Validating self-reporting of hearing-related symptoms against pure-tone audiometry, otoacoustic emission, and speech audiometry.

Validating self-reporting of hearing-related symptoms against pure-tone audiometry, otoacoustic emission, and speech audiometry.

Int J Audiol. 2016 May 19;:1-9

Authors: Fredriksson S, Hammar O, Magnusson L, Kähäri K, Persson Waye K

Abstract
OBJECTIVE: To validate self-reported hearing-related symptoms among personnel exposed to moderately high occupational noise levels at an obstetrics clinic.
DESIGN: Sensitivity, specificity, and predictive values were calculated for questionnaire items assessing hearing loss, tinnitus, sound sensitivity, poor hearing, difficulty perceiving speech, and sound-induced auditory fatigue. Hearing disorder was diagnosed by pure-tone audiometry, distortion product otoacoustic emissions, and HINT (Hearing In Noise Test).
STUDY SAMPLE: Fifty-five female obstetrics personnel aged 22-63 participated; including 26 subjects reporting hearing loss, poor hearing, tinnitus, or sound sensitivity, and 29 randomly selected subjects who did not report these symptoms.
RESULTS: The questionnaire item assessing sound-induced auditory fatigue had the best combination of sensitivity ≥85% (95% CIs 56 to 100%) and specificity ≥70% (95% CIs 55 to 84%) for hearing disorder diagnosed by audiometry or otoacoustic emission. Of those reporting sound-induced auditory fatigue 71% were predicted to have disorder diagnosed by otoacoustic emission. Participants reporting any hearing-related symptom had slightly worse measured hearing.
CONCLUSIONS: We suggest including sound-induced auditory fatigue in questionnaires for identification of hearing disorder among healthcare personnel, though larger studies are warranted for precise estimates of diagnostic performance. Also, more specific and accurate hearing tests are needed to diagnose mild hearing disorder.

PMID: 27195802 [PubMed - as supplied by publisher]

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Educating teenagers about hearing health by training them to educate children.

Educating teenagers about hearing health by training them to educate children.

Int J Audiol. 2016 May 19;:1-8

Authors: Welch D, Reddy R, Hand J, Devine IM

Abstract
OBJECTIVE: We investigated the change in hearing-health behaviour amongst teenagers trained to deliver the Dangerous Decibels programme to younger children.
DESIGN: The Dangerous Decibels programme uses a two-stage process to train 8-12 year-old children to protect their hearing from noise: (1) a team of experts train 'Educators' who (2) give classroom training to children in schools. Training teenagers as Educators may add a second level of benefit if teenagers internalize the hearing-health messages that they present and thus protect their own hearing better. They were assessed before training, immediately after, and three months later (after all had presented the classroom training) using a questionnaire. In addition, a focus group was conducted with a subgroup of the Educators to assess their subjective experience.
STUDY SAMPLE: We trained 44 Educators aged 14-17 years.
RESULTS: Results were generally positive: there were significant and sustained improvements in knowledge, self-reported behaviour, and perceived supports towards protecting hearing, and trends but not significant changes in attitudes or perceived barriers to hearing protection.
CONCLUSIONS: Providing training to teenagers had benefits beyond the delivery of training to younger children, but improvements in the delivery model may increase the uptake and impact on the teenagers.

PMID: 27196113 [PubMed - as supplied by publisher]

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Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: Patients' evaluations of the effectiveness of treatments.

Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: Patients' evaluations of the effectiveness of treatments.

Int J Audiol. 2016 May 19;:1-9

Authors: Aazh H, Moore BC, Lammaing K, Cropley M

Abstract
OBJECTIVE: To assess patients' judgements of the effectiveness of the tinnitus and hyperacusis therapies offered in a specialist UK National Health Service audiology department.
DESIGN: Cross-sectional service evaluation questionnaire survey. Patients were asked to rank the effectiveness of the treatment they received on a scale from 1 to 5 (1 = no effect, 5 = very effective).
STUDY SAMPLE: The questionnaire was sent to all patients who received treatment between January and March 2014 (n = 200) and 92 questionnaires were returned.
RESULTS: The mean score was greatest for counselling (Mean = 4.7, SD = 0.6), followed by education (Mean = 4.5, SD = 0.8), cognitive behavioural therapy - CBT (Mean = 4.4, SD = 0.7), and hearing tests (Mean = 4.4, SD = 0.9). Only 6% of responders rated counselling as 3 or below. In contrast, bedside sound generators, hearing aids, and wideband noise generators were rated as 3 or below by 25%, 36%, and 47% of participants, respectively.
CONCLUSION: The most effective components of the tinnitus and hyperacusis therapy interventions were judged by the patients to be counselling, education, and CBT.

PMID: 27195947 [PubMed - as supplied by publisher]

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Validating self-reporting of hearing-related symptoms against pure-tone audiometry, otoacoustic emission, and speech audiometry.

Validating self-reporting of hearing-related symptoms against pure-tone audiometry, otoacoustic emission, and speech audiometry.

Int J Audiol. 2016 May 19;:1-9

Authors: Fredriksson S, Hammar O, Magnusson L, Kähäri K, Persson Waye K

Abstract
OBJECTIVE: To validate self-reported hearing-related symptoms among personnel exposed to moderately high occupational noise levels at an obstetrics clinic.
DESIGN: Sensitivity, specificity, and predictive values were calculated for questionnaire items assessing hearing loss, tinnitus, sound sensitivity, poor hearing, difficulty perceiving speech, and sound-induced auditory fatigue. Hearing disorder was diagnosed by pure-tone audiometry, distortion product otoacoustic emissions, and HINT (Hearing In Noise Test).
STUDY SAMPLE: Fifty-five female obstetrics personnel aged 22-63 participated; including 26 subjects reporting hearing loss, poor hearing, tinnitus, or sound sensitivity, and 29 randomly selected subjects who did not report these symptoms.
RESULTS: The questionnaire item assessing sound-induced auditory fatigue had the best combination of sensitivity ≥85% (95% CIs 56 to 100%) and specificity ≥70% (95% CIs 55 to 84%) for hearing disorder diagnosed by audiometry or otoacoustic emission. Of those reporting sound-induced auditory fatigue 71% were predicted to have disorder diagnosed by otoacoustic emission. Participants reporting any hearing-related symptom had slightly worse measured hearing.
CONCLUSIONS: We suggest including sound-induced auditory fatigue in questionnaires for identification of hearing disorder among healthcare personnel, though larger studies are warranted for precise estimates of diagnostic performance. Also, more specific and accurate hearing tests are needed to diagnose mild hearing disorder.

PMID: 27195802 [PubMed - as supplied by publisher]

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[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material].

[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material].

HNO. 2016 May 19;

Authors: Struck HG, Glien A, Herzog M, Sandner A, Plontke SK, Heichel J

Abstract
BACKGROUND AND AIM: The lacrimal system (LS) crosses regions of ocular adnexa, the nose, and the paranasal sinuses. Surgery of disorders requires a targeted ophthalmologic and otolaryngologic examination. Since 2013, an Interdisciplinary Conference on Lacrimal System Disorders (ICLSD) has existed at the University Hospital Halle. First results of our experiences with this cooperation between ophthalmic and ENT surgeons are presented.
METHODS: In a retrospective study at the Department of Ophthalmology, University Hospital Halle, all patients aged 22-80 years (n = 43, 10 with bilateral manifestation; mean age 65.1 years) having had a consultation in ICLSD between February 2013 and May 2015 were analyzed. Thereby, 53 LS were included in the descriptive evaluation.
RESULTS: The main relevant pathology in terms of ophthalmologic manifestation was chronic dacryocystitis and its complications (n = 42), whereas nasal septum deviation (n = 11) and chronic rhinosinusitis (n = 10) were the most frequent otorhinolaryngologic pathologies. Prior to consultation, ENT (n = 34) and/or ophthalmic surgery (n = 40) had been performed. During ICLSD, an individualized therapeutic regime for each patient was developed. Surgery was required in 43 out of 53 LS. Of these, 32 were mainly ophthalmic, 11 mainly ENT interventions. At the time of evaluation (median 3 months; range 1 to 24 months), 29 out of 38 patients (76.3 %) were free of complaints.
CONCLUSION: Since 2013, competences of ophthalmic and ENT surgeons have been integrated in ICLSD for advanced diagnosis and therapy of lacrimal disorders at the University Hospital Halle. Encouraging functional results are shown in this study, as most patients have had a long and complicated history of lacrimal system disorders. ICLSD enables interdisciplinary patient care.

PMID: 27193235 [PubMed - as supplied by publisher]

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Schnarchen und obstruktive Schlafapnoe.

Schnarchen und obstruktive Schlafapnoe.

HNO. 2016 May 18;

Authors:

PMID: 27193140 [PubMed - as supplied by publisher]

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Management of isolated cricopharyngeal dysfunction: systematic review.

Management of isolated cricopharyngeal dysfunction: systematic review.

J Laryngol Otol. 2016 May 19;:1-5

Authors: Ashman A, Dale OT, Baldwin DL

Abstract
OBJECTIVE: A systematic review was performed to evaluate the safety and efficacy of different therapeutic interventions available for the management of isolated cricopharyngeal dysfunction.
METHODS: Studies were identified using the following databases: Ovid (Medline, Embase), the Cochrane Library, PubMed and Google Scholar. An initial search identified 339 articles. All titles and abstracts were reviewed. Fifty-six relevant articles were inspected in more detail; of these, 47 were included in the qualitative analysis.
RESULTS: No relevant randomised trials were found. A range of case series were used to perform a qualitative analysis. Botulinum toxin A injection and cricopharyngeal dilatation were associated with a higher risk of recurrence, but appear to be more suitable in elderly and co-morbid patients. In those patients requiring formal myotomy, endoscopic approaches appear to be as effective but less morbid when compared with classical open surgery.
CONCLUSION: There is good evidence for the safety and efficacy of the different therapeutic options for isolated cricopharyngeal dysfunction. However, further studies are required to compare the efficacy of the various treatment modalities.

PMID: 27194375 [PubMed - as supplied by publisher]

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Regenerative therapy for vestibular disorders using human induced pluripotent stem cells (iPSCs): neural differentiation of human iPSC-derived neural stem cells after in vitro transplantation into mouse vestibular epithelia.

Regenerative therapy for vestibular disorders using human induced pluripotent stem cells (iPSCs): neural differentiation of human iPSC-derived neural stem cells after in vitro transplantation into mouse vestibular epithelia.

Acta Otolaryngol. 2016 May 19;:1-7

Authors: Taura A, Nakashima N, Ohnishi H, Nakagawa T, Funabiki K, Ito J, Omori K

Abstract
OBJECTIVES: Vestibular ganglion cells, which convey sense of motion from vestibular hair cells to the brainstem, are known to degenerate with aging and after vestibular neuritis. Thus, regeneration of vestibular ganglion cells is important to aid in the recovery of balance for associated disorders.
METHODS: The present study derived hNSCs from induced pluripotent stem cells (iPSCs) and transplanted these cells into mouse utricle tissues. After a 7-day co-culture period, histological and electrophysiological examinations of transplanted hNSCs were performed.
RESULTS: Injected hNSC-derived cells produced elongated axon-like structures within the utricle tissue that made contact with vestibular hair cells. A proportion of hNSC-derived cells showed spontaneous firing activities, similar to those observed in cultured mouse vestibular ganglion cells. However, hNSC-derived cells around the mouse utricle persisted as immature neurons or occasionally differentiated into putative astrocytes. Moreover, electrophysiological examination showed hNSC-derived cells around utricles did not exhibit any obvious spontaneous firing activities.
CONCLUSIONS: Injected human neural stem cells (hNSCs) showed signs of morphological maturation including reconnection to denervated hair cells and partial physiological maturation, suggesting hNSC-derived cells possibly differentiated into neurons.

PMID: 27196942 [PubMed - as supplied by publisher]

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[III. An update on drug therapy for chordoma].

[III. An update on drug therapy for chordoma].

Gan To Kagaku Ryoho. 2016 Mar;43(3):317-21

Authors: Endo M

PMID: 27192740 [PubMed - in process]

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[II. The evidence of local treatments for malignant bone tumors in pelvis and spine].

[II. The evidence of local treatments for malignant bone tumors in pelvis and spine].

Gan To Kagaku Ryoho. 2016 Mar;43(3):313-6

Authors: Akiyama T

PMID: 27192739 [PubMed - in process]

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[I. Management of giant cell tumor of the spine and pelvis--current perspective].

[I. Management of giant cell tumor of the spine and pelvis--current perspective].

Gan To Kagaku Ryoho. 2016 Mar;43(3):307-12

Authors: Susa M, Horiuchi K, Morioka H

PMID: 27192738 [PubMed - in process]

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[Musculoskeletal tumor. Update therapeutic strategies for bone sarcomas of spine and pelvis].

[Musculoskeletal tumor. Update therapeutic strategies for bone sarcomas of spine and pelvis].

Gan To Kagaku Ryoho. 2016 Mar;43(3):305-6

Authors: Chuman H

PMID: 27192737 [PubMed - in process]

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Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty.

Related Articles

Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty.

Otol Neurotol. 2015 Sep;36(9):1537-42

Authors: Hunter JB, Sweeney AD, Carlson ML, Wanna GB, Rivas A, Weaver KD, Chambless LB, Thompson RS, Haynes DS, Bennett ML

Abstract
OBJECTIVES: To evaluate the effectiveness of resorbable mesh cranioplasty at reducing postoperative cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine tumor resection.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary academic referral center.
PATIENTS: Fifty-three consecutive cases using a resorbable mesh cranioplasty after translabyrinthine tumor resection were reviewed.
INTERVENTION: Temporal bone defects were repaired with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws.
MAIN OUTCOME MEASURES: Primary outcome measures included the incidence of postoperative CSF wound leak or rhinorrhea, pseudomeningocele formation, and surgical site infection.
RESULTS: Fifty-three cases (average age, 54.0 yr; range, 19.3-75.1 yr) were analyzed. The average body mass index was 30.8 kg/m2 (range, 17.9-48.3 kg/m2), and the average tumor size was 18.8 mm (range, 8-38 mm). One patient (1.9%) experienced CSF rhinorrhea on postoperative Day 16, which resolved after transmastoid middle ear and eustachian tube packing. One patient (1.9%) experienced a surgical site infection requiring surgical debridement and mesh removal 4 months after surgery. Compared with 1,441 prior translabyrinthine surgeries analyzed from our institution using a traditional fat graft closure without mesh, the rate of postoperative CSF leak was significantly less using the resorbable mesh cranioplasty technique (p = 0.0483).
CONCLUSION: Resorbable mesh cranioplasty is a safe and effective method to reduce postoperative CSF leak and pseudomeningocele formation after translabyrinthine craniotomy for tumor excision.

PMID: 26208128 [PubMed - indexed for MEDLINE]

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Jaw movement in people with Parkinson's Disease.

Jaw movement in people with Parkinson's Disease.

Codas. 2016 Apr;28(2):193-196

Authors: Albuquerque LC, Silva HJ

Abstract
This study aimed to characterize the amplitude and speed of isolated jaw movements and chewing using electrognathography in a volunteer and to compare these data with those of two other Parkinson Disease (PD) subjects, differentiated by the motor characteristics.
METHOD: The 3 participants were divided into three categories: one with 1 non-PD volunteer, a second category with 1 volunteer characterized by Parkinson's hypokinesia, and a third with 1 volunteer characterized by Parkinson's tremor.
RESULTS: There were differences among the three groups; however the most significant was between the non-PD and the PD-rigidity, in the amplitude and speed when performing the jaw movements and chewing. Factors related to the adaptive and compensatory processes derived from rigidity process seemed to better explain the observed changes among the PD groups.

PMID: 27191885 [PubMed - as supplied by publisher]

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Differences of brain electrical activity between moderate and severe obstructive sleep apneic patients: a LORETA study.

Related Articles

Differences of brain electrical activity between moderate and severe obstructive sleep apneic patients: a LORETA study.

J Sleep Res. 2016 May 18;

Authors: Toth M, Kondakor I, Faludi B

Abstract
The effects of initiation of continuous positive airway pressure (CPAP) therapy on electroencephalographic (EEG) background activity were investigated in patients exhibiting both moderate (n = 13) and severe (n = 12) obstructive sleep apnea syndromes in the testing of the potential differences of alterations of brain electrical activity caused by chronic hypoxia between these two groups. A normal control group (n = 14) was also examined. Two EEG examinations were achieved in each group: before and after first-time CPAP therapy. Low-resolution electromagnetic tomography (LORETA) was implemented towards localizing the generators of EEG activity in separate frequency bands. Prior to CPAP treatment, as a common direction of change, analysis with LORETA demonstrated increased activity in comparison with the patient and control groups. In the moderate group, significant changes were detected in the alpha2 band in the posterior cingulate cortex as well as in the beta1 band in the right posterior parietal cortex and the left supramarginal gyrus. In the severe group, significant changes were found in theta and alpha1 bands in the posterior cingulate cortex. Following CPAP treatment, these significant differences vanished in the severe group. In the moderate group, significantly decreased activity was seen in the beta3 band in the right fusiform gyrus. These findings potentially suggest a normalizing effect of CPAP therapy on EEG background activity in both groups of obstructive sleep apnea syndrome patients. Compensatory alterations of brain electrical activity in regions associated with influencing successful memory retrieval, emotional perception, default mode network, anorexia and fear network caused by chronic intermittent hypoxia could possibly be reversed with the use of CPAP therapy.

PMID: 27192694 [PubMed - as supplied by publisher]

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Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study.

Related Articles

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study.

Acta Otolaryngol. 2016 May 18;:1-7

Authors: Gür ÖE, Ensari N, Öztürk MT, Boztepe OF, Gün T, Selçuk ÖT, Renda L

Abstract
OBJECTIVES: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air-bone gap.
METHODS: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.
RESULTS: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p > 0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p < 0.05). The improvement in the mean air-bone gap was 14.1 dB in Group 1 and 12.4 dB in Group 2 on post-operative day 45 (p < 0.05).
CONCLUSIONS: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.

PMID: 27192505 [PubMed - as supplied by publisher]

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Hearing impairment, cochlear morphology, and peroxynitrite (ONOO(-)) formation in adult and aging NOS II knockout mice.

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Hearing impairment, cochlear morphology, and peroxynitrite (ONOO(-)) formation in adult and aging NOS II knockout mice.

Acta Otolaryngol. 2016 May 18;:1-8

Authors: Labbé D, Bloch W, Schick B, Michel O

Abstract
CONCLUSION: Nitric oxide synthase (NOS) II induction is a protective mechanism against age-related degeneration of the cochlea.
OBJECTIVES: An induction of NOS II has been described in different inner ear pathologies. The objective was to examine the role of NOS II in age-related degeneration of the cochlea.
METHODS: The hearing ability in adult and aging NOS II knockout mice (KO) and their wildtype (WT) littermates was explored via auditory brainstem response (ABR) measurements. Inner ear morphological differences were studied with scanning electron microscopy (SEM). Immunohistochemistry was used to examine the induction of NOS II in the inner ear of aging WT mice. Expression of nitrotyrosin, a marker protein for the reactive oxygen species peroxynitrite, was compared between KO and WT mice using immunohistochemistry.
RESULTS: Adult KO mice exhibited a mild hearing impairment. WT mice showed an induction of NOS II after 6 months of age. Age-related hearing deterioration was accelerated in KO mice, which was accompanied by increased nitrotyrosin formation and outer hair cell loss.

PMID: 27192390 [PubMed - as supplied by publisher]

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Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma.

Related Articles

Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma.

Acta Otolaryngol. 2016 May 18;:1-5

Authors: Joo YH, Cho KJ, Lee YS, Kim SY, Kim MS

Abstract
OBJECTIVES: The aim of this study was to evaluate the role of PNI in HPSCC.
METHODS: The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI.
RESULTS: PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p = 0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p = 0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p = 0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p = 0.001).
CONCLUSION: Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy.

PMID: 27192156 [PubMed - as supplied by publisher]

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The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue.

The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue.

Codas. 2016 Apr;28(2):113-117

Authors: Nagy A, Peladeau-Pigeon M, Valenzano TJ, Namasivayam AM, Steele CM

Abstract
Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.

PMID: 27191873 [PubMed - as supplied by publisher]

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Which Patients With Ossifying Fibroma of the Jaws Would Be Suitable for Radical Ablative Surgery?

Which Patients With Ossifying Fibroma of the Jaws Would Be Suitable for Radical Ablative Surgery?

J Craniofac Surg. 2016 May 17;

Authors: Lv M, Shen Y, Li J, Gvetadze SR, Sun J

Abstract
OBJECTIVE: The aim of authors' study was to present their 10-year experience in the treatment of giant ossifying fibroma (GOF), and to prove if GOF can be totally excised preventing recurrence. The authors' secondary goal was to study the aesthetic and functional outcomes after radical resection of GOF followed by immediate reconstruction.
METHODS: Eighteen patients who underwent radical ablative surgery of GOF of the jaw followed by immediate reconstruction with vascularized fibula flap or ilium flap between May 2003 and May 2013 were taken. Recurrence rate was statistically observed and 2-year postoperative aesthetic and functional outcomes were evaluated.
RESULTS: The average length of follow-up was 4.5 years. There was no residual tumor or tumor recurrence observed in any patient during the mean follow-up of 4.5 years, and good cosmesis and functional outcome was noted after ablative surgery of GOF followed by computer-assisted reconstruction.
CONCLUSIONS: For giant OF, if it is mainly located in the jaws without invasion of the skull base and/or pterygoid process, radical surgical treatment should be performed for prevention of tumor recurrence. And good aesthetic and functional results can be achieved by immediate computer-assisted reconstruction and dental rehabilitation.

PMID: 27192645 [PubMed - as supplied by publisher]

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Combined External-Endoscopic Endonasal Assisted Removal of a Nail Gun.

Combined External-Endoscopic Endonasal Assisted Removal of a Nail Gun.

J Craniofac Surg. 2016 May 17;

Authors: Dehgani Mobaraki P, Longari F, Lapenna R, Ricci G

Abstract
Management of penetrating trauma to the paranasal sinuses with retained foreign bodies represents a challenge due to the proximity to vital neurovascular structures. The authors report the successful treatment of a patient with a work-related nail gun injury, carried out by means of a combined endoscopic endonasal external assisted procedure.A transnasal endoscopic approach was planned to minimize inadvertent movements of the nail during surgery and in case necessary to repair the orbit or skull base. No major bleeding or neurovascular complication was observed after surgery and a computed tomography scan was performed after surgery confirming the complete removal of the nail and with no damage of the orbit nor the skull base.

PMID: 27192640 [PubMed - as supplied by publisher]

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Applying Craniofacial Principles to Neurosurgical Exposures in Cerebrovascular Aneurysm Repair.

Applying Craniofacial Principles to Neurosurgical Exposures in Cerebrovascular Aneurysm Repair.

J Craniofac Surg. 2016 May 17;

Authors: Alperovich M, Frey JD, Potts MB, Riina HA, Staffenberg DA

Abstract
The subspecialty of craniofacial surgery emphasizes skeletal exposure, preservation of critical structures, and provision of a superior cosmetic result. In recent decades, an emphasis on minimally invasive neurosurgical exposure has paved the way for increased collaboration between neurosurgeons and craniofacial surgeons.The 1990s saw the growing popularity of an eyebrow incision for orbital roof craniotomies in neurosurgery to address lesions in the anterior skull base. Disadvantages of this approach included conspicuous scarring above the brow skin, risk of injury to the frontal branch of the facial nerve, and numbness from supraorbital or supratrochlear nerve transection.A transpalpebral approach was first described in 2008 in the neurosurgical literature. An approach familiar to the craniofacial surgeon, transpalpebral exposure is used for zygomaticomaxillary complex fractures as well as aesthetic brow and periorbital surgery.In conjunction with neurosurgery, the authors have applied craniofacial principles to address the major pitfalls of the transpalpebral craniotomy. The authors present their patient series experience. Hopefully, in the future, other institutions will have increased collaboration between craniofacial surgeons and neurosurgeons.

PMID: 27192638 [PubMed - as supplied by publisher]

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Innate Immune Response of the Pig Laryngeal Mucosa to Endotracheal Intubation.

Related Articles

Innate Immune Response of the Pig Laryngeal Mucosa to Endotracheal Intubation.

Otolaryngol Head Neck Surg. 2016 Jan;154(1):138-43

Authors: Hughes OR, Ayling SM, Birchall MA

Abstract
OBJECTIVE: The aim of this study was to measure the effects of endotracheal intubation on innate immune response within the pig laryngeal mucosa.
STUDY DESIGN: Prospective controlled basic science study.
SETTING: The animal experiments and analyses were conducted at the University of Bristol.
SAMPLES AND METHODS: Eighteen pigs, matched at the major histocompatibility complex (MHC), were used in the study. The pigs were divided into 9 pairs. One of each pair (9 pigs in total) was intubated with an endotracheal tube under general anesthesia for 90 minutes. Two days later, pinch biopsies were taken from the supraglottis (specifically the false cords) and subglottis of both pigs. The experiment was repeated 8 more times. Based on quantitative immunohistochemistry, percentage areas of positive staining for CD172a, CD163, MHC class II, CD14, and CD16 were calculated separately for the epithelium and lamina propria of each biopsy.
RESULTS: Total areas of laryngeal mucosa (epithelium and lamina propria) expressing CD172a and coexpressing CD163 and CD172a were significantly reduced at 2 days following endotracheal intubation (P = .039 and P = .037, respectively). MHC class II expression and MHC class II coexpression with CD172a were similarly reduced following intubation (P = .003 and P = .005, respectively). In the supraglottis, MHC class II coexpression with CD16 and CD14 was also reduced following endotracheal intubation (P = .037).
CONCLUSIONS: Our results indicate that endotracheal intubation reduces the number of innate immune cells within the upper airway mucosa. This may be an important first step in a cascade leading to chronic wound and scar formation causing airway stenosis.

PMID: 26567047 [PubMed - indexed for MEDLINE]

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Triticeous Cartilage CT Imaging Characteristics, Prevalence, Extent, and Distribution of Ossification.

Related Articles

Triticeous Cartilage CT Imaging Characteristics, Prevalence, Extent, and Distribution of Ossification.

Otolaryngol Head Neck Surg. 2016 Jan;154(1):131-7

Authors: Alqahtani E, Marrero DE, Champion WL, Alawaji A, Kousoubris PD, Small JE

Abstract
OBJECTIVE: The triticeous cartilage is a small ovoid cartilaginous structure variably present as a component of the laryngeal skeleton. This structure has received scant attention in the literature and has yet to be described adequately on cross-sectional imaging.
STUDY DESIGN AND SETTING: Retrospective study in a tertiary medical center.
SUBJECTS AND METHODS: We investigated triticeous cartilage prevalence in a large population utilizing computed tomography images. The cases of all patients with computed tomography angiography images of the neck from October 1, 2013, to September 31, 2014, were examined. A total of 663 patients were included in this study (age: range, 18-97 years; mean ± SD, 65 ± 15 years), 58.4% men and 41.6% women. The presence of a triticeal cartilage and its site, number, and degree of ossification were recorded.
RESULTS: A total of 53.1% of patients had at least 1 triticeous cartilage (352 of 663). Prevalence was 57.4% (222 of 387) among men and 47.1% (130 of 276) among women. The presence of bilateral triticeous cartilages was more common than unilateral (63.1%, 222 of 352). A minority of patients (4.5%, 16 of 352) had a cartilaginous triticeous with no appreciable ossification, and more than half (54.0%, 190 of 352) had mild triticeal ossification. Moderate ossification was found in 34.9% of patients (123 of 352) and marked ossification in 6.5% (23 of 352).
CONCLUSION: The presence of a triticeous cartilage is common and of variable appearance. As the clinical and surgical significance of this anatomic structure may be misinterpreted, it is important for imaging interpreters to be familiar with this seldom-recognized anatomic structure and recognize its variable appearance on cross-sectional imaging to avoid a misdiagnosis.

PMID: 26556461 [PubMed - indexed for MEDLINE]

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Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.

Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.

J Craniofac Surg. 2016 May 12;

Authors: Işik S, Yilmaz B, Ekşi MŞ, Özcan-Ekşi EE, Akakin A, Toktaş ZO, Demir MK, Konya D

Abstract
In this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can be managed conservatively, it may progress and result in subdural fluid collections, hematoma formations, "brain sagging or slumping" states, syringohydromyelia, encephalopathy, coma, and even death. The authors present an 81-year-old man admitted with subdural hematoma 50 days following previous spinal surgery for lumbar spinal stenosis. In his previous spinal surgery he had had dural tear, which had been closed primarily. To the literature, only 21 patients have been reported to develop subdural hematoma following spinal surgery. In patients with subdural hematoma following spinal surgery, the female:male ratio was 3:4 and the median age was 55 years. Surgical diagnoses for previous spinal surgeries were intervertebral disc herniation (5), spinal canal stenosis and spondylolisthesis (6), failed back syndrome (2), tethered cord syndrome and myelodysplastic spine (2), spinal cord tumor, spinal epidural hematoma, vertebral dislocation, vertebral fracture, vertebral tumor, and inflammatory spine. Patients presented with signs and symptoms of subdural hematoma within 6 hours to 50 days following the spinal surgery. Source of cerebrospinal fluid leak was most commonly from lumbar region (13 patients, 62%). Ten of 21 (48%) patients were treated conservatively. Late-onset neurological findings should not prevent the evaluation of cranial vault with computed tomography and magnetic resonance imaging. Spinal dural tear should be more aggressively treated instead of suture alone approach, when recognized in older patients during the spinal surgery.

PMID: 27192649 [PubMed - as supplied by publisher]

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Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications.

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications.

Arq Neuropsiquiatr. 2016 May;74(5):388-395

Authors: Constantino ER, Leal R, Ferreira CC, Acioly MA, Landeiro JA

Abstract
Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%. Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.

PMID: 27191235 [PubMed - as supplied by publisher]

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Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study.

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study.

Acta Otolaryngol. 2016 May 18;:1-7

Authors: Gür ÖE, Ensari N, Öztürk MT, Boztepe OF, Gün T, Selçuk ÖT, Renda L

Abstract
OBJECTIVES: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air-bone gap.
METHODS: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.
RESULTS: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p > 0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p < 0.05). The improvement in the mean air-bone gap was 14.1 dB in Group 1 and 12.4 dB in Group 2 on post-operative day 45 (p < 0.05).
CONCLUSIONS: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.

PMID: 27192505 [PubMed - as supplied by publisher]

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Hearing impairment, cochlear morphology, and peroxynitrite (ONOO(-)) formation in adult and aging NOS II knockout mice.

Hearing impairment, cochlear morphology, and peroxynitrite (ONOO(-)) formation in adult and aging NOS II knockout mice.

Acta Otolaryngol. 2016 May 18;:1-8

Authors: Labbé D, Bloch W, Schick B, Michel O

Abstract
CONCLUSION: Nitric oxide synthase (NOS) II induction is a protective mechanism against age-related degeneration of the cochlea.
OBJECTIVES: An induction of NOS II has been described in different inner ear pathologies. The objective was to examine the role of NOS II in age-related degeneration of the cochlea.
METHODS: The hearing ability in adult and aging NOS II knockout mice (KO) and their wildtype (WT) littermates was explored via auditory brainstem response (ABR) measurements. Inner ear morphological differences were studied with scanning electron microscopy (SEM). Immunohistochemistry was used to examine the induction of NOS II in the inner ear of aging WT mice. Expression of nitrotyrosin, a marker protein for the reactive oxygen species peroxynitrite, was compared between KO and WT mice using immunohistochemistry.
RESULTS: Adult KO mice exhibited a mild hearing impairment. WT mice showed an induction of NOS II after 6 months of age. Age-related hearing deterioration was accelerated in KO mice, which was accompanied by increased nitrotyrosin formation and outer hair cell loss.

PMID: 27192390 [PubMed - as supplied by publisher]

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Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma.

Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma.

Acta Otolaryngol. 2016 May 18;:1-5

Authors: Joo YH, Cho KJ, Lee YS, Kim SY, Kim MS

Abstract
OBJECTIVES: The aim of this study was to evaluate the role of PNI in HPSCC.
METHODS: The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI.
RESULTS: PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p = 0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p = 0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p = 0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p = 0.001).
CONCLUSION: Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy.

PMID: 27192156 [PubMed - as supplied by publisher]

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Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty.

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Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty.

Otol Neurotol. 2015 Sep;36(9):1537-42

Authors: Hunter JB, Sweeney AD, Carlson ML, Wanna GB, Rivas A, Weaver KD, Chambless LB, Thompson RS, Haynes DS, Bennett ML

Abstract
OBJECTIVES: To evaluate the effectiveness of resorbable mesh cranioplasty at reducing postoperative cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine tumor resection.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary academic referral center.
PATIENTS: Fifty-three consecutive cases using a resorbable mesh cranioplasty after translabyrinthine tumor resection were reviewed.
INTERVENTION: Temporal bone defects were repaired with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws.
MAIN OUTCOME MEASURES: Primary outcome measures included the incidence of postoperative CSF wound leak or rhinorrhea, pseudomeningocele formation, and surgical site infection.
RESULTS: Fifty-three cases (average age, 54.0 yr; range, 19.3-75.1 yr) were analyzed. The average body mass index was 30.8 kg/m2 (range, 17.9-48.3 kg/m2), and the average tumor size was 18.8 mm (range, 8-38 mm). One patient (1.9%) experienced CSF rhinorrhea on postoperative Day 16, which resolved after transmastoid middle ear and eustachian tube packing. One patient (1.9%) experienced a surgical site infection requiring surgical debridement and mesh removal 4 months after surgery. Compared with 1,441 prior translabyrinthine surgeries analyzed from our institution using a traditional fat graft closure without mesh, the rate of postoperative CSF leak was significantly less using the resorbable mesh cranioplasty technique (p = 0.0483).
CONCLUSION: Resorbable mesh cranioplasty is a safe and effective method to reduce postoperative CSF leak and pseudomeningocele formation after translabyrinthine craniotomy for tumor excision.

PMID: 26208128 [PubMed - indexed for MEDLINE]

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[Not Available].

Related Articles

[Not Available].

Rev Med Brux. 2016 Jan-Feb;37(1):26-34

Authors: Magain AC, Richard T, De Becker B, Rorive S, Benahmed A, Vanhaeverbeek M

Abstract
In Belgium and around the world, the weight-control surgery has grown significantly since the beginning of the 21st century. The principal argument in favour of this type of surgery is the expected reduction of the obesity-associated morbidities. However, the expectatif reduction of mortality associated with this kind of surgery is based on a low level of evidence. Besides the mechanical complications, there are a number of health-related problems associated with the post-operative metabolic changes. Authors of the present article have observed four cases presenting with serious affections consecutive to bariatric interventions and reviewed the literature. The most frequent consequence of bariatric surgery is anaemia (15%), which is either due to iron or cyanocobalamine deficiency, followed by neuropathies, bone mineral loss, substance abuse or postprandial hypoglycaemia syndrome. Rare but severe complications are Wernicke's encephalopathy, fulminant hepatitis or hyperoxaluric tubular disease. The prevention, diagnosis and management of these new diseases are becoming a major public health concern.

PMID: 27120933 [PubMed - indexed for MEDLINE]

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[Menière's Disease].

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[Menière's Disease].

Laryngorhinootologie. 2015 Aug;94(8):530-54

Authors: Plontke SK, Gürkov R

Abstract
Menière`s disease is one of the most common inner ear and vestibular disorders. It is defined as the idiopathic syndrome of endolymphatic hydrops (ELH). Despite the development of several different animal models of ELH, its etiology and pathogenesis is still unresolved. In humans, endolymphatic hydrops may occur spontaneously or as a consequence of specific disorders with distinct inner ear pathologies, e. g., infectious labyrinthitis, noise induced hearing loss or vestibular schwannoma. Recent imaging studies using MRI have shown that hydropic ear disease is associated not only with the full triad of vertigo, hearing, loss and tinnitus/aural pressure, but also with inner ear symptoms that do not fulfill the clinical criteria of definite Menière's disease as set forth by the AAO-HNS. Therefore, terms like "atypical" or "cochlear"/"vestibular" Menière's disease or "forme fruste" should be avoided and the term "Menière's disease" should universally be applied according only to these guidelines. Besides that, the recent possibility of visualizing endolymphatic hydrops on MRI and thereby ascertaining the diagnosis in difficult cases and new audiovestibular function tests for the indirect detection of endolymphatic hydrops show promising results. Evidenced based reviews of currently available therapeutic options still reveal many uncertainties with regard to efficacy, with the exception of the ablative therapies, e. g., intratympanic gentamicin application.

PMID: 26243634 [PubMed - indexed for MEDLINE]

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Non-epithelial tumors of the larynx: a single institution review.

Non-epithelial tumors of the larynx: a single institution review.

Am J Otolaryngol. 2016 May-Jun;37(3):279-85

Authors: Karatayli-Ozgursoy S, Bishop JA, Hillel AT, Akst LM, Best SR

Abstract
AIM: Non-epithelial tumors of the larynx are rare and encompass a wide range of pathology. We present the decade-long experience of a single institution to define clinical presentations and outcomes.
MATERIAL AND METHODS: This is a ten year retrospective chart review of a tertiary head and neck cancer center. Index patients were identified from a review of a pathology database, and patient demographics, presenting signs and symptoms, treatment modalities, and clinical outcomes were extracted from electronic medical records. Epithelial tumors (squamous cell carcinoma, spindle cell carcinoma, and salivary tumors), granulomas, sarcoidosis, papilloma, and amyloidosis were all excluded.
RESULTS: Twenty-four patients with ages ranging from 2months-old to 84years were identified. Malignant lesions (11) included chondrosarcoma (6), Kaposi's sarcoma (2), metastatic melanoma, synovial cell sarcoma, and T cell neoplasm. Six were operated upon endolaryngeally, but four required either upfront or salvage total laryngectomy. Two received adjuvant therapy. Benign lesions (13) included hemangioma (4), granular cell tumor (3), myofibroblastic tumor (2), schwannoma (2), chondroma, and ossifying fibromyxoid tumor. Nine underwent endolaryngeal operations, and four were managed medically or with observation. None have required aggressive open resection or total laryngectomy.
CONCLUSION: Treatment approach of non-epithelial tumors of the larynx depends on the site and extent of the tumor, histology, and sensitivity of adjuvant therapy. Benign tumors can be managed without need for aggressive resection thereby sparing laryngeal function.

PMID: 27178524 [PubMed - in process]

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The price of robustness; impact of worst-case optimization on organ-at-risk dose and complication probability in intensity-modulated proton therapy for oropharyngeal cancer patients.

The price of robustness; impact of worst-case optimization on organ-at-risk dose and complication probability in intensity-modulated proton therapy for oropharyngeal cancer patients.

Radiother Oncol. 2016 May 10;

Authors: van de Water S, van Dam I, Schaart DR, Al-Mamgani A, Heijmen BJ, Hoogeman MS

Abstract
PURPOSE: To quantify the impact of the degree of robustness against setup errors and range errors on organ-at-risk (OAR) dose and normal tissue complication probabilities (NTCPs) in intensity-modulated proton therapy for oropharyngeal cancer patients.
MATERIAL AND METHODS: For 20 oropharyngeal cases (10 unilateral and 10 bilateral), robust treatment plans were generated using 'minimax' worst-case optimization. We varied the robustness against setup errors ('setup robustness') from 1 to 7mm and the robustness against range errors ('range robustness') from 1% to 7% (+1mm). We evaluated OAR doses and NTCP-values for xerostomia, dysphagia and larynx edema.
RESULTS: Varying the degree of setup robustness was found to have a considerably larger impact than varying the range robustness. Increasing setup robustness from 1mm to 3, 5, and 7mm resulted in average NTCP-values to increase by 1.9, 4.4 and 7.5 percentage point, whereas they increased by only 0.4, 0.8 and 1.2 percentage point when increasing range robustness from 1% to 3%, 5% and 7%. The degree of setup robustness was observed to have a clinically significant impact in bilateral cases in particular.
CONCLUSIONS: For oropharyngeal cancer patients, minimizing setup errors should be given a higher priority than minimizing range errors.

PMID: 27178142 [PubMed - as supplied by publisher]

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Phase II randomized trial of radiation therapy, cetuximab and pemetrexed with or without bevacizumab in patients with locoregionally-advanced head and neck cancer.

Phase II randomized trial of radiation therapy, cetuximab and pemetrexed with or without bevacizumab in patients with locoregionally-advanced head and neck cancer.

Ann Oncol. 2016 May 13;

Authors: Argiris A, Bauman JE, Ohr J, Gooding WE, Heron DE, Duvvuri U, Kubicek GJ, Posluszny DM, Vassilakopoulo M, Kim S, Grandis JR, Johnson JT, Gibson MK, Clump DA, Flaherty JT, Chiosea SI, Branstetter B, Ferris RL

Abstract
BACKGROUND: We previously reported the safety of concurrent cetuximab, an antibody against epidermal growth factor receptor (EGFR), pemetrexed and radiation therapy (RT) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). In this non-comparative phase II randomized trial, we evaluated this non-platinum combination with or without bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF).
PATIENTS AND METHODS: Patients with previously untreated stage III-IVB SCCHN were randomized to receive: conventionally fractionated radiation (70Gy), concurrent cetuximab, and concurrent pemetrexed (arm A); or the identical regimen plus concurrent bevacizumab followed by bevacizumab maintenance for 24 weeks (arm B). The primary endpoint was 2-year progression-free survival (PFS), with each arm compared to historical control. Exploratory analyses included the relationship of established prognostic factors to PFS and quality of life (QOL).
RESULTS: Seventy-eight patients were randomized: 66 oropharynx (42 HPV-positive, 15 HPV-negative, 9 unknown) and 12 larynx; 38 (49%) had heavy tobacco exposure. Two-year PFS was 79% (90% CI 0.69 - 0.92; p<0.0001) for arm A and 75% (90% CI 0.64 - 0.88; p<0.0001) for arm B, both higher than historical control. No differences in PFS were observed for stage, tobacco history, HPV status, or type of center (community versus academic). A significantly increased rate of hemorrhage occurred in arm B. SCCHN-specific QOL declined acutely, with marked improvement but residual symptom burden one year post-treatment.
CONCLUSIONS: RT with a concurrent non-platinum regimen of cetuximab and pemetrexed is feasible in academic and community settings, demonstrating expected toxicities and promising efficacy. Adding bevacizumab increased toxicity without apparent improvement in efficacy, countering the hypothesis that dual EGFR-VEGF targeting would overcome radiation resistance and enhance clinical benefit. Further development of cetuximab, pemetrexed and RT will require additional prospective study in defined, high-risk populations where treatment intensification is justified.

PMID: 27177865 [PubMed - as supplied by publisher]

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Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Eur Arch Otorhinolaryngol. 2016 May 13;

Authors: Gökcan MK, Günaydinoğlu E, Kurtuluş DF

Abstract
Glottic obstruction is a major cause of dyspnea. Without understanding the normal function of the glottis in breathing, treating dyspnea does not restore normal physiology. Therefore, we designed a computational fluid dynamics (CFD) model that tested the respiratory cycle in larynges with normal glottis and congenital glottic web (CGW). A CGW case and a control subject (CC) were selected from the computed tomography (CT) archive. 3D computational models of the larynges with structured boundary layer were constructed from axial CT images after mesh refinement study. CFD analyses were based on the Reynolds-averaged Navier-Stokes approach. Incompressible flow solver (pressure-based) and SST k-w turbulence model were chosen for this study. To simulate a real-time breathing process, time varying flow rate boundary condition was derived from the spirometer of a healthy, non-smoking woman. Glottic areas were measured as 51.64 and 125.43 mm(2) for the CGW patient and CC, respectively. Time-dependent velocity contours and streamlines for the CC and CGW patient were drawn. The CC showed uniform flow, all through the inspiration and expiration phases. However, the CGW patient showed separation of flow at the glottis level, which caused areas of stagnation in the supraglottis (during expiration) and the subglottis and trachea (during inspiration). Specialized geometry of the normal larynx maintained uniform flow with low shear stress values on the wall even at high mass flow rates. Distortion of this geometry may cause obstruction of flow at multiple levels and, therefore, should be evaluated at multiple levels.

PMID: 27177730 [PubMed - as supplied by publisher]

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Laryngeal amyloidosis presenting as false vocal fold bulging: clinical and therapeutic aspects.

Related Articles

Laryngeal amyloidosis presenting as false vocal fold bulging: clinical and therapeutic aspects.

Braz J Otorhinolaryngol. 2015 Mar-Apr;81(2):219-21

Authors: Caporrino Neto J, Alves NS, Gondra Lde A

PMID: 25731952 [PubMed - indexed for MEDLINE]

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Validation of the Home Hearing Test™.

Validation of the Home Hearing Test™.

J Am Acad Audiol. 2016 May;27(5):416-420

Authors: Margolis RH, Killion MC, Bratt GW, Saly GL

Abstract
BACKGROUND: The Home Hearing Test™ (HHT) is an automated pure-tone threshold test that obtains an air-conduction audiogram at five test frequencies. It was developed to provide increased access to hearing testing and support home telehealth programs.
PURPOSE: The study was conducted as part of an audiology telehealth trial based at the U.S. Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Air-conduction audiograms obtained by the HHT were compared to results obtained in the clinic.
RESEARCH DESIGN: Prospective, repeated measures.
STUDY SAMPLE: Twenty-eight participants, aged 44-88 yr (mean = 65) were recruited from the Nashville U.S. Department of Veterans Affairs audiology clinic. Participants were required to have a Windows personal computer in the home and were self-reported to be comfortable with using computers. Two participants had normal hearing and 26 had hearing loss of various severities and configurations.
DATA COLLECTION AND ANALYSIS: Audiograms were obtained in the audiology clinic by experienced audiologists following standard clinical protocols. Participants were provided with a kit for installing HHT on their home computers. The HHT air-conduction audiogram is obtained with Automated Method for Testing Auditory Sensitivity (AMTAS(®)), described in previous publications. Threshold pairs (clinic versus HHT) were analyzed by determining distributions of threshold differences and absolute differences. These were compared to distributions of differences between manual threshold pairs obtained by two audiologists and AMTAS(®) versus manual threshold pairs obtained under laboratory conditions.
RESULTS: Threshold differences (clinic versus HHT) were slightly larger than differences between thresholds obtained by two audiologists and AMTAS(®) versus manual threshold differences obtained under laboratory conditions. The differences were not statistically significant.
CONCLUSIONS: HHT air-conduction audiograms agree well with audiograms obtained in the clinic. HHT is well suited to home telehealth applications and personal use.

PMID: 27179261 [PubMed - as supplied by publisher]

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Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

J Am Acad Audiol. 2016 May;27(5):406-415

Authors: Bardy F, Sjahalam-King J, Van Dun B, Dillon H

Abstract
PURPOSE: To determine if one-octave multitone (MT) stimuli increase the amplitude of cortical auditory-evoked potentials (CAEPs) in individuals with a hearing loss when compared to standard pure-tone (PT) stimuli and narrow-band noise (NBN).
RESEARCH DESIGN: CAEPs were obtained from 16 hearing-impaired adults in response to PT and MT auditory stimuli centered around 0.5, 1, 2, and 4 kHz and NBN centered around 1 and 2 kHz. Hearing impairment ranged from a mild to a moderate hearing loss in both ears. Auditory stimuli were monaurally delivered through insert earphones at 10 and 20 dB above threshold. The root mean square amplitude of the CAEP and the detectability of the responses using Hotelling's T² were calculated and analyzed.
RESULTS: CAEP amplitudes elicited with MT stimuli were on average 29% larger than PT stimuli for frequencies centered around 1, 2, and 4 kHz. No significant difference was found for responses to 0.5-kHz stimuli. Significantly higher objective detection scores were found for MT when compared to PT. For the 1- and 2-kHz stimuli, the CAEP amplitudes to NBN were not significantly different to those evoked by PT but a significant difference was found between MT stimuli and both NBN and PT. The mean detection sensitivity of MT for the four frequencies was 80% at 10 dB SL and 95% at 20 dB SL, and was comparable with detection sensitivities observed in normal-hearing participants.
CONCLUSIONS: Using MT stimuli when testing CAEPs in adults with hearing impairment showed larger amplitudes and a higher objective detection sensitivity compared to using traditional PT stimuli for frequencies centered around 1, 2, and 4 kHz. These findings suggest that MT stimuli are a clinically useful tool to increase the efficiency of frequency-specific CAEP testing in adults with hearing impairment.

PMID: 27179260 [PubMed - as supplied by publisher]

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Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

J Am Acad Audiol. 2016 May;27(5):395-405

Authors: Sidiras C, Iliadou VV, Chermak GD, Nimatoudis I

Abstract
BACKGROUND: Including speech recognition in noise testing in audiological evaluations may reveal functional hearing deficits that may otherwise remain undetected.
PURPOSE: The current study explored the potential utility of the Speech-in-Babble (SinB) test in the assessment of central auditory processing disorder (CAPD) in young children for whom diagnosis is challenging.
RESEARCH DESIGN: A cross-sectional analysis.
STUDY SAMPLE: Forty-one Greek children 4-13 yr of age diagnosed with CAPD and exhibiting listening and academic problems (clinical group) and 20 age-matched controls with no listening or academic problems participated in the study.
DATA COLLECTION AND ANALYSIS: All participants' auditory processing was assessed using the same tests and instrumentation in a sound-treated room. Two equivalent lists of the SinB test, developed at the Psychoacoustic Laboratory of the Aristotle University of Thessaloniki, were administered monaurally in a counterbalanced order. SinB consists of lists of 50 phonetically balanced disyllabic words presented in background multitalker babble. Five signal-to-noise ratios (SNRs) were used in a fixed order. The children were instructed to repeat the word after each presentation. The SNR at which the child achieved 50% correct word identification served as the dependent variable or outcome measure, with higher SinB scores (measured in SNR dB) corresponding to poorer performance.
RESULTS: SinB performance was better (lower SNR) for the normal control group versus the clinical group [F(1,35) = 43.03, p < 0.0001]. SinB inversely correlated with age for both CAPD and control groups (r = -0.648, p << 0.001 and r = -0.658, p < 0.005, respectively). Regression analysis revealed that linear models better explained the variance in the data than a quadratic model for both the control and CAPD groups. The slope (beta value of the linear model) was steeper for the clinical group compared to the control group (beta = -0.306 versus beta = -0.130, respectively). An analysis of covariance run with age as the covariate to assess the potential effect of comorbidity on SinB performance in children with CAPD with and without comorbid conditions revealed no significant differences between groups [F(1,38) = 0.149, p > 0.05].
CONCLUSIONS: This study offers the first detailed presentation of the performance of Greek children on a Greek language SinB test. The main finding is that SinB scores improved as a function of age in a constant manner as represented by the slope of the linear regression line for both CAPD and control groups. Results suggest that this speech recognition in competition test holds promise for differentiating typically developing Greek children from those children with CAPD across the age range studied here (4-13 yr). The SinB seemed rather immune to the presence of comorbid conditions presented by some of the children in this study, suggesting its potential utility as a valid measure of central auditory processing. While there are many speech-in-noise or competition tests in English, there are fewer in other languages. Tests like the SinB should be developed in other languages to ensure that children demonstrating "listening" problems can be properly evaluated.

PMID: 27179259 [PubMed - as supplied by publisher]

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Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

J Am Acad Audiol. 2016 May;27(5):388-394

Authors: Duke MM, Wolfe J, Schafer E

Abstract
BACKGROUND: Cochlear implant (CI) recipients often experience difficulty understanding speech in noise and speech that originates from a distance. Many CI recipients also experience difficulty understanding speech originating from a television. Use of hearing assistance technology (HAT) may improve speech recognition in noise and for signals that originate from more than a few feet from the listener; however, there are no published studies evaluating the potential benefits of a wireless HAT designed to deliver audio signals from a television directly to a CI sound processor.
PURPOSE: The objective of this study was to compare speech recognition in quiet and in noise of CI recipients with the use of their CI alone and with the use of their CI and a wireless HAT (Cochlear Wireless TV Streamer).
RESEARCH DESIGN: A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in competing noise (65 dBA) with the CI sound processor alone and with the sound processor coupled to the Cochlear Wireless TV Streamer.
STUDY SAMPLE: Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study.
DATA COLLECTION AND ANALYSIS: Participants were evaluated in four conditions including use of the sound processor alone and use of the sound processor with the wireless streamer in quiet and in the presence of competing noise at 65 dBA. Speech recognition was evaluated in each condition with two full lists of Computer-Assisted Speech Perception Testing and Training Sentence-Level Test sentences presented from a light-emitting diode television.
RESULTS: Speech recognition in noise was significantly better with use of the wireless streamer compared to participants' performance with their CI sound processor alone. There was also a nonsignificant trend toward better performance in quiet with use of the TV Streamer. Performance was significantly poorer when evaluated in noise compared to performance in quiet when the TV Streamer was not used.
CONCLUSIONS: Use of the Cochlear Wireless TV Streamer designed to stream audio from a television directly to a CI sound processor provides better speech recognition in quiet and in noise when compared to performance obtained with use of the CI sound processor alone.

PMID: 27179258 [PubMed - as supplied by publisher]

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Ex vivo ovine model for head and neck surgical simulation.

Ex vivo ovine model for head and neck surgical simulation.

Am J Otolaryngol. 2016 May-Jun;37(3):272-8

Authors: Ianacone DC, Gnadt BJ, Isaacson G

Abstract
OBJECTIVE: To evaluate a fresh, ovine/sheep head and neck tissue model to teach otolaryngology-head and neck surgical techniques.
STUDY DESIGN: Observational animal study.
SETTING: A university animal resource facility.
METHODS: Tissue was collected from pre-pubescent sheep (n=10; mean age: 4months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated and stored at 5°C for 1-5days. The tissues were tested in a variety of simulated procedures by a medical student and four fellowship-trained otolaryngology faculty. Practicality and similarity to human surgeries were assessed.
RESULTS: While ovine head and neck structures are proportionally different, the consistencies of skin, subcutaneous tissues and bone are remarkably similar to that seen in human dissection. Particularly useful were the eyelids and orbits, facial nerve and parotid gland, mandible, anterior neck and submandibular triangle. Surgeries performed included blepharoplasty, ptosis repair, orbital floor exploration, facial nerve dissection and repair, mandibular plating, tracheotomy, laryngofissure, tracheal resection and laryngectomy. The model was also useful for flexible and microsuspension laryngoscopy.
CONCLUSION: Fresh, ovine tissue provides a readily available, anatomically compatible, affordable, model for training in otolaryngology-head and neck surgery. The use of sheep tissues carries a low risk for disease transmission and is ethically defensible. Structural variations in the sheep temporal bone, paranasal sinuses and skull base anatomy limit the usefulness of the model for surgical training in these areas.

PMID: 27178523 [PubMed - in process]

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Atypical culture-negative skull base osteomyelitis masquerading as advanced nasopharyngeal carcinoma.

Atypical culture-negative skull base osteomyelitis masquerading as advanced nasopharyngeal carcinoma.

Am J Otolaryngol. 2016 May-Jun;37(3):236-9

Authors: See A, Tan TY, Gan EC

Abstract
Skull base osteomyelitis typically arises as a complication of otogenic or sinonasal infections in immunocompromised patients. A much rarer entity, atypical skull base osteomyelitis is not associated with an obvious infective source. Atypical and culture-negative skull base osteomyelitis is even rarer and hampers diagnosis, as its clinical presentation is remarkably similar to skull base neoplasms. We report a case of extensive skull base osteomyelitis with orbital apex syndrome and multiple lower cranial nerve palsies which initially masqueraded as possible advanced nasopharyngeal carcinoma. Extensive investigations and consult with an infectious diseases specialist aided in elucidation of the correct diagnosis. Through this article, we emphasize that skull base osteomyelitis must be considered in the setting of headache, cranial neuropathies, elevated inflammatory markers and abnormal imaging findings. Early tissue sampling for histology, stainings and cultures and prompt appropriate treatment may prevent or arrest further complications.

PMID: 27178515 [PubMed - in process]

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Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Am J Otolaryngol. 2016 May-Jun;37(3):225-30

Authors: Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F

Abstract
PURPOSE: The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD).
MATERIALS AND METHODS: Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method.
RESULTS: Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups.
CONCLUSIONS: Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.

PMID: 27178513 [PubMed - in process]

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PET/CT in giant cell arteritis: High (18)F-FDG uptake in the temporal, occipital and vertebral arteries.

PET/CT in giant cell arteritis: High (18)F-FDG uptake in the temporal, occipital and vertebral arteries.

Rev Esp Med Nucl Imagen Mol. 2016 May 10;

Authors: Rehak Z, Vasina J, Ptacek J, Kazda T, Fojtik Z, Nemec P

Abstract
(18)F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High (18)F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high (18)F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).

PMID: 27177856 [PubMed - as supplied by publisher]

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Cytopathologic characteristics of SMARCB1 (INI-1) deficient sinonasal carcinoma: A potential diagnostic pitfall.

Cytopathologic characteristics of SMARCB1 (INI-1) deficient sinonasal carcinoma: A potential diagnostic pitfall.

Diagn Cytopathol. 2016 May 14;

Authors: Allison DB, Bishop JA, Ali SZ

Abstract
Tumors of the head and neck are extremely diverse and a subset are poorly differentiated and difficult to classify. Recently, a new entity has been described with rhabdoid and/or plasmacytoid cytologic features and a characteristic genetic signature-inactivation of the SMARCB1 (INI-1) tumor suppressor gene. To date, only 16 cases of SMARCB1 (INI-1) deficient sinonasal carcinoma have been described, and there are currently no reports of the cytopathologic features by fine needle aspiration (FNA) cytology. A case of a 77-year-old man who presented with a posterior ethmoid sinus lesion with invasion into the skull base and bone was reported. FNA cytology of a right retropharyngeal lymph node revealed relatively monomorphic, loosely cohesive clusters of plasmacytoid cells with occasional nucleoli, rare intranuclear cytoplasmic inclusions, and mitotic figures in a background of necrosis and absence of overt squamous or glandular differentiation. A diagnosis of metastatic myoepithelial carcinoma was made; however, retrospectively, the surgical excision showed loss of the SMARCB1 (INI-1) tumor suppressor gene by immunohistochemistry. In summary, the cytomorphologic features of SMARCB1 (INI-1) deficient sinonasal carcinoma are relatively nonspecific and overlap with other regional tumors, including myoepithelial neoplasms. As a result, this entity should be considered in the differential diagnosis for a plasmacytoid tumor arising in the sinonasal tract by FNA cytology. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.

PMID: 27177850 [PubMed - as supplied by publisher]

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Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

Am J Otolaryngol. 2016 May-Jun;37(3):225-30

Authors: Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F

Abstract
PURPOSE: The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD).
MATERIALS AND METHODS: Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method.
RESULTS: Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups.
CONCLUSIONS: Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.

PMID: 27178513 [PubMed - in process]

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Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Effect of glottic geometry on breathing: three-dimensional unsteady numerical simulation of respiration in a case with congenital glottic web.

Eur Arch Otorhinolaryngol. 2016 May 13;

Authors: Gökcan MK, Günaydinoğlu E, Kurtuluş DF

Abstract
Glottic obstruction is a major cause of dyspnea. Without understanding the normal function of the glottis in breathing, treating dyspnea does not restore normal physiology. Therefore, we designed a computational fluid dynamics (CFD) model that tested the respiratory cycle in larynges with normal glottis and congenital glottic web (CGW). A CGW case and a control subject (CC) were selected from the computed tomography (CT) archive. 3D computational models of the larynges with structured boundary layer were constructed from axial CT images after mesh refinement study. CFD analyses were based on the Reynolds-averaged Navier-Stokes approach. Incompressible flow solver (pressure-based) and SST k-w turbulence model were chosen for this study. To simulate a real-time breathing process, time varying flow rate boundary condition was derived from the spirometer of a healthy, non-smoking woman. Glottic areas were measured as 51.64 and 125.43 mm(2) for the CGW patient and CC, respectively. Time-dependent velocity contours and streamlines for the CC and CGW patient were drawn. The CC showed uniform flow, all through the inspiration and expiration phases. However, the CGW patient showed separation of flow at the glottis level, which caused areas of stagnation in the supraglottis (during expiration) and the subglottis and trachea (during inspiration). Specialized geometry of the normal larynx maintained uniform flow with low shear stress values on the wall even at high mass flow rates. Distortion of this geometry may cause obstruction of flow at multiple levels and, therefore, should be evaluated at multiple levels.

PMID: 27177730 [PubMed - as supplied by publisher]

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Distinct Disease and Functional Characteristics of Thyroid-Surgery-Related Vocal Fold Palsy.

Distinct Disease and Functional Characteristics of Thyroid-Surgery-Related Vocal Fold Palsy.

Thyroid. 2016 May 13;

Authors: Tseng WC, Pei YC, Wong AM, Li HY, Fang TJ

Abstract
BACKGROUND: Iatrogenic trauma induced by thyroid surgery is the most common etiology of unilateral vocal fold paralysis (UVFP). UVFP after thyroid surgery may lead to profound physical and psychosocial distress. In this study, we comprehensively evaluated UVFP caused by thyroid surgery, and compared the results with those caused by other surgical trauma.
STUDY DESIGN: Retrospective case series study.
METHODS: Patients with surgery-related UVFP were evaluated using quantitative laryngeal electromyography (LEMG), videolaryngostroboscopy, voice acoustic analysis, Voice Outcome Survey, and Short Form-36 quality-of-life questionnaire. Patients with thyroid surgery and other surgeries were compared.
RESULTS: A total of 105 patients were recruited, among whom 52 and 53 were assigned to the thyroid surgery and the other surgery group, respectively. Patients in the thyroid surgery group had a higher proportion of external branch of superior laryngeal nerve (eSLN) involvement, longer duration from disease onset to the first LEMG examination, lower jitter, higher harmonic-to-noise ratio, and better quality of life compared with the other surgery group. Specifically for patients in the thyroid surgery group, those with eSLN involvement tended to have more pronounced impairment in jitter and shimmer compared with patients without eSLN involvement.
CONCLUSION: UVFP caused by thyroid surgery has a distinct clinical presentation with relatively high involvement in the eSLN, better voice acoustics, longer waiting time before asking for evaluation, and less impact on quality of life. The involvement of eSLN in these patients further impaired their voice. Early referral is suggested for these patients especially with suspected eSLN injury.

PMID: 27177593 [PubMed - as supplied by publisher]

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Vestibular evoked myogenic potentials and motion sickness medications.

Vestibular evoked myogenic potentials and motion sickness medications.

Clin Neurophysiol. 2016 Jun;127(6):2350-4

Authors: Tal D, Shemy S, Kaminski-Graif G, Wiener G, Hershkovitz D

Abstract
OBJECTIVE: Seasickness is a widespread problem among naval crew, and has a major impact on their performance at sea. The three pharmacological agents most commonly employed in the treatment of seasickness are dimenhydrinate, cinnarizine, and scopolamine. At present, the effectiveness of anti-seasickness drugs is tested by a process of "trial and error", while sailing and exposed to sea conditions. A physiological test to evaluate the action of a drug might save crew members long periods of suffering, as well as simplifying the procedure of selecting the appropriate treatment for each individual. The cervical vestibular evoked myogenic potentials (cVEMP) test has come to be recognized as a reliable procedure for the objective evaluation of saccular function. It was the hypothesis of the present study that cVEMP otolith responses may be affected by anti-motion sickness drugs, which might thus make cVEMP a useful clinical neurophysiological tool for the assessment of drug absorption and efficacy.
METHODS: Thirty male sailors who regularly took medication for the treatment of seasickness participated in the study. Participants underwent the cVEMP test pre- and 1h post-drug administration.
RESULTS: A statistically significant decrease in p13 latency was found after administration of scopolamine compared with baseline (14.46ms vs. 15.09ms, p=0.0049), with significant prolongation of the binaural average inter-latency in this group. No differences were found in the dimenhydrinate and cinnarizine study groups.
CONCLUSIONS: This study demonstrated that scopolamine absorption can be verified by changes in cVEMP latencies.
SIGNIFICANCE: The potential of the cVEMP test for predicting action of scopolamine on the vestibular system.

PMID: 27178852 [PubMed - in process]

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Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Hear Res. 2016 May 10;

Authors: Veugen LC, Hendrikse MM, van Wanrooij MM, Agterberg MJ, Chalupper J, Mens LH, Snik AF, John van Opstal A

Abstract
Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds.. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.

PMID: 27178443 [PubMed - as supplied by publisher]

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A case-control study of medical, psychological and socio-economic factors influencing the severity of chronic rhinosinusitis.

A case-control study of medical, psychological and socio-economic factors influencing the severity of chronic rhinosinusitis.

Rhinology. 2016 May 12;

Authors: Philpott C, Erskine S, Hopkins C, Coombes E, Kara N, Sunkareneni V, Anari S, Salam M, Farboud A

Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) is a common and debilitating disorder. Little is known about the epidemiology of this disease. The aims of the study were to identify differences in socio-economic variables and quality of life between patients with chronic rhinosinusitis and healthy controls, to identify any significant associations between CRS and other medical co-morbidities, psychiatric disease or environmental exposure and to explore the experience of CRS from the perspective of CRS sufferers.
METHODS: Participants were recruited from ENT clinics from 30 centres across the UK. They completed a study-specific questionnaire considering environmental, medical and socio-economic factors, and SF-36 and SNOT-22 scores. All participants with CRS were diagnosed by a clinician and categorised as having CRS (with polyposis, without polyposis or allergic fungal rhinosinusitis (AFRS)). Controls included family and friends of those attending ENT outpatient clinics and hospital staff who had no diagnosis of nose or sinus problems and had not been admitted to hospital in the previous 12 months.
RESULTS: A total of 1470 study participants (1249 patients and 221 controls) were included in the final analysis. Highly significant differences were seen in generic and disease-specific quality of life scores between CRS sufferers and controls; mean SNOT-22 score 45.0 for CRS compared with 12.1 amongst controls. There were no clear differences in socioeconomic variables including social class, index of multiple deprivation and educational attainment between cases and controls. Common comorbidities with a clear association included respiratory and psychiatric disorders, with a higher frequency of reported upper respiratory tract infections.
CONCLUSIONS: CRS is associated with significant impairment in quality of life and with certain medical co-morbidities. In contrast to other common ENT disorders, no socioeconomic differences were found between patients and controls in this study.

PMID: 27172454 [PubMed - as supplied by publisher]

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Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan.

Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan.

Odontology. 2016 May 11;

Authors: Yonenaga K, Majima HJ, Oyama S, Ishibashi K, Tanno H

Abstract
Japan has entered an era of a super-aging population, and given the importance of oral nutrition, the need to evaluate swallowing function has increased. Herein, we contribute to continued developments in evaluating eating and swallowing functions by describing current videoendoscopy (VE) usage and trends to evaluate and diagnose causes of dysphagia. In all, 100 patients (58 men and 42 women; mean age: 79 years) with suspected dysphagia were enrolled; 15 of these were re-examinations. Examinations were conducted according to the Japanese Society of Dysphagia Rehabilitation VE examination guidelines for swallowing. In this study, several patients (77.8 %) with poor vocalization and a saliva reservoir were unable to eat. While evaluating the relationship between aspiration and pharyngeal or laryngeal influx, we found that when pharyngeal and laryngeal influx were present, the risk of aspiration was high. Some patients (38.9 %) were able to eat despite lacking a cough reflex; thus, the absence of a cough reflex does not necessarily equate to an inability to eat, even in patients unable to ingest nutrition orally. One case could ingest nutrition, even with no cough reflex. The 6-month survival rate after the examination of patients on nil per os status was 57.1 %, specifically in patients unable to ingest nutrition orally. These results suggest that decreased eating and swallowing functions indicate a poor prognosis for the patient's quality of life, as eating and swallowing require smooth passage in the oral phase. Therefore, actively requesting a dental intervention and oral rehabilitation is important for a patient presenting these issues.

PMID: 27167386 [PubMed - as supplied by publisher]

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Skull Base; +23 new citations

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