The Rhinitis Control Scoring System: Development and validation.

The Rhinitis Control Scoring System: Development and validation.

Am J Rhinol Allergy. 2016 Jan;30(1):54-9

Authors: Boulay ME, Boulet LP

Abstract
BACKGROUND: Allergic rhinitis is a common health problem that requires regular monitoring of symptoms to provide adequate treatment. There is a need to develop rhinitis control assessment tools that are meaningful and easy to interpret by both the patient and the practitioner.
OBJECTIVE: To develop a simple, easy-to-interpret instrument, the Rhinitis Control Scoring System (RCSS), for the assessment of rhinitis control, as a companion tool to the Asthma Control Scoring System previously validated.
METHODS: After a literature review and based on the Allergic Rhinitis and its Impact on Asthma guidelines, allergic rhinitis control parameters were identified. The draft items were subjected to cognitive debriefing regarding instructions, wordings, and response options. The second version of the draft was then pretested and modified according to the results. The final draft of the RCSS, based on the intensity and frequency of symptoms, was then pilot tested with 50 subjects who had allergic rhinitis for validation of some psychometric properties. Each subject completed the RCSS in addition to other rhinitis instruments. They also had nasal peak inspiratory flow measurements.
RESULTS: The RCSS showed good internal consistency (Cronbach α = 0.84). There was strong criterion validity between the RCSS scores and the other instruments. The discriminant validity demonstrated as mean RCSS scores differed significantly across groups of patients with different Total Nasal Symptom Score severity (F = 58.8, p < 0.0001).
CONCLUSIONS: This pilot study showed that the RCSS is a simple tool to assess and quantify rhinitis control by using a percentage score. This questionnaire allows the quantification of rhinitis control and, therefore, may help guide therapeutic interventions. Combined with the Asthma Control Scoring System, it can provide a global assessment of rhinitis and asthma control. Clinical Trial number NCT00967967.

PMID: 26867531 [PubMed - in process]

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The role of allergen immunotherapy in the management of allergic rhinitis.

The role of allergen immunotherapy in the management of allergic rhinitis.

Am J Rhinol Allergy. 2016 Jan;30(1):48-53

Authors: Cox L

Abstract
PURPOSE: To evaluate the role of allergen immunotherapy (AIT) in the treatment of allergic rhinitis (AR).
METHOD: Individual studies, systematic reviews, and practice guidelines that included information on sublingual AIT (SLIT) and subcutaneous AIT (SCIT) in the treatment of AR were considered.
RESULTS: AIT via the SLIT or SCIT route has been shown to be effective in treating AR symptoms with resultant improvements in overall quality of life, comorbid illnesses, and medication requirements. Persistent clinical benefits have been demonstrated years after AIT treatment discontinuation. AIT may prevent the progression of AR to asthma. In addition, studies that evaluated the pharmacoeconomics of AR treatment indicate that AIT may be more cost effective than pharmacotherapy. The AIT cost savings are likely underestimated in that few cost comparison studies considered AIT's long-term benefits or preventive effects.
CONCLUSION: Multiple individual studies and systematic reviews provide strong evidence for the clinical effectiveness of AIT in the treatment of AR. Cost-effectiveness and disease modification are additional advantages of AIT compared with standard drug treatment in the management of AR.

PMID: 26867530 [PubMed - in process]

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Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis.

Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis.

Am J Rhinol Allergy. 2016 Jan;30(1):44-7

Authors: Rosati MG, Peters AT

Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) is a common disease in the United States. There are a significant number of patients with CRS who are refractory to standard medical and surgical therapy. Many of these patients also have comorbid allergic rhinitis (AR) and asthma, although the underlying pathophysiology that connects these three conditions remains unclear.
OBJECTIVE: The goal of this article is to review the relationships among CRS, AR and asthma.
METHODS: Scientific literature that addresses the prevalence of AR and asthma in CRS populations, the effect of AR and asthma on CRS disease severity, and whether treatment of AR and asthma can affect CRS outcomes was reviewed.
RESULTS: The literature supports the relationship between AR and CRS, but there is no direct evidence of causality the between the two conditions. There is a high prevalence of CRS in patients with asthma and the presence of CRS is associated with worse asthma outcomes. There is weak evidence that treatment of CRS may improve asthma outcomes. Targeting type 2 inflammation via biologics is being investigated in the treatment of asthma and CRS.
CONCLUSION: AR, asthma, and CRS are closed related and understanding the associations among these comorbid diseases will have significant clinical implication.

PMID: 26867529 [PubMed - in process]

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The bacterial microbiome in chronic rhinosinusitis: Richness, diversity, postoperative changes, and patient outcomes.

The bacterial microbiome in chronic rhinosinusitis: Richness, diversity, postoperative changes, and patient outcomes.

Am J Rhinol Allergy. 2016 Jan;30(1):37-43

Authors: Cleland EJ, Bassiouni A, Vreugde S, Wormald PJ

Abstract
BACKGROUND: The bacterial microbiome in chronic rhinosinusitis (CRS) remains poorly understood. Microorganisms are believed to be important contributors to the inflammatory response seen in these patients.
OBJECTIVE: To examine the bacterial CRS microbiome by using a pyrosequencing technique and determine the diversity, richness, prevalence, and abundance of bacterial species in these patients. Furthermore, the postoperative changes that occur in the microbiome and correlations with patient outcomes are assessed.
METHODS: Swabs were collected from 23 patients with CRS and 11 controls during surgery. Further postoperative swabs were collected in the CRS group. Bacterial DNA was extracted from the swabs and then sequenced by using 16S ribosomal DNA bacterial tag-encoded FLX amplicon pyrosequencing.
RESULTS: A total of 456 unique bacterial species were detected. No difference was seen for richness or diversity between the study groups (p > 0.05). Diversity declined after surgery in the CRS group (p = 0.01). Propionibacterium acnes and Staphylococcus epidermidis were the most prevalent species. Several significant differences were determined for prevalence and mean relative abundance (MRA) between the study groups. In particular, Acinetobacter johnsonii was more prevalent and had a higher MRA in the controls. Furthermore, the MRA of this species increased after surgery and was associated with improved quality of life.
CONCLUSION: This study characterized the sinonasal microbiome in a group of controls and patients with CRS. Important differences in diversity, prevalence, abundance, and temporal changes were described. Of great interest is the potential association between A. johnsonii and health. These findings provide new insights into the interplay between the microbiome and health in the paranasal sinuses.

PMID: 26867528 [PubMed - in process]

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Characterizing airflow profile in the postoperative maxillary sinus by using computational fluid dynamics modeling: A pilot study.

Characterizing airflow profile in the postoperative maxillary sinus by using computational fluid dynamics modeling: A pilot study.

Am J Rhinol Allergy. 2016 Jan;30(1):29-36

Authors: Choi KJ, Jang DW, Ellison MD, Frank-Ito DO

Abstract
BACKGROUND: Maxillary antrostomy is commonly performed during endoscopic sinus surgery. Little is known about the association surrounding recalcitrant maxillary sinusitis, antrostomy size, and intranasal airflow changes. Furthermore, the interaction between sinus mucosa and airflow is poorly understood. This study used computational fluid dynamics (CFD) modeling to investigate postoperative airflow characteristics between diseased and nondiseased maxillary sinuses in subjects with recurrent disease.
METHODS: A retrospective review of patients from a tertiary-level academic rhinology practice was performed. Seven subjects with endoscopic evidence of postoperative maxillary sinus disease that presented as chronic unilateral crusting at least 1 year after bilateral maxillary antrostomies were selected. A three-dimensional model of each subject's sinonasal cavity was created from postoperative computed tomographies and used for CFD analysis.
RESULTS: Although the variables investigated between diseased and nondiseased sides were not statistically significant, the diseased side in six subjects had a smaller antrostomy, and five of these subjects had both reduced nasal unilateral airflow and increased unilateral nasal resistance on the diseased side. The ratio of posterior wall shear stress (WSS) of the maxillary sinus to the total WSS was higher on the diseased side in six subjects. Results also showed strong correlations between antrostomy and CFD variables on the diseased side than on the nondiseased side.
CONCLUSION: This pilot study showed that the majority of the simulated sinonasal models exhibited common characteristics on the side with persistent disease, such as smaller antrostomy, reduced nasal airflow, increased nasal resistance, and increased posterior WSS. Although statistical significance was not established, this study provided preliminary insight into variables to consider in a larger cohort study.

PMID: 26867527 [PubMed - in process]

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The relationship between serum vitamin D and chronic rhinosinusitis: A systematic review.

The relationship between serum vitamin D and chronic rhinosinusitis: A systematic review.

Am J Rhinol Allergy. 2016 Jan;30(1):23-8

Authors: Stokes PJ, Rimmer J

Abstract
BACKGROUND: An exciting development in upper respiratory tract disease is the pathophysiology of vitamin D (VD3). There now is substantial literature to indicate that VD3 acts as an immunomodulator of adaptive and innate immunity locally within the respiratory epithelium. Chronic rhinosinusitis (CRS) places a relatively large socioeconomic burden on developed nations, yet remains a difficult disease to treat. VD3, therefore, has become an area of clinical interest because it may provide an adjunctive drug therapy option in CRS, thereby potentially improving the quality of life of these patients.
OBJECTIVE: A systematic review of the relationship among serum VD3 levels, CRS phenotype, and disease severity by using outcome assessments.
METHODS: A systematic search was performed by using the PubMed, MEDLINE, and EMBASE databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured serum VD3 levels and correlated the measurements to any subtype of CRS (with or without nasal polyps) were included for qualitative analysis.
RESULTS: Seven articles were included (four prospective and three retrospective studies), with a total of 539 patients. There were significantly lower VD3 levels in the polypoid phenotypes of CRS compared with controls. Low VD3 levels were often associated with an increased degree of inflammation.
CONCLUSION: The available evidence indicated that there is a significant relationship between low VD3 levels and polypoid CRS phenotypes. The association between VD3 levels and disease severity and VD3 potential for drug therapy remains unclear, which warrants further research in the area.

PMID: 26867526 [PubMed - in process]

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Microbiome of the paranasal sinuses: Update and literature review.

Microbiome of the paranasal sinuses: Update and literature review.

Am J Rhinol Allergy. 2016 Jan;30(1):3-16

Authors: Lee JT, Frank DN, Ramakrishnan V

Abstract
BACKGROUND: Our understanding of the resident microbiome of the paranasal sinuses has changed considerably in recent years. Once presumed to be sterile, healthy sinus cavities are now known to harbor a diverse assemblage of microorganisms, and, it is hypothesized that alterations in the kinds and quantities of these microbes may play a role in the pathogenesis of chronic rhinosinusitis (CRS).
OBJECTIVES: To review the current literature regarding the sinus microbiome and collate research findings from relevant studies published to date.
METHODS: A systematic literature review was performed on all molecular studies that investigated the microbial communities of the paranasal sinuses. Methods of detection, microbiome composition, and comparative profiling between patients with and without CRS were explored.
RESULTS: A complex consortium of microorganisms has been demonstrated in the sinuses of both patients with and without CRS. However, the latter generally have been characterized by reduced biodiversity compared with controls, with selective enrichment of particular microbes (e.g., Staphylococcus aureus). Such disruptions in the resident microbiome may contribute to disease pathogenesis by enhancing the virulence of potential pathogens and adversely modulating immune responses.
CONCLUSION: The advent of culture-independent molecular approaches has led to a greater appreciation of the intricate microbial ecology of the paranasal sinuses. Microbiota composition, distribution, and abundance impact mucosal health and influence pathogen growth and function. A deeper understanding of the host-microbiome relationship and its constituents may encourage development of new treatment paradigms for CRS, which target restoration of microbiome homeostasis and cultivation of optimal microbial communities.

PMID: 26867525 [PubMed - in process]

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Editorial: The microbiome of the sinuses and its relevance in health and disease.

Editorial: The microbiome of the sinuses and its relevance in health and disease.

Am J Rhinol Allergy. 2016 Jan;30(1):1-2

Authors: Carney AS

PMID: 26867524 [PubMed - in process]

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Epidermal growth factor receptor inhibitor AG1478 inhibits mucus hypersecretion in airway epithelium.

Epidermal growth factor receptor inhibitor AG1478 inhibits mucus hypersecretion in airway epithelium.

Am J Rhinol Allergy. 2016 Jan;30(1):1-6

Authors: Takezawa K, Ogawa T, Shimizu S, Shimizu T

Abstract
BACKGROUND: Mucus hypersecretion and neutrophil infiltration are important characteristics of airway inflammation. Epidermal growth factor receptor (EGFR) transactivation induces mucus and inflammatory cytokine secretion from airway epithelial cells. To elucidate the roles of EGFR in airway inflammation, the in vitro effects on mucin production and interleukin (IL) 8 secretion from cultured airway epithelial cells and the in vivo effects on mucus hypersecretion and neutrophil infiltration in rat nasal mucosa of the EGFR tyrosine kinase inhibitor AG1478 were examined.
METHODS: The in vitro effects of AG1478 treatment of cultured NCI-H292 cells on lipopolysaccharide (LPS) induced or tumor necrosis factor (TNF) α induced MUC5AC mucin and IL-8 secretion were evaluated. Hypertrophic and metaplastic changes of goblet cells, mucus production and neutrophil infiltration in rat nasal epithelium were induced by intranasal instillation of LPS in vivo, and the inhibitory effects of AG1478 by intraperitoneal injection or intranasal instillation were examined.
RESULTS: AG1478 (1-1000 nM) significantly inhibited both LPS-induced and TNF-α-induced secretion of MUC5AC and IL-8 from cultured NCI-H292 cells in a dose-dependent manner. The expression of MUC5AC and IL-8 messenger RNAs was also significantly inhibited. Intranasal instillation of AG1478 one hour after intranasal LPS instillation significantly inhibited LPS-induced goblet cell metaplasia, mucus production, and neutrophil infiltration in rat nasal epithelium, as did intraperitoneal injection of AG1478 one hour before LPS instillation.
CONCLUSIONS: These results indicated that EGFR transactivation plays an important role in mucin and IL-8 secretion from airway epithelial cells. Intranasal instillation of an EGFR tyrosine kinase inhibitor may be a new therapeutic approach for the treatment of upper airway inflammation.

PMID: 26867523 [PubMed - in process]

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Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

J Neurosurg. 2016 Feb 12;:1-7

Authors: Chung LK, Ung N, Spasic M, Nagasawa DT, Pelargos PE, Thill K, Voth B, Hirt D, Gopen Q, Yang I

Abstract
OBJECTIVE Superior semicircular canal dehiscence (SSCD) is a rare disorder characterized by the formation of a third opening in the inner ear between the superior semicircular canal and the middle cranial fossa. Aberrant communication through this opening causes a syndrome of hearing loss, pulsatile tinnitus, disequilibrium, and autophony. This study analyzed the clinical outcomes of a single-institution series of patients with SSCD undergoing surgical repair by the same otolaryngologist and neurosurgeon. METHODS All patients who underwent SSCD repair at the University of California, Los Angeles, between March 2011 and November 2014 were included. All patients had their SSCD repaired via middle fossa craniotomy by the same otolaryngologist and neurosurgeon. Outcomes were analyzed with Fisher's exact test. RESULTS A total of 18 patients with a mean age of 56.2 years (range 27-84 years) and an average follow-up of 5.0 months (range 0.2-21.8 months) underwent 21 cases of SSCD repair. Following treatment, all patients (100%) reported resolution in ≥ 1 symptom associated with SSCD. Autophony (p = 0.0005), tinnitus (p = 0.0059), and sound- and/or pressure-induced dizziness (p = 0.0437) showed significant symptomatic resolution. Following treatment, 29% (2/7) of patients developed imbalance, 20% (1/5) of patients developed sound- and/or pressure-induced dizziness, and 18% (2/11) of patients developed aural fullness. Among patients with improved symptoms following surgical repair, none reported recurrence of symptoms at subsequent follow-up visits. CONCLUSIONS SSCD remains an underdiagnosed and undertreated condition. Surgical repair of SSCD using a middle fossa craniotomy is associated with a high rate of symptom resolution. Continued investigation using a larger patient cohort and longer-term follow-up could further demonstrate the effectiveness of using middle fossa craniotomy for SSCD repair.

PMID: 26871374 [PubMed - as supplied by publisher]

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Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review.

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Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review.

Otolaryngol Head Neck Surg. 2015 Nov;153(5):721-30

Authors: Aron M, Lea J, Nakku D, Westerberg BD

Abstract
OBJECTIVE: To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head trauma.
DATA SOURCES: Systematic review of the literature was performed using Medline, EMBASE, and Cochrane databases. English and French articles meeting inclusion criteria and published between 1946 and October 2014 were included.
REVIEW METHODS: Data were independently extracted from the articles by 2 reviewers using data collection forms developed a priori. Inclusion and exclusion criteria were decided a priori. Studies were included if they reported on at least 1 case of posttraumatic BPPV (t-BPPV), reported on outcomes of all patients with t-BPPV, had a clearly defined inception point, and provided a clear diagnosis of BPPV (defined a priori by reviewers).
RESULTS: A total of 3017 titles, 362 abstracts, and 67 articles were reviewed, from which 16 articles met inclusion criteria and underwent data extraction. There were a total of 207 patients with posttraumatic BPPV identified. Among the 207 patients, 151 (73%) had resolution of symptoms. The T-BPPV patients may have more multi-canal involvement and may require more repositioning maneuvers for resolution compared to patients with nontraumatic BPPV.
CONCLUSIONS: Available evidence does not support the notion that symptom resolution rates in patients with posttraumatic BPPV are worse than those with nontraumatic BPPV. However, well-designed studies with adequate cohorts are lacking. Additional well-executed studies are needed to confirm this lack of difference in resolution rates.

PMID: 26183524 [PubMed - indexed for MEDLINE]

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Caloric test as a predictor tool of postural control in CI users.

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Caloric test as a predictor tool of postural control in CI users.

Acta Otolaryngol. 2015 Jul;135(7):685-91

Authors: Abramides PA, Bittar RS, Tsuji RK, Bento RF

Abstract
CONCLUSIONS: Balance was improved at 365 days after CI in all patients. Caloric test findings were important determinants of balance outcomes over a year after CI. Pre-operative vestibular assessment findings should be documented because postural recovery over time depends on this information.
OBJECTIVE: To verify the importance of the caloric test as a pre-operative predictor tool of postural control after CI surgery.
METHODS: Prospective observational study made with 24 post-lingual deafness patients who underwent unilateral CI surgery. Vestibular assessments: questionnaire assessing vertigo, caloric tests, rotary chair (RC) testing, and computerized dynamic posturography (CDP), were sequentially performed for all patients before and 60, 120, 180, and 365 days after CI.
RESULTS: Thirteen patients (54.2%) reported dizziness before CI. At the end of the study, dizziness remained unchanged in one (7.7%) patient, ameliorated in 11 (84.6%), and worsened in one (7.7%). Baseline caloric tests identified 29.2% patients with normal reflexes, 33.3% with unilateral areflexia or hyporeflexia, 12.5% with bilateral hyporeflexia, and 25% with bilateral vestibular loss (BVL). Most patients exhibited objective improvements in postural stability. At 365 days, the CDP condition (particularly C5) and CS were higher for caloric tests responders at baseline than for those with BVL at baseline.

PMID: 25812584 [PubMed - indexed for MEDLINE]

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Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable Meniere's disease.

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Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable Meniere's disease.

Acta Otolaryngol. 2015 Jul;135(7):667-72

Authors: Sakagami M, Kitahara T, Ito T, Ota I, Nishimura T, Nishimura A, Otsuka S, Yamanaka T

Abstract
CONCLUSIONS: At the second postoperative year, there were no significant differences between results for vertigo and hearing after endolymphatic sac drainage with steroid instillation surgery (EDSS) and EDSS with posterior tympanotomy with steroids at the round window (EDRW). In particular, as regards hearing recovery to the preoperative level, the periods after EDRW were shorter than those after the second EDSS.
OBJECTIVES: Patients sometimes faces recurrent problems years after EDSS due to endolymphatic sac closure and/or disease progression. In the present study, we examined the effects of EDRW on vertigo and hearing after revision surgery for intractable relapsed Meniere's disease.
METHODS: Sixteen patients with Meniere's disease had revision surgery due to intractable recurrence of disease, and were followed up regularly at least for 2 years. As revision surgery, EDSS was performed repeated in eight cases and EDRW was performed in the other eight. There were no significant differences between the patients' backgrounds in the two groups.
RESULTS: Periods of hearing recovery to the preoperative level were 11.5 ± 4.4 months after the first EDSS, although it took 16.4 ± 2.6 months longer after revision surgery with the second EDSS (p = 0.038 < 0.05: first EDSS vs second EDSS) and was 10.0 ± 3.3 months shorter after revision surgery with EDRW (p = 0.010 < 0.05: second EDSS vs EDRW).

PMID: 25762028 [PubMed - indexed for MEDLINE]

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[Benign paroxysmal positional vertigo: frequent misdiagnosis].

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[Benign paroxysmal positional vertigo: frequent misdiagnosis].

Laryngorhinootologie. 2014 Dec;93(12):816-7

Authors: Hegemann S, Helling K

PMID: 25594096 [PubMed - indexed for MEDLINE]

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Speech Practice Effects on Bilingual Children's Fast Mapping Performance.

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Speech Practice Effects on Bilingual Children's Fast Mapping Performance.

Semin Speech Lang. 2015 May;36(2):109-19

Authors: Kan PF, Sadagopan N

Abstract
Learning a new word involves many subsystems and their interactions. The purpose of this study was to examine whether speech practice facilitates the subsequent fast mapping performance of bilingual preschool children. Participants were 18 typically developing preschoolers who learned Cantonese (L1) as a home language and English (L2) as a second language. Each participant was asked to repeat each of the four novel words after an auditory model (speech practice) before he or she was exposed to the novel word-objects in the subsequent fast mapping task. Significant speech practice and language effects on fast mapping production scores were found. These findings suggest a complex relationship between speech learning, fast mapping, and L1-L2 language skills. Our results suggest that clinical methods that facilitate bilingual children's production skills (e.g., repeat after a model) hold promise as a means of improving the initial stage of word learning in both languages.

PMID: 25922996 [PubMed - indexed for MEDLINE]

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Phonological development in young bilinguals: clinical implications.

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Phonological development in young bilinguals: clinical implications.

Semin Speech Lang. 2015 May;36(2):100-8

Authors: Core C, Scarpelli C

Abstract
This article reviews recent research on bilingual phonological development and describes the nature of bilingual phonology, focusing on characteristics of cross-linguistic influence on bilingual phonological abilities. There is evidence of positive and negative transfer (acceleration and deceleration) on children's phonological abilities. Several methodological issues limit the ability to generalize findings from previous research to larger groups of bilingual children (e.g., small sample size, lack of consideration of age of acquisition of each language, and language abilities of the participants). Sources of heterogeneity in language development are presented and discussed. Phonological abilities are related to language abilities in bilingual first language learners of English and Spanish. Empirical evidence from research in our laboratory supports this claim. We discuss implications of research findings and limitations for future research and clinical practice. We provide specific recommendations for bilingual research and for clinical assessment of young bilingual children.

PMID: 25922995 [PubMed - indexed for MEDLINE]

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Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms.

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Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms.

Acta Otolaryngol. 2015 Jul;135(7):635-9

Authors: Hägg M, Tibbling L, Franzén T

Abstract
CONCLUSION: Misdirected swallowing can be triggered by esophageal retention and hiatal incompetence. The results show that oral IQoro(R) screen (IQS) training improves misdirected swallowing, hoarseness, cough, esophageal retention, and globus symptoms in patients with hiatal hernia.
OBJECTIVES: The present study investigated whether muscle training with an IQS influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia.
METHODS: A total of 28 adult patients with hiatal hernia suffering from misdirected swallowing and esophageal retention symptoms for more than 1 year before entry to the study were evaluated before and after training with an IQS. The patients had to fill out a questionnaire regarding symptoms of misdirected swallowing, hoarseness, cough, esophageal retention, and suprasternal globus, which were scored from 0-3, and a VAS on the ability to swallow food. The effect of IQS traction on diaphragmatic hiatus (DH) pressure was recorded in 12 patients with hiatal hernia using high resolution manometry (HRM).
RESULTS: Upon entry into the study, misdirected swallowing, globus sensation, and esophageal retention symptoms were present in all 28 patients, hoarseness in 79%, and cough in 86%. Significant improvement was found for all symptoms after oral IQS training (p < 0.001). Traction with an IQS resulted in a 65 mmHg increase in the mean HRM pressure of the DH.

PMID: 25963055 [PubMed - indexed for MEDLINE]

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World gastroenterology organisation global guidelines: dysphagia--global guidelines and cascades update September 2014.

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World gastroenterology organisation global guidelines: dysphagia--global guidelines and cascades update September 2014.

J Clin Gastroenterol. 2015 May-Jun;49(5):370-8

Authors: Malagelada JR, Bazzoli F, Boeckxstaens G, De Looze D, Fried M, Kahrilas P, Lindberg G, Malfertheiner P, Salis G, Sharma P, Sifrim D, Vakil N, Le Mair A

PMID: 25853874 [PubMed - indexed for MEDLINE]

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Changing trends in the incidence of juvenile nasopharyngeal angiofibroma: seven decades of experience at King George's Medical University, Lucknow, India.

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Changing trends in the incidence of juvenile nasopharyngeal angiofibroma: seven decades of experience at King George's Medical University, Lucknow, India.

J Laryngol Otol. 2016 Feb 11;:1-6

Authors: Mishra A, Mishra SC

Abstract
BACKGROUND: The occurrence of juvenile nasopharyngeal angiofibroma is reportedly higher in India than in some other parts of the world, and our centre has seen a four-fold increase in its occurrence across seven decades.
METHODS: This paper reports a retrospective archival analysis of 701 juvenile nasopharyngeal angiofibroma cases from 1958 to 2013, and considers probable environmental factors in an Indian context that may affect its biology and the global distribution, as reported in the literature.
RESULTS: A continuously progressive increase in occurrence was evident, but the rapid rise observed in the current decade was alarming. The world map of juvenile nasopharyngeal angiofibroma incidence does not reflect true global distribution given the paucity of reporting. Our centre has dealt with approximately 400 cases in the last 24 years.
CONCLUSION: With the alarming increase in juvenile nasopharyngeal angiofibroma incidence, there is a need for a registry to define its epidemiology. The world literature needs to reflect the status of juvenile nasopharyngeal angiofibroma incidence in the third world as well. Environmental factors known for hormone disruptive actions may influence its occurrence. Such aspects need to be considered to plan specific prevention policies.

PMID: 26864451 [PubMed - as supplied by publisher]

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Vestibular pathology in children with enlarged vestibular aqueduct.

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Vestibular pathology in children with enlarged vestibular aqueduct.

Laryngoscope. 2016 Feb 10;

Authors: Yang CJ, Lavender V, Meinzen-Derr JK, Cohen AP, Youssif M, Castiglione M, Manickam V, Bachmann KR, Greinwald JH

Abstract
OBJECTIVES/HYPOTHESIS: To establish the prevalence of abnormal vestibular test findings in children with enlarged vestibular aqueduct (EVA) and determine if these findings correlate with clinical symptoms, radiographic findings (EVA size and laterality), audiometric findings, and genetic testing in these patients.
STUDY DESIGN: Prospective cohort.
METHODS: Patients 3 to 12 years of age with hearing loss and imaging findings consistent with EVA treated at our tertiary care institution were sequentially enrolled from 2009 to 2011. The following six outcome measurements were analyzed: audiometric findings, EVA laterality, temporal bone measurements, genetic testing, vestibular testing (cervical-evoked myogenic potentials, posturography, rotational chair, and calorics), and vestibular symptoms.
RESULTS: Twenty-seven patients with EVA (mean age 9.2 years, 48% female) were enrolled in and completed the study. Vertigo was reported in six patients. Twenty-four of 27 (89%) had at least one abnormal vestibular test result. Midpoint and operculum size correlated with directional preponderance (P = .042 and P = .032, respectively). Also, high-frequency pure tone average (HFPTA) correlated with unilateral weakness (P = .002). Walking at a later age correlated with abnormal posturography results. There was no correlation between EVA laterality and vestibular test findings.
CONCLUSION: We found a high rate of vestibular pathology in children with EVA; however, the prevalence of abnormal vestibular test findings in this patient population was not correlated with vestibular symptoms. Enlarged vestibular aqueduct size, HFPTA, and walking at a later age were correlated with abnormal vestibular test findings. In view of these results, it may be prudent to consider vestibular testing in children with these clinical characteristics.
LEVEL OF EVIDENCE: 2b. Laryngoscope, 2015.

PMID: 26864825 [PubMed - as supplied by publisher]

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