Incidence of Oropharyngeal Cancer Among Elderly Patients in the United States.

Incidence of Oropharyngeal Cancer Among Elderly Patients in the United States.

JAMA Oncol. 2016 Jul 14;

Authors: Zumsteg ZS, Cook-Wiens G, Yoshida E, Shiao SL, Lee NY, Mita A, Jeon C, Goodman MT, Ho AS

Abstract
Importance: An escalating incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) has been reported predominantly among middle-aged adults. However, HPV infection is believed to occur many years before cancer develops, and tissue studies suggest that HPV DNA is found in the majority of OPSCC diagnosed in patients 65 years or older.
Objective: To update the trends in OPSCC incidence using US cancer registry data, with an emphasis on age-specific trends.
Design, Setting, and Participants: Data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2012) were queried to compare changes in incidence and survival trends in OPSCC with selected tobacco-related cancers (larynx, oral cavity, hypopharynx, lung) and an HPV-related cancer (anus). A total of 40 264 patients who received a diagnosis of OPSCC from 2000 to 2012 were included. Elderly patients were defined as those 65 years or older.
Main Outcomes and Measures: The annual percentage change in OPSCC incidence from 2000 to 2012, stratified according to age group.
Results: Among the 40 264 patients who received a diagnosis of OPSCC from 2000 to 2012, 13 313 (33.1%) were aged 65 years or older and 80.3% were male. Significant increases in the age-adjusted incidence of OPSCC were observed during the study period for both younger adults aged 45 to 64 years (annual percentage change [APC], 2.31; 95% CI, 1.76-2.86; P < .001) and patients 65 years or older (APC, 2.92; 95% CI, 2.32-3.51; P < .001). These changes were driven predominantly by base-of-tongue and tonsil cancers in men. Concomitantly, the incidence of tobacco-associated head and neck cancers decreased for elderly patients (larynx: APC, -1.54; 95% CI, -2.00 to -1.08; P < .001; oral cavity: APC, -1.23; 95% CI, -1.84 to -0.62; P = .001; hypopharynx: APC, -2.44; 95% CI, -3.01 to -1.86; P < .001), whereas the incidence of anal cancer significantly increased (APC, 4.42; 95% CI, 3.28 to 5.57; P < .001). Furthermore, improved overall and cause-specific survival over time were observed for both younger and elderly patients with OPSCC. Nevertheless, absolute cause-specific survival remained worse for elderly patients (3-year CSS, 60.8%; 95% CI, 59.6%-61.9%) in comparison with those aged 45 to 64 years (75.7%; 95% CI, 75.1%-76.4%; P < .001).
Conclusions and Relevance: The incidence of OPSCC is increasing among elderly patients in the United States, likely driven by HPV-associated cancers. Given the unique challenges related to treating elderly patients with OPSCC, their limited enrollment in clinical trials, and the aging US population, clinical studies investigating improved therapeutic strategies for elderly patients with HPV-positive OPSCC should be performed.

PMID: 27415639 [PubMed - as supplied by publisher]

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Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2.

Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):212-7

Authors: Chiesa Estomba CM, Reinoso FA, Velasquez AO, Fernandez JL, Conde JL, Hidalgo CS

Abstract
INTRODUCTION: Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected.
OBJECTIVE: The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM.
METHODS: Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate.
RESULTS: The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 ± 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%.
CONCLUSION: TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation.

PMID: 27413401 [PubMed]

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Bitot's Spots in Gastric Bypass Patient.

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Bitot's Spots in Gastric Bypass Patient.

Ophthalmology. 2016 Mar;123(3):521

Authors: Surapaneni KR, Koreishi A, Phelps PO

PMID: 26902561 [PubMed - indexed for MEDLINE]

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Does Intubation Improve Outcomes Over Supraglottic Airways in Adult Out-of-Hospital Cardiac Arrest?

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Does Intubation Improve Outcomes Over Supraglottic Airways in Adult Out-of-Hospital Cardiac Arrest?

Ann Emerg Med. 2016 Mar;67(3):396-8

Authors: Carlson JN, Wang HE

PMID: 26475247 [PubMed - indexed for MEDLINE]

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In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness.

Related Articles

In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness.

Head Neck. 2015 Oct;37(10):1483-7

Authors: Castillo Farías F, Cobeta I, Souviron R, Barberá R, Mora E, Benito A, Royuela A

Abstract
BACKGROUND: In-office biopsy is an effective technique to diagnose the nature of pharyngolaryngeal lesions.
METHODS: We selected patients with pharyngolaryngeal lesions suspicious for malignancy. For in-office biopsy procedures, laryngeal cytology and direct laryngoscopy biopsy were performed, and diagnostic parameters and costs were estimated.
RESULTS: Eighty-eight patients were selected for this study. For laryngeal cytology, sensitivity was 70.3% (95% confidence interval [CI] = 59.9% to 80.7%), specificity 100% with a positive predictive value of 100% and a negative predictive value of 50% (95% CI = 35.2% to 64.8%). In-office biopsy sensitivity was 81% (95% CI = 72.6% to 89.3%), specificity 100% with a positive predictive value of 100% and a negative predictive value of 20% (95% CI = 2.5% to 37.5%). At our hospital, the use of in-office biopsies as a first approach for diagnosis saves $50,140.80 U.S. per annum.
CONCLUSION: In-office biopsy is a more affordable technique that enables histologic diagnosis of pharyngolaryngeal lesions in a large percentage of patients.

PMID: 24889909 [PubMed - indexed for MEDLINE]

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Oncologic outcomes of supratracheal laryngectomy: Critical analysis.

Related Articles

Oncologic outcomes of supratracheal laryngectomy: Critical analysis.

Head Neck. 2015 Oct;37(10):1417-24

Authors: Rizzotto G, Crosetti E, Lucioni M, Bertolin A, Monticone V, Sprio AE, Berta GN, Succo G

Abstract
BACKGROUND: Laryngeal cancer management should pursue function-sparing therapeutic options. Even though demolitive surgery provides better control of disease at intermediate to advanced stages when compared to chemoradiotherapy, it does not preserve laryngeal function. Supratracheal partial laryngectomy has been described as a function-sparing surgical technique for laryngeal cancer with subglottic extension.
METHODS: In this retrospective study, we analyzed the clinical outcomes of 115 patients who underwent supratracheal partial laryngectomy.
RESULTS: At 5 years, overall survival (OS), disease-free survival (DFS), and locoregional control rates were 78.9%, 68.5%, and 69.6%, respectively; DFS and locoregional control prevalences were greatly affected by pT4a classification (49.0% and 51.4%, respectively); and laryngeal function preservation was maintained in 78.3% of patients despite being affected by pT4a classification (59.3%) and age ≥65 (64.6%).
CONCLUSION: For cases with glottic tumors and with subglottic extension, the choice of supratracheal partial laryngectomy versus chemoradiotherapy can be considered to be effective in terms of prognostic and functional results.

PMID: 24839082 [PubMed - indexed for MEDLINE]

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Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Ann Otol Rhinol Laryngol. 2016 Jul 12;

Authors: Zacharias SR, Myer CM, Meinzen-Derr J, Kelchner L, Deliyski DD, de Alarcón A

Abstract
OBJECTIVES: To compare clinicians' ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation.
METHODS: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings.
RESULTS: Clinicians were more likely to rate regularity on HSV versus VLS videos (P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location (P = .002). Supraglottic phase symmetry (P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions (P < .0001).
CONCLUSIONS: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations.

PMID: 27411363 [PubMed - as supplied by publisher]

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Clinical Translation of Tissue Engineered Trachea Grafts.

Clinical Translation of Tissue Engineered Trachea Grafts.

Ann Otol Rhinol Laryngol. 2016 Jul 12;

Authors: Chiang T, Pepper V, Best C, Onwuka E, Breuer CK

Abstract
OBJECTIVE: To provide a state-of-the-art review discussing recent achievements in tissue engineered tracheal reconstruction.
DATA SOURCES AND REVIEW METHODS: A structured PubMed search of the current literature up to and including October 2015. Representative articles that discuss the translation of tissue engineered tracheal grafts (TETG) were reviewed.
CONCLUSIONS: The integration of a biologically compatible support with autologous cells has resulted in successful regeneration of respiratory epithelium, cartilage, and vascularization with graft patency, although the optimal construct composition has yet to be defined. Segmental TETG constructs are more commonly complicated by stenosis and delayed epithelialization when compared to patch tracheoplasty.
IMPLICATIONS FOR PRACTICE: The recent history of human TETG recipients represents revolutionary proof of principle studies in regenerative medicine. Application of TETG remains limited to a compassionate use basis; however, defining the mechanisms of cartilage formation, epithelialization, and refinement of in vivo regeneration will advance the translation of TETG from the bench to the bedside.

PMID: 27411362 [PubMed - as supplied by publisher]

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Penetration of hypochlorites with lowered surface tension into dentine tubules.

Penetration of hypochlorites with lowered surface tension into dentine tubules.

Minerva Stomatol. 2016 Jul 14;

Authors: Palazzi F, Sadile G, Mohammadi Z, Del Fabbro M, Riccitiello F

Abstract
BACKGROUND: The purpose of the present study was to assess the effect of concentration and temperature of sodium hypochlorite (NaOCl) with added surfactants and time of exposure on its penetration into human dentine.
METHODS: Seventy-five extracted permanent maxillary anterior teeth with single canals were shaped by using ProTaper SX hand-operated instruments. Then teeth were sectioned perpendicular to their long axis. The crowns and apical thirds of all the teeth were removed. The remaining roots were processed into 4-mm-long blocks and stained overnight in crystal violet. One hundred fifty stained blocks were further split into halves and treated by six NaOCl-based solutions from different brands: three solutions added with surfactants (Hypoclean, H6, Chlor-Xtra) and their regular counterparts (5.25%, 6%, <%6NaOCl). The dentine blocks were exposed to the solutions for 2, 5, and 20 minutes at 20°C, 37°C, and 45°C, respectively. The depth of penetration of NaOCl was determined by bleaching of the stain and measured by light microscopy at magnifications of 20x and 40x. Statistical analysis was made by using two way ANOVA and by comparing groups two by two with t-test.
RESULTS: The shortest penetration (130.80±1.92μm) was measured after incubation with 5.25%NaOCl for 2 minutes at 20°C; the highest penetration (375.40 ± 3.05μm) was obtained with Chlor-Xtra for 20 minutes at 45°C. Temperature and exposure time had a significant direct relationship with penetration of sodium hypochlorites with lowered surface tension into dentinal tubules.
CONCLUSIONS: The exposure time and temperature of sodium hypochlorite as well as the addition of surfactants may influence the penetration depth of irrigants into dentinal tubules.

PMID: 27416154 [PubMed - as supplied by publisher]

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The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL).

The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL).

Int Arch Otorhinolaryngol. 2016 Jul;20(3):202-6

Authors: Ayres A, Jotz GP, Rieder CR, Schuh AF, Olchik MR

Abstract
INTRODUCTION: Dysphagia is a common symptom in Parkinson's disease (PD) and it has been associated with poor quality of life (QoL), anxiety, depression.
OBJECTIVE: The aim of this study was to evaluate the quality of life in individuals with PD before and after SLP therapy.
METHODS: The program consisted of four individual therapy sessions. Each session comprised guidelines regarding food and postural maneuvers (chin down). The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was applied before and after therapy.
RESULTS: The sample comprised of 10 individuals (8 men), with a mean (SD) age of 62.2 (11.3) years, mean educational attainment of 7.5 (4.3) years, and mean disease duration of 10.7 (4.7) years. Thirty percent of patients were Hoehn and Yahr (H&Y) stage 2, 50% were H&Y stage 3, and 20% were H&Y stage 4. Mean scores for all SWAL-QOL domains increased after the intervention period, with significant pre- to post-therapy differences in total score (p = 0.033) and domain 4 (symptom frequency) (p = 0.025). There was also a bias significance for domain 5 (food selection) (p = 0.095).
CONCLUSION: Patients exhibited improvement in swallowing-related quality of life after a SLP therapy program. The earlier in the course of PD, greater the improvement observed after therapy.

PMID: 27413399 [PubMed]

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Understanding the Viscosity of Liquids used in Infant Dysphagia Management.

Understanding the Viscosity of Liquids used in Infant Dysphagia Management.

Dysphagia. 2016 Jul 13;

Authors: Frazier J, Chestnut AH, Jackson A, Barbon CE, Steele CM, Pickler L

Abstract
When assessing swallowing in infants, it is critical to have confidence that the liquids presented during the swallow study closely replicate the viscosity of liquids in the infant's typical diet. However, we lack research on rheological properties of frequently used infant formulas or breastmilk, and various forms of barium contrast media used in swallow studies. The aim of the current study was to provide objective viscosity measurements for typical infant liquid diet options and barium contrast media. A TA-Instruments AR2000 Advanced Rheometer was used to measure the viscosity of five standard infant formulas, three barium products, and two breastmilk samples. Additionally, this study measured the viscosity of infant formulas and breastmilk when mixed with powdered barium contrast in a 20 % weight-to-volume (w/v) concentration. The study findings determined that standard infant formulas and the two breastmilk samples had low viscosities, at the lower end of the National Dysphagia Diet (NDD) thin liquid range. Two specialty formulas tested had much thicker viscosities, close to the lower boundary of the NDD nectar-thick liquid range. The study showed differences in viscosity between 60 % w/v barium products (Liquid E-Z-Paque(®) and E-Z-Paque(®) powder); the powdered product had a much lower viscosity, despite identical barium concentration. When E-Z-Paque(®) powdered barium was mixed in a 20 % w/v concentration using water, standard infant formulas, or breastmilk, the resulting viscosities were at the lower end of the NDD thin range and only slightly thicker than the non-barium comparator liquids. When E-Z-Paque(®) powdered barium was mixed in a 20 % w/v concentration with the two thicker specialty formulas (Enfamil AR 20 and 24 kcal), unexpected alterations in their original viscosity occurred. These findings highlight the clinical importance of objective measures of viscosity as well as objective data on how infant formulas or breastmilk may change in consistency when mixed with barium.

PMID: 27412005 [PubMed - as supplied by publisher]

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A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population.

A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population.

Dysphagia. 2016 Jul 13;

Authors: Valenzano TJ, Waito AA, Steele CM

Abstract
Dysphagia is reported to be a common secondary complication for individuals with traumatic spinal injuries. Different etiologies of traumatic spinal injuries may lead to different profiles of swallowing impairment. We conducted a systematic review to determine the characteristics of dysphagia after traumatic spinal injury and to describe interventions currently used to improve swallowing function in this population. A comprehensive multiengine literature search identified 137 articles of which five were judged to be relevant. These underwent review for study quality, rating for level of evidence, and data extraction. The literature describing dysphagia after traumatic spinal injury was comprised predominantly of low-level evidence and single case reports. Aspiration, pharyngeal residue, and decreased/absent hyolaryngeal elevation were found to be common characteristics of dysphagia in this population. The most commonly used swallowing interventions included tube feeding, compensatory swallowing strategies, and steroids/antibiotics. Improvement in swallowing function following swallowing intervention was reported in all studies; however, there was no control for spontaneous recovery. The results demonstrate a need for high-quality research to profile the pathophysiology of dysphagia after traumatic spinal injury and controlled studies to demonstrate the efficacy of swallowing interventions in this population.

PMID: 27412004 [PubMed - as supplied by publisher]

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Prognoses of new complete dentures from the patient's denture assessment of existing dentures.

Prognoses of new complete dentures from the patient's denture assessment of existing dentures.

Clin Oral Investig. 2016 Jul 13;

Authors: Komagamine Y, Kanazawa M, Sasaki Y, Sato Y, Minakuchi S

Abstract
OBJECTIVES: The aim was to determine prognostic factors affecting frequent post-delivery adjustments of new complete dentures using patients' assessments of existing complete dentures.
MATERIALS AND METHODS: A total of 125 edentulous participants (56 men, 69 women; mean age, 76.4 years) who required new complete dentures evaluated existing dentures using the patient's denture assessment (PDA), a questionnaire regarding the self-assessment of dentures composed of 22 question items and containing six subscales: "function," "lower denture," "upper denture," "expectation," "esthetics and speech," and "importance." Moreover, the numbers of post-delivery adjustments of new dentures were recorded. A multiple logistic regression analysis was performed to identify significant factors for frequent adjustments of new dentures with five subscales of the PDA (excluding "importance"), level of mandibular ridge resorption, and age as independent variables.
RESULTS: The analysis showed that "function," "esthetics and speech," and level of mandibular ridge resorption were significant variables for a frequent number of post-delivery adjustments of new complete dentures.
CONCLUSIONS: The results suggested that patients' assessments of existing dentures using the PDA might allow a prediction of prognosis for complete denture treatments. Additionally, low "function" scores and high "esthetics and speech" scores for existing dentures and high levels of mandibular ridge resorption were significant prognostic factors affecting frequent post-delivery adjustments of new complete dentures.
CLINICAL RELEVANCE: It may be difficult for edentulous persons to adapt to new complete dentures, especially those who have complaints about mastication and swallowing with existing dentures and poor mandibular ridges, but are satisfied with esthetics and speech.

PMID: 27411335 [PubMed - as supplied by publisher]

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[COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER].

[COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Apr;30(4):447-52

Authors: Yang H, Zhang H, Chen H, Yang S, Wang J, Hu D

Abstract
OBJECTIVE: To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer.
METHODS: After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014 (chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010 (series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups (P > 0.05). The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region.
RESULTS: Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group (P < 0.05), while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group (P < 0.05). The patients were followed up 1-5 years (mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh-flap group were significantly better than those of the series-wound flaps group (P < 0.05), while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups (P > 0.05).
CONCLUSION: Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.

PMID: 27411273 [PubMed - in process]

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Dysphagia Related to Esophagus Compression by Anterior Cervical Ossification in a Patient with Ankylosing Spondylitis.

Related Articles

Dysphagia Related to Esophagus Compression by Anterior Cervical Ossification in a Patient with Ankylosing Spondylitis.

J Rheumatol. 2015 Oct;42(10):1922-3

Authors: Toussirot É, Mauvais O, Aubry S

PMID: 26429205 [PubMed - indexed for MEDLINE]

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Race and Sex Differences in Adult Facial Fracture Risk.

Race and Sex Differences in Adult Facial Fracture Risk.

JAMA Facial Plast Surg. 2016 Jul 14;

Authors: Hanba C, Svider PF, Chen FS, Carron MA, Folbe AJ, Eloy JA, Zuliani GF

Abstract
Importance: There are well-described racial, sex, and age differences related to osteoporosis and hip and/or extremity fractures. Nonetheless, there has been virtually no inquiry evaluating whether these findings carry over to facial fracture.
Objective: To characterize the incidence of facial fractures by patient demographics and injury mechanism, focusing on whether differences are noted with race, sex, and advancing age.
Main Outcomes and Measures: Retrospective analysis of the National Electronic Injury Surveillance System (NEISS) was performed in October and November 2015, specifically evaluating adult emergency department (ED) visits from 2012 to 2014 related to facial trauma. Entries were organized by age groups (both individual decades as well as younger adults [18-59 years] vs older adults [60-89 years]), sex, and race (white, black, Asian, other/unspecified). Incidence of facial fractures and mechanism of injury were also evaluated.
Results: There were 33 825 NEISS entries correlating to 1 401 196 ED (range, 1 136 048-1 666 344) visits for adult facial injury, with 14.4% involving fracture. A greater proportion of facial injuries among younger men (<60 years) were fractures relative to younger women (15.5% vs 12.5%; difference of the mean [DOM], 3.0%; 95% CI, 2.8%-3.1%; P < .001); however, on comparison by sex in elderly populations (≥ 60 years), women had an increased fracture predilection (15.0% vs 14.0%; DOM, 1.0%; 95% CI, 0.8%-1.2%; P < .001). Also, older women had a significantly greater risk of fracture relative to those younger than 60 years (15.0% vs 12.5%; DOM, 2.5%; 95% CI, 2.4%-2.7%; P < .001), a comparison that was significant among whites and Asians. Black women had a significantly decreased risk of fracture in the older aged population. (8.4% vs 9.1%; DOM, 0.7%; 95% CI, 0.2%- 1.3%; P = .001). Both on individual comparisons of younger and older cohorts, white and Asian individuals of either sex had significantly greater rates of facial fracture injury than blacks. Among younger cohorts in either sex, injuries sustained during participation in recreational activities were a significant factor, replaced largely by injuries due to housing structural elements and falls among older cohorts.
Conclusions and Relevance: There is an increase in the risk of facial fracture among postmenopausal women sustaining facial injuries, with these results significant among whites and Asians. In contrast, a decreased risk was noted on comparison of younger and older black women. Mechanism of injuries also varied significantly by age, race, and sex.
Level of Evidence: 4.

PMID: 27414775 [PubMed - as supplied by publisher]

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The transclival artery: a variant persistent carotid-basilar arterial anastomosis not previously reported.

The transclival artery: a variant persistent carotid-basilar arterial anastomosis not previously reported.

BMJ Case Rep. 2016;2016

Authors: Kirkland JD, Dahlin BC, O'Brien WT

Abstract
During embryological development, primitive anastomoses exist between the carotid and vertebrobasilar arteries. These anastomoses typically regress or are incorporated into the developing vasculature. Persistence beyond fetal development, however, results in vascular anomalies that alter haemodynamic flow with a predisposition for aneurysm formation. The carotid-vertebrobasilar anastomoses mirror the primitive communications and include (from most to least common) the trigeminal, hypoglossal, proatlantal and otic arteries. The hypoglossal and proatlantal variants extend through the hypoglossal canal or foramen magnum, respectively. We present a previously undescribed variant of these persistent fetal anastomoses, the 'transclival artery', which courses through its own transclival skull base canal/foramen.

PMID: 27413022 [PubMed - in process]

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Forgetful but not forgotten: Bathroom-related craniofacial trauma among the elderly.

Forgetful but not forgotten: Bathroom-related craniofacial trauma among the elderly.

Laryngoscope. 2016 Jul 14;

Authors: Hanba C, Gupta A, Svider PF, Folbe AJ, Eloy JA, Zuliani GF, Carron MA

Abstract
OBJECTIVES/HYPOTHESIS: As our population ages, injuries attributable to falls continue to increase, impacting healthcare delivery. Evaluation of craniofacial trauma with focus on elderly patients remains an underappreciated concern. Our objectives were to evaluate injury trends associated with elderly bathroom falls, as this information may be useful for counseling and preventive purposes.
STUDY DESIGN: Database review.
METHODS: The National Electronic Injury Surveillance System was evaluated for craniofacial trauma among patients 60 years and older presenting to the emergency department (ED) (2010-2014). Injury descriptions were reviewed for mechanism of injury, patient demographics, and other injury characteristics.
RESULTS: In total, 7.2% of the estimated 3.4 million ED visits for elderly craniofacial trauma were bathroom related. Females comprised the majority (60.9%) of patients, and a plurality of patients were in their 80s. A greater proportion of facial injuries resulted from syncope (16.6% vs. 10.9% compared to head injuries). Toilets facilitated a greater proportion of facial insults and were more likely to require admission; the most common mechanism was "falling off." Showers contributed a majority of head injuries and had a lower median age than toilet injuries. Fractures comprised 12.6% of facial injuries; of craniofacial fractures, common sites included the nose (54%), mandible (6%), and orbit (6%). Admitted patients were significantly older than those who were released.
CONCLUSIONS: Bathroom falls result in a significant proportion of elderly traumatic injury. The trends we present offer the opportunity for targeted preventative measures to decrease the occurrence of these events. Additionally, this information may adjunct a detailed history and physical to ensure appropriate patient management.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27411519 [PubMed - as supplied by publisher]

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[Infratentorial ischemic stroke in children: Three case reports].

Related Articles

[Infratentorial ischemic stroke in children: Three case reports].

Arch Pediatr. 2011 May;18(5):544-9

Authors: Ouattara-Doumbia M, Le Moing AG, Bourel-Ponchel E, Delignières A, Schauvliege J, de Broca A, Chabrol B, Berquin P

Abstract
Ischemic stroke is rare in children, most of which occur in the supratentorial brain, and infratentorial infarcts are very rare. Some clinical manifestations may be similar but others such as ataxia and cranial nerve palsy are more specific. Vertebral artery dissection is the most frequent cause of stroke in the vertebrobasilar territory, but the cause most often remains unknown in children. We report three cases of infratentorial stroke in children. The first observation concerns a 4-year-old boy brought to medical attention because left hemicorporal motor deficit associated with ataxia following a minor cranial traumatism. While computed tomography (CT) of the brain was normal, magnetic resonance imaging (MRI) revealed an area of signal alteration on the diffusion-weighted image within the right protuberance. The second observation is a 15-year-old girl who developed sudden-onset ataxia. The CT scan and MRI of the brain revealed an acute bilateral cerebellar stroke. MRI angiography showed an anatomical variant of the left vertebral artery that did not participate in the Willis polygon. In these two observations, no other abnormalities were detected except they were homozygotous for MTHFR mutation in the first observation and minor alpha-thalassemia for the second one. The outcome in these two children was good without sequelae after a 6-month follow-up. The third observation is a 6-year-old girl who suddenly exhibited cephalalgia, ataxia, and left visual impairment. The brain MRI revealed left occipital and cerebellar strokes due to vertebral artery dissection. The authors recommend the systematic search for vertebral artery dissection in cases of infratentorial stroke.

PMID: 21458968 [PubMed - indexed for MEDLINE]

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Recurrence and survival after gross total removal of resectable undifferentiated or poorly differentiated thyroid carcinoma.

Recurrence and survival after gross total removal of resectable undifferentiated or poorly differentiated thyroid carcinoma.

Thyroid. 2016 Jul 13;

Authors: Lee DY, Won JK, Choi HS, Park DJ, Jung KC, Sung MW, Kim KH, Hah JH, Park YJ

Abstract
BACKGROUND: This study aimed to evaluate the recurrence and survival after initial curative-intent surgery of resectable anaplastic thyroid cancer (ATC) and poorly differentiated thyroid cancer (PDTC).
METHODS: A retrospective analysis was conducted on patients with ATC and PDTC who had been treated from the period 1985 to 2013. Among them, 119 patients who had undergone surgery with curative intent were included in this study. The outcome measures included the clinical response to treatment and the recurrence rates of three separate thyroid cancer groups: ATC, differentiated thyroid cancer (DTC) with anaplastic foci, and PDTC.
RESULTS: Initial remission was achieved in 100 patients (84.0%), with higher percentages in patients with DTC with anaplastic foci (97.8%) and PDTC (96.7%) compared to ATC (60.5%). Overall recurrence rate after initial remission was 30.8% in ATC, 25.9% PDTC, and 6.7% DTC with anaplastic foci. Pathologic diagnosis, preexisting goiter or tumors, along with tracheal and lymphatic/vascular invasion were correlated with recurrence (p<0.001, p=0.001, 0.006, 0.003, 0.016, respectively). All patients without initial remission died due to local failure, and most patients with recurrence, apart from two PDTC patients, had distant metastasis. Overall mortality after initial curative-intent surgery was 58.1% in ATC, 8.7% DTC with anaplastic foci, and 20% PDTC.
CONCLUSIONS: The initial remission of resectable tumors was higher and the recurrence rate was lower in DTC with anaplastic foci and PDTC compared to ATC. Careful monitoring of the development of distant metastasis is necessary, especially in patients with aggressive pathology with tracheal and lymphovascular invasion.

PMID: 27412715 [PubMed - as supplied by publisher]

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Frequency-Dependent Neural Activity in Patients with Unilateral Vascular Pulsatile Tinnitus.

Frequency-Dependent Neural Activity in Patients with Unilateral Vascular Pulsatile Tinnitus.

Neural Plast. 2016;2016:4918186

Authors: Lv H, Zhao P, Liu Z, Wang G, Zeng R, Yan F, Dong C, Zhang L, Li R, Wang P, Li T, Gong S, Wang Z

Abstract
Previous resting-state functional magnetic resonance imaging (rs-fMRI) studies have shown that neurological changes are important findings in vascular pulsatile tinnitus (PT) patients. Here, we utilized rs-fMRI to measure the amplitude of low-frequency fluctuations (ALFF) in forty patients with unilateral PT and forty age-, gender-, and education-matched normal control subjects. Two different frequency bands (slow-4, 0.027-0.073 Hz, and slow-5, 0.010-0.027 Hz, which are more sensitive to subcortical and cortical neurological signal changes, resp.) were analyzed to examine the intrinsic brain activity in detail. Compared to controls, PT patients had increased ALFF values mainly in the PCu, bilateral IPL (inferior parietal lobule), left IFG (inferior frontal gyrus), and right IFG/anterior insula and decreased ALFF values in the multiple occipital areas including bilateral middle-inferior occipital lobe. For the differences of the two frequency bands, widespread ALFF differences were observed. The ALFF abnormalities in aMPFC/ACC, PCu, right IPL, and some regions of occipital and parietal cortices were greater in the slow-5 band compared to the slow-4 band. Additionally, the THI score of PT patients was positively correlated with changes in slow-5 and slow-4 band in PCu. Pulsatile tinnitus is a disease affecting the neurological activities of multiple brain regions. Slow-5 band is more sensitive in detecting the alternations. Our results also indicated the importance of pathophysiological investigations in patients with pulsatile tinnitus in the future.

PMID: 27413554 [PubMed - in process]

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Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation.

Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):271-4

Authors: Bento RF, Gebrim EM, Magalhães AT, Pereira LV, Fonseca AC

Abstract
INTRODUCTION: Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing.
OBJECTIVE: This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation.
DATA SYNTHESIS: The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochlea measuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochlea was anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB.
CONCLUSION: Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

PMID: 27413411 [PubMed]

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Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):261-70

Authors: Albernaz PL

Abstract
INTRODUCTION: Metabolic activity of the inner ear is very intense, and makes it sensitive to changes in the body homeostasis. This study involves a group of patients with inner ear disorders related to carbohydrate metabolism disturbances, including hearing loss, tinnitus, dizziness, and episodes of vertigo.
OBJECTIVES: To describe the symptoms of metabolic inner ear disorders and the examinations required to establish diagnoses. These symptoms are often the first to allow for an early diagnosis of metabolic disorders and diabetes.
METHODS: Retrospective study of 376 patients with inner ear symptoms suggestive of disturbances of carbohydrate metabolism. The authors present patientś clinical symptoms and clinical evaluations, with emphasis on the glucose and insulin essays.
RESULTS: Authors based their conclusions on otolaryngological findings, diagnostic procedures and treatment principles. They found that auditory and vestibular symptoms usually occur prior to other manifestations of metabolic changes, leading to an early diagnosis of hyperinsulinemia, intestinal sugar malabsorption or diabetes. Previously undiagnosed diabetes mellitus type II was found in 39 patients.
CONCLUSIONS: The identification of carbohydrate metabolism disturbances is important not only to minimize the patients' clinical symptoms, but also to help maintain their general health.

PMID: 27413410 [PubMed]

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Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss.

Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):248-53

Authors: Flores LS, Teixeira AR, Rosito LP, Seimetz BM, Dall'Igna C

Abstract
INTRODUCTION: Tinnitus is one of the symptoms that affects individuals suffering from noise induced hearing loss. This condition can be disabling, leading the affected individual to turn away from work.
OBJECTIVE: This literature review aims to analyze the possible association between gender and tinnitus pitch and loudness, the degree of hearing loss and the frequencies affected in subjects with noise-induced hearing loss.
METHODS: This contemporary cohort study was conducted through a cross-sectional analysis. The study sample consisted of adults with unilateral or bilateral tinnitus, who had been diagnosed with noise-induced hearing loss. The patients under analysis underwent an otorhinolaryngological evaluation, pure tone audiometry, and acuphenometry.
RESULTS: The study included 33 subjects with noise-induced hearing loss diagnoses, of which 22 (66.7%) were men. Authors observed no statistical difference between gender and loudness/pitch tinnitus and loudness/pitch in subjects with bilateral tinnitus. Authors found an inverse relation between tinnitus loudness with intensity greater hearing threshold and the average of the thresholds and the grade of hearing loss. The tinnitus pitch showed no association with higher frequency of hearing threshold.
CONCLUSION: Data analysis shows that, among the individuals evaluated, the greater the hearing loss, the lower the loudness of tinnitus. We did not observe an association between hearing loss and tinnitus pitch.

PMID: 27413408 [PubMed]

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Cognitive Evaluation and Quality of Life Assessment in Patients with Subjective Tinnitus.

Cognitive Evaluation and Quality of Life Assessment in Patients with Subjective Tinnitus.

Acta Neurol Taiwan. 2016 Mar;25(1):1-9

Authors: Dağ E, Bayar Muluk N, Karabiçak H, Kürşat Arikan O, Türkel Y

PMID: 27411793 [PubMed - in process]

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Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation.

Ann Otol Rhinol Laryngol. 2016 Jul 12;

Authors: Zacharias SR, Myer CM, Meinzen-Derr J, Kelchner L, Deliyski DD, de Alarcón A

Abstract
OBJECTIVES: To compare clinicians' ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation.
METHODS: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings.
RESULTS: Clinicians were more likely to rate regularity on HSV versus VLS videos (P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location (P = .002). Supraglottic phase symmetry (P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions (P < .0001).
CONCLUSIONS: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations.

PMID: 27411363 [PubMed - as supplied by publisher]

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Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Hearing Loss, Dizziness, and Carbohydrate Metabolism.

Int Arch Otorhinolaryngol. 2016 Jul;20(3):261-70

Authors: Albernaz PL

Abstract
INTRODUCTION: Metabolic activity of the inner ear is very intense, and makes it sensitive to changes in the body homeostasis. This study involves a group of patients with inner ear disorders related to carbohydrate metabolism disturbances, including hearing loss, tinnitus, dizziness, and episodes of vertigo.
OBJECTIVES: To describe the symptoms of metabolic inner ear disorders and the examinations required to establish diagnoses. These symptoms are often the first to allow for an early diagnosis of metabolic disorders and diabetes.
METHODS: Retrospective study of 376 patients with inner ear symptoms suggestive of disturbances of carbohydrate metabolism. The authors present patientś clinical symptoms and clinical evaluations, with emphasis on the glucose and insulin essays.
RESULTS: Authors based their conclusions on otolaryngological findings, diagnostic procedures and treatment principles. They found that auditory and vestibular symptoms usually occur prior to other manifestations of metabolic changes, leading to an early diagnosis of hyperinsulinemia, intestinal sugar malabsorption or diabetes. Previously undiagnosed diabetes mellitus type II was found in 39 patients.
CONCLUSIONS: The identification of carbohydrate metabolism disturbances is important not only to minimize the patients' clinical symptoms, but also to help maintain their general health.

PMID: 27413410 [PubMed]

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Neurological Complications of Ebola Virus Infection.

Neurological Complications of Ebola Virus Infection.

Neurotherapeutics. 2016 Jul 13;

Authors: Billioux BJ, Smith B, Nath A

Abstract
Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.

PMID: 27412684 [PubMed - as supplied by publisher]

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[Dysphonia and Dysphagia Caused by a Pedunculated Polyp of the Hypopharynx].

[Dysphonia and Dysphagia Caused by a Pedunculated Polyp of the Hypopharynx].

Laryngorhinootologie. 2016 Jul 14;

Authors: Schwarte B, Bootz F, Zhou H, Schade G

PMID: 27414484 [PubMed - as supplied by publisher]

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Insights on different analysis techniques in the monothermal and bithermal caloric test - which parameter should we use to quantify vestibular function?

Insights on different analysis techniques in the monothermal and bithermal caloric test - which parameter should we use to quantify vestibular function?

Int J Audiol. 2016 Jul 14;:1-8

Authors: Radomskij P, Smith S, Kuttva S

Abstract
OBJECTIVE: To investigate the use of maximum slow component velocity (MSCV) and time-constant duration (TCd) of elicited nystagmus in quantifying the caloric response and to assess the efficacy of these parameters in the monothermal screening test.
DESIGN: Retrospective analysis of caloric results obtained from 150 patients. Bithermal unilateral weakness (UW), directional preponderance (DP), monothermal caloric asymmetry (MCA) based on warm or cool irrigations only, were calculated using both MSCV and TCd.
STUDY SAMPLE: 66 males and 84 females, aged 16-88 years (μ = 50, σ = 17), who underwent vestibular assessment.
RESULTS: The correlation-coefficient between bithermal caloric unilateral weaknesses calculated using either MSCV or TCd is 0.155 (p < 0.01). Using MSCV and setting significant MCA at 10%, the sensitivity and specificity were respectively 100% and 34% for monothermal warm and 82% and 53% for monothermal cool tests. Using TCd and setting significant MCA at 5%, the sensitivity and specificity were respectively 90% and 77% for monothermal warm and 100% and 74% for monothermal cool tests.
CONCLUSIONS: In the monothermal warm caloric test, MSCV can be used more reliably than monothermal cool to predict normal bithermal caloric response. The reverse is true if using TCd. Unilateral-weakness calculated using TCd and MSCV were poorly correlated and therefore likely to be demonstrating different aspects of vestibular function.

PMID: 27414985 [PubMed - as supplied by publisher]

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A review of the perceptual effects of hearing loss for frequencies above 3 kHz.

A review of the perceptual effects of hearing loss for frequencies above 3 kHz.

Int J Audiol. 2016 Jul 14;:1-8

Authors: Moore BC

Abstract
BACKGROUND: Hearing loss caused by exposure to intense sounds usually has its greatest effects on audiometric thresholds at 4 and 6 kHz. However, in several countries compensation for occupational noise-induced hearing loss is calculated using the average of audiometric thresholds for selected frequencies up to 3 kHz, based on the implicit assumption that hearing loss for frequencies above 3 kHz has no material adverse consequences. This paper assesses whether this assumption is correct.
DESIGN: Studies are reviewed that evaluate the role of hearing for frequencies above 3 kHz.
RESULTS: Several studies show that frequencies above 3 kHz are important for the perception of speech, especially when background sounds are present. Hearing at high frequencies is also important for sound localization, especially for resolving front-back confusions.
CONCLUSIONS: Hearing for frequencies above 3 kHz is important for the ability to understand speech in background sounds and for the ability to localize sounds. The audiometric threshold at 4 kHz and perhaps 6 kHz should be taken into account when assessing hearing in a medico-legal context.

PMID: 27414746 [PubMed - as supplied by publisher]

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Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas.

Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas.

Int J Audiol. 2016 Jul 14;:1-11

Authors: Murphy WJ, Themann CL, Murata TK

Abstract
OBJECTIVE: This field study aimed to assess the noise reduction of hearing protection for individual workers, demonstrate the effectiveness of training on the level of protection achieved, and measure the time required to implement hearing protector fit testing in the workplace.
DESIGN: The National Institute for Occupational Safety and Health (NIOSH) conducted field studies in Louisiana and Texas to test the performance of HPD Well-Fit.
STUDY SAMPLE: Fit tests were performed on 126 inspectors and engineers working in the offshore oil industry.
RESULTS: Workers were fit tested with the goal of achieving a 25-dB PAR. Less than half of the workers were achieving sufficient protection from their hearing protectors prior to NIOSH intervention and training; following re-fitting and re-training, over 85% of the workers achieved sufficient protection. Typical test times were 6-12 minutes.
CONCLUSIONS: Fit testing of the workers' earplugs identified those workers who were and were not achieving the desired level of protection. Recommendations for other hearing protection solutions were made for workers who could not achieve the target PAR. The study demonstrates the need for individual hearing protector fit testing and addresses some of the barriers to implementation.

PMID: 27414471 [PubMed - as supplied by publisher]

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Validation of list equivalency for Mandarin speech materials to use with cochlear implant listeners.

Validation of list equivalency for Mandarin speech materials to use with cochlear implant listeners.

Int J Audiol. 2016 Jul 14;:1-10

Authors: Li Y, Wang S, Su Q, Galvin JJ, Fu QJ

Abstract
OBJECTIVES: Speech materials validated with normal-hearing listeners may not be appropriate for clinical assessment of cochlear implant (CI) users. The aim of this study was to validate list equivalency of the Mandarin Speech Perception (MSP) sentences, disyllables, and monosyllables in Mandarin-speaking CI patients.
DESIGN: Recognition of MSP sentences, disyllables, and monosyllables each were measured for all 10 lists.
STUDY SAMPLE: 67 adult and 32 pediatric Mandarin-speaking CI users.
RESULTS: There was no significant difference between adult and pediatric subject groups for all test materials. Significant differences were observed among lists within each test. After removing one or two lists within each test, no significant differences were observed among the remaining lists. While there was equal variance among lists within a given test, the variance was larger for children than for adults, and increased from monosyllables to disyllables to sentences.
CONCLUSIONS: Some adjustment to test lists previously validated with CI simulations was needed to create perceptually equivalent lists for real CI users, suggesting that test materials should be validated in the targeted population. Differences in mean scores and variance across test materials suggest that CI users may differ in their ability to make use of contextual cues available in sentences and disyllables.

PMID: 27414242 [PubMed - as supplied by publisher]

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Theoretical Issues of Validity in the Measurement of Aided Speech Reception Threshold in Noise for Comparing Nonlinear Hearing Aid Systems.

Theoretical Issues of Validity in the Measurement of Aided Speech Reception Threshold in Noise for Comparing Nonlinear Hearing Aid Systems.

J Am Acad Audiol. 2016 Jul;27(7):504-14

Authors: Naylor G

Abstract
BACKGROUND: Adaptive Speech Reception Threshold in noise (SRTn) measurements are often used to make comparisons between alternative hearing aid (HA) systems. Such measurements usually do not constrain the signal-to-noise ratio (SNR) at which testing takes place. Meanwhile, HA systems increasingly include nonlinear features that operate differently in different SNRs, and listeners differ in their inherent SNR requirements.
PURPOSE: To show that SRTn measurements, as commonly used in comparisons of alternative HA systems, suffer from threats to their validity, to illustrate these threats with examples of potentially invalid conclusions in the research literature, and to propose ways to tackle these threats.
RESEARCH DESIGN: An examination of the nature of SRTn measurements in the context of test theory, modern nonlinear HAs, and listener diversity.
STUDY SAMPLE, DATA COLLECTION, AND ANALYSIS: Examples from the audiological research literature were used to estimate typical interparticipant variation in SRTn and to illustrate cases where validity may have been compromised.
RESULTS AND CONCLUSIONS: There can be no doubt that SRTn measurements, when used to compare nonlinear HA systems, in principle, suffer from threats to their internal and external/ecological validity. Interactions between HA nonlinearities and SNR, and interparticipant differences in inherent SNR requirements, can act to generate misleading results. In addition, SRTn may lie at an SNR outside the range for which the HA system is designed or expected to operate in. Although the extent of invalid conclusions in the literature is difficult to evaluate, examples of studies were nevertheless identified where the risk of each form of invalidity is significant. Reliable data on ecological SNRs is becoming available, so that ecological validity can be assessed. Methodological developments that can reduce the risk of invalid conclusions include variations on the SRTn measurement procedure itself, manipulations of stimulus or scoring conditions to place SRTn in an ecologically relevant range, and design and analysis approaches that take account of interparticipant differences.

PMID: 27406658 [PubMed - in process]

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Introduction to Special Issue: Towards Ecologically Valid Protocols for the Assessment of Hearing and Hearing Devices.

Introduction to Special Issue: Towards Ecologically Valid Protocols for the Assessment of Hearing and Hearing Devices.

J Am Acad Audiol. 2016 Jul;27(7):502-3

Authors: Keidser G

PMID: 27406657 [PubMed - in process]

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Acceptance of internet-based hearing healthcare among adults who fail a hearing screening.

Acceptance of internet-based hearing healthcare among adults who fail a hearing screening.

Int J Audiol. 2016 Sep;55(9):483-490

Authors: Rothpletz AM, Moore AN, Preminger JE

Abstract
OBJECTIVE: This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants' acceptance of IHHC (Phase 2).
STUDY SAMPLE: Twenty-seven adults (age 55+) who failed a hearing screening participated.
DESIGN: During Phase 1 participants were administered the University of Rhode Island Change Assessment (URICA) and patient technology acceptance model (PTAM) Questionnaire. During Phase 2 participants were randomly assigned to a training or control group. Training group participants attended an instructional class on existing IHHC websites. The control group received no training. The PTAM questionnaire was re-administered to both groups 4-6 weeks following the initial assessment.
RESULTS: The majority of participants were either considering or preparing to do something about their hearing loss, and were generally accepting of IHHC websites (Phase 1). The participants who underwent brief IHHC training reported increases in hearing healthcare knowledge and slight improvements in computer self-efficacy (Phase 2).
CONCLUSIONS: Older adults who fail hearing screenings may be good candidates for IHHC. The incorporation of a simple user-interface and short-term training may optimize the usability of future IHHC programs for this population.

PMID: 27409278 [PubMed - as supplied by publisher]

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Cricohyoidoepiglottopexy in Laryngeal Trauma.

Cricohyoidoepiglottopexy in Laryngeal Trauma.

Otolaryngol Head Neck Surg. 2016 Jul 12;

Authors: Ferreira E, Nabuco Araújo C, Agostinho S, Santos AR

PMID: 27406707 [PubMed - as supplied by publisher]

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Endoscopic Endonasal Repair of Septal Perforation with Interpositional Auricular Cartilage Grafting via a Mucosal Regeneration Technique.

Endoscopic Endonasal Repair of Septal Perforation with Interpositional Auricular Cartilage Grafting via a Mucosal Regeneration Technique.

Otolaryngol Head Neck Surg. 2016 Jul 12;

Authors: Ozturan O, Yenigun A, Senturk E, Eren SB, Aksoy F

Abstract
We evaluated the efficacy of interpositional auricular cartilage grafting for perforation with an endoscopic endonasal approach via a mucosal regeneration technique. In total, 12 patients with symptomatic septal perforations were operated on by way of an endoscopic endonasal approach after an adequately sized cartilage graft was harvested. The graft was inserted between the circumferentially incised and elevated flaps of the perforation and secured by vertical and horizontal nonabsorbable aligning approximation stitches and prolonged placement of silicone splints. The average perforation size was 12.3 mm (range, 4-19 mm). Bleeding, incrustation, pain, whistling respiration, and nasal congestion symptoms were relieved entirely in 10 of 12 patients (83.3%) who had successful treatment. This study showed that an endoscopic endonasal approach via a mucosal regeneration technique without direct mucosa-to-mucosa repair can be applied successfully without disrupting the neighboring nasal structures for septal perforations up to 20 mm and as effectively as other, more complex surgical interventions.

PMID: 27406706 [PubMed - as supplied by publisher]

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Effects of Covering Surgical Wounds with Polyglycolic Acid Sheets for Posttonsillectomy Pain.

Effects of Covering Surgical Wounds with Polyglycolic Acid Sheets for Posttonsillectomy Pain.

Otolaryngol Head Neck Surg. 2016 Jul 12;

Authors: Miyaguchi SI, Horii A, Kambara R, Takemoto N, Akazawa H, Takahashi N, Baba H, Inohara H

Abstract
Postoperative pain is a remaining issue in tonsillectomy. Polyglycolic acid (PGA) is a biocompatible material used for absorbent suture reinforcement, and its sheet has been applied for covering defects after resection of oral carcinoma. The aim of this study is to examine whether the attachment of a PGA sheet to surgical wounds would reduce posttonsillectomy pain. In this prospective single-blind study, 17 consecutive adult patients were recruited who needed to undergo tonsillectomy, mainly due to habitual tonsillitis. Following bilateral tonsillectomies, a PGA sheet was attached with fibrin glue to only 1 side, without notification to patients of which side. Postoperative pain of each side was separately evaluated with a visual analog scale at 4 time points: before each meal and before sleep. Postoperative pain of both the PGA sheet-attached and nonattached sides was most severe before breakfast among 4 time points. Postoperative pain measured before breakfast was significantly more severe in the PGA sheet-attached side than the nonattached side. As such, this study provided solid data on the negative effects of PGA sheeting on posttonsillectomy pain.

PMID: 27406705 [PubMed - as supplied by publisher]

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Surgery in MEN 2A Patients Older Than 5 Years with Micro-MTC: Outcome at Long-term Follow-up.

Surgery in MEN 2A Patients Older Than 5 Years with Micro-MTC: Outcome at Long-term Follow-up.

Otolaryngol Head Neck Surg. 2016 Jul 12;

Authors: Tonelli F, Giudici F, Marcucci T, Cavalli T, Spini S, Gheri RG, Brandi ML

Abstract
In multiple endocrine neoplasia syndrome type 2A (MEN 2A), early total thyroidectomy (TT; performed before the age of 5 years) is the best option to prevent medullary thyroid carcinoma (MTC) development, but the management of MEN 2A patients diagnosed after childhood is still under debate. Seventeen consecutive patients diagnosed with MEN 2A after the age of 5 years (mean age, 23.3 years) with a pathologic diagnosis of micro-MTC without nodal involvement were enrolled. All patients underwent TT with thymectomy and central compartment lymph node dissection. During surgery, parathyroid tissue removal occurred in 14 patients. No major postoperative complications nor persistent hypoparathyroidism was observed. After a mean follow-up of 16.6 years, no patient developed primary hyperparathyroidism or disease recurrence. Even if TT is recommended before the age of 5, when MEN 2A diagnosis is performed after this age in micro-MTC without nodal involvement, TT with thymectomy and central compartment lymphadenectomy can provide good oncologic and functional results.

PMID: 27406704 [PubMed - as supplied by publisher]

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Does adenoid hypertrophy affect disease severity in children with allergic rhinitis?

Does adenoid hypertrophy affect disease severity in children with allergic rhinitis?

Eur Arch Otorhinolaryngol. 2016 Jul 12;

Authors: Dogru M, Evcimik MF, Calim OF

Abstract
Our study aims to evaluate the presence of adenoid hypertrophy (AH) in children with allergic rhinitis (AR) and the association of AH disease severity and clinical laboratory finding from retrospective, cross-sectional, and nonrandomized trial. The study included 566 children being treated and followed up for allergic rhinitis. Skin prick test for the same allergens was performed for all patients. Adenoid tissue was analyzed by an ENT specialist and the diagnosis was confirmed based on the patient history, endoscopic physical examination and radiology. Adenoid hypertrophy was detected in 118 (21.2 %) of the children with AR. Children with and without AH did not differ statistically and significantly by gender, age, presence of atopy in the family, exposure to smoke (p > 0.05). Comparison of the groups for AR duration demonstrated significantly higher frequency of persistent rhinitis in patients with AH (p < 0.05). Of the AR patients with AH, 90 (76.3 %) had moderate-severe rhinitis and 274 (62.6 %) AR patients without AH had moderate-severe rhinitis (p = 0.005). Itchy nose was more frequent in AR patients without AH, and nasal congestion was more common in AR patients with AH (p = 0.017 and p = 0.001, respectively). The presence of asthma was more common among AR patients without AH (p = 0.037). Intergroup comparisons for presence of atopic dermatitis, the percentage of eosinophil, serum IgE levels, the number of positive sensitivity, polysensitization, sensitivity to house dust mite, cockroach, pollens and dander yielded no significant difference (p > 0.05). On the other hand, sensitivity to Alternaria alternata was significantly more frequent in AR patients with AH (p = 0.032). The presence of AH increased the severity of the disease and prolongs disease duration. There was a negative relationship between AH and asthma in children with AR. AH is more common among children with mold sensitivity. AH should be considered and investigated particularly in non-asthmatic children with pronounced nasal congestion and A. alternata sensitivity.

PMID: 27405740 [PubMed - as supplied by publisher]

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VEMPs in central neurological disorders.

Related Articles

VEMPs in central neurological disorders.

Clin Neurophysiol. 2016 Apr;127(4):2020-1

Authors: Deriu F, de Natale ER, Magnano I, Ginatempo F

PMID: 26971484 [PubMed - indexed for MEDLINE]

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Cutaneous head and neck melanoma in OPTiM, a randomized phase 3 trial of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor for the treatment of unresected stage IIIB/IIIC/IV melanoma.

Cutaneous head and neck melanoma in OPTiM, a randomized phase 3 trial of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor for the treatment of unresected stage IIIB/IIIC/IV melanoma.

Head Neck. 2016 Jul 13;

Authors: Andtbacka RH, Agarwala SS, Ollila DW, Hallmeyer S, Milhem M, Amatruda T, Nemunaitis JJ, Harrington KJ, Chen L, Shilkrut M, Ross M, Kaufman HL

Abstract
BACKGROUND: Cutaneous head and neck melanoma has poor outcomes and limited treatment options. In OPTiM, a phase 3 study in patients with unresectable stage IIIB/IIIC/IV melanoma, intralesional administration of the oncolytic virus talimogene laherparepvec improved durable response rate (DRR; continuous response ≥6 months) compared with subcutaneous granulocyte-macrophage colony-stimulating factor (GM-CSF).
METHODS: Retrospective review of OPTiM identified patients with cutaneous head and neck melanoma given talimogene laherparepvec (n = 61) or GM-CSF (n = 26). Outcomes were compared between talimogene laherparepvec and GM-CSF treated patients with cutaneous head and neck melanoma.
RESULTS: DRR was higher for talimogene laherparepvec-treated patients than for GM-CSF treated patients (36.1% vs 3.8%; p = .001). A total of 29.5% of patients had a complete response with talimogene laherparepvec versus 0% with GM-CSF. Among talimogene laherparepvec-treated patients with a response, the probability of still being in response after 12 months was 73%. Median overall survival (OS) was 25.2 months for GM-CSF and had not been reached with talimogene laherparepvec.
CONCLUSION: Treatment with talimogene laherparepvec was associated with improved response and survival compared with GM-CSF in patients with cutaneous head and neck melanoma. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27407058 [PubMed - as supplied by publisher]

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Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: A systematic review and meta-analysis.

Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: A systematic review and meta-analysis.

Head Neck. 2016 Jul 13;

Authors: Jayaram SC, Muzaffar SJ, Ahmed I, Dhanda J, Paleri V, Mehanna H

Abstract
BACKGROUND: Treatment of recurrent oropharyngeal cancer is widely thought to have poor outcomes. Justification for treatment, especially in advanced cases, can be difficult.
METHODS: A systematic search of MEDLINE, Embase, and Cochrane databases was conducted. Included studies reported specific recurrent oropharyngeal cancer survival data.
RESULTS: Twenty-two retrospective studies were included. Pooled 3-year overall survival (OS) was 26% (95% confidence interval [CI] = 22% to 29%; I squared = 40.7%; p = .057). Pooled 5-year OS was 23% (95% CI = 20% to 27%; I squared = 73.9%; p = .000). Surgical treatment was superior to radiation (5-year OS 26% vs 16%, respectively; p < .001). The 5-year OS improved over time: 18% in the pre-2000 cohort; 35% in the mixed pre-2000 and post-2000 group; and 51% in the post-2000 cohort (p < .001).
CONCLUSION: Outcomes have improved considerably over the last 2 decades, resulting in approximately 50% overall 5-year survival. Human papillomavirus (HPV) status, patient selection, and improvements in care may explain this. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27405247 [PubMed - as supplied by publisher]

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Metastatic right ventricular mass with intracavitary obliteration.

Metastatic right ventricular mass with intracavitary obliteration.

J Community Hosp Intern Med Perspect. 2016;6(3):31679

Authors: Kalvakuri K, Banga S, Upalakalin N, Shaw C, Davila WF, Mungee S

Abstract
Metastatic cardiac tumors are more common than the primary cardiac tumors. Cervical cancer metastasizing outside of the pelvis is commonly spread to the lungs, liver, bones and lymph nodes than to the heart. Right-sided metastasis to the heart is more common than to the left side. Intramural spread is more common than intracavitary growth of metastatic cardiac tumors leading to delayed clinical presentation. Intracavitary mass can be confused with intracavitary thrombus which can be seen in the setting of pulmonary embolism. Transthoracic echocardiography plays a major role in the decision making and management of pulmonary embolism, and this modality can also be used to diagnose cardiac masses. Other modalities like TEE, cardiac CT, cardiac MRI and PET-CT scan have further utility in delineating these masses. This may help to plan appropriate management of the right ventricular mass particularly in cases where the patient history and CT pulmonary angiography results favor the diagnosis of pulmonary embolism. We present the case of a 49-year-old woman with a history of supracervical hysterectomy and salpingo-oophorectomy on oral estrogen therapy who was admitted with complaints of pleuritic chest pain and respiratory insufficiency after a long flight. Initial work-up showed sub-segmental pulmonary embolus in the right posterior lower lobe pulmonary artery, and the patient was managed on intravenous heparin. Lack of appropriate response to standard therapy led to further evaluation. Multimodality imaging and biopsies revealed a large right intracavitary ventricular metastatic squamous cell tumor, with the cervix as the primary source.

PMID: 27406457 [PubMed]

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Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane review.

Is vestibular rehabilitation effective in improving dizziness and function after unilateral peripheral vestibular hypofunction? An abridged version of a Cochrane review.

Eur J Phys Rehabil Med. 2016 Jul 12;

Authors: Hillier S, McDonnell M

Abstract
INTRODUCTION: Unilateral peripheral vestibular dysfunction (UPVD) is characterised by complaints of dizziness, gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation. The aim was to assess the effectiveness of vestibular rehabilitation in people with symptomatic UVPD.
EVIDENCE ACQUISITION: A systematic review was conducted for the population of adults diagnosed with symptomatic UPVD, living in the community. We searched all relevant databases and trials registers to identify randomised controlled trials comparing vestibular rehabilitation versus control (e.g. placebo), other treatment (non-vestibular rehabilitation, e.g. pharmacological) or another form of vestibular rehabilitation. We considered possible effectiveness in the domains of symptoms (dizziness) or function (activities, quality of life) and where possible combined results in meta-analyses to provide overall estimates of effect.
EVIDENCE SYNTHESIS: We included 39 studies involving 2,441 participants with UPVD in the review. Individual and pooled analyses of the primary outcome (frequency of dizziness) showed a statistically significant effect in favour of vestibular rehabilitation over control or no intervention (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.85 to 3.86). Secondary outcomes measures related to levels of activity or participation showed a strong trend towards significant differences between the groups (standardised mean difference -0.83, 95% CI -1.02 to -0.64). However when movement-based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49). There were no reported adverse effects and risk of bias was generally low across the studies.
CONCLUSIONS: There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for UPVD. For the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.

PMID: 27406654 [PubMed - as supplied by publisher]

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Effects of microvascular decompression surgery on posture control: A case report in an elderly patient.

Related Articles

Effects of microvascular decompression surgery on posture control: A case report in an elderly patient.

Neurophysiol Clin. 2015 Sep;45(3):191-201

Authors: Bernard-Demanze L, Elzière M, Oddon PA, Montava M, Lavieille JP

Abstract
AIMS OF THE STUDY: We report the case of an 84-year-old woman with neurovascular conflict of the left cochleovestibular nerve. Prior to surgery, the patient complained of positional vertigo and dizziness for the past two years, and marked instability. Hearing loss and tinnitus were reported on the left side. The aim of this study was to investigate the effects of microvascular decompression of the cochleovestibular nerve on posture control.
MATERIALS AND METHODS: Evaluation of cochleovestibular function and posture control was performed before and after surgery. Postural performance was analyzed in static and dynamic conditions, with and without vision, and with optokinetic stimulation. Perception of the static visual vertical (SVV) was recorded in darkness.
RESULTS: Positional vertigo and tinnitus disappeared immediately after the decompression. The SVV remained unchanged one week after the surgery. Speech intelligibility of the left ear was improved (30 dB), and the vestibular deficit on this side was also significantly reduced (54% versus 18%). However, the more spectacular result was the effect on postural control. This elderly patient improved her postural balance in both static and dynamic conditions, and became able to maintain her equilibrium in the more challenging dynamic conditions, with and without vision, as early as one week after the surgery, a postural performance that she had been unable to do preoperatively.
CONCLUSION: This work is the first to show that the postural deficits resulting from neurovascular conflict of the cochleovestibular nerve are strongly improved after microvascular decompression.

PMID: 26297294 [PubMed - indexed for MEDLINE]

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The effect of adenoid hypertrophy and adenoidectomy in patients on cardiovascular risk reduction.

The effect of adenoid hypertrophy and adenoidectomy in patients on cardiovascular risk reduction.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):251-2

Authors: Şereflican M, Yurttaş V, Erdem F

PMID: 27405084 [PubMed - in process]

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Co-occurrence of subacute granulomatous thyroiditis and papillary microcarcinoma.

Co-occurrence of subacute granulomatous thyroiditis and papillary microcarcinoma.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):248-50

Authors: Şenel F, Karaman H, Ertan T

Abstract
Subacute thyroiditis, which is most commonly observed after a viral infection and may heal spontaneously, is an inflammatory thyroid disease. The co-occurrence of subacute thyroiditis and papillary carcinoma is quite rare. A 58-year-old male patient who applied to our hospital with the complaints of sore throat and neck swelling was performed total thyroidectomy following physical examination, ultrasound, and laboratory analysis. In histopathological examination, many granuloma structures were observed in both lobes, and a papillary microcarcinoma focus of 2 mm in diameter was seen in the left lobe. The co-occurrence of subacute thyroiditis and papillary carcinoma was deemed worthy of presentation as it is rarely observed.

PMID: 27405083 [PubMed - in process]

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[Nasal type natural killer/T cell lymphoma: case series and literature review].

[Nasal type natural killer/T cell lymphoma: case series and literature review].

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):241-7

Authors: Düzlü M, Ant A, Tutar H, Karamert R, Şahin M, Sayar E, Cesur N

Abstract
Nasal type natural killer/T-cell lymphoma is a rare type of extranodal non-Hodgkin lymphoma which originates from nasal cavity and paranasal sinuses. Exact diagnosis of nasal natural killer/T-cell lymphoma, which is a rapidly progressive clinical condition, may be established by immunohistochemical analysis on biopsy material after clinical suspicion. In this article, we report four cases of nasal natural killer/T-cell lymphoma who were followed-up in our clinic and discuss the diagnosis and treatment of the disease in light of the literature data.

PMID: 27405082 [PubMed - in process]

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Isolated middle ear meningioma.

Isolated middle ear meningioma.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):238-40

Authors: Batıoğlu-Karaaltın A, Turgut FN, Yılmaz M, Batur Ş, Öztürk Ö

Abstract
Meningiomas are slowly progressive, benign tumors that originate from meningothelial cells. Extracranial meningiomas, especially isolated middle ear meningiomas, are very rare. In this article, we report a rare secretory type primary middle ear meningioma which was histopathologically confirmed in a 46-year-old female patient who presented with otological and neurootological symptoms.

PMID: 27405081 [PubMed - in process]

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[A case of brucellosis presenting with suppurative parotitis involvement].

[A case of brucellosis presenting with suppurative parotitis involvement].

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):234-7

Authors: Kanmaz L, Karakeçili F, Çıkman A, Özçiçek F, Karavaş E

Abstract
Brucellosis is a common zoonotic infection caused by Brucella bacteria. Brucella infections are usually presented with various clinical manifestations, and often accompanied by multiple organ involvements. In this article, we present a case of brucellosis with suppurative parotitis involvement accompanied by parotid abscess and fistula in a 60-year-old male patient. According to the literature review we conducted regarding complications of brucellosis, our case is the first case reported in the literature. Significant improvement in patient's suppurative parotitis and clinical findings was observed at the fifth week of combination antibiotic therapy. Patient's complaints resolved completely after eight weeks of treatment.

PMID: 27405080 [PubMed - in process]

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Vocal cord paralysis: What matters between idiopathic and non-idiopathic cases?

Vocal cord paralysis: What matters between idiopathic and non-idiopathic cases?

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):228-33

Authors: Özbal Koç AE, Türkoğlu SB, Erol O, Erbek S

Abstract
OBJECTIVES: This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP).
PATIENTS AND METHODS: This retrospective cohort was performed on data extracted from medical files of 92 consecutive patients (43 males, 49 females; median age 52.1±23.1 years; min. 1 - max. 87) with VCP diagnosed in the otorhinolaryngology department between April 2012 and December 2015. Diagnoses associated with VCP, side of involvement (right, left or bilateral) and previous medical histories were noted and compared between patients with idiopathic and non-idiopathic VCP.
RESULTS: Vocal cord paralysis occurred on the left side (n=56, 60.9%), right side (n=28, 30.4%) or bilaterally (n=8, 8.7%). A clinical entity related with VCP was identified in 63 patients (68.5%), while 29 (31.5%) patients had idiopathic VCP. Most common etiologies for VCP were thyroid surgery (n=32, 34.8%), cardiovascular surgery (n=9, 9.8%), lung cancer (n=6, 6.5%) and cardiac anomalies (n=4, 4.3%), respectively. Patients with idiopathic VCP were significantly older (p<0.001), while gender distribution (p=0.121) and side of involvement (p=0.340) did not differ between two groups.
CONCLUSION: Vocal cord paralysis is a relatively common clinical entity with substantial rate of morbidity. Identification of the underlying etiology and awareness on the clinical characteristics are keystones for foreseeing complications and determining the appropriate therapeutic modality.

PMID: 27405079 [PubMed - in process]

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Relationship between serum magnesium level and subjective tinnitus.

Relationship between serum magnesium level and subjective tinnitus.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):225-7

Authors: Uluyol S, Kılıçaslan S, Yağız Ö

Abstract
OBJECTIVES: This study aims to assess the relationship between serum magnesium level and bilateral subjective tinnitus.
PATIENTS AND METHODS: The study included a total of 76 patients (36 males, 40 females; mean age 48.5±6.5 years; range 43 to 65 years) suffering from severe bilateral subjective tinnitus (accepted as severe and catastrophic according to tinnitus severity index) as the study group and 86 healthy participants (42 males, 44 females; mean age 43.8±7.3 years; range 40 to 61 years) as the control group. Serum magnesium levels of both groups were measured and compared statistically.
RESULTS: The serum magnesium concentration was significantly lower in the study group compared to the control group (1.8±0.2 vs. 2.3±0.4 mg/dL, p=0.03).
CONCLUSION: The significant association between serum magnesium level and tinnitus shows the importance of magnesium in the pathophysiology of subjective tinnitus.

PMID: 27405078 [PubMed - in process]

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Role of nasal problems on positional and nonpositional obstructive sleep apnea.

Role of nasal problems on positional and nonpositional obstructive sleep apnea.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):219-24

Authors: Cevizci R, Kemaloğlu YK, Yılmaz M, Düzlü M, Karamert R

Abstract
OBJECTIVES: This study aims to examine the relationship between nasal pathologies and positional (PP) obstructive sleep apnea (OSA) or nonpositional (NPP) OSA.
PATIENTS AND METHODS: A total of 44 male OSA patients (mean age 48.0±6.8 years; range 31 to 60 years) suffering from nasal obstruction were retrospectively evaluated for nasal obstruction scores, overall apnea hypopnea index (AHI) and AHI in supine and nonsupine positions, daytime sleepiness scores, and body mass index (BMI). Patients were divided into two equal groups as PP group and NPP group. Output parameters were snoring severity index, clinical nasal obstruction score, septal deviation score, conchal hypertrophy score, and allergic rhinitis (AR) score. These parameters were correlated with the type of OSA.
RESULTS: Apnea hypopnea index was significantly lower in PP group than in NPP group (p<0.03). Spearman correlation analysis revealed significant negative correlation between AR score and PP (r=-0.40, p<0.0001). Pearson correlation test revealed significant correlation between AHI and BMI (r=0.32, p<0.05).
CONCLUSION: We suggest that AR is not only an important risk factor for OSA, but also patients with AR tend to be NPP OSA patients because of the serious nasal obstruction which already causes an increase in nasal resistance or pharyngeal collapsibility.

PMID: 27405077 [PubMed - in process]

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Paratracheal lymph node dissection, in which patients should it be performed?

Paratracheal lymph node dissection, in which patients should it be performed?

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):213-8

Authors: Çomoğlu Ş, Çomoğlu E, Enver N, Yılmaz E, Çelik M, Polat B, Ulusan M, Aslan İ, Değer K

Abstract
OBJECTIVES: This study aims to evaluate the effect of paratracheal lymph node (PTLN) metastasis on survival in patients with advanced laryngeal and hypopharyngeal cancer.
PATIENTS AND METHODS: Medical records of advanced laryngeal and hypopharyngeal cancers who underwent surgery between May 1995 and June 2008 were assessed and 78 of the patients (63 males, 15 females; mean age 55±11.3 years; range 25 to 76 years) who has PTLN metastasis were included in this study. The mean follow-up period was 23 months. Fifty-three patients had primary laryngeal cancer, and the remaining 25 patients had primary hypopharyngeal cancer.
RESULTS: Paratracheal lymph node metastasis was detected in eight (15%) of 53 patients with laryngeal carcinoma, six (42%) of 14 patients with postcricoid carcinoma, and one (14%) of seven patients with posterior pharyngeal wall carcinoma. Paratracheal lymph node metastasis was not detected in patients with pyriform sinus carcinoma (n=4). Paratracheal lymph node metastasis was detected in a total of 15 patients, of whom 11 had extranodal spread (ENS). Multivariate analysis showed that the presence of ENS was the most effective prognostic factor on the overall survival (p<0.0005).
CONCLUSION: The presence of PTLN metastasis with ENS is an important prognostic indicator on overall survival. We recommend PTLN dissection particularly in patients with advanced laryngeal or hypopharyngeal cancer for histopathological analysis and prognostication because ENS can only be precisely detected by pathological evaluation.

PMID: 27405076 [PubMed - in process]

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The importance of voice analysis in evaluating the effectiveness of reflux treatment.

The importance of voice analysis in evaluating the effectiveness of reflux treatment.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):207-12

Authors: Batıoğlu-Karaaltın A, Develioğlu ÖN, Tarhan Ö, Külekçi M

Abstract
OBJECTIVES: This study aims to investigate the effects of reflux treatment in voice disorders in laryngopharyngeal reflux (LPR) patients using acoustic analyses and the relationship between scoring systems.
PATIENTS AND METHODS: A total of 84 LPR patients (18 males, 66 females; mean age 43.1±11.3 years; range 18 to 73 years) were evaluated using reflux symptom index (RSI), reflux findings score (RFS), videolaryngostroboscopic examination, and acoustic analysis with Dr. Speech 4 before LPR treatment and at the first and third months after treatment.
RESULTS: Maximum phonation time, fundamental frequency (F0), jitter, and shimmer scores did not show any statistically significant alteration at the posttreatment period according to pretreatment scores (p>0.05). However, the alteration in Harmonics-to-Noise ratio and Signals-to-Noise ratio scores were statistically significant (p=0.017 and p=0.003, respectively). Reflux symptom index results showed significant positive correlation with F0 at the pretreatment, and at posttreatment first and third month evaluations (Spearman's rank correlation coefficient [rho]=0.246, p=0.024; rho=0.300, p=0.006; rho=0.305, p=0.005, respectively).
CONCLUSION: The relationship between the parameters of acoustic analysis and RSI and RFS values seems to be controversial for diagnosis and follow-up of LPR patients, requiring further investigations.

PMID: 27405075 [PubMed - in process]

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Endoscopic transcanal stapes surgery: our technique and outcomes.

Endoscopic transcanal stapes surgery: our technique and outcomes.

Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):201-6

Authors: Dursun E, Özgür A, Terzi S, Oğurlu M, Coşkun ZÖ, Demirci M

Abstract
OBJECTIVES: This study aims to evaluate the outcomes of endoscopic stapes surgery in terms of hearing gain and complications.
PATIENTS AND METHODS: The medical records of 31 patients (13 males, 18 females; mean age 41.5±8.6 years; range 23 to 60 years) who underwent endoscopic stapes surgery in our clinic between April 2013 and June 2015 were retrospectively analyzed. The mean preoperative and postoperative pure tone bone conduction, air-bone gap, postoperative air-bone gap gain, duration of surgery and complications were evaluated.
RESULTS: The right ear was operated on 15 patients and the left ear on 16 patients. The mean postoperative air-bone gap was statistically significantly improved, compared to preoperative values (p<0.001). The mean air-bone gap gain was 25.5±7.0 dB.
CONCLUSION: Our study results suggest that endoscopy is a safe method which can be used in stapes surgery.

PMID: 27405074 [PubMed - in process]

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