Distribution of Macromolecular Tracer Particles (Thorotrast(R)) in the Cochlea. An Electron Microscopic Study in Guinea Pig: Part I. The organ of Corti, the basilar membrane and the tympanic covering layer.

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Distribution of Macromolecular Tracer Particles (Thorotrast(R)) in the Cochlea. An Electron Microscopic Study in Guinea Pig: Part I. The organ of Corti, the basilar membrane and the tympanic covering layer.

Acta Otolaryngol. 1974 Jan;77(319):19-41

Authors: Angelborg C

Abstract
Thorotrast(R) containing thorium dioxide particles with diameters of around 100 Å was introduced in perilymph or endolymph using various methods and concentrations. The location of the tracer particles in the cochleas was determined using the transmission electron microscope. Injection of tracer into the cerebrospinal fluid (CSF) was considered to be the least unphysiological way to bring the tracer to the cochlea, and therefore most of the experiments were performed in that way. The distribution of tracer was very dependent on the mode of injection and the concentration of tracer in the cochlea. With very high concentrations it appeared that every kind of cell had a capacity of phagocytizing. No significant tracer uptake was noted in the cells of the organ of Corti after direct injection of small amounts of tracer in the cochlear duct. After tracer administration in the cerebrospinal fluid, the tracer rapidly reached the scala tympani. The tympanic border cells contained large numbers of tracer particles, while lesser amounts were found in the homogenous parts of the basilar membrane. No tracer was seen in the cells of the organ of Corti. After perfusion of the cochlear perilymph, some tracer was seen in the cells of the organ of Corti. The limited passage of tracer to the organ of Corti was not regarded as proof of free communication between perilymph and cortilymph. Glycerol administration to the animals did not change the propagation of tracer in the cochlea. After injection of tracer into dead animals, tracer inclusions could be seen in the tympanic border cells, indicating the possibility of a cell phagocytizing ability, also some time after death.

PMID: 26947360 [PubMed]

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Surface Structures of the Human Vestibular Sensory Regions.

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Surface Structures of the Human Vestibular Sensory Regions.

Acta Otolaryngol. 1974 Jan;77(319):3-18

Authors: Rosenhall U, Engström B

Abstract
The hair bundles and other surface organelles of the human vestibular sensory regions have been studied with SEM and TEM. The material was taken from individuals of different ages, from the fetal period to old age. The hair bundles have a remarkably mature appearance in fetuses three to four months old. Each hair bundle consists of one kinocilium and of many stereocilia of different length. Some hair bundles are shorter than the majority. There are indications that these short hair bundles, which are especially numerous at the edges of the maculae, belong to type II sensory cells. In old individuals, laminated inclusions are often seen in the cytoplasm close to the cuticular plate. Each supporting cell is equipped with microvilli and a solitary kinocilium in the fetal period. In adults these microvilli are shorter and more scanty, and the kinocilium is usually missing.

PMID: 26947359 [PubMed]

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Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population.

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Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population.

J Voice. 2016 Mar 4;

Authors: Moore J, Greenberg C, Thibeault SL

Abstract
OBJECTIVE: To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI).
STUDY DESIGN: Prospective, survey study.
METHODS: Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database with voice, concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study. The VHI was sent to patients 6 months post clinic visit to determine change in voice handicap from baseline. General health was screened using the 12-item Short Form Health Survey, using physical component summary and mental component summary scores. Predictor variables included treatment (medical and/or behavioral); dysphonia sub-diagnosis; grade, roughness, breathiness, asthenia, and strain rating; age; sex; socioeconomic factors; smoking history; and comorbidity score.
RESULTS: Two hundred thirty-seven patients met study criteria and were followed longitudinally. Eighty-two patients returned 6-month surveys. The VHI was significantly correlated with mental component summary scores. Patients with a higher grade in baseline grade, roughness, breathiness, asthenia, and strain score were more likely to receive voice intervention (P = 0.04). Six-month improvement in VHI score was associated with both higher initial VHI score and higher educational level in both univariate (P < 0.01, P = 0.04) and multivariate analyses (P < 0.01, P = 0.02). Voice treatment (medical and/or behavioral) was not a significant factor for improvement in VHI score.
CONCLUSIONS: Our results suggest that it is important to consider baseline self-perceived voice impact measures and educational level in setting expectations for voice treatment. Future studies examining the relationship between treatment patterns and voice-related patient outcomes are warranted.

PMID: 26952321 [PubMed - as supplied by publisher]

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Alcohol responsiveness in laryngeal dystonia: a survey study.

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Alcohol responsiveness in laryngeal dystonia: a survey study.

J Neurol. 2015 Jun;262(6):1548-56

Authors: Kirke DN, Frucht SJ, Simonyan K

Abstract
Laryngeal dystonia (LD) is a task-specific focal dystonia of unknown pathophysiology affecting speech production. We examined the demographics of anecdotally reported alcohol use and its effects on LD symptoms using an online survey based on Research Electronic Data Capture (REDCap™) and National Spasmodic Dysphonia Association's patient registry. From 641 participants, 531 were selected for data analysis, and 110 were excluded because of unconfirmed diagnosis. A total of 406 patients (76.5 %) had LD and 125 (23.5 %) had LD and voice tremor (LD/VT). The consumption of alcohol was reported by 374 LD (92.1 %) and 109 LD/VT (87.2 %) patients. Improvement of voice symptoms after alcohol ingestion was noted by 227 LD (55.9 % of all patients) and 73 LD/VT (58.4 %), which paralleled the improvement observed by patient's family and/or friends in 214 LD (57.2 %) and 69 LD/VT (63.3 %) patients. The benefits lasted 1-3 h in both groups with the maximum effect after 2 drinks in LD patients (p = 0.002), whereas LD/VT symptoms improved independent of the consumed amount (p = 0.48). Our data suggest that isolated dystonic symptoms, such as in LD, are responsive to alcohol intake and this responsiveness is not attributed to the presence of VT, which is known to have significant benefits from alcohol ingestion. Alcohol may modulate the pathophysiological mechanisms underlying abnormal neurotransmission of γ-aminobutyric acid (GABA) in dystonia and as such provide new avenues for novel therapeutic options in these patients.

PMID: 25929664 [PubMed - indexed for MEDLINE]

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Tinnitus: Is there a place for brain stimulation?

Tinnitus: Is there a place for brain stimulation?

Surg Neurol Int. 2016;7(Suppl 4):S125-9

Authors: van Zwieten G, Smit JV, Jahanshahi A, Temel Y, Stokroos RJ

Abstract
Tinnitus is the perception of a "phantom sound" and has a high prevalence. Although many therapies have been investigated within the last decades, there is still no effective standard therapy. Animal studies and human functional imaging studies revealed that tinnitus perception is associated with many complex changes in multiple brain structures. There is growing evidence that brain stimulation might be able to interrupt the local altered neuronal activity and hereby inhibit tinnitus perception. In this editorial review, an update is given on the most promising targets for brain stimulation. Promising structures for stimulation are the dorsal cochlear nucleus, the inferior colliculus and the medial geniculate body of the thalamus. For cortical stimulation, the auditory cortex is considered as a target. Nevertheless, the field is waiting for evidence from well-designed clinical trials, based on supporting evidence from experimental/mechanistic research, to support or discourage the application of brain stimulation in tinnitus.

PMID: 26958429 [PubMed]

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Disability evaluation in acoustic blast trauma.

Disability evaluation in acoustic blast trauma.

Indian J Occup Environ Med. 2015 Sep-Dec;19(3):138-40

Authors: Raju G

Abstract
INTRODUCTION: Acoustic blast trauma is different from Noise induced hearing loss. Blast trauma can damage the tympanic membrane, ossicles and cochlea singly or in combination. It produces immediate severe hearing loss and may be associated with tinnitus and vestibular symptoms. Hearing loss recovers spontaneously in many cases but may be permanent in 30-55% cases. Thirteen patients working in an explosive manufacturing unit in Andhra Pradesh were exposed to blast trauma at work place. All these workers complained of immediate hearing loss and were subjected to audiological investigations.
METHODS: Initial evaluation showed a severe sensorineural type of hearing loss 10 of the 13 cases (77%). They were referred to our Medical board for disability evaluation after 2-3 years of initial injury. Pure tone audiometry indicated severe hearing loss in 12 of 13 cases (92%) that was not correlating clinically. Re-evaluation with Acoustic reflex and ABR (BERA) tests were done and permanent disability was evaluated with the results of these investigations.
OBSERVATIONS: No significant hearing loss was found in most patients and these patients had minimal disability.
CONCLUSION: Objective hearing tests should be carried out after one year or more before evaluation of permanent disability.

PMID: 26957811 [PubMed]

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Emerging hubs in phantom perception connectomics.

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Emerging hubs in phantom perception connectomics.

Neuroimage Clin. 2016;11:181-94

Authors: Mohan A, De Ridder D, Vanneste S

Abstract
Brain networks are small-world networks typically characterized by the presence of hubs, i.e. nodes that have significantly greater number of links in comparison to other nodes in the network. These hubs act as short cuts in the network and promote long-distance connectivity. Long-distance connections increase the efficiency of information transfer but also increase the cost of the network. Brain disorders are associated with an altered brain connectome which reflects either as a complete change in the network topology, as in, the replacement of hubs or as an alteration in the connectivity between the hubs while retaining network structure. The current study compares the network topology of binary and weighted networks in tinnitus patients and healthy controls by studying the hubs of the two networks in different oscillatory bands. The EEG of 311 tinnitus patients and 256 control subjects are recorded, pre-processed and source-localized using sLORETA. The hubs of the different binary and weighted networks are identified using different measures of network centrality. The results suggest that the tinnitus and control networks are distinct in all the frequency bands but substantially overlap in the gamma frequency band. The differences in network topology in the tinnitus and control groups in the delta, theta and the higher beta bands are driven by a change in hubs as well as network connectivity; in the alpha band by changes in hubs alone and in the gamma band by changes in network connectivity. Thus the brain seems to employ different frequency band-dependent adaptive mechanisms trying to compensate for auditory deafferentation.

PMID: 26955514 [PubMed - in process]

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Efficacy of balloon dilation in the treatment of symptomatic Eustachian tube dysfunction: One year follow-up study.

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Efficacy of balloon dilation in the treatment of symptomatic Eustachian tube dysfunction: One year follow-up study.

Am J Otolaryngol. 2016 Mar-Apr;37(2):99-102

Authors: Xiong H, Liang M, Zhang Z, Xu Y, Ou Y, Chen S, Yang H, Zheng Y

Abstract
PURPOSE: Eustachian tube balloon dilation (ETBD) has been recently described as feasible treatment for patients with refractory Eustachian tube dysfunction (ETD). The aim of this study was to evaluate the efficacy of ETBD in the treatment of symptomatic Eustachian tube dysfunction (SETD) by subjective and objective analysis.
MATERIALS AND METHODS: Forty patients who underwent ETBD were included in the study. Subjects' inclusion criteria were as follows: symptoms of ETD (aural fullness predominantly, with or without otalgia, muffle hearing and tinnitus), normal tympanic membrane, type A or C tympanograms, and without a history of any middle ear diseases. Main outcomes including subjective improvement, otoscopy, pure-tone audiometry, impedance audiometry, R-value in tubomanometry (TMM) at three pressure measurements (30, 40, and 50mbar), Eustachian Tube Score (ETS) and the ability to perform a Valsalva maneuver were assessed preoperatively, 1week, 3months and 12months postoperatively.
RESULTS: All cases were dilated successfully. A significant effect of treatment was documented when measuring subjective improvement, impedance audiometry, R-value in TMM, ETS and the ability to perform a Valsalva maneuver 1week, 3months and 12month postoperatively. Subjective symptoms were not relieved only in one patient. The overall success rate for all patients was 98%.
CONCLUSIONS: ETBD can provide both short- and long-term benefits to those who are diagnosed SETD and refractory to medical management. SETD might be an optimal indication for ETBD in the treatment of ETD.

PMID: 26954860 [PubMed - in process]

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SENP1 but not fetal hemoglobin differentiates chronic mountain sickness from healthy Andean highlanders.

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SENP1 but not fetal hemoglobin differentiates chronic mountain sickness from healthy Andean highlanders.

Exp Hematol. 2016 Mar 4;

Authors: Hsieh MM, Callacondo D, Rojas-Camayo J, Quesada-Olarte J, Wang X, Uchida N, Maric I, Remaley AT, Leon-Velarde F, Villafuerte FC, Tisdale JF

Abstract
Chronic mountain sickness (CMS) results from chronic hypoxia. It is unclear why certain highlanders develop CMS. We hypothesized modest increases in fetal hemoglobin (HbF) is associated with lower CMS severity. In this cross-sectional study, we showed that normal HbF levels (median 0.4%) were found in all 153 adult Andean natives in Cerro de Pasco, Peru. Compared to healthy adults, the borderline elevated hemoglobin group frequently had symptoms (headaches, tinnitus, cyanosis, dilatation of veins) of CMS. Although the mean hemoglobin levels differed between healthy (17.1) and CMS (22.3 g/dL) groups, mean plasma erythropoietin (EPO) levels were similar (healthy, 17.7; CMS, 12.02 mIU/mL). Sanger sequencing showed SNPs in endothelial PAS domain 1 (EPAS1) and egl nine homolog 1 (EGLN1), associated with lower hemoglobin in Tibetans, were not identified in Andeans. Sanger sequencing of sentrin-specific protease 1 (SENP1) and acidic nuclear phosphoprotein 32 family, member D (ANP32D), in healthy and CMS individuals showed that non-G/G genotypes were associated with higher CMS score. No JAK2 V617F mutation was detected in CMS individuals. Thus HbF or other classic erythropoietic parameters were not different between healthy and CMS individuals. However, the non-G/G genotypes of SENP1 appeared to differentiate CMS from healthy Andean highlanders.

PMID: 26952840 [PubMed - as supplied by publisher]

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Myeloid sarcoma: An unusual and rare laryngeal presentation.

Myeloid sarcoma: An unusual and rare laryngeal presentation.

Int J Surg Case Rep. 2016 Feb 21;21:99-103

Authors: Tan SN, Gendeh HS, Sani A, Mat-Baki M

Abstract
INTRODUCTION: Myeloid Sarcoma (MS) or Granulocytic Sarcoma is an uncommon laryngeal malignancy. It may arise from myelodysplastic syndromes, malignancy or de novo. Presentation in the larynx is rare and some may present with Acute Myeloid Leukaemia (AML) whereby the later may be asymptomatic.
CASE PRESENTATION: A 44-year-old South East Asian lady presented with a six months history of hoarseness, shortness of breath, reduced exercise tolerance, weight loss and laryngeal irritation. Symptoms progressed to coughing with liquids two months prior. On examination, she had a resting biphasic stridor and laryngoscopy revealed right immobile vocal cord with a firm right ventricle mass extending into the right paraglottic space. She was pale and haematology investigations revealed microcytic hypochromic anaemia. Magnetic Resonance Imaging (MRI) of the neck and thorax showed thickening of the right false cord, true cord and aryepiglottic fold. A biopsy taken during endolaryngeal microsurgery (ELMS) confirmed myeloid sarcoma of the right ventricle and para glottic mass. Further investigation revealed a background of AML and she then underwent chemotherapy.
DISCUSSION: MS is a rarity with only nine reported cases between the years of 1954 until 2015. Immunohistochemistry and immunophenotyping are definite for diagnosis confirmation as MS cells often exhibit myeloperoxidase (MPO), lymphocyte common antigen (LCA) and CD117 markers. MS is treated with are chemotherapy (either systemic or intrathecal), radiotherapy, surgical excision or in combination. Systemic chemotherapy has better efficacy and prognosis as compared to localised treatment of radiotherapy or surgical excision. However, there has yet to be a definitive chemotherapy protocol. Prognosis is poor with a 5-year survival rate of 48%.
CONCLUSION: Although laryngeal MS is a rare phenomenon, early recognition is key and patients should always be investigated for an underlying myeloproliferative or dysplastic disease.

PMID: 26957189 [PubMed - as supplied by publisher]

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Paracetamol 325 mg/tramadol 37.5 mg effect on pain during needle electromyography: a double-blind crossover clinical trial.

Paracetamol 325 mg/tramadol 37.5 mg effect on pain during needle electromyography: a double-blind crossover clinical trial.

Acta Neurol Belg. 2016 Mar 8;

Authors: Kalantar SS, Abbasi M, Faghihi-Kashani S, Majedi H, Ahmadi M, Agah E, Tafakhori A

Abstract
Needle insertion during electromyography (EMG) may cause varying levels of pain that could lead to inaccurate assessment and premature termination of the procedure. The aim of this study is to compare paracetamol 325 mg/tramadol 37.5 mg with placebo in relieving pain before EMG. This is a randomized, crossover, placebo-controlled, double-blind clinical trial; forty-four healthy individuals, including 27 males with a mean age of 35.3 years (range 18-59 years), entered this study. The needles were inserted unilaterally 2 h after administration of two analgesic tablets of paracetamol 325 mg/tramadol 37.5 mg or two placebo tablets. The pain was scored through a 100-mm visual analog scale (VAS) immediately and 2 h after the procedure. The side effects were also recorded. Within a week, the procedure was repeated on the other upper limb, changing the treatment and placebo. The immediate and 2-h VAS scores were notably lower after administration of treatment compared to placebo (immediate pain: 17.5 ± 12.8 vs. 32.1 ± 16.0, P < 0.001; and 2-h pain: 1.6 ± 5.6 vs. 5.8 ± 7.9, P = 0. 002). There was a higher prevalence of side effects when treatment was used (48 vs. 9 %, P < 0.001). Although most symptoms were mild, transient and resolved without medical interventions, on one occasion a volunteer experienced brief loss of consciousness and one subject had severe vertigo that required hospitalization and fluid therapy. Paracetamol 325 mg/tramadol 37.5 mg administration prior to EMG could effectively alleviate pain. Further application of this medication in patients with neuromuscular disorders would warrant additional clinical trials, particularly considering the adverse events.

PMID: 26957290 [PubMed - as supplied by publisher]

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Quantitative Analysis of Psychiatric Disorders in Intractable Peripheral Vertiginous Patients: A Prospective Study.

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Quantitative Analysis of Psychiatric Disorders in Intractable Peripheral Vertiginous Patients: A Prospective Study.

Otol Neurotol. 2016 Mar 7;

Authors: Zhai F, Wang J, Zhang Y, Dai CF

Abstract
OBJECTIVE: To investigate the correlation between psychological disorder and vestibular dysfunction in patients suffering from intractable peripheral vertigo.
STUDY DESIGN: Prospective study.
SETTING: In-patients in a university hospital.
METHODS: Prospective design of 26 intractable peripheral vertiginous patients with peripheral vestibular dysfunction and 20 controls recruited from the EENT hospital. Hospital Anxiety and Depression scale, Self-rating Anxiety scale, Self-rating Depression scale, Symptom Checklist-90 were used in this study. All vertigo patients received intratympanic gentamicin/dexamethasone administration or endolymphatic sac decompression. Pre- and posttreatment scores were collected and compared. All the results were statistically analyzed using Stata 8.0. t test or rank-sum test and paired-sample t test or rank-sum test were performed.
RESULTS: The outcomes of Hospital Anxiety and Depression scale, Self-rating Anxiety scale, Self-rating Depression scale, Symptom Checklist-90 were significantly greater in vertiginous group than that in normal controls (p < 0.05). The pretreatment scores of these four scales were greater than the posttreatment scores in vertiginous patients, especially in Class A and B groups (p < 0.05). The scores of more scales were demonstrated to be statistically different in patients with over 5 years of the disorder and among patient in stages 1 to 3 than in stage 4 (p < 0.05). No significant difference was noted between male and female participants in all the questionnaires used (p > 0.05).
CONCLUSION: Increased anxiety/depression levels were noted in peripheral vertiginous patients compared with normal controls through psychiatric questionnaires, and then a significant decrease after the effective treatment of vertigo, suggesting that vertigo attack may contribute to psychological dysfunction. The intervention seemed to be more effective in lowering anxiety/depression levels among patients in earlier stage of Ménière's disease marked by pure-tone audiometry results.

PMID: 26954350 [PubMed - as supplied by publisher]

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"Med Oral Patol Oral Cir Bucal"[jour]; +16 new citations

16 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Med Oral Patol Oral Cir Bucal"[jour]

These pubmed results were generated on 2016/03/08

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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"Med Oral Patol Oral Cir Bucal"[jour]; +16 new citations

16 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Med Oral Patol Oral Cir Bucal"[jour]

These pubmed results were generated on 2016/03/08

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Outcomes of an International Audiology Service-Learning Study-Abroad Program

Purpose

The purpose of this study was to evaluate students' academic and civic learning, with particular interest in cultural competence, gained through participation in the Speech, Language, and Hearing Sciences in Zambia study-abroad program.

Method

Twelve female students participated in the program. Quantitative data collected included pre- and postprogram administration of the Public Affairs Scale (Levesque-Bristol & Cornelius-White, 2012) to measure changes in participants' civic learning. Qualitative data included journals, end-of-program reflection papers, videos, and researcher field notes. Feedback was also obtained from community-partner organizations via a questionnaire and rating scale.

Results

Comparison of the pre- and postprogram Public Affairs Scale data showed a significant increase in cultural competence and a marginal increase in community engagement at the conclusion of the program. Qualitative data showed that participants' cultural awareness was increased, they benefited from hands-on learning, and they experienced a variety of emotions and emotional and personal growth.

Conclusions

Results show that a short-term study-abroad program with a service-learning component can be a mechanism for students to enhance academic and civic learning, specifically cultural competence and clinical skills. Sustainability of programs is a challenge that needs to be addressed.

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Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

J Neurol Surg B Skull Base. 2016 Feb;77(1):66-74

Authors: Upadhyay S, Dolci RL, Buohliqah L, Fiore ME, Ditzel Filho LF, Prevedello DM, Otto BA, Carrau RL

Abstract
Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

PMID: 26949591 [PubMed]

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Plasmacytoma of the Skull Base: A Meta-Analysis.

Plasmacytoma of the Skull Base: A Meta-Analysis.

J Neurol Surg B Skull Base. 2016 Feb;77(1):61-5

Authors: Na'ara S, Amit M, Gil Z, Billan S

Abstract
Objective Extramedullary plasmacytomas are rare tumors. In the current study we aim to characterize its clinical course at the skull base and define the most appropriate therapeutic protocol. Methods We conducted a meta-analysis of articles in the English language that included data on the treatment and outcome of plasmacytoma of the base of skull. Results The study cohort consisted of 47 patients. The tumor originated from the clivus and sphenoclival region in 28 patients (59.5%), the nasopharynx in 10 patients (21.2%), the petrous apex in 5 patients (10.6%), and the orbital roof in 4 patients (8.5%). The chief complaints at presentation included recurrent epistaxis and cranial nerve palsy, according to the site of tumor. Twenty-two patients (46.8%) had surgical treatment; 25 (53.2%) received radiation therapy. Adjuvant therapy was administered in 11 cases (50%) with concurrent multiple myeloma. The 2-year and 5-year overall survival rates were 78% and 59%, respectively. Clear margin resection was achieved in a similar proportion of patients who underwent endoscopic surgery and open surgery (p = 0.83). A multivariate analysis of outcome showed a similar survival rate of patients treated surgically or with radiotherapy. Conclusions The mainstay of treatment for plasmacytoma is based on radiation therapy, but when total resection is feasible, endoscopic resection is a valid option.

PMID: 26949590 [PubMed]

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Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients.

Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients.

J Neurol Surg B Skull Base. 2016 Feb;77(1):54-60

Authors: Zhan R, Li X, Li X

Abstract
Objective To assess the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for apoplectic pituitary adenoma. Design A retrospective study. Setting Qilu Hospital of Shandong University; Brain Science Research Institute, Shandong University. Participants Patients admitted to Qilu Hospital of Shandong University who were diagnosed with an apoplectic pituitary tumor and underwent EETA for resection of the tumor. Main Outcome Measures In total 45 patients were included in a retrospective chart review. Data regarding patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications were obtained from the chart review. Results In total, 38 (92.7%) of 41 patients with loss of vision obtained visual remission postoperatively. In addition, 16 patients reported a secreting adenoma, and postsurgical hormonal levels were normal or decreased in 14 patients. All other symptoms, such as headache and alteration of mental status, recovered rapidly after surgery. Two patients (4.4%) incurred cerebrospinal fluid leakage. Six patients (13.3%) experienced transient diabetes insipidus (DI) postoperatively, but none of these patients developed permanent DI. Five patients (11.1%) developed hypopituitarism and were treated with replacement of hormonal medicine. No cases of meningitis, carotid artery injury, or death related to surgery were reported. Conclusion EETA offers a safe and effective surgical option for apoplectic pituitary tumors and is associated with low morbidity and mortality.

PMID: 26949589 [PubMed]

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Management of Recurrent Trigeminal Neuralgia Associated with Petroclival Meningioma.

Management of Recurrent Trigeminal Neuralgia Associated with Petroclival Meningioma.

J Neurol Surg B Skull Base. 2016 Feb;77(1):47-53

Authors: Bir SC, Maiti TK, Bollam P, Nanda A

Abstract
Objective Petroclival meningioma (PM) presents with trigeminal neuralgia (TN) in < 5% of cases. Neurosurgeons often face the dilemma of formulating a treatment protocol when TN recurs. In this study, we sought to set up a protocol in patients with PM who had a recurrent TN. Materials and Methods We performed a retrospective review of 57 patients with PM. Of the 57 patients, only 7 patients presented with TN, and six patients experienced recurrent TN. The study population was evaluated clinically and radiographically after treatment. Results Overall improvement of pain control after various treatments was 67%, and tumor control was 100%. The pain-free period was 2 years for the Gamma Knife radiosurgery (GKRS) group and 4 years for the resection group when treated as a primary treatment (p = 0.034). Of the six patients, four patients had Barrow Neurosurgical Institute (BNI) score I (no TN, no medication), and two patients had BNI score III (some pain controlled with medication). The Karnofsky performance scale score was significantly improved after treatment compared with the pretreated status (78 versus 88; p = 0.044). Conclusion Microsurgical resection is superior to GKRS in achieving and maintaining pain-free status in patients with recurrent trigeminal pain associated with PM.

PMID: 26949588 [PubMed]

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Adjuvant Stereotactic Radiosurgery and Radiation Therapy for the Treatment of Intracranial Chordomas.

Adjuvant Stereotactic Radiosurgery and Radiation Therapy for the Treatment of Intracranial Chordomas.

J Neurol Surg B Skull Base. 2016 Feb;77(1):38-46

Authors: Choy W, Terterov S, Ung N, Kaprealian T, Trang A, DeSalles A, Chung LK, Martin N, Selch M, Bergsneider M, Yong W, Yang I

Abstract
Objective Chordomas are locally aggressive, highly recurrent tumors requiring adjuvant radiotherapy following resection for successful management. We retrospectively reviewed patients treated for intracranial chordomas with adjuvant stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT). Methods A total of 57 patients underwent 83 treatments at the UCLA Medical Center between February 1990 and August 2011. Mean follow-up was 57.8 months. Mean tumor diameter was 3.36 cm. Overall, 8 and 34 patients received adjuvant SRS and SRT, and the mean maximal dose of radiation therapy was 1783.3 cGy and 6339 cGy, respectively. Results Overall rate of recurrence was 51.8%, and 1- and 5-year progression-free survival (PFS) was 88.2% and 35.2%, respectively. Gross total resection was achieved in 30.9% of patients. Adjuvant radiotherapy improved outcomes following subtotal resection (5-year PFS 62.5% versus 20.1%; p = 0.036). SRS and SRT produced comparable rates of tumor control (p = 0.28). Higher dose SRT (> 6,000 cGy) (p = 0.013) and younger age (< 45 years) (p = 0.03) was associated with improved rates of tumor control. Conclusion Adjuvant radiotherapy is critical following subtotal resection of intracranial chordomas. Adjuvant SRT and SRS were safe and improved PFS following subtotal resection. Higher total doses of SRT and younger patient age were associated with improved rates of tumor control.

PMID: 26949587 [PubMed]

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Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects.

Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects.

J Neurol Surg B Skull Base. 2016 Feb;77(1):32-7

Authors: Costa DJ, Walen S, Varvares M, Walker R

Abstract
Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options. Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects. Design Retrospective case series with a mean follow-up of 13 months. Setting Tertiary academic center. Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction. Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum. Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome. Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm(2) (range: 7.8-120 cm(2)), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result. Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure.

PMID: 26949586 [PubMed]

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A Quantitative Analysis of Published Skull Base Endoscopy Literature.

A Quantitative Analysis of Published Skull Base Endoscopy Literature.

J Neurol Surg B Skull Base. 2016 Feb;77(1):24-31

Authors: Hardesty DA, Ponce FA, Little AS, Nakaji P

Abstract
Objectives Skull base endoscopy allows for minimal access approaches to the sinonasal contents and cranial base. Advances in endoscopic technique and applications have been published rapidly in recent decades. Setting We utilized an Internet-based scholarly database (Web of Science, Thomson Reuters) to query broad-based phrases regarding skull base endoscopy literature. Participants All skull base endoscopy publications. Main Outcome Measures Standard bibliometrics outcomes. Results We identified 4,082 relevant skull base endoscopy English-language articles published between 1973 and 2014. The 50 top-cited publications (n = 51, due to articles with equal citation counts) ranged in citation count from 397 to 88. Most of the articles were clinical case series or technique descriptions. Most (96% [49/51])were published in journals specific to either neurosurgery or otolaryngology. Conclusions A relatively small number of institutions and individuals have published a large amount of the literature. Most of the publications consisted of case series and technical advances, with a lack of randomized trials.

PMID: 26949585 [PubMed]

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Anatomical Factors Influencing Selective Vestibular Neurectomy: A Comparison of Posterior Fossa Approaches.

Anatomical Factors Influencing Selective Vestibular Neurectomy: A Comparison of Posterior Fossa Approaches.

J Neurol Surg B Skull Base. 2016 Feb;77(1):19-23

Authors: Master AN, Flores JM, Gardner LG, Cosetti MK

Abstract
Objectives To identify measurable anatomical factors that may guide the surgical approach for posterior fossa selective vestibular neurectomy (SVN) and predict identification of the vestibulocochlear cleavage (VCC) plane. Study Design Dissection of fixed cadaveric heads through retrolabyrinthine and retrosigmoid-internal auditory canal (RSG-IAC) approaches with measurement of landmarks. Setting Cadaveric dissection model. Main Outcome Measures Area of the Trautmann triangle (TT) and the distance from the posterior semicircular canal to the anterior border of the sigmoid along the posterior Donaldson line (pDL). VCC planes from each approach were calculated and compared. Results Overall mean pDL was 8.53 mm (range: 5-11.5 mm); mean TT area was 124 mm(2) (range: 95-237 mm(2)). The VCC was identified in 63% of ears through the retrolabyrinthine (RVN) approach alone, whereas 37% of ears required the RSG-IAC approach. In ears requiring IAC dissection, the VCC was found within 1 to 2 mm distal to the porus. The pDL (p < 0.05) and area of TT (p < 0.05) were significantly larger in the RVN group compared with the RSG-IAC group. Conclusion Ears amenable to the RVN approach had a greater pDL and TT area. These anatomical measurements may have a role in surgical planning and the choice of approach for SVN.

PMID: 26949584 [PubMed]

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Nasal Deformities Following Nasoseptal Flap Reconstruction of Skull Base Defects.

Nasal Deformities Following Nasoseptal Flap Reconstruction of Skull Base Defects.

J Neurol Surg B Skull Base. 2016 Feb;77(1):14-8

Authors: Rowan NR, Wang EW, Gardner PA, Fernandez-Miranda JC, Snyderman CH

Abstract
Objectives To identify the prevalence and risk factors for nasal deformities after endoscopic endonasal surgery (EES) of the skull base. Design Retrospective case series. Setting Tertiary referral academic center. Participants EES patients from January 2011 to October 2013. Main Outcome Measures Surgical approach, method of skull base reconstruction, and postoperative nasal deformities. Results Of 328 patients, 19 patients (5.8%) had nasal dorsum collapse, 3 (0.9%) with new septal perforations and 2 (0.6%) with septal deviations requiring surgical correction. Postoperative deformities were only found in the setting of nasoseptal flap reconstruction (p = 0.0001) and were most common in patients who had undergone an approach involving more than one anatomical subsite (p = 0.0021). Patients with nasal deformities were on average 6 years younger (p = 0.08) and were more likely to have a malignant pathology (p = 0.08). Conclusions All deformities were associated with use of a nasoseptal flap for reconstruction and were most common in combined approaches, suggesting that flap size may play a role in the development of nasal deformities. The mechanism of nasal dorsum collapse is unclear but does not appear to be related to septal cartilage necrosis. These findings warrant a prospective analysis to identify risk factors for postoperative nasal deformities and data for counseling of patients.

PMID: 26949583 [PubMed]

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Imaging Characteristics of Olfactory Neuroblastoma (Esthesioneuroblastoma).

Imaging Characteristics of Olfactory Neuroblastoma (Esthesioneuroblastoma).

J Neurol Surg B Skull Base. 2016 Feb;77(1):1-5

Authors: Dublin AB, Bobinski M

Abstract
This presentation outlines the clinical and imaging characteristics of esthesioneuroblastoma.

PMID: 26949582 [PubMed]

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Prophylactic use of anticoagulation and hemodilution for the prevention of venous thromboembolic events following meningioma surgery.

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Prophylactic use of anticoagulation and hemodilution for the prevention of venous thromboembolic events following meningioma surgery.

Clin Neurol Neurosurg. 2016 Mar 2;144:1-6

Authors: Moussa WM, Mohamed MA

Abstract
OBJECTIVES: Brain tumors may be associated with postoperative venous thromboembolic (VTE) events with possible devastating consequences. Meningioma has the highest incidence of postoperative VTE events among all brain tumors. Hemodilution and anticoagulation both proved efficacy in deep venous thrombosis (DVT) prophylaxis that is why we theorized that this regimen would be beneficial for VTE prophylaxis in operated intracranial meningioma patients without added risk to the patients.
PATIENTS AND METHODS: A retrospective double-blinded study, where the records of consecutive intracranial meningioma patients were revised comparing the efficacy of two regimens of postoperative VTE prophylaxis. Patients were divided into 2 groups; group A was submitted to the use of compressive stockings, low-molecular weight heparin (LMWH) administration and hemodilution, while group B was submitted only to the use of compressive stockings.
RESULTS: The study included 194 patients. Mean age of patients was 55 years (range from 27 to 78 years). VTE events were diagnosed in 16 patients (8.2%) all of them belonged to group B. The median time for VTE events was 12 days. Older age (P=.0001), larger size tumor (p=0.0438), delayed ambulation postoperatively (p=0.0351) as well as skull base location of meningioma (p=0.0163) were associated with higher incidence of postoperative VTE. Overall, group A patients showed more favorable outcome as compared to group B.
CONCLUSION: In addition to the use of elastic stockings, we recommend starting hemodilution at the outset of surgery, LMWH administration starting 12h postoperatively as well as refraining from the use of diuretics during and after intracranial meningioma surgery till the patient became fully ambulatory to reduce the incidence of postoperative VTE events.

PMID: 26945875 [PubMed - as supplied by publisher]

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Removal of a penetrating orbital and anterior fossa foreign body using an eyebrow incision.

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Removal of a penetrating orbital and anterior fossa foreign body using an eyebrow incision.

Br J Neurosurg. 2015 Apr;29(2):306-7

Authors: Berrington T, Chang B, Thomson S

Abstract
In this case, we present an underutilised eyebrow approach for removing penetrating foreign bodies of the orbit extending into the anterior fossa floor. Excellent visualisation of the sub-frontal region is achieved and a large trauma craniotomy is avoided, but care must be taken to preserve the supra-orbital and fronto-temporal nerves.

PMID: 25390464 [PubMed - indexed for MEDLINE]

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Three-dimensional effects of pterygomaxillary disconnection during surgically assisted rapid palatal expansion: a cadaveric study.

Three-dimensional effects of pterygomaxillary disconnection during surgically assisted rapid palatal expansion: a cadaveric study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 3;

Authors: Möhlhenrich SC, Modabber A, Kamal M, Fritz U, Prescher A, Hölzle F

Abstract
OBJECTIVE: The aim of this study was to investigate the influence of pterygomaxillary disconnection on the transversal expansion of the maxilla.
STUDY DESIGN: Fifteen cadaver heads were used for surgically assisted rapid palatal expansion (SARPE), which was carried out twice on the same heads-with and without pterygoid disconnection. The maxillae were expanded by 10 mm by using a rapid palatal expander. Study models before and after both SARPE techniques were made and scanned by an oral scanner for virtual analysis by software.
RESULTS: Performing pterygomaxillary disconnection during SARPE led to a decrease in the deviation between the incisor regions from 5.42 ± 1.13 mm to 4.05 ± 1.12 mm (P = .002) and an increase in the distance between second premolar regions from 2.63 ± 1.64 mm to 4.07 ± 2.01 mm (P = .040).
CONCLUSIONS: SARPE without pterygomaxillary disconnection led to a V-shaped transverse expansion of the maxilla, whereas osteotomy of the pterygoid plates led to a parallel transverse expansion.

PMID: 26948022 [PubMed - as supplied by publisher]

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Early and late physical and psychosocial effects of primary surgery in patients with oral and oropharyngeal cancers: a systematic review.

Early and late physical and psychosocial effects of primary surgery in patients with oral and oropharyngeal cancers: a systematic review.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 8;

Authors: Mortensen A, Jarden M

Abstract
The purpose of this systematic review is to explore early and late physical and psychosocial effects of primary surgery for oral and oropharyngeal cancers and to investigate the factors that influence these effects. PubMed, Cinahl, and PsycInfo were searched for studies concerning patients diagnosed with oral and oropharyngeal cancers and treated with primary surgery and which followed the treatment trajectory from time of diagnosis to 10 years after surgery; these studies reported the quantitative assessments and qualitative experiences of the patient's physical and psychosocial well-being. Of the 438 articles accessed, 20 qualified for inclusion, of which 16 and 4 were quantitative and qualitative articles, respectively, and mainly quality-of-life assessments. Time of measurement ranged from time of diagnosis to 9 years after the surgical procedure. The total number of patients included in this review was 3386; of these, 1996 were treated by surgery alone and 1390 with combined surgery and adjuvant radiation therapy and/or chemotherapy. The studies showed that because of the nature of their disease, patients are negatively affected by the different types of surgical treatment for oral and oropharyngeal cancers, with both early and late interrelated effects, and by the side effects of adjuvant therapy.

PMID: 26948021 [PubMed - as supplied by publisher]

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Odontogenic myxoma with diffuse calcifications: a case report and review of a rare histologic feature.

Odontogenic myxoma with diffuse calcifications: a case report and review of a rare histologic feature.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 3;

Authors: Hammad HM, Hasen YM, Odat AM, Mikdadi AM, Safadi RA

Abstract
Calcifications have been rarely reported in odontogenic myxoma. We describe here an additional case and review all reported cases. A 45-year-old female patient presented with a gingival swelling around a mobile mandibular left second molar. Radiographic investigation revealed a large multilocular radiolucent lesion of the posterior mandible. Microscopic examination revealed an odontogenic myxoma with numerous newly formed trabeculae of bone or cementum-like material present throughout the specimen, reminiscent of those seen in fibro-osseous lesions of the jaws. After total excision, regular follow-up of the patient showed gradual healing of the surgical defect. To our knowledge, only a few documented cases of odontogenic myxoma with calcifications have been reported in the literature. This histopathologic finding is rare but should not lead to the misdiagnosis of a central odontogenic fibroma, cemento-ossifying fibroma, fibro-osseous lesion, or low-grade osteosarcoma.

PMID: 26948020 [PubMed - as supplied by publisher]

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Bilateral sagittal split surgery is not a predictable treatment for temporomandibular dysfunction in patients with retrognathia.

Bilateral sagittal split surgery is not a predictable treatment for temporomandibular dysfunction in patients with retrognathia.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 2;

Authors: Kuhlefelt M, Laine P, Thorén H

Abstract
OBJECTIVE: A prospective study to clarify the impact of forward bilateral sagittal split osteotomy (BSSO) on temporomandibular dysfunction (TMD).
STUDY DESIGN: We examined and interviewed patients with BSSO before and at 1 year after surgery to evaluate the changes in TMD symptoms. A well-known TMD index, which incorporated two complementary subindices-the objective functional Helkimo dysfunction index (Di) and the subjective symptomatic anamnestic index (Ai)-was used. Patients with a forward movement of the mandible and osteosynthesis with titanic miniplates were included.
RESULTS: Forty patients (26 females and 14 males, mean age of study population 36.9 years) retrognathia completed the study. There was no change in TMD symptoms in 24 patients (60%), as measured by the Di, and 26 (65%), as measured by the Ai. Twelve patients improved (30%), according to the Di scores and 10 (25%) according to the Ai scores. Four patients had more TMD symptoms at follow-up (10%), as measured by both Di and Ai.
CONCLUSIONS: Surgery for orthognathia is a predictable treatment for improving aesthetics and occlusion but less predictable for alleviating TMD symptoms in patients with retrognathia. TMD symptoms should therefore be treated independently.

PMID: 26948019 [PubMed - as supplied by publisher]

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Sera and salivary matrix metalloproteinases are elevated in patients with vesiculoerosive disease: a pilot study.

Sera and salivary matrix metalloproteinases are elevated in patients with vesiculoerosive disease: a pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 9;

Authors: Mair YH, Jhamb T, Visser MB, Aguirre A, Kramer JM

Abstract
BACKGROUND: Oral vesiculoerosive (VE) diseases, such as lichen planus and mucous membrane pemphigoid, are immune-mediated pathoses. Matrix metalloproteinase (MMP)-2 and MMP-9 are elevated in oral lesional biopsy specimens of patients with VE disease. However, the systemic levels and activity of MMP-2 and MMP-9 in this patient population are poorly understood. We performed a pilot study to determine whether the levels and activity of MMP-2 and MMP-9 are elevated in the sera and saliva of patients with VE disease.
STUDY DESIGN: We recruited patients with VE disease (n = 10) and healthy controls (n = 19). We collected sera and saliva and performed enzyme-linked immunosorbent assays to measure MMP levels. We used gelatin zymography and Biotrak assays to determine enzyme activity. Data were analyzed using the Mann-Whitney test.
RESULTS: There was no difference in the activity of either MMP in the sera or saliva of patients with VE disease compared with controls. Significantly, MMP-2 levels were elevated in the sera of patients with VE disease (P < .0001), whereas MMP-9 was elevated in their saliva (P = .003).
CONCLUSIONS: MMP-2 is elevated in the sera of patients with VE disease, and MMP-9 is increased in their saliva. Therefore, these enzymes may be potential markers of disease or therapeutic targets.

PMID: 26948018 [PubMed - as supplied by publisher]

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Simultaneous removal of third molars and completion of a sagittal split osteotomy: effects of age and presence of third molars.

Simultaneous removal of third molars and completion of a sagittal split osteotomy: effects of age and presence of third molars.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Dec 19;

Authors: Camargo IB, Van Sickels JE, Cunningham LL

Abstract
OBJETIVES: The risk of removal of third molars (M3) during a sagittal split osteotomy (SSO) is controversial. The purpose of this study was to review our experience with removal of mandibular M3 during versus before SSO.
STUDY DESIGN: A chart and radiographic review was completed in all patients who underwent an SSO from April 2010 until September 2014. The presence or absence of M3, degree of impaction, age, sex, and occurrence of bad splits were noted. The variables were analyzed using the Pearson χ(2), ANOVA, and Fisher's exact tests set to a significance of 5%.
RESULTS: For the 215 patients, the mean age was 23.28 years with an increase in the incidence of bad splits in older patients (P = .013). Sixty-six (30.70%) of them had at least 1 M3 present at the time of surgery. There were 6 (2.79%) bad splits. Paradoxically, looking at the occurrence of bad splits and presence of third molar, when the data were analyzed by the number of patients undergoing the procedure, there was slight evidence of a difference (P = .073), but when the data were analyzed by the surgical site, there was a statistically significant association (P = .05).
CONCLUSION: The discrepancy between the 2 ways of analyzing the data may be related to there being double the number of observations when analyzed by surgical site and thus the analysis being more powerful.

PMID: 26948017 [PubMed - as supplied by publisher]

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The relationship between balance confidence and control in individuals with Parkinson's disease.

The relationship between balance confidence and control in individuals with Parkinson's disease.

Parkinsonism Relat Disord. 2016 Feb 18;

Authors: Lee HK, Altmann LJ, McFarland N, Hass CJ

Abstract
INTRODUCTION: A broad range of subjective and objective assessments have been used to assess balance confidence and balance control in persons with Parkinson's disease (PD). However, little is known about the relationship between self-perceived balance confidence and actual balance control in PD. The purpose of this investigation was to determine the relationship between self-perceived balance confidence and objectively measured static/dynamic balance control abilities.
METHODS: Forty-four individuals with PD participated in the study. Patients were stratified into 2 groups based on the modified Hoehn and Yahr (H&Y) disability score: early stage, H&Y ≤ 2.0 and moderate stage, H&Y ≥ 2.5. All participants completed the activities-specific balance confidence (ABC) scale and performed standing balance and gait initiation tasks to assess static and dynamic balance control. The center of pressure (COP) sway (CE95%Sway) during static balance and the peak distance between the projections of the COP and the center of mass (COM) in the transverse plane (COPCOM) during gait initiation were calculated. Pearson correlation analyses were conducted relating the ABC score and CE95%Sway and COPCOM.
RESULTS: For early stage PD, there was a moderate correlation between ABC score and CE95%Sway (r = -0.56, R(2) = 0.32, p = 0.002), while no significant correlation was found between ABC score and COPCOM (r = -0.24, R(2) = 0.06, p = 0.227). For moderate stage PD, there was a moderate correlation between ABC score and COPCOM (r = 0.49, R(2) = 0.24, p = 0.044), while no correlation was found between ABC score and CE95%Sway (r = -0.19, R(2) = 0.04, p = 0.478).
CONCLUSION: Individuals with different disease severities showed different relationships between balance confidence and actual static/dynamic balance control.

PMID: 26949065 [PubMed - as supplied by publisher]

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Halitosis associated volatile sulphur compound levels in patients with laryngopharyngeal reflux.

Related Articles

Halitosis associated volatile sulphur compound levels in patients with laryngopharyngeal reflux.

Eur Arch Otorhinolaryngol. 2016 Mar 5;

Authors: Avincsal MO, Altundag A, Ulusoy S, Dinc ME, Dalgic A, Topak M

Abstract
Previous reports have suggested that laryngopharyngeal reflux (LPR) may cause halitosis. However, it remains unclear if LPR is a risk factor for halitosis. The aim of this study was to investigate if patients diagnosed with LPR have an increased probability of halitosis compared to a normal population. Fifty-eight patients complaining of LPR symptoms and 35 healthy subjects were included in the study. A LPR diagnosis was made using an ambulatory 24-h double pH-probe monitor, which is the gold standard diagnostic tool for LPR. Additionally, halitosis was evaluated by measuring the levels of volatile sulphur compounds using OralChroma™ and an organoleptic test score. The result of the final diagnosis of the 58 patients after the 24 h ambulatory pH monitoring was that 42 patients had LPR. Significant correlations were observed between the organoleptic test score and hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) levels. These were also significantly correlated with LPR. We found a strong positive association between LPR and volatile sulphur compound levels. The H2S and CH3SH levels differed significantly between the LPR and control groups (p < 0.0001 and p < 0.0001, respectively). Halitosis was significantly associated with the occurrence and severity of LPR. The present study provides clear evidence for an association between halitosis and LPR. Halitosis has a high frequency in patients with LPR and reflux characteristics are directly related to their severity and therefore could be considered as a manifestation of LPR.

PMID: 26946304 [PubMed - as supplied by publisher]

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Haemophilus influenzae biofilm formation in chronic otitis media with effusion.

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Haemophilus influenzae biofilm formation in chronic otitis media with effusion.

Eur Arch Otorhinolaryngol. 2016 Mar 5;

Authors: Van Hoecke H, De Paepe AS, Lambert E, Van Belleghem JD, Cools P, Van Simaey L, Deschaght P, Vaneechoutte M, Dhooge I

Abstract
Otitis media with effusion (OME) is a highly prevalent disease in children, but the exact pathogenesis and role of bacteria are still not well understood. This study aimed to investigate the presence of otopathogenic bacteria in the middle ear effusion (MEE) and adenoid of children with chronic OME (COME), and to investigate in vivo whether these bacteria, especially Haemophilus influenzae, are organized as a biofilm in the middle ear fluid. MEE and adenoid samples were collected from 21 patients with COME. Extensive bacterial culturing and genotyping was performed on all middle ear and adenoid samples. Fluorescence in situ hybridization (FISH) and confocal laser scanning microscopy (CLSM) was used to visualize possible biofilm structures for a selection of middle ear effusion samples. 34 MEE samples were collected from 21 patients of which 64.7 % were culture positive for bacteria and 47.0 % were culture positive for Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and/or Streptococcus pneumoniae. All 21 adenoid samples were culture positive for one or more of these four otopathogens. H. influenzae (35.3 %) and S. pneumoniae (76.2 %) were the most frequently cultured bacteria in the MEE and adenoid samples, respectively. The same bacterial species was found in MEE and adenoid for 84.6 % of the patients and in 81.2 % of the cases where the same species was found in more than one site it involved the same bacterial genotype. FISH and CLSM demonstrated the presence of H. influenzae specific biofilm structures in five of the eight culture positive MEEs that were tested, but in none of the two culture negative MEEs. The findings in this study indicate that the adenoid acts as a reservoir for bacteria in MEE and confirms that biofilms, in at least half of the cases consisting of H. influenzae, are indeed present in the MEE of children with COME. Biofilms may thus play a crucial role in the pathogenesis of COME, which is important in the understanding of this disease and the development of potential future treatment options.

PMID: 26946303 [PubMed - as supplied by publisher]

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Association of BRAF(V600E) Mutation and MicroRNA Expression with Central Lymph Node Metastases in Papillary Thyroid Cancer: A Prospective Study from Four Endocrine Surgery Centers.

Association of BRAF(V600E) Mutation and MicroRNA Expression with Central Lymph Node Metastases in Papillary Thyroid Cancer: A Prospective Study from Four Endocrine Surgery Centers.

Thyroid. 2016 Mar 7;

Authors: Aragon Han P, Kim HS, Cho S, Fazeli R, Najafian A, Khawaja H, McAlexander M, Dy B, Sorensen M, Aronova A, Sebo TJ, Giordano TJ, Fahey TJ, Thompson GB, Gauger PG, Somervell H, Bishop JA, Eshleman JR, Schneider EB, Witwer KW, Umbricht CB, Zeiger MA

Abstract
BACKGROUND: Studies have demonstrated an association of the BRAF(V600E) mutation and microRNA (miR) expression with aggressive clinicopathologic features in papillary thyroid cancer (PTC). Analysis of BRAF(V600E) mutations with miR expression data may improve perioperative decision making for patients with PTC, specifically in identifying patients harboring central lymph node metastases (CLNM).
METHODS: Between January 2012 and June 2013, 237 consecutive patients underwent total thyroidectomy and prophylactic central lymph node dissection (CLND) at four endocrine surgery centers. All tumors were tested for the presence of the BRAF(V600E) mutation and miR-21, miR-146b-3p, miR-146b-5p, miR-204, miR-221, miR-222, and miR-375 expression. Bivariate and multivariable analyses were performed to examine associations between molecular markers and aggressive clinicopathologic features of PTC.
RESULTS: Multivariable logistic regression analysis of all clinicopathologic features found miR-146b-3p and miR-146b-5p to be independent predictors of CLNM, while the presence of BRAF(V600E) almost reached significance. Multivariable logistic regression analysis limited to only predictors available preoperatively (molecular markers, age, sex, and tumor size) found miR-146b-3p, miR-146b-5p, miR-222, and BRAF(V600E) mutation to predict CLNM independently. While BRAF(V600E) was found to be associated with CLNM (48% mutated in node-positive cases vs. 28% mutated in node-negative cases), its positive and negative predictive values (48% and 72%, respectively) limit its clinical utility as a stand-alone marker. In the subgroup analysis focusing on only classical variant of PTC cases (CVPTC), undergoing prophylactic lymph node dissection, multivariable logistic regression analysis found only miR-146b-5p and miR-222 to be independent predictors of CLNM, while BRAF(V600E) was not significantly associated with CLNM.
CONCLUSION: In the patients undergoing prophylactic CLNDs, miR-146b-3p, miR-146b-5p, and miR-222 were found to be predictive of CLNM preoperatively. However, there was significant overlap in expression of these miRs in the two outcome groups. The BRAF(V600E) mutation, while being a marker of CLNM when considering only preoperative variables among all histological subtypes, is likely not a useful stand-alone marker clinically because the difference between node-positive and node-negative cases was small. Furthermore, it lost significance when examining only CVPTC. Overall, our results speak to the concept and interpretation of statistical significance versus actual applicability of molecular markers, raising questions about their clinical usefulness as individual prognostic markers.

PMID: 26950846 [PubMed - as supplied by publisher]

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Tinnitus Self-Efficacy and Other Tinnitus Self-Report Variables in Patients With and Without Post-Traumatic Stress Disorder.

Tinnitus Self-Efficacy and Other Tinnitus Self-Report Variables in Patients With and Without Post-Traumatic Stress Disorder.

Ear Hear. 2016 Mar 4;

Authors: Fagelson MA, Smith SL

Abstract
OBJECTIVE: Individuals with tinnitus and co-occurring psychological conditions typically rate their tinnitus as more disturbing than individuals without such comorbidities. Little is known about how tinnitus self-efficacy, or the confidence that individuals have in their abilities to successfully manage the effects of tinnitus, is influenced by mental or psychological health (PH) status. The purpose of this study was to examine the influence of psychological state on tinnitus perceptions and tinnitus self-efficacy in individuals with chronic tinnitus.
DESIGN: Observational study. Three groups (N = 199) were examined and included: (1) those with tinnitus without a concurrent psychological condition (tinnitus-only; n = 103), (2) those with tinnitus and concurrent PH condition other than post-traumatic stress disorder (PTSD; tinnitus + PH; n = 34), and (3) those with tinnitus and PTSD (tinnitus + PTSD; n = 62). The Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) was administered. Responses on the SETMQ were compared among the groups, as well as to other indicators of tinnitus perception such as (1) the percentage of time tinnitus was audible (tinnitus awareness), (2) the percentage of time tinnitus was distressing/bothersome, (3) tinnitus loudness, (4) tinnitus handicap inventory scores, (5) subjective ratings of degree of hearing loss, and (6) subjective ratings of sound tolerance problems.
RESULTS: The tinnitus + PTSD group reported significantly poorer tinnitus self-efficacy levels on average than the tinnitus-only group on all SETMQ subscales and poorer self-efficacy levels than the tinnitus + PH group for most subscales (except for routine management and devices). Tinnitus self-efficacy levels were similar between the tinnitus + PH and tinnitus-only groups except for the emotional response subscale in which the tinnitus-only patients reported higher self-efficacy on average than both the other groups. Group differences were not seen for tinnitus loudness ratings nor for the amount of time individuals were aware of their tinnitus. Group differences were observed for the percentage of time tinnitus was distressing/bothersome, self-reported degree of hearing loss, sound tolerance problems ratings, and responses on the tinnitus handicap inventory (THI). In general, the group differences revealed patient ratings for the tinnitus-only group were least severe, followed by the tinnitus + PH group, and the tinnitus + PTSD group rated tinnitus effects as most severe. With all patient responses, the tinnitus + PTSD group was found to be significantly more affected by tinnitus than the tinnitus-only group; in some cases, the responses were similar between the tinnitus + PTSD and tinnitus + PH group and in other cases, responses were similar between the tinnitus + PH group and the tinnitus-only group.
CONCLUSIONS: Tinnitus self-efficacy, along with other self-assessed tinnitus characteristics, varied across groups distinguished by PH diagnoses. In general, individuals with tinnitus and concurrent PTSD reported significantly poorer tinnitus self-efficacy and more handicapping tinnitus effects when compared to individuals with other psychological conditions or those with tinnitus alone. The group differences highlighted the need to consider tinnitus self-efficacy in intervention strategies, particularly for patients with tinnitus and concurrent PTSD as the results reiterated the unique ability of PTSD to interact in powerful and disturbing ways with the tinnitus experience and with patients' coping ability.

PMID: 26950001 [PubMed - as supplied by publisher]

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Fractionated Stereotactic Radiotherapy for Facial Nerve Schwannomas.

Fractionated Stereotactic Radiotherapy for Facial Nerve Schwannomas.

J Neurol Surg B Skull Base. 2016 Feb;77(1):75-80

Authors: Shi W, Jain V, Kim H, Champ C, Jain G, Farrell C, Andrews DW, Judy K, Liu H, Artz G, Werner-Wasik M, Evans JJ

Abstract
Purpose Data on the clinical course of irradiated facial nerve schwannomas (FNS) are lacking. We evaluated fractionated stereotactic radiotherapy (FSRT) for FNS. Methods Eight consecutive patients with FNS treated at our institution between 1998 and 2011 were included. Patients were treated with FSRT to a median dose of 50.4 Gy (range: 46.8-54 Gy) in 1.8 or 2.0 Gy fractions. We report the radiographic response, symptom control, and toxicity associated with FSRT for FNS. Results The median follow-up time was 43 months (range: 10-75 months). All patients presented with symptoms including pain, tinnitus, facial asymmetry, diplopia, and hearing loss. The median tumor volume was 1.57 cc. On the most recent follow-up imaging, five patients were noted to have stable tumor size; three patients had a net reduction in tumor volume. Additionally, six patients had improvement in clinical symptoms, one patient had stable clinical findings, and one patient had worsened House-Brackmann grade due to cystic degeneration. Conclusion FSRT treatment of FNS results in excellent control of growth and symptoms with a small rate of radiation toxicity. Given the importance of maintaining facial nerve function, FSRT could be considered as a primary management modality for enlarging or symptomatic FNS.

PMID: 26949592 [PubMed]

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Bilateral Cranial IX and X Nerve Palsies After Mild Traumatic Brain Injury.

Bilateral Cranial IX and X Nerve Palsies After Mild Traumatic Brain Injury.

Ann Rehabil Med. 2016 Feb;40(1):168-71

Authors: Yoo SD, Kim DH, Lee SA, Joo HI, Yeo JA, Chung SJ

Abstract
We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.

PMID: 26949684 [PubMed]

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Diagnosis and Clinical Course of Unexplained Dysphagia.

Diagnosis and Clinical Course of Unexplained Dysphagia.

Ann Rehabil Med. 2016 Feb;40(1):95-101

Authors: Yeom J, Song YS, Lee WK, Oh BM, Han TR, Seo HG

Abstract
OBJECTIVE: To investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.
METHODS: We retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.
RESULTS: Among the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).
CONCLUSION: Careful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.

PMID: 26949675 [PubMed]

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The Relation Between the Presence of Aspiration or Penetration and the Clinical Indicators of Dysphagia in Poststroke Survivors.

The Relation Between the Presence of Aspiration or Penetration and the Clinical Indicators of Dysphagia in Poststroke Survivors.

Ann Rehabil Med. 2016 Feb;40(1):88-94

Authors: Han H, Shin G, Jun A, Park T, Ko D, Choi E, Kim Y

Abstract
OBJECTIVE: To examine the relation between the presence of penetration or aspiration and the occurrence of the clinical indicators of dysphagia. The presence of penetration or aspiration is closely related to the clinical indicators of dysphagia. It is essential to understand these relationships in order to implement proper diagnosis and treatment of dysphagia.
METHODS: Fifty-eight poststroke survivors were divided into two groups: patients with or without penetration or aspiration. Medical records and videofluoroscopic swallowing examinations were reviewed. The occurrence of clinical indicators of dysphagia between two groups was analyzed with Cross Tabulation and the Pearson chi-square test (p<0.05).
RESULTS: Poststroke survivors with penetration or aspiration had significantly high occurrences of delayed initiation of the swallow (p=0.04) and reduced hyolaryngeal elevation (p<0.01) than those without penetration or aspiration.
CONCLUSION: The results of this study indicate that delayed initiation of the swallow is a strong physiological indicator of penetration or aspiration during the oral stage of swallowing in poststroke survivors. For the pharyngeal stage of swallowing, hyoid and laryngeal elevation is a key event related to occurrence of penetration or aspiration. Clinical indicators should be investigated further to allow appropriate implementation of treatment strategies for stroke survivors.

PMID: 26949674 [PubMed]

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Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies.

Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies.

J Clin Neurosci. 2016 Mar 3;

Authors: Kapitza S, Pangalu A, Horstmann GA, van Eck AT, Regli L, Tarnutzer AA

Abstract
We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema.

PMID: 26947104 [PubMed - as supplied by publisher]

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Aided Electrophysiology Using Direct Audio Input: Effects of Amplification and Absolute Signal Level

Purpose

This study investigated (a) the effect of amplification on cortical auditory evoked potentials (CAEPs) at different signal levels when signal-to-noise ratios (SNRs) were equated between unaided and aided conditions, and (b) the effect of absolute signal level on aided CAEPs when SNR was held constant.

Method

CAEPs were recorded from 13 young adults with normal hearing. A 1000-Hz pure tone was presented in unaided and aided conditions with a linear analog hearing aid. Direct audio input was used, allowing recorded hearing aid noise floor to be added to unaided conditions to equate SNRs between conditions. An additional stimulus was created through scaling the noise floor to study the effect of signal level.

Results

Amplification resulted in delayed N1 and P2 peak latencies relative to the unaided condition. An effect of absolute signal level (when SNR was constant) was present for aided CAEP area measures, such that larger area measures were found at higher levels.

Conclusion

Results of this study further demonstrate that factors in addition to SNR must also be considered before CAEPs can be used to clinically to measure aided thresholds.

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[Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

[Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

Neurocirugia (Astur). 2016 Mar 1;

Authors: Narro-Donate JM, Huete-Allut A, Velasco-Albendea FJ, Escribano-Mesa JA, Mendez-Román P, Masegosa-González J

Abstract
Cranial chondromas are tumours arising from chondrocyte embryonic remnants cells that usually appear in the skull base synchondrosis. In contrast to the rest of the organism, where chondroid tumours are the most common primary bone tumour just behind the haematopoietic lineage ones, they are a rarity at cranial level, with an incidence of less than 1% of intracranial tumours. The case is reported on a 42 year-old male referred to our clinic due to the finding of an extra-axial lesion located close to the Meckel's cave region, with extension to the posterior fossa and brainstem compression after progressive paraparesis of 6 months onset. With the diagnosis of trigeminal schwannoma, a subtotal tumour resection was performed using a combined supra-infratentorial pre-sigmoidal approach. The postoperative histopathology report confirmed the diagnosis of cranial chondroma.

PMID: 26944382 [PubMed - as supplied by publisher]

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Microvascular decompression for elderly patients with trigeminal neuralgia.

Microvascular decompression for elderly patients with trigeminal neuralgia.

J Clin Neurosci. 2016 Mar 1;

Authors: Phan K, Rao PJ, Dexter M

Abstract
Microvascular decompression (MVD) has been demonstrated to be an excellent surgical treatment approach in younger patients with trigeminal neuralgia (TN). However, it is not clear whether there are additional morbidity and mortality risks for MVD in the elderly population. We performed a systematic literature review using six electronic databases for studies that compared outcomes for MVD for TN in elderly (cut-off ⩾60, 65, 70years) versus younger populations. Outcomes examined included success rate, deaths, strokes, thromboembolism, meningitis, cranial nerve deficits and cerebrospinal fluid leaks. There were 1524 patients in the elderly cohort and 3488 patients in the younger cohort. There was no significant difference in success rates in elderly versus younger patients (87.5% versus 84.8%; P=0.47). However, recurrence rates were lower in the elderly (11.9% versus 15.6%; P=0.03). The number of deaths in the elderly cohort was higher (0.9% versus 0.1%; P=0.003). Rates of stroke (2.5% versus 1%) and thromboembolism (1.1% versus 0%) were also higher for elderly TN patients. No differences were found for rates of meningitis, cranial nerve deficits or cerebrospinal fluid leak. MVD remains an effective and reasonable strategy in the elderly population. There is evidence to suggest that rates of complications such as death, stroke, and thromboembolism may be significantly higher in the elderly population. The presented results may be useful in the decision-making process for MVD in elderly patients with TN.

PMID: 26944213 [PubMed - as supplied by publisher]

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Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

Related Articles

Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

Rhinology. 2016 Mar 2;

Authors: Rudmik L, Soler ZM, Hopkins C, Schlosser RJ, Peters A, White AA, Orlandi RR, Fokkens WJ, Douglas R, Smith TL

Abstract
INTRODUCTION: Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS.
METHODS: The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting.
RESULTS: A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is equals or is greater than 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score equals or is greater than 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is equals or is greater than 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score equals or is greater than 20.
CONCLUSION: This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

PMID: 26934470 [PubMed - as supplied by publisher]

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Tonsillectomy versus tonsillotomy for sleep-disordered breathing in children: a meta analysis.

Related Articles

Tonsillectomy versus tonsillotomy for sleep-disordered breathing in children: a meta analysis.

PLoS One. 2015;10(3):e0121500

Authors: Wang H, Fu Y, Feng Y, Guan J, Yin S

Abstract
OBJECTIVES: Tonsillotomy has gained popular acceptance as an alternative to the traditional tonsillectomy in the management of sleep-disordered breathing in children. Many studies have evaluated the outcomes of the two techniques, but uncertainty remains with regard to the efficacy and complications of tonsillotomy versus a traditional tonsillectomy. This study was designed to investigate the efficacy and complications of tonsillotomy versus tonsillectomy, in terms of the short- and long-term results.
METHODS: We collected data from electronic databases including MEDLINE, EMBASE, and the Cochrane Library. The following inclusion criteria were applied: English language, children, and prospective studies that directly compared tonsillotomy and tonsillectomy in the management of sleep disordered breathing. Subgroup analysis was then performed.
RESULTS: In total, 10 eligible studies with 1029 participants were included. Tonsillotomy was shown to be advantageous over tonsillectomy in short-term measures, such as a lower hemorrhage rate, shorter operation time, and faster pain relief. In long-term follow-up, there was no significant difference in resolution of upper-airway obstructive symptoms, the quality of life, or postoperative immune function between the tonsillotomy and tonsillectomy groups. The risk ratio of SDB recurrence was 3.33 (95% confidence interval = 1.62 6.82, P = 0.001), favoring tonsillectomy at an average follow-up of 31 months.
CONCLUSIONS: Tonsillotomy may be advantageous over tonsillectomy in the short term measures and there are no significant difference of resolving obstructive symptoms, quality of life and postoperative immune function. For the long run, the dominance of tonsillotomy may be less than tonsillectomy with regard to the rate of sleep-disordered breathing recurrence.

PMID: 25807322 [PubMed - indexed for MEDLINE]

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In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma.

In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma.

J Laryngol Otol. 2016 Mar 4;:1-12

Authors: Mishra A, Mishra SC, Verma V, Singh HP, Kumar S, Tripathi AM, Patel B, Singh V

Abstract
BACKGROUND: Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.
METHODS: Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.
RESULTS: The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).
CONCLUSION: These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

PMID: 26940398 [PubMed - as supplied by publisher]

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Olfactory event-related potentials: a new approach for the evaluation of olfaction in nasopharyngeal carcinoma patients treated with chemo-radiotherapy.

Related Articles

Olfactory event-related potentials: a new approach for the evaluation of olfaction in nasopharyngeal carcinoma patients treated with chemo-radiotherapy.

J Laryngol Otol. 2016 Mar 2;:1-9

Authors: Galletti B, Santoro R, Mannella VK, Caminiti F, Bonanno L, De Salvo S, Cammaroto G, Galletti F

Abstract
OBJECTIVE: Olfactory dysfunction is a possible side effect of chemo-radiotherapy performed in patients affected by nasopharyngeal carcinoma. Self-rating measurements and olfactory event-related potentials were used and compared in order to evaluate the impact of this treatment on the olfactory system.
METHODS: Nine patients underwent subjective evaluation of olfactory function (using visual analogue scales for olfactory symptoms and quality of life, and a six-item Hyposmia Rating Scale), and a quantitative and objective measurement (olfactory event-related potentials).
RESULTS: Spearman's rank correlation analyses highlighted significant relationships between the clinical scales and olfactory event-related potentials. Inter-group analyses showed significant differences in the latency and in the amplitude of olfactory event-related potentials between patients and controls.
CONCLUSION: Taking into account the small sample size and the lack of pre-treatment assessment, olfactory event-related potentials seemed to allow a more objective diagnosis of unilateral and bilateral olfactory loss. Moreover, olfactory event-related potentials and subjective scales results were concordant.

PMID: 26931794 [PubMed - as supplied by publisher]

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A Genetic view of Laryngeal Cancer heterogeneity.

A Genetic view of Laryngeal Cancer heterogeneity.

Cell Cycle. 2016 Mar 3;:0

Authors: de Miguel-Luken MJ, Chaves-Conde M, Carnero A

Abstract
During the recent decades significant improvements in the understanding of laryngeal molecular biology allowed a better characterization of the tumor. However, despite increased molecular knowledge and clinical efforts, survival of patients with laryngeal cancer remains the same as 30 years ago. Although this result may not make major conclusions as preservation approaches were not broadly used until the time of database collection, it seems to be clear that there is still window for improvement. Although the cornerstone for laryngeal cancer eradication is to implement smoking cessation programs, survival progresses will be hopefully seen in the future. Introducing molecular biomarkers as predictive factors to determine which patients will benefit of preservation treatments may become one of the next steps to improve survival. Furthermore, the development of new therapeutic modalities joint to biomarkers to selectively apply such new therapy in these patients may help to define new modalities with improved survival. New inhibitors against Notch pathway, EGFR, VRK1 or DNA damage repair may become gold standard if we are able to identify patients that may benefit from them, either on survival or functional larynx preservation. It is the moment for an inflexion point on the way laryngeal cancer is clinically managed.

PMID: 26940775 [PubMed - as supplied by publisher]

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[PROGNOSTICATION OF "HARD" TRACHEAL INTUBATION IN PATIENTS, SUFFERING PURULENT-INFLAMMATORY DISEASES OF THE JAW-FACIAL REGION].

[PROGNOSTICATION OF "HARD" TRACHEAL INTUBATION IN PATIENTS, SUFFERING PURULENT-INFLAMMATORY DISEASES OF THE JAW-FACIAL REGION].

Klin Khir. 2015 Nov;(11):54-6

Authors: Artemenko VY, Budnyuk OO

Abstract
Clinical follow-up was conducted in 75 patients, to whom the operation and intensive therapy were performed in 2006-2015 yrs for phlegmon of the neck. Difficulties while providing passability of respiratory ways have occurred in 73.3% patients. It was established, that the predictors of "hard" tracheal intubation in patients, operated on for cervical phlegmon, are follows: the cervical tissues oedema, restriction of the mouth opening lesser than 3 cm, odontogenous phlegmon of oral cavity and the neck, rigid epiglottis, the larynx oedema. Presence of these factors demands application of endoscopic methods for tracheal intubation in such patients.

PMID: 26939430 [PubMed - in process]

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Hereditary angioedema type I: a case report.

Related Articles

Hereditary angioedema type I: a case report.

Medwave. 2016;16(1):e6378

Authors: Muñoz Peralta F, Buller Vigueira E, Cabello Pulido J

Abstract
Hereditary angioedema is a rare disease with great heterogeneity of symptoms such as edema of the skin, gastro-intestinal mucosa and larynx or pharynx. Even though there are three types, the most frequent is type I, which is a result from a deficiency of the complement C1 inhibitor. The severity of its symptoms along with the low prevalence of the disease and the need for appropriate specific treatment make the diagnosis and treatment of the pathology an outstanding subject for the family physician. The present is the case of a male teenager with alpha-1 antitrypsin deficiency since he was six months old, angioedema on arms and legs since 11 years old and diagnosed with hereditary angioedema type I one year after. The definitive diagnosis of the disease enabled an appropriate treatment which consists in preventing outbreaks that may compromise the patient's life and, if they occur, administration of complement C1 inhibitor.

PMID: 26938198 [PubMed - as supplied by publisher]

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