered questionnaire to assess falls, fall-related injuries, and fear of falling. The recruitment period was 6 months.
RESULTS: A total of 569 patients (mean age 59.6 ± 17.1 years, 55% females) and 100 healthy participants were included (response rate > 90%). Dizzy patients with central balance disorders (Parkinsonian, cerebellar, and brainstem oculomotor syndromes) had the highest fall rates (> 50% recurrent fallers, odds ratio > 10). The rate of recurrent fallers was 30% in bilateral vestibular failure and peripheral neuropathy (odds ratio > 5). Patients with functional dizziness (somatoform or phobic vertigo) were concerned about falling but did not fall more often than healthy controls (odds ratio 0.87).
CONCLUSION: Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients.

PMID: 26890425 [PubMed - as supplied by publisher]

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Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension.

Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension.

J Vestib Res. 2016 Jan 28;25(5-6):233-239

Authors: D'Silva LJ, Staecker H, Lin J, Sykes KJ, Phadnis MA, McMahon TM, Connolly D, Sabus CH, Whitney SL, Kluding PM

Abstract
OBJECTIVE: Benign Paroxysmal Positional Vertigo (BPPV) has been linked to comorbidities like diabetes and hypertension. However, the relationship between type 2 diabetes (DM) and BPPV is unclear. The purpose of this retrospective study was to examine the relationship between DM and BPPV in the presence of known contributors like age, gender and hypertension.
METHODS: A retrospective review of the records of 3933 individuals was categorized by the specific vestibular diagnosis and for the presence of type 2 DM and hypertension. As the prevalence of BPPV was higher in people with type 2 DM compared to those without DM, multivariable logistic regressions were used to identify variables predictive of BPPV. The relationship between type 2 DM, hypertension and BPPV was analyzed using mediation analysis.
RESULTS: BPPV was seen in 46% of individuals with type 2 DM, compared to 37% of individuals without DM (p< 0.001). Forty two percent of the association between type 2 DM and BPPV was mediated by hypertension, and supported hypertension as a complete mediator in the relationship between type 2 DM and BPPV.
CONCLUSIONS: Hypertension may provide the mediating pathway by which diabetes affects the vestibular system. Individuals with complaints of dizziness, with comorbidities including hypertension and diabetes, may benefit from a screening for BPPV.

PMID: 26890424 [PubMed - as supplied by publisher]

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[Clinical features of sudden sensorineural hearing loss accompanied with inner ear hemorrhage].

[Clinical features of sudden sensorineural hearing loss accompanied with inner ear hemorrhage].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Dec;50(12):996-1000

Authors: Chen X, Lin C, Fang Z, Chen X, Ye S, Cheng J, Zhang R

Abstract
OBJECTIVE: To investigate the clinical features, diagnosis and prognosis of sudden sensorineural hearing loss accompanied with inner ear hemorrhage.
METHODS: Eleven cases of sudden sensorineural hearing loss accompanied with inner ear hemorrhage were retrospectively analyzed, including clinical manifestation, hematological and audiological examinations, as well as characteristics of inner ear three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).
RESULTS: Eleven cases of sudden hearing loss with inner ear hemorrhage were accompanied by varying degrees of vertigo, lasting from several minutes to several hours, nine of whom had persistent tinnitus. The audiometry curves of the 11 cases included total deafness or flat descending type. The inner ear 3D-FLAIR MRI studies revealed abnormal high signals at different positions of the inner ear, one case with endolymphatic hydrops. After the treatment, seven cases were invalid, two cases had notable effect, and two cases were effective.
CONCLUSIONS: Abnormal high signals in the inner ear were sensitively detected by 3D-FLAIR MRI sequence, which was applied for the diagnosis of the sudden hearing loss accompanied with inner ear hemorrhage. The effect of conventional treatment was not good and the appropriate treatments for this type of sudden hearing loss need further investigation.

PMID: 26888129 [PubMed - in process]

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How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo?

Related Articles

How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo?

J Laryngol Otol. 2015 May;129(5):421-4

Authors: Hughes D, Shakir A, Goggins S, Snow D

Abstract
OBJECTIVE: To evaluate the total number of Epley manoeuvres required to provide symptomatic relief to patients newly diagnosed with benign paroxysmal positional vertigo.
METHODS: This retrospective audit assessed every patient referred to the audiology department for investigations of their symptoms over a period of one year. Only patients diagnosed with benign paroxysmal positional vertigo confirmed via a positive Dix-Hallpike test result, with no suggestion of dual pathology, were included.
RESULTS: Seventy patients with a positive Dix-Hallpike test result were identified. The total number of Epley manoeuvres required ranged from one to five. Thirty-three patients (47 per cent) were asymptomatic following one Epley manoeuvre. Eleven patients (16 per cent) needed 2 manoeuvres and 15 patients (21 per cent) required 3 manoeuvres for symptomatic control.
CONCLUSION: Symptomatic control of benign paroxysmal positional vertigo was obtained following a single Epley manoeuvre for 47 per cent of patients. The majority of patients (84 per cent) experienced symptomatic improvement following three Epley manoeuvres.

PMID: 25816719 [PubMed - indexed for MEDLINE]

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Narrow band imaging for the diagnosis of head and neck squamous cell carcinoma: A systematic review.

Narrow band imaging for the diagnosis of head and neck squamous cell carcinoma: A systematic review.

Head Neck. 2016 Feb 18;

Authors: Cosway B, Drinnan M, Paleri V

Abstract
Narrow band imaging (NBI) is reported to improve the diagnostic accuracy of head and neck cancers. The purpose of this review was to evaluate the diagnostic accuracy of NBI in the literature. A systematic review was performed in PubMed, Web of Knowledge, and the Cochrane Library until March 2015. Two reviewers independently assessed articles and extracted data. Meta-analyses were performed in MetaDisc 1.6. Five hundred seventeen studies were identified and 17 were included in this study. Combined use of NBI and white light imaging (WLI) showed high diagnostic accuracies for primary, recurrent, and nasopharyngeal lesions. Methodological heterogeneity exists and meta-analyses were only appropriate for cancers of unknown primary (CUP) in which NBI performed on 115 patients across 4 studies demonstrated high sensitivity (74.1%; 95% confidence interval [CI] = 52.5% to 100%) and specificity (94.1%; 95% CI = 23.7% to 100%). NBI may further help identify lesions in CUP not seen by positron emission tomography (PET)-CT. NBI offers a high level of diagnostic accuracy for head and neck cancers. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26891200 [PubMed - as supplied by publisher]

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Risk of swallowing-related chest infections in patients with nasopharyngeal carcinoma treated with definitive intensity-modulated radiotherapy.

Risk of swallowing-related chest infections in patients with nasopharyngeal carcinoma treated with definitive intensity-modulated radiotherapy.

Head Neck. 2016 Feb 18;

Authors: Xiong J, Krishnaswamy G, Raynor S, Loh KS, Kwa AL, Lim CM

Abstract
BACKGROUND: Pulmonary complications secondary to dysphagia may be encountered in patients with nasopharyngeal carcinoma (NPC) after definitive intensity-modulated radiotherapy. The purpose of this study was to identify patients with NPC at risk of developing swallowing-related chest infections (SRCIs).
METHODS: Retrospective chart review was performed on 217 patients with stage I to IVB NPC treated definitively with radiotherapy or chemoradiotherapy.
RESULTS: Twenty-six patients (12.0%) developed SRCIs; 4 of these patients (15.3%) required intensive care unit (ICU) admission and 9 (34.6%) died of the complication. The median time interval between completions of radiotherapy to the development of SRCIs was 24.5 months. Advanced age, recurrent disease, and concurrent chemoradiotherapy were significantly associated with the development of SRCIs in the multivariable analysis.
CONCLUSION: SRCI is a common and potentially fatal complication for postirradiated patients with NPC. Advanced age, concurrent chemoradiotherapy, and recurrent cancer were strong risk factors for postirradiated patients with NPC to develop SRCIs. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26891064 [PubMed - as supplied by publisher]

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Induction docetaxel and S-1 followed by concomitant radiotherapy with low-dose daily cisplatin in locally advanced head and neck carcinoma.

Induction docetaxel and S-1 followed by concomitant radiotherapy with low-dose daily cisplatin in locally advanced head and neck carcinoma.

Head Neck. 2016 Feb 18;

Authors: Kim HR, Lee CG, Choi EC, Kim JH, Koh YW, Cho BC

Abstract
BACKGROUND: The purpose of this study was to assess the efficacy and safety of induction chemotherapy with docetaxel-S-1, and radiotherapy (RT) with concurrent daily cisplatin in locally advanced head and neck carcinoma.
METHOD: Fifty patients received 2 cycles of induction chemotherapy with induction chemotherapy with docetaxel and S-1, followed by 7 cycles of RT with concurrent daily cisplatin.
RESULTS: The most frequent grade 3 to 4 hematologic toxicity was neutropenia (14%). Forty of 50 patients who completed induction chemotherapy with docetaxel and S-1 subsequently started RT with concurrent daily cisplatin, all within 3 to 4 weeks after the start of the second cycle of induction chemotherapy with docetaxel and S-1. The best response to induction chemotherapy with docetaxel and S-1 and after completion of RT with concurrent daily cisplatin was partial response (PR) in 52.5% and complete response in 47.5%, respectively. With a median follow-up of 61 months, 5-year progression-free survival (PFS) and overall survival (OS) were 63.3% and 65.7%, respectively.
CONCLUSION: Administration of induction chemotherapy with docetaxel and S-1 before RT with concurrent daily cisplatin chemoradiotherapy (CRT) resulted in a high response rate with good tolerability, and did not compromise subsequent CRT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26890965 [PubMed - as supplied by publisher]

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Association between multidisciplinary team care approach and survival rates in patients with oral cavity squamous cell carcinoma.

Association between multidisciplinary team care approach and survival rates in patients with oral cavity squamous cell carcinoma.

Head Neck. 2016 Feb 18;

Authors: Liao CT, Kang CJ, Lee LY, Hsueh C, Lin CY, Fan KH, Wang HM, Ng SH, Lin CH, Tsao CK, Fang TJ, Huang SF, Chang KP, Chang YL, Yang LY, Yen TC

Abstract
BACKGROUND: The purpose of this study was to investigate whether multidisciplinary team care (MDTC) is associated with outcomes in oral cavity squamous cell carcinoma (SCC).
METHODS: We retrospectively examined 1616 patients with oral cavity SCC who underwent radical surgery between 1996 and 2011. The study participants were classified into 2 subgroups according to the use of MDTC.
RESULTS: Five-year outcomes were significantly better in the MDTC group than in the no-MDTC group (neck control, 88% vs 84%, p = .0397; disease-specific survival [DSS], 83% vs 78%, p = .0114; and overall survival [OS], 70% vs 64%, p = .0002, respectively). Among patients who were scheduled to undergo adjuvant therapy, the number who completed their adjuvant treatment was significantly higher in the MDTC group than in the no-MDTC group (90% vs 60% to 70%, p < .001).
CONCLUSION: The association of MDTC with improved outcomes may be potentially explained by a better therapeutic alliance between the patient and the tumor board, and/or a greater thoroughness in clinical management. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26890807 [PubMed - as supplied by publisher]

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Cervical metastases of oral maxillary squamous cell carcinoma: A systematic review and meta-analysis.

Cervical metastases of oral maxillary squamous cell carcinoma: A systematic review and meta-analysis.

Head Neck. 2016 Feb 18;

Authors: Zhang WB, Peng X

Abstract
Cervical treatment of oral maxillary squamous cell carcinoma (SCC) remains controversial. We determined the metastases incidence and evaluated its predictive factors. Systematic review and meta-analysis was conducted of 23 Chinese and English-language articles retrieved from PubMed, Ovid, Embase, Cochrane Library, China National Knowledge Infrastructure, and Chinese Scientific and Technological Journal databases. Total cervical metastases and occult metastases rate was 32% and 21%, respectively. Positive lymph node detection was likeliest from levels I to III. The maxillary gingival metastases rate was higher than that of the hard palate. Advanced-stage tumors had higher metastatic risk than early-stage tumors. Well-differentiated tumors had a significantly higher metastases rate than medium and poor-differentiation tumors. N0 cases had survival benefit compared with N+ cases. Metastases rate of oral maxillary SCC correlates significantly with T classification and pathological stage. T and N classifications impact outcome significantly. Therefore, levels I to III selective neck dissection is recommended for patients with T3/4 cN0 disease. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26890607 [PubMed - as supplied by publisher]

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Rare cases of benign tumors of the head and neck: lipoma of larynx and sternocleidomastoid muscle.

Rare cases of benign tumors of the head and neck: lipoma of larynx and sternocleidomastoid muscle.

Kulak Burun Bogaz Ihtis Derg. 2016 Mar-Apr;26(2):118-22

Authors: Demir D, Eraslan Ö, Güven M, Kösem M

Abstract
In this article, we report two rare cases of lipoma in the head and neck region. Thirty-four-year-old case 1 presented with hoarseness and sensation of foreign body in throat. While 54-year-old case 2 presented with complaint of a mass in left side of neck. The imaging methods showed the masses in false vocal fold and the sternocleidomastoid muscle. Diagnosis and treatment of the masses were discussed in light of the literature.

PMID: 26890715 [PubMed - as supplied by publisher]

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[Application of special larynx polypus forceps for difficult laryngeal exposure in microlaryngosurgery].

[Application of special larynx polypus forceps for difficult laryngeal exposure in microlaryngosurgery].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;50(11):948-9

Authors: Deng J, Sima G, Shi F

PMID: 26888002 [PubMed - in process]

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Cricoid pressure during rapid sequence induction: using the force or not.

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Cricoid pressure during rapid sequence induction: using the force or not.

Br J Hosp Med (Lond). 2015 Dec;76(12):730

Authors: Melia D

PMID: 26646342 [PubMed - indexed for MEDLINE]

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Clinical Characteristics of Arytenoid Dislocation After Endotracheal Intubation.

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Clinical Characteristics of Arytenoid Dislocation After Endotracheal Intubation.

J Craniofac Surg. 2015 Jun;26(4):1358-60

Authors: Lee DH, Yoon TM, Lee JK, Lim SC

Abstract
OBJECTIVE: The objective of this study was to review the clinical characteristics of the arytenoid dislocations after the endotracheal intubation and to identify the factors affecting voice recovery in the arytenoid dislocation after the endotracheal intubation.
METHODS: A retrospective chart review was performed at Chonnam National University Hwasun Hospital from April 2008 to February 2014.
RESULTS: A total of 13 patients with the arytenoid dislocation were identified. The patients had undergone the endotracheal intubation for head and neck surgery (n = 7), abdominal surgery (n = 4), and orthopedic surgery (n = 2). The most common symptom was hoarseness (100%), followed by swallowing difficulty (15.4%). All of the patients with the arytenoid dislocations after the endotracheal intubation were treated by the closed reduction. All of the patients regained normal voice and vocal fold movement after the closed reduction in spite of late surgical intervention. There was no statistical significance between the Cormack-Lehane classification, expertise of anesthetist, patient's position, operation time, duration between first operation and the closed reduction, and period of voice improvement.
CONCLUSION: This study indicates that the arytenoid dislocations after the endotracheal intubation may be needed for the aggressive surgical intervention, even if the diagnosis was delayed.

PMID: 26080195 [PubMed - indexed for MEDLINE]

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A comparative histopathological study of vocal fold polyps in smokers versus non-smokers.

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A comparative histopathological study of vocal fold polyps in smokers versus non-smokers.

J Laryngol Otol. 2015 May;129(5):484-8

Authors: Effat KG, Milad M

Abstract
BACKGROUND: A large proportion of patients with vocal fold polyps are cigarette smokers. However, prior to this report no comparative study of polyp histopathology in smokers versus non-smokers had been performed.
METHODS: A prospective histopathological study of vocal fold polyps excised from 29 patients was undertaken. This comprised a comparative analysis of polyp histopathology in smokers versus non-smokers and a review of the pertinent literature.
RESULTS: Vocal fold polyps were larger in smokers than in non-smokers. Histopathological features significantly associated with the polyps of smokers versus those of non-smokers were increased keratinisation, dysplasia, a basement membrane thinning and hyaline degeneration.
CONCLUSION: Cigarette smoke has an injurious effect on vocal fold polyp epithelium and leads to increased hyaline degeneration in polyps.

PMID: 25788125 [PubMed - indexed for MEDLINE]

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A comparison between left molar direct laryngoscopy and the use of a Bonfils intubation fibrescope for tracheal intubation in a simulated difficult airway.

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A comparison between left molar direct laryngoscopy and the use of a Bonfils intubation fibrescope for tracheal intubation in a simulated difficult airway.

Can J Anaesth. 2015 Jun;62(6):609-17

Authors: Gupta A, Thukral S, Lakra A, Kumar S

Abstract
BACKGROUND: Tracheal intubation in patients with an immobilized cervical spine can be difficult because of a restricted mouth opening and limited neck movements. Use of the Bonfils intubation fibrescope (BIF) or left molar (LM) laryngoscopy may be suitable options for tracheal intubation in such patients. Intubation adjuncts, such as an endotracheal tube introducer, may improve the overall intubation success rate with the LM approach. Formal studies are currently lacking on the use of LM laryngoscopy with a tube introducer.
METHODS: After Institutional Review Board approval, a cervical collar (to simulate a difficult airway scenario) was placed on 120 prospective elective surgical patients who were randomly assigned to tracheal intubation with a BIF (Group BIF, n = 60) or with tube introducer-assisted LM laryngoscopy with routine optimal external laryngeal manipulation (Group LM, n = 60). The groups were compared for the primary endpoint, total intubation time, as well as for time to glottic view, tube introducer insertion time, intubation success rate, number of intubation attempts, and airway complications.
RESULTS: The mean (SD) total time for intubation was longer in Group LM than in Group BIF [40.4 (14.2) sec vs 33.1 (15.4) sec, respectively; mean difference 7.3 sec; 99% confidence interval (CI) 3.2 to 14.4; P < 0.001] despite less mean (SD) total time required for glottic view [15.4 (10.3) sec vs 23.8 (15.7) sec, respectively; mean difference 8.3 sec; 99% CI 2.3 to 14.7; P < 0.001]. The overall success rate was comparable between groups (95.0% in Group BIF vs 96.6% in Group LM; P = 0.64). Tracheal intubations could not be performed as per protocol in three patients in Group BIF and in two patients in Group LM and were considered as failures. No differences between the groups were found in the incidence of side effects.
CONCLUSION: The tube introducer-assisted LM approach to intubation may be a good alternative to the BIF approach in patients with anticipated and unanticipated difficult airway scenarios.

PMID: 25681041 [PubMed - indexed for MEDLINE]

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Variations of mucosal-sparing septectomy for endonasal approach to the craniocervical junction.

Variations of mucosal-sparing septectomy for endonasal approach to the craniocervical junction.

Laryngoscope. 2016 Feb 18;

Authors: Eloy JA, Vazquez A, Marchiano E, Baredes S, Liu JK

Abstract
OBJECTIVES/HYPOTHESIS: Recent advances in surgical techniques have rendered the craniocervical junction (CCJ) accessible transnasally. Endoscopic endonasal transclival and transodontoid approaches are routinely performed in leading skull base centers. Usually, these approaches involve a posterior bony and mucosal septectomy, which may compromise the vascularized pedicled nasoseptal flap (PNSF), a robust reconstructive option for repair of large skull base defects. With the possibility of an intraoperative cerebrospinal fluid leak and the reported success of the PNSF for repair of these defects, preserving the integrity of the PNSF is beneficial during the endoscopic endonasal approach to the CCJ. We describe three new variations/refinements of the endoscopic endonasal approach to the CCJ that preserve the mucosal integrity of the posterior nasal septum and PNSF.
METHODS: Photo and video documentation of cadaveric dissections.
RESULTS: The steps required for the different variations in approaching the CCJ are demonstrated. These three options are: 1) nonopposing Killian incisions with submucosal elevation of PNSFs laterally under the inferior turbinates (the PNSFs are retracted laterally and left attached superiorly onto the nasal septum and laterally under the inferior turbinate); 2) bilateral non-opposing PNSFs tucked beneath their respective middle turbinate or into the sphenoid sinus; and 3) a hybrid approach combining option 1 performed on one side and option 2 on the contralateral side. All three options allowed for a mucosal-sparing septectomy to provide ample access to the CCJ.
CONCLUSION: These variations/refinements of the mucosal-sparing approach to the CCJ allowed adequate surgical access with sufficient maneuverability while preserving both PNSFs.
LEVEL OF EVIDENCE: NA. Laryngoscope, 2015.

PMID: 26891223 [PubMed - as supplied by publisher]

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Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction.

Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction.

Craniomaxillofac Trauma Reconstr. 2016 Mar;9(1):40-5

Authors: Khadakban D, Kudpaje A, Thankappan K, Jayaprasad K, Gorasia T, Vidhyadharan S, Mathew J, Sharma M, Iyer S

Abstract
Anterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16-80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal.

PMID: 26889347 [PubMed]

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Extragnathic and gnathic odontome.

Extragnathic and gnathic odontome.

Indian J Dent Res. 2015 Nov-Dec;26(6):641-3

Authors: Sekhar M, Selvaraj L

Abstract
This is a very rare case report of a multiple odontome involving the upper jaws, lower jaws and an extragnathic site. A thirty seven year-old male complained of missing teeth in his left upper and lower jaw since childhood. Radiographic examination revealed multiple calcified teeth like structures in the left side of the patient's maxilla, mandible and mastoid region of skull base. We arrived at the diagnosis of compound odontome. Patient was otherwise systemically normal and with good health. He underwent surgical enucleation of the jaw odontome while the extragnathic odontome was left under observation. This rare case report proves that the embryonic dental cells might migrate to the primordium of the Rathke's pouch and further might be carried towards the site of the developing cranial base region.

PMID: 26888246 [PubMed - in process]

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[Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery].

[Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;50(11):909-14

Authors: Liu J, Han J, Yang D, Liu D, Li R, Yu Y, Zhang Q, Fernandez Miranda JC, Gardner PA, Snyderman CH

Abstract
OBJECTIVE: To identify the landmarks of transpterygoid approach and to report its application in a series of cases.
METHODS: Two silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma. Clinical records were reviewed.
RESULTS: In terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified. In terms of clinical data, three patients with spontaneous CSF leak underwent repair. Six patients with benign lesions underwent complete tumor resection. In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month. For these benign skull base lesions, there was no recurrence during the follow-up period. In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor. Final control was achieved with chemotherapy and radiation. In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated.
CONCLUSION: An understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone. The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.

PMID: 26887995 [PubMed - in process]

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Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection.

Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection.

Neurosurg Rev. 2016 Feb 18;

Authors: Potapov AA, Goryaynov SA, Okhlopkov VA, Shishkina LV, Loschenov VB, Savelieva TA, Golbin DA, Chumakova AP, Goldberg MF, Varyukhina MD, Spallone A

Abstract
5-aminolevulinic acid (5-ALA) is a natural precursor of protoporphyrin IX (PP IX), which possesses fluorescent properties and is more intensively accumulated in tumor cells than in normal tissue. Therefore, the use of 5-ALA in the surgical treatment of intracranial tumors, particularly gliomas, has gained popularity in the last years, whereas its use in other intracranial pathological entities including meningiomas has been reported occasionally. This study describes a series of 28 patients with intracranial meningiomas, who were administered 5-ALA for a better visualization of tumor boundaries. Twelve patients underwent also laser spectroscopic analysis in order to confirm the visual impression of tumor tissue visualization. Bone infiltration was readily demonstrated. In one case, the tumor recurrence could have been prevented by removal of a tumor remnant, which would possibly have been better recognized if spectroscopic analysis had been used. Fluorescent navigation (FN) is a useful method for maximizing the radicality of meningioma surgery, particularly if the tumor infiltrates the bone, the skull base, and/or the surrounding structures.

PMID: 26887580 [PubMed - as supplied by publisher]

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A clivus plate fixation for reconstruction of ventral defect of the craniovertebral junction: a novel fixation device for craniovertebral instability.

Related Articles

A clivus plate fixation for reconstruction of ventral defect of the craniovertebral junction: a novel fixation device for craniovertebral instability.

Eur Spine J. 2015 Aug;24(8):1658-65

Authors: Ji W, Tong J, Huang Z, Zheng M, Wu X, Chen J, Zhu Q

Abstract
PURPOSE: A fabricated mesh cage and/or posterior occipitocervical instrumentation alone has been used for reconstruction of ventral defect of the upper cervical spine. However, using a trimmed mesh cage it was hard to achieve optimal clival screw purchase and it migrated or broke. A specific instrumentation at the craniovertebral junction (CVJ) should incorporate the morphology of the CVJ and biomechanical validation. The purpose of the present study was to develop an innovative clivus plate integrated with the clinical anatomy of CVJ and to evaluate the stability of the clivus plate fixation (CPF), stand-alone or combined with a posterior occipitocervical fixation (POCF).
METHODS: Dimensions relevant to the clivus plate were measured on 40 adult dry bones and CT images of 30 patients. The CPF was composed of the clivus plate and a titanium mesh cage. The clivus plate was anchored to the clivus, atlas and C3 body and connected to the mesh cage. Six fresh cadaveric head-neck specimens (Oc-C4) were used in this study (46 ± 15 years old, 2 F/4 M). A continuous pure moment of ±1.5 Nm was applied to the specimen in flexion, extension, lateral bending and axial rotation. The status of intact, CPF alone, and CPF plus POCF was tested on each specimen. The CPF was implanted to the specimen following resection of the C1 anterior arch, C2 vertebral body, C2-C3 disc and atlantoaxial ligaments. The POCF was applied with screws anchoring at the occiput, C1, C3 and C4. The range of motion (ROM) and neutral zone (NZ) from the occiput to C3 were calculated.
RESULTS: The clivus plate was developed based on measurements of 40 adult dry bones and CT images of 30 patients. The plates were successfully applied to all specimens. No obvious loosening or mismatch was observed. The mean clival length and widest and narrowest diameter of the clivus were 26, 33 and 19 mm, respectively. The clivus screw length was 8 mm for the caudal holes and 10 mm for the cephalad hole. The CPF reduced ROMs to 3.9° in flexion, 2.8° in extension, 4.2° in lateral bending and 6.8° in axial rotation. The combined CPF and POCF constrained motion within 0.6° in all directions and more than the CPF (P < 0.05). NZs after the CPF were 1.0° in flexion-extension, 2.1° in lateral bending and 2.2° in axial rotation, respectively. NZs after the CPF plus POCF were within 0.2° in all directions and less than the CPF (P < 0.05).
CONCLUSION: This study demonstrated screw purchase in the adult clivus and developed an innovative clivus plate fixation for reconstructing an extensive ventral defect in the upper cervical spine. The clivus plate fixation combined a posterior instrumentation ensuring reliable upper cervical stability.

PMID: 26002353 [PubMed - indexed for MEDLINE]

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Variations of mucosal-sparing septectomy for endonasal approach to the craniocervical junction.

Variations of mucosal-sparing septectomy for endonasal approach to the craniocervical junction.

Laryngoscope. 2016 Feb 18;

Authors: Eloy JA, Vazquez A, Marchiano E, Baredes S, Liu JK

Abstract
OBJECTIVES/HYPOTHESIS: Recent advances in surgical techniques have rendered the craniocervical junction (CCJ) accessible transnasally. Endoscopic endonasal transclival and transodontoid approaches are routinely performed in leading skull base centers. Usually, these approaches involve a posterior bony and mucosal septectomy, which may compromise the vascularized pedicled nasoseptal flap (PNSF), a robust reconstructive option for repair of large skull base defects. With the possibility of an intraoperative cerebrospinal fluid leak and the reported success of the PNSF for repair of these defects, preserving the integrity of the PNSF is beneficial during the endoscopic endonasal approach to the CCJ. We describe three new variations/refinements of the endoscopic endonasal approach to the CCJ that preserve the mucosal integrity of the posterior nasal septum and PNSF.
METHODS: Photo and video documentation of cadaveric dissections.
RESULTS: The steps required for the different variations in approaching the CCJ are demonstrated. These three options are: 1) nonopposing Killian incisions with submucosal elevation of PNSFs laterally under the inferior turbinates (the PNSFs are retracted laterally and left attached superiorly onto the nasal septum and laterally under the inferior turbinate); 2) bilateral non-opposing PNSFs tucked beneath their respective middle turbinate or into the sphenoid sinus; and 3) a hybrid approach combining option 1 performed on one side and option 2 on the contralateral side. All three options allowed for a mucosal-sparing septectomy to provide ample access to the CCJ.
CONCLUSION: These variations/refinements of the mucosal-sparing approach to the CCJ allowed adequate surgical access with sufficient maneuverability while preserving both PNSFs.
LEVEL OF EVIDENCE: NA. Laryngoscope, 2015.

PMID: 26891223 [PubMed - as supplied by publisher]

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Transdural retrieval of a retropulsed lumbar interbody cage: Technical case report.

Transdural retrieval of a retropulsed lumbar interbody cage: Technical case report.

Asian J Neurosurg. 2016 Jan-Mar;11(1):71

Authors: Zaidi HA, Shah A, Kakarla UK

Abstract
The purpose of this case report was to describe a novel method to retrieve a herniated lumbar interbody cage. Transforaminal lumbar interbody fusion (TLIF) is an increasingly popular method of spinal fixation and fusion. Unexpected retropulsion of an interbody is a rare event that can result in intractable pain or motor compromise necessitating surgical retrieval of the interbody. Both anterior and posterior approaches to removing migrated cages may be associated with significant surgical morbidity and mortality. A 60-year-old woman underwent an L4-S1 TLIF coupled with pedicle screw fixation at a previous hospital 5 years prior to admission. She noted sudden-onset bilateral lower extremity weakness and right-sided foot drop. Magnetic resonance imaging and radiographs were notable for purely centrally herniated interbody. A posterior, midline transdural approach was used to retrieve the interbody. Situated in between nerve rootlets to the ventral canal, this virgin corridor allowed us to easily visualize and protect neurological structures while safely retrieving the interbody. The patient experienced an immediate improvement in symptoms and was discharged on postoperative day 3. At 12-month follow-up, she had no evidence of cerebrospinal fluid (CSF) leak and had returned to normal activities of daily living. While the risk of CSF leak may be higher with a transdural approach, we maintain that avoiding unnecessary retraction of the nerve roots may outweigh this risk. To our knowledge, this is the first case report of a transdural approach for the retrieval of a retropulsed lumbar interbody cage.

PMID: 26889290 [PubMed]

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[Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery].

[Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;50(11):909-14

Authors: Liu J, Han J, Yang D, Liu D, Li R, Yu Y, Zhang Q, Fernandez Miranda JC, Gardner PA, Snyderman CH

Abstract
OBJECTIVE: To identify the landmarks of transpterygoid approach and to report its application in a series of cases.
METHODS: Two silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma. Clinical records were reviewed.
RESULTS: In terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified. In terms of clinical data, three patients with spontaneous CSF leak underwent repair. Six patients with benign lesions underwent complete tumor resection. In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month. For these benign skull base lesions, there was no recurrence during the follow-up period. In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor. Final control was achieved with chemotherapy and radiation. In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated.
CONCLUSION: An understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone. The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.

PMID: 26887995 [PubMed - in process]

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Implications of different patterns of "double-layer sign" in cervical ossification of the posterior longitudinal ligament.

Related Articles

Implications of different patterns of "double-layer sign" in cervical ossification of the posterior longitudinal ligament.

Eur Spine J. 2015 Aug;24(8):1631-9

Authors: Yang H, Yang L, Chen D, Wang X, Lu X, Yuan W

Abstract
PURPOSE: To make a preliminary classification of double-layer sign according to the morphological characteristics of the ossified and central hypodense mass and clarify implications of different patterns of "double-layer sign".
METHODS: The 268 patients of cervical ossification of the posterior longitudinal ligament (OPLL) who underwent anterior corpectomy were retrospectively analyzed from January 2009 to January 2014. All these patients were performed cervical plain X-rays, CT and MRI. The double-layer sign was observed on axial bone window of CT images. According to the morphological characteristics of the ossified and central hypodense mass, this sign was classified into three types: type A was crescent shape, type B was short-straight shape and type C was long-straight shape. Type A was named when the central hypodense mass traced an arc and the OPLL is much more extensive than the dural ossification (DO). It belonged to type B when the central hypodense mass traced a short-straight line, less than or equal to half of the base width of the vertebrae. The OPLL may be extensive or equal to the DO. Type C was defined when it was more than half of the base width, presenting with a long-straight line and DO is much more extensive than OPLL. Intraoperative findings including dural mater ossification and adhesion, postoperative CSF leakage and outcome were all studied. Two spinal surgeons with rich experiences read the CT images according to this classification method and verified its consistency.
RESULTS: Ninety-two patients were found in association with DO during the anterior decompression procedure, meanwhile the double-layer sign could be seen on axial bone window of CT imaging. In these 92 patients, there were 51 patients presenting with type A, and the ossified mass was completely resected with ossified dura mater reserved. Only two patients presented with dural defect and postoperative CSF leakage. Thirty-five patients was classified as type B, of which six accompanied by CSF leakage. All the other six patients of type C presented with CSF leakage after operation. There was a significant correlation between the occurence of CSF leakage and pattern of double-layer sign, but not gender, age, duration of symptoms, extent of OPLL and occupying rate. The Kappa value between the two surgeons was 0.82, showing a good consistency of the method.
CONCLUSIONS: OPLL patients with double-layer sign of type C is almost inevitably followed by CSF leakage after anterior decompression. For type A and B, occurrence of CSF leakage is not as high as we thought before. Pattern of double-layer sign should be a considered factor when anterior or posterior approach is chosen.

PMID: 25840783 [PubMed - indexed for MEDLINE]

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An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications.

Related Articles

An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications.

Spine (Phila Pa 1976). 2015 Apr 1;40(7):450-61

Authors: Bumpass DB, Buchowski JM, Park A, Gray BL, Agarwal R, Baty J, Zebala LP, Riew KD, Santiago P, Ray WZ, Wright NM

Abstract
STUDY DESIGN: Retrospective analysis of inpatient and outpatient data from a single academic trauma center.
OBJECTIVE: To test the effectiveness of a conservative treatment algorithm for civilian spinal gunshot wounds (CSGSWs) by comprehensively evaluating neurological status and recovery, fracture type, concomitant injuries, indications for surgery, and complications.
SUMMARY OF BACKGROUND DATA: Few large studies exist to guide treatment of CSGSWs, and none have been published in nearly 20 years.
METHODS: A search of International Classification of Diseases, Ninth Revision (ICD-9) codes was performed for all hospital patients treated from 2003 to 2011 by either neurosurgery or orthopedic surgery to identify 159 consecutive patients who sustained CSGSWs. Mean follow-up was 13.6 months. American Spinal Injury Association grading was used to assess neurological injury.
RESULTS: Fifty percent of patients had neurological deficits from CSGSW. Complete spinal injury was the most common injury grade; thoracic injuries had the most risk of complete injury (P < 0.001). Nearly 80% of patients had concomitant injuries to other organs. Operative treatment was more likely in patients with severe neurological injuries (P = 0.008) but was not associated with improved neurological outcomes (P = 1.00). Nonoperative treatment did not lead to any cases of late spinal instability or neurological deterioration. Overall, 31% of patients had an improvement of at least 1 American Spinal Injury Association grade by final follow-up. Nearly half of patients experienced at least 1 GSW-related complication; risk of complications was associated with neurological injury grade (P < 0.001) and operative treatment (P = 0.04).
CONCLUSION: The vast majority of CSGSWs should be managed nonoperatively, regardless of neurological grade or number of spinal columns injured. Indications for surgery include spinal infection and persistent cerebrospinal fluid leaks.
LEVEL OF EVIDENCE: 3.

PMID: 25811133 [PubMed - indexed for MEDLINE]

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[Outpatient surgical practices in otorhinolaryngology].

[Outpatient surgical practices in otorhinolaryngology].

Kulak Burun Bogaz Ihtis Derg. 2016 Mar-Apr;26(2):123-8

Authors: Kurtoğlu G, Erdağ TK

Abstract
OBJECTIVES: In this study, we report outpatient surgical procedures in an ear nose and throat (ENT) clinic of a university hospital for the first time in Turkey.
MATERIAL AND METHODS: All patients who were operated between January 2012 and December 2013 by our ENT surgeons either in central operating room or in outpatient surgery unit were retrospectively analyzed. Age of the patients, type of operation, type of anesthesia, and the time of discharge were recorded.
RESULTS: The highest number of outpatient surgical procedures was in the 1-18 age group. The most widely used type of anesthesia was general anesthesia, while adeno/tonsillectomy and tympanostomy tube insertion were the most commonly performed operations. The total number of surgeries was 2,714 and 379 (13.96%) of these patients were discharged on the same day.
CONCLUSION: Outpatient surgery has become widespread in the past three decades, particularly. However, in our study, the ratio of outpatient surgery to all surgical interventions was very low, compared to developed countries.

PMID: 26890716 [PubMed - as supplied by publisher]

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Rare cases of benign tumors of the head and neck: lipoma of larynx and sternocleidomastoid muscle.

Rare cases of benign tumors of the head and neck: lipoma of larynx and sternocleidomastoid muscle.

Kulak Burun Bogaz Ihtis Derg. 2016 Mar-Apr;26(2):118-22

Authors: Demir D, Eraslan Ö, Güven M, Kösem M

Abstract
In this article, we report two rare cases of lipoma in the head and neck region. Thirty-four-year-old case 1 presented with hoarseness and sensation of foreign body in throat. While 54-year-old case 2 presented with complaint of a mass in left side of neck. The imaging methods showed the masses in false vocal fold and the sternocleidomastoid muscle. Diagnosis and treatment of the masses were discussed in light of the literature.

PMID: 26890715 [PubMed - as supplied by publisher]

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Unilateral sudden hearing loss: a rare symptom of Moyamoya disease.

Unilateral sudden hearing loss: a rare symptom of Moyamoya disease.

Kulak Burun Bogaz Ihtis Derg. 2016 Mar-Apr;26(2):114-7

Authors: Gül F, Berçin S, Müderris T, Yalçıner G, Ünal Ö, Kırış M

Abstract
A 38-year-old female patient experienced a sudden onset of unilateral sensorineural hearing loss due to Moyamoya disease. A detailed summary of audiological and neurological findings indicated that the sudden hearing loss might be due to Moyamoya disease resulting in occlusion of posterior and middle cerebral arteries. Intravenous prednisolone and trimetazidine dihydrochloride may improve hearing thresholds and speech understanding. To our knowledge, this is the first article in the literature reporting a case of sudden hearing loss as the first manifestation of Moyamoya disease in a young adult.

PMID: 26890714 [PubMed - as supplied by publisher]

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Reflections on clinical expertise and silent know-how in voice therapy.

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Reflections on clinical expertise and silent know-how in voice therapy.

Logoped Phoniatr Vocol. 2015 Jul;40(2):66-71

Authors: Iwarsson J

Abstract
The concept of 'clinical expertise' is described as a part of evidence-based practice (EBP) together with 'external scientific evidence' and 'patient values and perspectives'. However, clinical expertise in the management of voice disorders has not been described or discussed in much detail. The expertise seems to consist partly of silent know-how that, from the outside, may seem improperly related to the personality of the speech-language pathologist or exclusively dependent on the number of years in the field. In this paper, it is suggested that clinical expertise in voice therapy consists of specific skills that can be explicitly described and trained. These skills are discussed together with educational aspects that contribute to the development of clinical expertise. The skills are also discussed from the perspectives of the past, present, and future.

PMID: 25110954 [PubMed - indexed for MEDLINE]

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Tumor infiltrating lymphocytes and survival in patients with head and neck squamous cell carcinoma.

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Tumor infiltrating lymphocytes and survival in patients with head and neck squamous cell carcinoma.

Head Neck. 2016 Feb 16;

Authors: Nguyen N, Bellile E, Thomas D, McHugh J, Rozek L, Virani S, Peterson L, Carey TE, Walline H, Moyer J, Spector M, Perim D, Prince M, McLean S, Bradford CR, Taylor JM, Wolf GT, Head and Neck SPORE Program Investigators

Abstract
BACKGROUND: Because immune responses within the tumor microenvironment are important predictors of tumor biology, correlations of types of tumor infiltrating lymphocytes (TILs) with clinical outcomes were determined in 278 patients with head and neck squamous cell carcinoma (HNSCC).
METHODS: Infiltrating levels of CD4 (helper T cells), CD8 (cytotoxic/suppressor T cells), FoxP3 (regulatory T cells), CD68 (myeloid-derived suppressor cells,) and CD1a (Langerhans) cells were measured in tissue microarrays (TMAs). Cox models tested associations with patient outcomes after adjusting for all known prognostic factors. Median follow-up was 36.6 months.
RESULTS: Higher CD4 and CD8 TIL levels were associated with improved overall survival (OS; hazard ratio [HR] = 0.77; 95% confidence interval [CI]  = 0.65-0.93; p = .005 and HR = 0.77; 95% CI = 0.64-0.94; p = .008, respectively), and relapse-free survival (RFS; p = .03 and .05, respectively). After controlling for prognostic factors, higher CD4 levels predicted improved OS and disease-specific survival (DSS; p = .003 and p = .004, respectively).
CONCLUSION: The findings suggest that TILs are a significant independent prognostic factor for HNSCC that differ by treatment. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26879675 [PubMed - as supplied by publisher]

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Exponentially growing osteosarcoma of mandible with acromegaly.

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Exponentially growing osteosarcoma of mandible with acromegaly.

Head Neck. 2016 Feb 16;

Authors: Choi N, Kim S, Cho J, Kim BK, Cho YS, Jang JY, Baek CH

Abstract
BACKGROUND: Osteosarcoma of the head and neck is aggressive malignancy that might be affected by growth hormone. The purpose of this study was to demonstrate an unusual case of osteosarcoma with acromegaly.
METHODS AND RESULTS: This case is about a 39-year-old woman with an osteosarcoma of the mandible, who had a history of exponential tumor growth in spite of chemotherapy at another hospital. She transferred to Samsung Medical Center and underwent a wide resection of tumor and free flap reconstruction. During postoperative care, a brain MRI and hormonal test revealed a growth hormone-secreting pituitary adenoma, and then a transsphenoidal approach pituitary tumor removal was performed. Immunohistochemistry of the osteosarcoma indicated positive for insulin-like growth factor (IGF)-2 and somatostatin receptor.
CONCLUSION: This study proved the IGF-2 and somatostatin receptor from the osteosarcoma of the patient with acromegaly, and this could explain that the growth hormone secreting from the pituitary adenoma might be a risk factor of therapeutic intractability and growth acceleration of osteosarcoma. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26879563 [PubMed - as supplied by publisher]

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Salvage total laryngectomy after external-beam radiotherapy: A 20-year experience.

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Salvage total laryngectomy after external-beam radiotherapy: A 20-year experience.

Head Neck. 2016 Feb 16;

Authors: Sandulache VC, Vandelaar LJ, Skinner HD, Cata J, Hutcheson K, Fuller CD, Phan J, Siddiqui Z, Lai SY, Weber RS, Zafereo ME

Abstract
BACKGROUND: The purpose of this study was to present our evaluation of the clinical and functional outcomes after salvage total laryngectomy (STL).
METHODS: We conducted a retrospective review of 218 patients who underwent STL between 1994 and 2014.
RESULTS: Seventy percent of patients originally had T1 or T2, N0 tumors and 73% had definitive external-beam radiotherapy (EBRT) alone. A majority utilized tracheoesophageal prosthesis (77%) and were gastrostomy free (80%) at last follow-up. The 5-year disease control and overall survival (OS) rates were 65% and 57%, respectively. Patients with a disease-free interval after initial treatment <2 years were more likely to develop a recurrence (p = .001) and die of disease (p = .032) after STL. The disease-free interval after EBRT impacted disease control (p < .001), with 5-year disease control of 92% for >5-year disease-free interval and 60% for <2-year disease-free interval.
CONCLUSION: Most patients remain disease-free after STL, achieve intelligible tracheoesophageal speech, and maintain an oral diet. Delayed recurrence after initial treatment portends better survival and may indicate a distinct biological profile. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26879395 [PubMed - as supplied by publisher]

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Anaplastic thyroid carcinoma: Failure of conventional therapy but hope of targeted therapy.

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Anaplastic thyroid carcinoma: Failure of conventional therapy but hope of targeted therapy.

Head Neck. 2016 Feb 16;

Authors: Lennon P, Deady S, Healy ML, Toner M, Kinsella J, Timon CI, O'Neill JP

Abstract
BACKGROUND: Anaplastic thyroid cancer has a median survival between 1.2 and 10 months. The purpose of our study was to evaluate the outcomes of patients with anaplastic thyroid cancer in Ireland.
METHODS: We carried out a retrospective analysis of the Irish National Cancer Database for patients with anaplastic thyroid cancer between 2000 and 2010.
RESULTS: Of a total of 64 patients (40 women, 24 men), the median age was 69 years, and 29.7% of the patients had distant metastases. The overall median survival was 2.3 months and the 1, 2, and 5-year survival was 12.5%, 6.25%, and 4.69%, respectively. On univariate analysis age, sex, metastases at diagnosis, and multimodality treatment were statistically significant indicators of prognosis, and metastases at diagnosis remained statistically significant on multivariate analysis.
CONCLUSION: These results correlate with the American Thyroid Association (ATA) guidelines, in which, when possible, multimodality therapy offers a survival advantage to a select group of patients. Novel therapies may offer the greatest hope for these patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26879282 [PubMed - as supplied by publisher]

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Pharmacological agents used for treatment and prevention in noise-induced hearing loss.

Pharmacological agents used for treatment and prevention in noise-induced hearing loss.

Eur Arch Otorhinolaryngol. 2016 Feb 16;

Authors: Sakat MS, Kilic K, Bercin S

Abstract
Noise is a stress factor that causes auditory, psychological and physiological effects. The realization that sudden loud noises or chronic exposure to noise in social and working environments can cause hearing loss has led to increased interest in noise-induced hearing loss (NIHL). The best means of preventing primary damage is protection against noise. Since this protection is not always possible for various reasons, the use of pharmacological agents to prevent or treat NIHL should also be considered. The purpose of this study is to discuss current pharmacological protection and treatment options in the light of the literature, since no such extensive reviews have been performed to date, including agents used for protection against and treatment of NIHL. We reviewed both animal and clinical studies, and these are discussed separately for ease of comprehension. For each agent, first animal studies, then clinical studies, if available, are discussed. We also performed a two-step search of the literature. In the first step, we searched the terms "noise induced hearing loss", "treatment" and "protection" in Pubmed. Based on the results obtained, we identified the agents used for the treatment of and protection against NIHL. In the second step, we searched the names of the agents identified in the first step, together with the term "noise induced hearing loss," and reviewed the results.

PMID: 26882913 [PubMed - as supplied by publisher]

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Clinical practice guideline: tonsillitis II. Surgical management.

Clinical practice guideline: tonsillitis II. Surgical management.

Eur Arch Otorhinolaryngol. 2016 Feb 16;

Authors: Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R

Abstract
In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative morbidity in terms of pain and bleeding. Although tonsillar tissue remains along the capsule, the outcome appears not to differ from TE, at least in the pediatric population and young adults. Age and a history of tonsillitis are not a contraindication, abscess formation in the tonsillar remnants is an extremely rare finding. The volume of the tonsils should be graded according to Brodsky and a grade >1 is considered to be eligible for TT. The number of episodes during 12 months prior to presentation is crucial to indicate either TE or TT. While surgery is not indicated in patients with less than three episodes, a wait-and-see policy for 6 months is justified to include the potential of a spontaneous healing before surgery is considered. Six or more episodes appear to justify tonsil surgery. (2) Needle aspiration, incision and drainage, and abscess tonsillectomy are effective methods to treat patients with peritonsillar abscess. Compliance and ability of the patient to cooperate must be taken into account when choosing the surgical method. Simultaneous antibiotic therapy is recommended but still subject of scientific research. Abscess tonsillectomy should be preferred, if complications have occurred or if alternative therapeutic procedures had failed. Simultaneous TE of the contralateral side should only be performed when criteria for elective TE are matched or in cases of bilateral peritonsillar abscess. Needle aspiration or incision and drainage should be preferred if co-morbidities exist or an increased surgical risk or coagulation disorders are present. Recurrences of peritonsillar abscesses after needle aspiration or incision and drainage are rare. Interval TE should not be performed, the approach is not supported by contemporary clinical studies. (3) In patients with infectious mononucleosis TE should not be performed as a routine procedure for symptom control. TE is indicated in cases with clinically significant upper airway obstruction resulting from inflammatory tonsillar hyperplasia. If signs of a concomitant bacterial infection are not present, antibiotics should not be applied. Steroids may be administered for symptom relief.

PMID: 26882912 [PubMed - as supplied by publisher]

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Management algorithm for HIV-associated parotid lymphoepithelial cysts.

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Management algorithm for HIV-associated parotid lymphoepithelial cysts.

Eur Arch Otorhinolaryngol. 2016 Feb 16;

Authors: Mourad WF, Patel S, Young R, Khorsandi AS, Concert C, Shourbaji RA, Ciarrocca K, Bakst RL, Shasha D, Guha C, Garg MK, Hu KS, Kalnicki S, Harrison LB

Abstract
We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.

PMID: 26879995 [PubMed - as supplied by publisher]

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Hearing outcome does not depend on the interval of intratympanic steroid administration in idiopathic sudden sensorineural hearing loss.

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Hearing outcome does not depend on the interval of intratympanic steroid administration in idiopathic sudden sensorineural hearing loss.

Eur Arch Otorhinolaryngol. 2016 Feb 15;

Authors: Suzuki H, Koizumi H, Ohkubo JI, Hohchi N, Ikezaki S, Kitamura T

Abstract
We studied the effect of intratympanic steroid administration with different intervals on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). The subjects were 197 consecutive patients (197 ears) with ISSNHL (hearing level ≥40 dB, interval between onset and treatment ≤30 days). They received systemic administration of prednisolone (100 mg followed by tapered doses) combined with intratympanic injection of dexamethasone (4 mg/ml). Intratympanic injection was performed once a week for 4 weeks in 105 patients (long-interval group), or 4 times in 1 week in 92 patients (short-interval group). The hearing outcomes were evaluated at two points of time: 1 week from the start of treatment, and 1-2 months after the completion of treatment when the hearing level reached a plateau. There was no significant difference in the cure rate, marked-recovery rate, recovery rate, hearing gain, hearing level, or percent hearing improvement between the long- and short-interval groups at either point of time. Multiple regression analysis also showed that the final hearing level did not depend on the interval of intratympanic steroid injection. These results indicate that the hearing outcome of ISSNHL does not improve even if the interval of intratympanic injection is shortened. This implies that a lower total number of intratympanic steroid injections may be as effective as the present protocol.

PMID: 26879994 [PubMed - as supplied by publisher]

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Severe hydrocephalus complicated with benign paroxysmal positional vertigo: one case report.

Severe hydrocephalus complicated with benign paroxysmal positional vertigo: one case report.

Int J Clin Exp Med. 2015;8(11):21807-12

Authors: Chen JJ, Cheng WJ, Rao J, Lu YF, Qiu WW

Abstract
In this study, we reported one female patient diagnosed with severe hydrocephalus who presented with benign paroxysmal positional vertigo (BPPV). She presented with progressive headache and dizziness prior to hospitalization as chief complaints. She received Diagnostic Dix-Hallpike and Roll tests to make a definite diagnosis. The patient was cured after Gufoni maneuver and did not recur after 6-month follow-up. The diagnostic procedures of this female case prompted that prior to formal treatment, patients developing severe hydrocephalus complicated with BPPV should receive provocative test for positional dizziness, performed by experienced physicians from the Department of neurology and otolaryngology.

PMID: 26885146 [PubMed]

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Safety and efficacy of AMG 334 for prevention of episodic migraine: a randomised, double-blind, placebo-controlled, phase 2 trial.

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Safety and efficacy of AMG 334 for prevention of episodic migraine: a randomised, double-blind, placebo-controlled, phase 2 trial.

Lancet Neurol. 2016 Feb 12;

Authors: Sun H, Dodick DW, Silberstein S, Goadsby PJ, Reuter U, Ashina M, Saper J, Cady R, Chon Y, Dietrich J, Lenz R

Abstract
BACKGROUND: The calcitonin gene-related peptide (CGRP) pathway is a promising target for preventive therapies in patients with migraine. We assessed the safety and efficacy of AMG 334, a fully human monoclonal antibody against the CGRP receptor, for migraine prevention.
METHODS: In this multicentre, randomised, double-blind, placebo-controlled, phase 2 trial, patients aged 18-60 years with 4 to 14 migraine days per month were enrolled at 59 headache and clinical research centres in North America and Europe, and randomly assigned in a 3:2:2:2 ratio to monthly subcutaneous placebo, AMG 334 7 mg, AMG 334 21 mg, or AMG 334 70 mg using a sponsor-generated randomisation sequence centrally executed by an interactive voice response or interactive web response system. Study site personnel, patients, and the sponsor study personnel were masked to the treatment assignment. The primary endpoint was the change in monthly migraine days from baseline to the last 4 weeks of the 12-week double-blind treatment phase. The primary endpoint was calculated using the least squares mean at each timepoint from a generalised linear mixed-effect model for repeated measures. Safety endpoints were adverse events, clinical laboratory values, vital signs, and anti-AMG 334 antibodies. The study is registered with ClinicalTrials.gov, number NCT01952574. An open-label extension phase of up to 256 weeks is ongoing and will assess the long-term safety of AMG 334.
FINDINGS: From Aug 6, 2013, to June 30, 2014, 483 patients were randomly assigned to placebo (n=160), AMG 334 7 mg (n=108), AMG 334 21 mg (n=108), or AMG 334 70 mg (n=107). The mean change in monthly migraine days at week 12 was -3·4 (SE 0·4) days with AMG 334 70 mg versus -2·3 (0·3) days with placebo (difference -1·1 days [95% CI -2·1 to -0·2], p=0·021). The mean reductions in monthly migraine days with the 7 mg (-2·2 [SE 0·4]) and the 21 mg (-2·4 [0·4]) doses were not significantly different from that with placebo. Adverse events were recorded in 82 (54%) patients who received placebo, 54 (50%) patients in the AMG 334 7 mg group, 54 (51%) patients in the AMG 334 21 mg group, and 57 (54%) patients in the AMG 334 70 mg group. The most frequently reported adverse events were nasopharyngitis, fatigue, and headache. Serious adverse events were reported for one patient in the AMG 334 7 mg group (ruptured ovarian cyst) and one patient in the AMG 334 70 mg group (migraine and vertigo); these events were judged to be unrelated to AMG 334 treatment. Nine (3%) of 317 patients had neutralising antibodies. No apparent association was recorded between patients with positive anti-AMG 334 antibodies and adverse events. No clinically significant vital signs, laboratory, or electrocardiogram findings were recorded.
INTERPRETATION: These results suggest that AMG 334 70 mg might be a potential therapy for migraine prevention in patients with episodic migraine and support further investigation of AMG 334 in larger phase 3 trials.
FUNDING: Amgen.

PMID: 26879279 [PubMed - as supplied by publisher]

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A cross-sectional survey assessing sources of movement-related fear among people with fibromyalgia syndrome.

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A cross-sectional survey assessing sources of movement-related fear among people with fibromyalgia syndrome.

Clin Rheumatol. 2015 Jun;34(6):1109-19

Authors: Russek L, Gardner S, Maguire K, Stevens C, Brown EZ, Jayawardana V, Mondal S

Abstract
Fear of movement may contribute to functional limitations and loss of well-being among individuals with fibromyalgia (FM). The objectives of this study were to assess factors contributing to movement-related fear and to explore relationships among these factors, function and wellness, in a widespread population of people with FM. This was an internet survey of individuals with FM. Respondents completed a battery of surveys including the Fibromyalgia Impact Questionnaire--Revised (FIQR), Tampa Scale of Kinesiophobia (TSK), Activities-Specific Balance Confidence Scale (ABC), Primary Care Posttraumatic Stress Disorder screen (PC-PTSD), Vertigo Symptom Scale (VSS-SF), a joint hypermobility syndrome screen (JHS), and screening questions related to obsessive-compulsive personality disorder (OCPD), physical activity, work status, and demographics. Analysis included descriptive statistics, Pearson product-moment correlations, and linear regression. Over a 2-year period, 1,125 people (97.6 % female) completed the survey battery. Kinesiophobia was present in 72.9 % of the respondents, balance confidence was compromised in 74.8 %, PTSD likely in 60.4 %, joint hypermobility syndrome likely in 46.6 %, and OCPD tendencies in 26.8 %. The total FIQR and FIQR perceived function subscores were highly correlated (p < 0.0005, r > 0.4) with pain, kinesiophobia, balance confidence, and vertigo. Reported activity level had poor correlation (r < 0.25) with all measured variables. Pain, ABC, VSS, and TSK predicted FIQR and FIQR-pf, explaining 65 and 48 % of the variance, respectively. Kinesiophobia, balance complaints, vertigo, PTSD, and joint hypermobility were common in this population of people with FM. Sources of movement-related fear correlated to overall wellness and perceived function as measured by the FIQR and FIQR-pf.

PMID: 24481649 [PubMed - indexed for MEDLINE]

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[Bony lacrimal duct stenosis and hand abnormalities as signs of systemic disease].

[Bony lacrimal duct stenosis and hand abnormalities as signs of systemic disease].

HNO. 2016 Feb 17;

Authors: Heichel J, Bredehorn-Mayr T, Böhm K, Linné M, Riedel S, Struck HG

PMID: 26886494 [PubMed - as supplied by publisher]

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Prevalence and complications of MRI scans of cochlear implant patients : English version.

Prevalence and complications of MRI scans of cochlear implant patients : English version.

HNO. 2016 Feb 17;

Authors: Grupe G, Wagner J, Hofmann S, Stratmann A, Mittmann P, Ernst A, Todt I

Abstract
BACKGROUND: Cochlear implants (CI) are the preferred method of treatment for patients with severe to profound bilateral sensorineural hearing loss and unilateral deafness. For many years, because of the magnetic field applied during magnetic resonance imaging (MRI) examinations, MRI examinations were contraindicated for CI patients or feasible only under specific circumstances. MRI examinations of CI recipients entail complications and therefore preventive measures have to be considered. The aim of this study was to evaluate the prevalence of MRI scans in CI recipients and the occurrence of complications and furthermore to investigate the preventive measures taken in radiological daily routine.
MATERIALS AND METHODS: A retrospective questionnaire was sent to 482 patients that received CIs from 1999-2013. Details of the MRI examination and subjective and objective incidents during and after the MRI scan were evaluated.
RESULTS: A total of 204 CI recipients answered the retrospective questionnaire (42.3 %). Twenty patients (9.8 %) with 23 implants underwent a total of 33 MRI scans with their cochlear implant in place. In 16 cases the scanned region was the head (49 %). Preventive measures in the form of head bandages were taken in 20 cases (61 %). The most common complication was pain in 23 cases (70 %) and the most serious complication was the dislocation of the internal magnet in 3 cases (9 %).
CONCLUSIONS: The number of CI recipients undergoing MRI scans is high. Possible complications and preventive measures attract too little attention in radiological daily routine.

PMID: 26886493 [PubMed - as supplied by publisher]

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