Noisy vestibular stimulation improves dynamic walking stability in bilateral vestibulopathy.

Noisy vestibular stimulation improves dynamic walking stability in bilateral vestibulopathy.

Neurology. 2016 May 6;

Authors: Wuehr M, Nusser E, Decker J, Krafczyk S, Straube A, Brandt T, Jahn K, Schniepp R

Abstract
OBJECTIVE: To examine the effects of imperceptible levels of white noise galvanic vestibular stimulation (nGVS) on dynamic walking stability in patients with bilateral vestibulopathy (BVP).
METHODS: Walking performance of 13 patients with confirmed BVP (mean age 50.1 ± 5.5 years) at slow, preferred, and fast speeds was examined during walking with zero-amplitude nGVS (sham trial) and nonzero-amplitude nGVS set to 80% of the individual cutaneous threshold for GVS (nGVS trial). Eight standard gait measures were analyzed: stride time, stride length, base of support, double support time percentage as well as the bilateral phase coordination index, and the coefficient of variation (CV) of stride time, stride length, and base of support.
RESULTS: Compared to the sham trial, nGVS improved stride time CV by 26.0% ± 8.4% (p < 0.041), stride length CV by 26.0% ± 7.7% (p < 0.029), base of support CV by 27.8% ± 2.9% (p < 0.037), and phase coordination index by 8.4% ± 8.8% (p < 0.013). The nGVS effects on walking performance were correlated with subjective ratings of walking balance (ρ = 0.79, p < 0.001). Effect of nGVS on walking stability was most pronounced during slow walking.
CONCLUSIONS: In patients with BVP, nGVS is effective in improving impaired gait performance, predominantly during slower walking speeds. It primarily targets the variability and bilateral coordination characteristics of the walking pattern, which are linked to dynamic walking stability. nGVS might present an effective treatment option to immediately improve walking performance and reduce the incidence of falls in patients with BVP.
CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients with BVP, an imperceptible level of nGVS improves dynamic walking stability.

PMID: 27164706 [PubMed - as supplied by publisher]

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Effect of double-door laminoplasty on atypical symptoms associated with cervical spondylotic myelopathy/radiculopathy.

Effect of double-door laminoplasty on atypical symptoms associated with cervical spondylotic myelopathy/radiculopathy.

BMC Surg. 2016;16(1):31

Authors: Sun Y, Muheremu A, Yan K, Yu J, Zheng S, Tian W

Abstract
BACKGROUND: Double-door laminoplasty is an effective method in treating patients with cervical spondylosis. Many patients with cervical spondylosis experience a set of atypical symptoms such as vertigo and tinnitus, and wish to know if the surgical treatment for cervical spondylosis can also alleviate those symptoms. The current research was carried out to investigate if atypical symptoms can be alleviated in patients who received laminoplasty for the treatment of cervical spondylosis.
METHODS: One hundred ninety patients who received laminoplasty to treat cervical spondylotic myelopathy/radiculopathy in our center and complained about one or more of the atypical symptoms before the surgery were followed for a mean of 61.9 months (from 39 to 87 months) after the surgery. Severity scores were retrospectively collected by follow up outpatient visits or phone interviews. The data was calculated based on patient feedback on the frequency and severity of those symptoms before the surgery and at last follow up, and were compared by paired sample t-tests.
RESULTS: Most patients reported that the atypical symptoms such as vertigo (P <0.001), nausea (P <0.001), headache (P <0.001), tinnitus (P = 0.001), blur vision (P = 0.005), palpitation (P <0.001) and gastrointestinal discomfort (P = 0.001) were significantly alleviated at the last follow up; there was no significant change in the severity of hypomnesia (P = 0.675).
CONCLUSION: Double-door laminoplasty can significantly alleviate most of the atypical symptoms in patients with cervical spondylosis. Further research is needed to explore mechanisms underlying this extra benefit of laminoplasty.

PMID: 27160834 [PubMed - in process]

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A nationwide study on enlargement of the vestibular aqueduct in Japan.

A nationwide study on enlargement of the vestibular aqueduct in Japan.

Auris Nasus Larynx. 2016 May 6;

Authors: Noguchi Y, Fukuda S, Fukushima K, Gyo K, Hara A, Nakashima T, Ogawa K, Okamoto M, Sato H, Usami SI, Yamasoba T, Yokoyama T, Kitamura K

Abstract
OBJECTIVE: To document the clinical features and associated pure-tone audiometry data in patients with enlargement of the vestibular aqueduct (EVA), and to identify risk factors for fluctuating hearing loss (HL) and vertigo/dizziness in EVA patients.
METHODS: In this nationwide survey in Japan, a first survey sheet was mailed to 662 board-certified otolaryngology departments to identify the ones treating EVA patients. A second survey sheet, which contained solicited clinical information and the results of the hearing tests, was mailed to all facilities that reported treating EVA cases. We analyzed clinical information, including age at the time of the most recent evaluation, gender, EVA side, age at onset, initial symptoms, precipitating factors, and etiology from survey responses, and assessed 4-frequency (500, 1000, 2000, and 4000Hz) pure-tone average (PTA) from accompanying pure-tone audiometry data. A multivariate logistic regression analysis was utilized to identify the possible risk factors for fluctuating HL and vertigo/dizziness.
RESULTS: In total, 513 hospitals (response rate, 77.5%) responded to the first survey, and 113 reported treating patients with EVA. Seventy-nine out of the 113 hospitals (response rate 69.9%) responded to the second survey, and the data of 380 EVA patients were registered and analyzed. Of the 380 patients, 221 (58.2%) were female, suggesting female preponderance. The patient age ranged from 0 to 73 years (mean, 16.7 years; median, 13 years; interquartile range, 6-24 years). EVA was bilateral in 91.1% of the patients (346/380). The most prevalent initial symptom was HL (341/380), followed by vertigo/dizziness/imbalance (34/380). Sudden HL occurred secondary to head trauma in 5.3% of the patients and upper respiratory infection in 5.0%. Pure-tone audiometry showed profound HL (PTA >91dB) in 316 (52.0%) of the 608 ears in the 304 patients tested, and asymmetric HL, defined as >10dB, in 147 (48.4%) of the 304 patients. The mean PTA was 83.7dB (median, 91.3dB; interquartile range, 71.3-103.8dB), and the severity in PTA did not correlate with age. Multivariate logistic regression identified age ≥10 years (compared to age of 0-9 years), bilateral HL (compared to unilateral HL/normal hearing), a history of head trauma, and Pendred syndrome (compared to the other EVA-associated disorders) as significant risk factors for fluctuating HL and/or vertigo/dizziness.
CONCLUSION: The present nationwide survey of 380 EVA patients provided a more precise description of the clinical features, including risk factors for fluctuating HL and vertigo/dizziness.

PMID: 27160786 [PubMed - as supplied by publisher]

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Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series.

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Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy: A Case Series.

Chest. 2016 May;149(5):e127-31

Authors: Olivier PY, Joyeux-Faure M, Gentina T, Launois SH, d'Ortho MP, Pépin JL, Gagnadoux F

Abstract
Baclofen, a gamma-aminobutyric acid-B agonist with muscle-relaxant properties, is widely used in patients with severe spasticity. In animals, baclofen has been shown to decrease respiratory drive. In humans, however, use of baclofen at the standard dose did not significantly impair sleep-disordered breathing in a susceptible population of snorers. Recently, there has been increasing interest in the role of baclofen for the treatment of alcohol dependence. We describe severe central sleep apnea (CSA) in four patients with none of the conditions commonly associated with CSA who were receiving chronic baclofen therapy for alcohol withdrawal. In one patient, baclofen withdrawal was associated with a complete resolution of CSA. Three patients were treated by adaptive servo-ventilation while continuing their treatment with baclofen. Given the increasing number of patients receiving baclofen for alcohol withdrawal treatment, physicians should be aware that these patients might be affected by severe CSA. Future studies are required to determine the mechanisms, prevalence, and treatment modalities of sleep-disordered breathing associated with baclofen usage.

PMID: 27157226 [PubMed - in process]

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Orbital Metastasis of Undifferentiated/Anaplastic Thyroid Carcinoma.

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Orbital Metastasis of Undifferentiated/Anaplastic Thyroid Carcinoma.

Ophthal Plast Reconstr Surg. 2015 Sep-Oct;31(5):e120-3

Authors: Gupta D, Chappell M, Tailor TD, Keene CD, Moe K, Jian-Amadi A, Chang SH

Abstract
A 52-year-old woman presented with decreased vision, diplopia, esotropia, proptosis, and right orbital pain. Clinical examination was suspicious for an orbital mass and additionally revealed a thyroid gland mass. Imaging studies showed an enhancing mass within the right lateral rectus muscle and a heterogeneous mass in the left lobe of the thyroid gland. Excisional biopsies of the thyroid and orbital lesions were consistent with metastatic undifferentiated/anaplastic thyroid carcinoma. This represents the first reported case of undifferentiated/anaplastic thyroid carcinoma metastatic to the orbit.

PMID: 25679298 [PubMed - indexed for MEDLINE]

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Tinnitus, Oscillopsia, and Hyperventilation-Induced Nystagmus: Vestibular Paroxysmia.

Tinnitus, Oscillopsia, and Hyperventilation-Induced Nystagmus: Vestibular Paroxysmia.

Open J Clin Med Case Rep. 2016;2(7)

Authors: Ward BK, Gold DR

Abstract
Vestibular paroxysmia is the name given to vascular compression of the vestibulocochlear nerve. Substantial evidence has been discovered in support of vascular compression of the trigeminal nerve as the etiology for trigeminal neuralgia, and effective therapies have been targeted to address this pathophysiology. Perhaps due to the common and often vaguely-described symptoms of dizziness and tinnitus, vascular compression of the vestibulocochlear nerve as a cause of symptoms has remained controversial. Recent clinical studies, however, have better defined diagnostic criteria for vestibular paroxysmia. In this report we discuss a case of vestibular paroxysmia, highlighting some findings of the condition that also uniquely separate it from other more common vestibular disorders. Finally, we discuss current clinical management of vestibular paroxysmia.

PMID: 27158666 [PubMed - as supplied by publisher]

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Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: A case-matched control analysis.

Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: A case-matched control analysis.

Med Dosim. 2016 May 3;

Authors: Holliday EB, Kocak-Uzel E, Feng L, Thaker NG, Blanchard P, Rosenthal DI, Gunn GB, Garden AS, Frank SJ

Abstract
A potential advantage of intensity-modulated proton therapy (IMPT) over intensity-modulated (photon) radiation therapy (IMRT) in the treatment of oropharyngeal carcinoma (OPC) is lower radiation dose to several critical structures involved in the development of nausea and vomiting, mucositis, and dysphagia. The purpose of this study was to quantify doses to critical structures for patients with OPC treated with IMPT and compare those with doses on IMRT plans generated for the same patients and with a matched cohort of patients actually treated with IMRT. In this study, 25 patients newly diagnosed with OPC were treated with IMPT between 2011 and 2012. Comparison IMRT plans were generated for these patients and for additional IMRT-treated controls extracted from a database of patients with OPC treated between 2000 and 2009. Cases were matched based on the following criteria, in order: unilateral vs bilateral therapy, tonsil vs base of tongue primary, T-category, N-category, concurrent chemotherapy, induction chemotherapy, smoking status, sex, and age. Results showed that the mean doses to the anterior and posterior oral cavity, hard palate, larynx, mandible, and esophagus were significantly lower with IMPT than with IMRT comparison plans generated for the same cohort, as were doses to several central nervous system structures involved in the nausea and vomiting response. Similar differences were found when comparing dose to organs at risks (OARs) between the IMPT cohort and the case-matched IMRT cohort. In conclusion, these findings suggest that patients with OPC treated with IMPT may experience fewer and less severe side effects during therapy. This may be the result of decreased beam path toxicities with IMPT due to lower doses to several dysphagia, odynophagia, and nausea and vomiting-associated OARs. Further study is needed to evaluate differences in long-term disease control and chronic toxicity between patients with OPC treated with IMPT in comparison to those treated with IMRT.

PMID: 27158021 [PubMed - as supplied by publisher]

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[The Significance of Resection of the Cricoid Cartilage as a Surgical Procedure in Laryngotracheal Surgery].

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[The Significance of Resection of the Cricoid Cartilage as a Surgical Procedure in Laryngotracheal Surgery].

Nihon Jibiinkoka Gakkai Kaiho. 2015 Oct;118(10):1233-40

Authors: Hirai T, Fukushima N, Kano M, Miyahara N, Miyoshi A, Ariki M, Masuda S, Nagamine H

Abstract
The cricoid cartilage has been regarded as an extremely important organ because it plays important role in both of phonation and breathing. We herein report on two different types of surgical procedure for laryngotracheal diseases with aggressive resection of the cricoid cartilage. The first procedure is a tracheostomaplasty by partial resection of the cricoid cartilage. A tracheostoma is made by resection of the cricoid cartilage in the range of approximately a one-third front. This method is effective for such cases having difficulty in tracheostomy owing their backgrounds with such condition as neck stiffness, obesity, higher displacement of the brachiocephalic artery, short neck, thyroid disease and so on. We applied this procedure for eight cases with such difficult backgrounds. In all cases, we were able to make a good tracheostoma and the postoperative courses were uneventful. The second procedure is a glottic closure with resection of the cricoid cartilage and thyroid cartilage. We applied this procedure for six cases with intractable dysphagia. One case had a postoperative bleeding. We were able to make good conditions in all cases with a large tracheostoma and no pharyngeal-tracheal leakage. In conclusion, the surgical procedure involving resection of the cricoid cartilage can be applied to some laryngotracheal diseases.

PMID: 26727823 [PubMed - indexed for MEDLINE]

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Ribosome biogenesis dysfunction leads to p53-mediated apoptosis and goblet cell differentiation of mouse intestinal stem/progenitor cells.

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Ribosome biogenesis dysfunction leads to p53-mediated apoptosis and goblet cell differentiation of mouse intestinal stem/progenitor cells.

Cell Death Differ. 2015 Nov;22(11):1865-76

Authors: Stedman A, Beck-Cormier S, Le Bouteiller M, Raveux A, Vandormael-Pournin S, Coqueran S, Lejour V, Jarzebowski L, Toledo F, Robine S, Cohen-Tannoudji M

Abstract
Ribosome biogenesis is an essential cellular process. Its impairment is associated with developmental defects and increased risk of cancer. The in vivo cellular responses to defective ribosome biogenesis and the underlying molecular mechanisms are still incompletely understood. In particular, the consequences of impaired ribosome biogenesis within the intestinal epithelium in mammals have not been investigated so far. Here we adopted a genetic approach to investigate the role of Notchless (NLE), an essential actor of ribosome biogenesis, in the adult mouse intestinal lineage. Nle deficiency led to defects in the synthesis of large ribosomal subunit in crypts cells and resulted in the rapid elimination of intestinal stem cells and progenitors through distinct types of cellular responses, including apoptosis, cell cycle arrest and biased differentiation toward the goblet cell lineage. Similar observations were made using the rRNA transcription inhibitor CX-5461 on intestinal organoids culture. Importantly, we found that p53 activation was responsible for most of the cellular responses observed, including differentiation toward the goblet cell lineage. Moreover, we identify the goblet cell-specific marker Muc2 as a direct transcriptional target of p53. Nle-deficient ISCs and progenitors disappearance persisted in the absence of p53, underlying the existence of p53-independent cellular responses following defective ribosome biogenesis. Our data indicate that NLE is a crucial factor for intestinal homeostasis and provide new insights into how perturbations of ribosome biogenesis impact on cell fate decisions within the intestinal epithelium.

PMID: 26068591 [PubMed - indexed for MEDLINE]

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Feasibility and Advantage of a Muscle-Sparing Laterally Based Pericranial Flap.

Feasibility and Advantage of a Muscle-Sparing Laterally Based Pericranial Flap.

J Craniofac Surg. 2016 May;27(3):552-557

Authors: Yano T, Okazaki M, Tanaka K, Tsunoda A, Aoyagi M, Kishimoto S

Abstract
BACKGROUND: For a safe and reliable middle skull base reconstruction, the temporalis muscle flaps or pericranial-temporalis muscle flaps have usually been used as the first-choice in clinical practice. But these flaps have an inevitable disadvantage, namely, temporal hollowing. To address this problem, in this study, the authors describe the feasibility and advantages of using a muscle-sparing laterally based pericranial flap.
METHOD: The authors reviewed 19 patients who had undergone middle skull base reconstruction using laterally based pericranial flaps. There were two types of these flaps. One was the conventional type: a laterally based pericranial flap combined with the temporoparietal fascia and temporal muscle, that is a conventional laterally based pericranial flap (C-PCF). The other was the muscle-sparing type: a laterally based pericranial flap combined with the temporoparietal fascia, but sparing and preserving the temporal muscle (MS-PCF). The first 9 patients were reconstructed with a C-PCF and the latter 10 patients were reconstructed with an MS-PCF.
RESULTS: There was no significant difference between C-PCF and MS-PCF as regards reconstructive time and postoperative hospital stay. In addition, there was no significant difference between C-PCF and MS-PCF in regard to perioperative complications. The rate of temporal hollowing did not reach a significant difference; MS-PCF patients tended to have less temporal hollowing (10%) compared with C-PCF patients (55.6%).
DISCUSSION: An MS-PCF could provide safe and reliable skull base reconstruction without lengthening reconstructive time or increasing complications. Moreover, an MS-PCF improves the esthetical results of surgery on skull base patients and provides an extra option for other reconstructive procedures by preserving the temporal muscle.

PMID: 27159855 [PubMed - as supplied by publisher]

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Comparative diagnostic value of 18F-fluoride PET-CT versus MRI for skull-base bone invasion in nasopharyngeal carcinoma.

Comparative diagnostic value of 18F-fluoride PET-CT versus MRI for skull-base bone invasion in nasopharyngeal carcinoma.

Nucl Med Commun. 2016 May 6;

Authors: Le Y, Chen Y, Zhou F, Liu G, Huang Z, Chen Y

Abstract
PURPOSE: This study compared the diagnostic value of F-fluoride PET-computed tomography (PET-CT) and MRI in skull-base bone erosion in nasopharyngeal carcinoma (NPC) patients.
METHODS: A total of 93 patients with biopsy-confirmed NPC were enrolled, including 68 men and 25 women between 23 and 74 years of age. All patients were evaluated by both F-fluoride PET-CT and MRI, and the interval between the two imaging examinations was less than 20 days. The patients received no treatment either before or between scans. The studies were interpreted by two nuclear medicine physicians or two radiologists with more than 10 years of professional experience who were blinded to both the diagnosis and the results of the other imaging studies. The reference standard was skull-base bone erosion at a 20-week follow-up imaging study.
RESULTS: On the basis of the results of the follow-up imaging studies, 52 patients showed skull-base bone erosion. The numbers of true positives, false positives, true negatives, and false negatives with F-fluoride PET-CT were 49, 4, 37, and 3, respectively. The numbers of true positives, false positives, true negatives, and false negatives with MRI were 46, 5, 36, and 6, respectively. The sensitivity, specificity, and crude accuracy of F-fluoride PET-CT were 94.23, 90.24, and 92.47%, respectively; for MRI, these values were 88.46, 87.80, and 88.17%. Of the 52 patients, 43 showed positive findings both on F-fluoride PET-CT and on MRI. Within the patient cohort, F-fluoride PET-CT and MRI detected 178 and 135 bone lesions, respectively.
CONCLUSION: Both F-fluoride PET-CT and MRI have high sensitivity, specificity, and crude accuracy for detecting skull-base bone invasion in patients with NPC. F-fluoride PET-CT detected more lesions than did MRI in the skull-base bone. This suggests that F-fluoride PET-CT has a certain advantage in evaluating the skull-base bone of NPC patients. Combining the two methods could improve the diagnostic accuracy of skull-base bone invasion for NPC.

PMID: 27159589 [PubMed - as supplied by publisher]

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Outcomes of complete vs targeted approaches to endoscopic sinus surgery.

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Outcomes of complete vs targeted approaches to endoscopic sinus surgery.

Int Forum Allergy Rhinol. 2015 Aug;5(8):691-700

Authors: DeConde AS, Suh JD, Mace JC, Alt JA, Smith TL

Abstract
BACKGROUND: Functional endoscopic sinus surgery (FESS) was historically predicated on targeted widening of narrow anatomic structures that caused postobstructive persistent sinus inflammation. It is now clear that chronic rhinosinusitis (CRS) is a multifactorial disease with subsets of patients which may require a more extensive surgical approach. This study compares quality-of-life (QOL) and disease severity outcomes after FESS based on the extent of surgical intervention.
METHODS: Participants with CRS were prospectively enrolled into an ongoing, multi-institutional, observational, cohort study. Surgical extent was determined by physician discretion. Participants undergoing bilateral frontal sinusotomy, ethmoidectomy, maxillary antrostomy, and sphenoidotomy were considered to have undergone "complete" surgery, whereas all other participants were categorized as receiving "targeted" surgery. Improvement was evaluated between surgical subgroups with at least 6-month follow-up using the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Brief Smell Inventory Test (B-SIT).
RESULTS: A total of 311 participants met inclusion criteria with 147 subjects undergoing complete surgery and 164 targeted surgery. A higher prevalence of asthma, acetylsalicylic acid (ASA) sensitivity, nasal polyposis, and a history of prior sinus surgery (p ≤ 0.002) was present in participants undergoing complete surgery. Mean improvement in SNOT-22 (28.1 ± 21.9 vs 21.9 ± 20.6; p = 0.011) and B-SIT (0.8 ± 3.1 vs 0.2 ± 2.4; p = 0.005) was greater in subjects undergoing complete surgery. Regression models demonstrated a 5.9 ± 2.5 greater relative mean improvement on SNOT-22 total scores with complete surgery over targeted approaches (p = 0.016).
CONCLUSION: Complete surgery was an independent predictor of greater postoperative SNOT-22 score improvement, yet did not achieve clinical significance. Further study is needed to determine the optimal surgical extent.

PMID: 25907972 [PubMed - indexed for MEDLINE]

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Resection and microvascular reconstruction of bisphosphonate-related osteonecrosis of the jaw: The role of microvascular reconstruction.

Resection and microvascular reconstruction of bisphosphonate-related osteonecrosis of the jaw: The role of microvascular reconstruction.

Head Neck. 2016 May 9;

Authors: Neto T, Horta R, Balhau R, Coelho L, Silva P, Correia-Sá I, Silva Á

Abstract
BACKGROUND: Current treatment guidelines caution against osseous reconstruction using free flap tissue to treat bisphosphonate-related osteonecrosis of the jaw (BRONJ). The primary rationale for this stance is the theoretical risk of nonunion and recurrence of disease within the reconstruction. Emerging evidence suggests that these theoretical risks may be overestimated. We performed a literature review of this procedure for the treatment of advanced BRONJ. We also present a new case report of resection and microvascular reconstruction in a 58-year-old man with stage III BRONJ.
METHODS: A MEDLINE search was performed to gather all reports of maxillary and mandibular reconstruction using free tissue flap transfer for BRONJ. Inclusion criteria were confirmed stage II or III BRONJ, free tissue transfer and reconstruction, and reported complications. Articles were excluded if they contained only local flap reconstruction, wound closure without reconstruction, or osteoradionecrosis. Outcomes from our case report were added to the analysis.
RESULTS: We identified 10 articles that met criteria. Adding our case, we identified 40 cases of free flap reconstruction. The rate of nonunion was 5% (2 of 40). Fistulas formed in 4 cases (10%). BRONJ recurred in 2 cases (5%).
CONCLUSION: Complication rates after free flap microvascular reconstruction in BRONJ seem acceptable. Nonunion is relatively rare and should not be the sole reason to recommend against free flap reconstruction. A randomized clinical trial would help clarify the role of this procedure in refractory BRONJ; however, we believe that segmental resection and microvascular reconstruction is a viable option in select cases of BRONJ. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27159622 [PubMed - as supplied by publisher]

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Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial.

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Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial.

PLoS One. 2015;10(8):e0134130

Authors: Na HS, Jeon YT, Shin HJ, Oh AY, Park HP, Hwang JW

Abstract
TRIAL REGISTRATION: ClinicalTrials.gov NCT01035021.

PMID: 26252522 [PubMed - indexed for MEDLINE]

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Long-term follow-up after surgery in localized laryngeal amyloidosis.

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Long-term follow-up after surgery in localized laryngeal amyloidosis.

Eur Arch Otorhinolaryngol. 2016 May 7;

Authors: Hazenberg AJ, Hazenberg BP, Dikkers FG

Abstract
To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive patients with localized laryngeal amyloidosis surgically treated in a tertiary hospital between 1994 and February 2016. Recurrence rate, revision surgery, progression to systemic amyloidosis, and changes in voice were monitored yearly. Eighteen patients were included. Seven women and eleven men had a median age 50 years (range 21-77 years) and median follow-up 6.4 years (2.4-17 years). Amyloid was located in subglottis (5), glottis (8), false vocal folds (8) and other supraglottic areas (5), in more than one laryngeal region (13) and bilaterally (12). Cold steel excision was used at the glottis; CO2 laser excision, sometimes assisted by microdebrider, at other laryngeal areas. Eleven patients needed revision surgery, ten within the first 4 years after surgical treatment. One patient needed his first revision surgery after 11 years. Five patients needed a second revision within 6 years after initial diagnosis. Two patients needed a third revision. Indications for first revision surgery were progression (8) with dysphonia (7), dyspnea (2), dysphagia (1), exclusion of malignancy (1), and aphonia (1). No patient developed systemic amyloidosis during follow-up. Although local progression of amyloid necessitates revision surgery once or twice in the first 4-6 years, progression slows down thereafter. Late progression, however, remains possible.

PMID: 27156084 [PubMed - as supplied by publisher]

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Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients.

Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients.

Neurol Neurochir Pol. 2016 May-Jun;50(3):172-179

Authors: Alfotih GT, Zheng MG, Cai WQ, Xu XK, Hu Z, Li FC

Abstract
BACKGROUND: Radiation induced brain injury ranges from acute reversible edema to late, irreversible radiation necrosis. Radiation induced temporal lobe necrosis is associated with permanent neurological deficits and occasionally progresses to death.
OBJECTIVE: We present our experience with surgery on radiation induced temporal lobe necrosis (RTLN) in nasopharyngeal carcinoma (NPC) patients with special consideration of clinical presentation, surgical technique, and outcomes.
METHOD: This retrospective study includes 12 patients with RTLN treated by the senior author between January 2010 and December 2014. Patients initially sought medical treatment due to headache; other symptoms were hearing loss, visual deterioration, seizure, hemiparesis, vertigo, memory loss and agnosia. A temporal approach through a linear incision was performed for all cases. RTLN was found in one side in 7 patients, and bilaterally in 5. 4 patients underwent resection of necrotic tissue bilaterally and 8 patients on one side.
RESULTS: No death occurred in this series of cases. There were no post-operative complications, except 1 patient who developed aseptic meningitis. All 12 patients were free from headache. No seizure occurred in patients with preoperative epilepsy. Other symptoms such as hemiparesis and vertigo improved in all patients. Memory loss, agnosia and hearing loss did not change post-operatively in all cases. The follow-up MR images demonstrated no recurrence of necrotic lesions in all 12 patients.
CONCLUSION: Neurosurgical intervention through a temporal approach with linear incision is warranted in patients with radiation induced temporal lobe necrosis with significant symptoms and signs of increased intracranial pressure, minimum space occupying effect on imaging, or neurological deterioration despite conservative management.

PMID: 27154443 [PubMed - as supplied by publisher]

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Changes in endolymphatic hydrops in patients with Ménière's disease treated conservatively for more than 1 year.

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Changes in endolymphatic hydrops in patients with Ménière's disease treated conservatively for more than 1 year.

Acta Otolaryngol. 2015 Sep;135(9):866-70

Authors: Suga K, Kato M, Yoshida T, Nishio N, Nakada T, Sugiura S, Otake H, Kato K, Teranishi M, Sone M, Naganawa S, Nakashima T

Abstract
CONCLUSION: This study revealed that endolymphatic hydrops (EH) reduced in some cases with Ménière's disease (MD) treated conservatively. It appears that the EH reduction was associated with improvement of the clinical symptoms.
OBJECTIVES: The relationship between the degree of EH and clinical symptoms is not clear at present. The purpose of the present study was to investigate the time course of the relationship in patients with MD treated conservatively.
PATIENTS: Twelve patients with MD treated conservatively for more than 1 year in a university hospital.
METHODS: Twenty ears of 12 patients with MD treated conservatively were evaluated. The presence or absence of vertigo, tinnitus and ear fullness was confirmed when magnetic resonance imaging (MRI) was performed. Using a 3 T MRI scanner, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI was performed 2 or 3 times 24 hours after intra-tympanic gadolinium injection or 4 hours after intravenous gadolinium injection.
RESULTS: In the three ears in which the symptoms alleviated, EH was reduced in two ears, but EH was reduced in only one of 17 ears in which the symptoms did not alleviate. The Fisher exact test revealed that EH reduction occurred more frequently in ears with alleviation of the symptoms (p < 0.05).

PMID: 26094970 [PubMed - indexed for MEDLINE]

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Refractory Granulomatosis with Polyangiitis Presenting as Facial Paralysis and Bilateral Sudden Deafness.

Refractory Granulomatosis with Polyangiitis Presenting as Facial Paralysis and Bilateral Sudden Deafness.

J Audiol Otol. 2016 Apr;20(1):55-8

Authors: Kim SH, Jung AR, Kim SI, Yeo SG

Abstract
Granulomatosis with polyangiitisis [(GPA) or Wegener granulomatosis] is a multi-system disease characterized by granuloma formation and necrotizing vasculitis. GPA classically shows involvement of the respiratory tracts and the renal system. However, locoregional disease is common and may include otologic manifestations. Although otologic involvement can occur during the course of GPA, no report has described facial palsy with sudden sensorineural total deafness with vertigo as the presenting feature of GPA. This case describes a patient with multiorgan involving resistant form of GPA initially presenting with bilateral profound sudden sensorineural hearing loss and left facial paralysis with vertigo. The condition responded well to treatment with rituximab.

PMID: 27144236 [PubMed]

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Short-Term Outcomes of Acute Low-Tone Sensorineural Hearing Loss According to Treatment Modality.

Short-Term Outcomes of Acute Low-Tone Sensorineural Hearing Loss According to Treatment Modality.

J Audiol Otol. 2016 Apr;20(1):47-52

Authors: Chang J, Yum G, Im HY, Jung JY, Rah YC, Choi J

Abstract
BACKGROUND AND OBJECTIVES: We compared improvements in hearing thresholds in acute low-tone sensorineural hearing loss (ALHL) patients after two different treatments: steroid alone and steroid and diuretic combined. We analyzed how the duration between the onset of symptoms and the initiation of treatment affected hearing loss improvement and investigated the relation between presence of vertigo in ALHL patients and ALHL progression to Ménière's disease (MD).
SUBJECTS AND METHODS: We retrospectively analyzed the medical records of 47 ALHL patients aged 21 to 76 years. Patients received either orally administered steroid alone (n=12) or steroid and diuretic combined (n=35). We compared improvements in the two groups' hearing thresholds at three lower frequencies (125, 250, and 500 Hz) after participants had received one month of each respective treatment.
RESULTS: Our two treatments did not show any statistical difference in hearing loss improvement after one month. Forty percent of ALHL patients with vertigo developed MD, which was a significantly higher rate than the 12.5% of ALHL patients without vertigo who developed MD. The shorter duration between the onset of symptoms and the initiation of treatment significantly increased improvement in the sum of lower frequency hearing threshold after one month.
CONCLUSIONS: The current study suggests that steroid and diuretic administered together and steroid alone similarly improve the hearing threshold in ALHL patients after one month. We concluded that patients should initiate ALHL treatment as soon as they experience symptoms. ALHL patients should also be notified of their higher risk of developing MD.

PMID: 27144234 [PubMed]

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Labyrinthine sequestration secondary to auditory implantation: report of two cases and review of the literature.

Related Articles

Labyrinthine sequestration secondary to auditory implantation: report of two cases and review of the literature.

J Laryngol Otol. 2015 Dec;129(12):1238-42

Authors: Warner E, Eze N, Connor S, Jiang D

Abstract
BACKGROUND: Auditory implantation into the inner ear is increasingly performed for a variety of indications. Infective complications are rare, but when they occur they can have devastating consequences.
CASE REPORTS: This paper reports two cases where vestibular sequestration of the bony labyrinth developed following implantation into the middle ear.
CONCLUSION: To the authors' knowledge, these are the first reported cases where vestibular sequestration has resulted from auditory implant surgery. This paper outlines the radiological changes characteristic of this pathology. It also describes the surgical and conservative treatment options for this condition, challenging the previously accepted belief that affected patients always require aggressive surgical intervention.

PMID: 26654641 [PubMed - indexed for MEDLINE]

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