Source:Journal of Voice
Author(s): Amanda Hu
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Τετάρτη 31 Αυγούστου 2016
Book Review: Laryngeal Physiology for the Surgeon and Clinician: Second Edition
Source:Journal of Voice
Author(s): Amanda Hu
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A Preliminary Investigation of the Air-Bone Gap: Changes in Intracochlear Sound Pressure With Air- and Bone-conducted Stimuli After Cochlear Implantation.
Hypothesis: A cochlear implant electrode within the cochlea contributes to the air-bone gap (ABG) component of postoperative changes in residual hearing after electrode insertion. Background: Preservation of residual hearing after cochlear implantation has gained importance as simultaneous electric-acoustic stimulation allows for improved speech outcomes. Postoperative loss of residual hearing has previously been attributed to sensorineural changes; however, presence of increased postoperative ABG remains unexplained and could result in part from altered cochlear mechanics. Here, we sought to investigate changes to these mechanics via intracochlear pressure measurements before and after electrode implantation to quantify the contribution to postoperative ABG. Methods: Human cadaveric heads were implanted with titanium fixtures for bone conduction transducers. Velocities of stapes capitulum and cochlear promontory between the two windows were measured using single-axis laser Doppler vibrometry and fiber-optic sensors measured intracochlear pressures in scala vestibuli and tympani for air- and bone-conducted stimuli before and after cochlear implant electrode insertion through the round window. Results: Intracochlear pressures revealed only slightly reduced responses to air-conducted stimuli consistent with previous literature. No significant changes were noted to bone-conducted stimuli after implantation. Velocities of the stapes capitulum and the cochlear promontory to both stimuli were stable after electrode placement. Conclusion: Presence of a cochlear implant electrode causes alterations in intracochlear sound pressure levels to air, but not bone, conducted stimuli and helps to explain changes in residual hearing noted clinically. These results suggest the possibility of a cochlear conductive component to postoperative changes in hearing sensitivity. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Development of a Squelch Effect in Adult Patients After Simultaneous Bilateral Cochlear Implantation.
Objectives: To investigate whether a squelch effect occurs in the first 3 years after simultaneous bilateral cochlear implantation and to investigate whether this effect increases during follow-up. Study Design: Prospective study as part of a multicenter randomized controlled trial that compares simultaneous bilateral cochlear implantation to sequential and unilateral cochlear implantation. Setting: Tertiary referral center. Patients: Nineteen postlingually deafened adults. Intervention: Simultaneous bilateral cochlear implantation. Main Outcome Measure: The squelch effect, measured yearly with a speech-intelligibility-in-noise test with spatially separated sources. Bilateral results were compared to unilateral results in which the cochlear implant at the noise side was turned off. The squelch effect was investigated for the patients' best performing ear and for the left and right ears separately. Results: In 13 individual patients, a squelch effect was present after 1 year. This number increased during follow-up years. On group level, a squelch effect was present in patients' best performing ear after 2 and 3 years (1.9 dB). A squelch effect was present in both ears after 3 years (AS: 1.7 dB, AD: 1.3 dB). Conclusion: Patients who underwent simultaneous bilateral cochlear implantation developed a measurable benefit from the squelch effect after 2 years in their best performing ear and after 3 years in both ears. These observations suggest that the brain learns to use interaural differences to segregate sound from noise after simultaneous bilateral cochlear implantation. The squelch effect increased over time which suggests a growth in cortical integration and differentiation of inputs from bilateral CIs due to brain plasticity. Trial Registration: Dutch Trial Register NTR1722. Level of evidence: 1b. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Hearing Loss Progresses Faster in Patients With Growing Intracanalicular Vestibular Schwannomas.
Objective: To determine whether certain patient and tumor characteristics influence the progression of hearing loss in vestibular schwannoma (VS) patients. Study Design: Retrospective study. Setting: Tertiary referral center, Erasmus Medical Centre in Rotterdam, The Netherlands. Patients: One hundred fifty-five patients referred from 2000 through 2010 with intracanalicular, small or medium sized, unilateral VS, managed without active treatment. Intervention: Wait and scan protocol with sequential magnetic resonance imaging and audiometry. Main Outcome Measures: Hearing loss as pure-tone average (PTA) in dB and progression of hearing loss expressed as the annual change in PTA or annual hearing decreasing rate (AHDR) in dB/yr. Results: At presentation the mean hearing loss was 47 dB and the mean asymmetry between the tumor ear and the contralateral ear was 28 dB. The mean AHDR in wait and scan patients was 3.5 dB/yr (sd 4.6). Tumor growth was associated with the AHDR in patients with intracanalicular tumors. In patients with tumors extending into the cerebellopontine angle, we found a negative association between the AHDR and the PTA of the contralateral side. The explained variance, however, was low. No association was found between the AHDR and patient age, PTA in the tumor ear, tumor size, speech discrimination score at diagnosis or hypo-intensity of the cochlear fluids on magnetic resonance imaging. Conclusion: There is no association between hearing deterioration and clinical characteristics in our 155 VS patients. Hearing loss is associated with tumor growth in intracanalicular tumors only. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Endoscopic Versus Microscopic Approach in Stapes Surgery: Are Operative Times and Learning Curve Important for Making the Choice?.
Objective: Analyze the surgical outcomes of endoscopic stapes surgery, comparing the results with a conventional stapes surgery under microscopic approach. Estimate the operation type of each surgical approach and show a learning curve of endoscopic stapes surgery. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: Twenty patients who underwent endoscopic stapedotomy for otosclerosis and 20 patients who underwent microscopic stapedotomy for otosclerosis. Interventions: Endoscopic and microscopic stapes surgery. Main Outcome Measures: Operating time, preoperative and postoperative hearing, intraoperative findings, postoperative complications, and postoperative pain. Results: The group of patients who underwent endoscopic stapes surgery showed a mean operative time calculated to be 45.0 min. The group of patients treated by microscopic approach had an estimated mean value of 36.5 min. Statistical difference was evident (p value = 0.01). The average duration of endoscopic surgery varied as the surgeon gained experience. There were no statistical differences between the average surgical times for the endoscopic and microscopic approaches (p >0.05) in the last 4-month period of surgery. Through the endoscopic approach the percentage of ears with a postoperative air-bone gap 0.05) was reported. No difference regarding the incidence of intraoperative findings and postoperative complications between endoscopic and microscopic approaches was found. Conclusion: Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Longer initial operative times and a learning curve are the principal grounds that might discourage most ear-surgeons from commencing endoscopic stapes surgery. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Cochlear Size and Shape Variability and Implications in Cochlear Implantation Surgery.
Hypothesis: To study variations in cochlear size and shape with potential implications for cochlear implants. Background: A comprehension of the cochlear morphology is essential for nontraumatic electrode insertion and hearing preservation in individual surgery. Methods: A total of 310 normal developed cochleae with three-dimensional multiplanar reconstructed computed tomography images were studied. We measured the linear length of the half (1/2TL) and three quarters (3/4TL) of the basal turn, the first turn (1TL), the first two turns (2TL), and the cochlear length. The length and width of the cochlear base as well as the tilt angle within the first turn ([alpha]) and the angle between the first and second turns ([gamma]) of the cochlea were also measured. Results: The measurement results showed that cochlear size and shape vary greatly among individuals. The length and width of cochlear base had positive correlations with 1/2TL (r2 = 0.526 and r2 = 0.625), 3/4TL (r2 = 0.633 and r2 = 0.729), 1TL (r2 = 0.658 and r2 = 0.754), 2TL (r2 = 0.677 and r2 = 0.795) and cochlear length (r2 = 0.622 and r2 = 0.769) respectively. The mean tilt angle [alpha] was 9.72 +/- 1.85 degrees while the angle [gamma] was 14.90 +/- 1.36 degrees, and both had significant positive correlations with the ratio of length to width of cochlear base (p = 0.040 and p = 0.013). Conclusion: The significant variations of the cochlear anatomy suggest that personalized cochlear implant is needed. The width of cochlear base has a stronger association with the linear length of cochlea. And the angle within the first turn and between the first and second turns can be predicted by the ratio of length to width of cochlear base. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Hearing Preservation After Cochlear Implantation May Improve Long-term Word Perception in the Electric-only Condition.
Objective: To correlate hearing preservation with word perception in the electric-only condition in recipients of full length cochlear implant (CI) electrode arrays. Study Design: Retrospective chart review. Setting: Tertiary academic referral center. Patients: CI recipients between January 2003 and December 2013 who had measurable residual acoustic hearing before surgery and serial postoperative word perception tests. Intervention: Demographic data, pre- and postoperative pure-tone average, and postoperative monosyllabic word perception scores were evaluated. Main Outcome Measure: Hearing preservation was correlated with postoperative monosyllabic word perception scores. Results: Data from 96 ears in 91 subjects were included. Complete or partial hearing preservation was achieved in 48%. After 6 and 12 months, no significant difference in word perception was found between subjects with and without hearing preservation. However, after 18 or more months, subjects with hearing preservation had significantly better word perception scores (83% versus 72%, p
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Book Review: Laryngeal Physiology for the Surgeon and Clinician: Second Edition
Publication date: Available online 30 August 2016
Source:Journal of Voice
Author(s): Amanda Hu
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Visual and auditory cortical evoked potentials in interictal episodic migraine: An audit on 624 patients from three centres
Background
Many studies report a habituation deficit of visual evoked potentials (VEP) and/or increased intensity dependence of auditory evoked cortical potentials (IDAP) in episodic migraine patients between attacks. These findings have a pathophysiological interest, but their diagnostic utility is not known.
AimsTo perform an audit on a large database of interictal VEP and IDAP recordings in episodic migraine patients and evaluate their diagnostic accuracy.
MethodsWe pooled data for VEP habituation and IDAP measured in 624 episodic migraineurs (EM) and 360 healthy volunteers (HV) from three centers. Thresholds were calculated by Receiver Operating Curve analysis and used to calculate sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and the accuracy of each test, using ICHD diagnostic criteria as the gold standard.
ResultsIn EM, VEP habituation was significantly lower than in HV, and IDAP slopes were significantly steeper. VEP (five blocks of 50 responses), VEP (six blocks of 100 responses) and IDAP had respectively 61.0%, 61.4% and 45.7% sensitivity, and 77.9%, 77.9% and 87.2% specificity. Their positive (LR+) and negative (LR-) likelihood ratios were respectively 2.760, 2.778, 3.570 and 0.500, 0.495, 0.623, with diagnostic accuracies of 65.3%, 69.0% and 54.3%. In combined VEP + IDAP recordings, an abnormality of at least one test had 83.4% sensitivity, 66.7% specificity, 2.504 LR+, 0.249 LR– and 81.1% accuracy.
ConclusionsIn this large database, VEP habituation is significantly reduced and IDAP increased in episodic migraine patients between attacks. Taken alone, neither VEP nor IDAP has sufficient diagnostic accuracy. However, when both tests are performed in the same patient, an abnormality of at least one of them is highly predictive of interictal episodic migraine.
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Spatiotemporal Pattern of Human Cortical and Subcortical Activity during Early-Stage Odor Processing
The dynamics of early-stage cortical and subcortical responses in the human brain to odor stimulation are currently unknown. The objective of the present study was to analyze spatiotemporal patterns of human brain activity during odor perception using magnetoencephalography (MEG). In 12 normosmic healthy subjects, we investigated the onset of brain activity in relation to ipsilateral and contralateral stimulation with 2 odorants. Olfactory stimuli (200ms duration) were applied using an olfactometer, and brain activity was recorded with a 248-magnetometer whole-head MEG system. Olfactory responses were identified shortly (within 150ms) after stimulus onset in both hemispheres. Stimulation on the ipsilateral side yielded signals earlier (starting at 90ms) compared with contralateral stimulation in the primary olfactory cortex, hippocampus, parahippocampal gyrus, amygdala, and orbitofrontal cortex (P < 0.001). The duration and peak amplitude of olfactory evoked magnetic fields were found to increase with increasing poststimulus time in the majority of the investigated cortical structures (P ≤ 0.019 and P ≤ 0.021). The study showed the locations of early olfactory brain activity in humans within 150ms after the onset of stimuli. Olfactory activation is processed on the ipsilateral side of stimulation in early stages. After a short delay of 34ms a corresponding pattern of activation was also seen in the contralateral hemisphere, indicating the functional connectivity between the 2 hemispheres in the anterior commissure.
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Fecal incontinence in irritable bowel syndrome: Prevalence and associated factors in Swedish and American patients
Abstract
Background
Fecal incontinence (FI) is a prevalent but poorly recognized problem in the general population with profound negative effects on daily life. The prevalence of FI in irritable bowel syndrome (IBS) and its association with clinical, demographic, and pathophysiological factors remain largely unknown.
Methods
One US (n=304) and one Swedish (n=168) patient cohort fulfilling Rome III criteria for IBS completed Rome III diagnostic questions on FI and IBS symptoms, and questionnaires on IBS symptom severity, quality of life, anxiety and depression, and work productivity impairment. The patients also underwent assessments of colorectal sensitivity and motility.
Key Results
Fecal incontinence ≥ one day per month was reported by 19.7% (USA) and 13.7% (Sweden) of IBS patients. These proportions rose to 43.4% and 29.8% if patients with less frequent FI were included. Fecal incontinence prevalence was higher in older age groups, with a clear increase above age 40. Irritable bowel syndrome patients with FI reported greater overall IBS symptom severity, more frequent and loose stools, and greater urgency. Negative effects of FI on quality of life, psychological distress, and work productivity were demonstrated. No associations were found between colorectal physiology and FI.
Conclusions & Inferences
Fecal incontinence is common in IBS patients, and similar to previous general population reports, the major risk factors for FI in IBS are older age, rectal urgency, and loose, frequent stools. When IBS patients have comorbid FI, the impact on quality of life, psychological symptoms, and work impairment appears greater.
We studied one US (n=304) and one Swedish IBS cohort (n=168), and fecal incontinence (FI) ≥ one day per month was reported by 19.7% (USA) and 13.7% (Sweden) of IBS patients.FI was associated with loose, frequent stools, urgency, and adverse impact on quality of life, psychological symptoms, and work productivity.
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A Systematic Review of the Literature on Disorders of Sleep and Wakefulness in Parkinson’s Disease From 2005-2015
Sleep disorders are among the most common non-motor manifestations in Parkinson's disease (PD) and have a significant negative impact on quality of life. While sleep disorders in PD share most characteristics with those that occur in the general population, there are several considerations specific to this patient population regarding diagnosis, management, and implications. The available research on these disorders is expanding rapidly, but many questions remain unanswered. We thus conducted a systematic review of the literature published from 2005-2015 on the following disorders of sleep and wakefulness in PD: REM sleep behavior disorder, insomnia, nocturia, restless legs syndrome and periodic limb movements, sleep disordered breathing, excessive daytime sleepiness, and circadian rhythm disorders.
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Tinnitus Disappears Completely
As sufferers know, there are no cures for tinnitus. This is an ailment that sufferers have simply learned to manage. You can find stories of people who have been victim to a noise in their ears that never goes away, a sound so disruptive it prevents sleeping, interferes with socializing and can actually lead to headaches and distraction. You can find sufferers whose afflictions are fairly mild, intermittent and annoying.
Search the Internet, you can also find many stories where tinnitus disappears completely. Here are a few:
"The Buzzing in my right here has gone. Completely. I'ts now Saturday evening and still no buzzing. This is the longest time in 3 years that I have gone without the buzz in my right ear." – Dean
Dean attributes his good fortune to an extract many regard as a hoax.
"Used to have tinnitus, it went away after a year or so, and I don't take chances anymore with my hearing. These are cheap, and they work." – marton
marton does not attribute any specific treatment to his claim.
"When i was first diagnosed with tinnitus 5 years ago, i was devastated and confused. it had become a real and meaningful threat to my life. i finally found the right combination of treatments that have since eliminated the noise i used to hear in my ears. amazingly, my tinnitus completely disappeared." – Anonymous
Again, this sufferer does not break down the specifics of their treatment.
Unfortunately, while these sufferers claim tinnitus disappears completely, these are personal stories with no real medical investigation. You can certainly find plenty of ads that claim to have a cure, making declarations that are more promotional than scientific, but deep research will find no medical evidence that tinnitus disappears completely.
The responsible clinician would never imply tinnitus disappears completely. They may not argue it couldn't happen, but they would prefer to see scientific studies and proof that supports the claim. The research community would love to use these stories to establish better ways to treat the millions of people suffering with the ailment to varying degrees.
Currently, appropriate treatments deal with managing tinnitus, usually helping sufferers find ways to minimize the distraction and repercussions of the condition. Tinnitus as a result of ear infection can be treated with antibiotics. An audiologist, alternative therapy or a tinnitus masker might help.
If you are suffering with tinnitus, see your doctor right away.
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Altered sleep-wake patterns in blindness: a combined actigraphy and psychometric study
• PSQI scores indicate a higher prevalence of sleep disturbances in blind individuals.• Blind individuals have larger variability in the efficiency and timing of their night-time sleep episodes.• Variability measures of sleep efficiency and night-time sleep timing correlate with PSQI scores.• Results cannot be attributed to differences in chronotype between blind and sighted participants.
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Repetitive Transcranial Magnetic Stimulation for Treatment Resistant Depression: Re-establishing connections
A significant number of individuals suffering from major depressive disorder (MDD) fail to achieve an adequate response to currently available treatments and are thus considered to be suffering from treatment resistant depression (TRD). A recent addition to the neurostimulation armamentarium for the treatment of individuals suffering from TRD is repetitive transcranial magnetic stimulation (rTMS). rTMS is a non-invasive technique for which accumulated evidence has demonstrated efficacy and safety for TRD (Perera et al.
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Ewing sarcomas of the sino-nasal tract and maxillary bone
Publication date: Available online 31 August 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Jbali Souheil, Kedous Skander, Dhambri Sawssen, Mahfoudhi Sana, Yazid Delia, Mahjoubi Khalil, Gargoura Asma, Ayadi Mouna, Attia Zied, Touati Slim, Gritli Said
Ewing's sarcoma is a malignant tumor belonging to the group of small round cells tumors. Histologically similar to soft tissue neoplasms originally described as primitive neuro-ectodermal tumors (PNET), in the WHO classification, Ewing's sarcoma and PNET are labeled together under the rubric of EWS/PNET. Rarely located in the nasal cavity and the para-nasal sinuses, we report three cases of Ewing's sarcoma of maxillary bone and sinus. Our patients, 2 males and one female, were aged 20, 16 and 13years respectively. The chief complaint was a painful face swelling. The diagnosis was retained on histologic and immuno-histochemical results. In two cases, surgery was performed as primary treatment modality followed by chemo-radiotherapy, which was the only therapeutic modality in the remaining case. After a follow-up of 2, 3 and 8years (for each patient), we did not report local or distant failures.
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Management of primary T1–T4 glottic squamous cell carcinoma by transoral laser microsurgery
Objectives/Hypothesis
Evaluate the oncologic outcomes of patients with early and select advanced primary glottic squamous cell carcinoma (SCCa) managed by transoral laser microsurgery (TLM).
Study Design
Retrospective cohort study.
Methods
Ninety cases of TLM-managed primary glottic SCCa were identified retrospectively using a prospectively collected database.
Results
Outcomes of patients with pTis–pT2a disease (n = 65) and pT2b–pT4a disease (n = 25) were, respectively: 5-year local control, 86.2% and 67.5%; 5-year disease-free survival, 64.9% and 44.9%; 5-year disease-specific survival, 96.4% and 59.0%; laryngeal preservation, 96.9% and 80%. Five of nine patients (56%) with supraglottic–glottic–subglottic tumors were local recurrence-free compared to the 70 of 81 (86%) patients with glottic, supraglottic–glottic, and glottic–subglottic tumors. Seven of 13 patients (54%) with positive or indeterminate margins were local recurrence-free compared to 68 of 77 (88%) patients with negative margins.
Conclusions
Given sample size considerations, this study highlights the satisfactory oncologic outcomes of TLM-treated glottic cancer and the potential importance of margin management and disease extension within the larynx.
Level of Evidence
4 Laryngoscope, 2016
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Histologic Evaluation of Micronized AlloDerm After Injection Laryngoplasty in a Rabbit Model
Objectives/Hypothesis
Micronized AlloDerm is a commonly used injectable material for injection laryngoplasty; however, the histologic response to laryngeal implantation and resorption rate over time have not been elucidated. This study aimed to evaluate the in vivo response of micronized AlloDerm over time after laryngeal implantation using a rabbit model.
Study Design
Animal model.
Methods
The left recurrent laryngeal nerve was sectioned in five New Zealand White rabbits to create a vocal cord paralysis. Two weeks later, injection laryngoplasty was performed with 100 μL of micronized AlloDerm. Animals were sacrificed 4 (two rabbits) and 12 (three rabbits) weeks after injection. Histologic sections were stained and evaluated by a single pathologist. Volume estimates were made by assuming the implant took an ellipsoid shape using dimensions calculated from histologic slides.
Results
In all cases, histological analysis revealed a lymphocytic inflammatory response infiltrating the peripheral margins of injection. After 4 weeks, the volume of injected material remaining in two rabbits was 404 and 278 mm3 (average 341 mm3). After 12 weeks, the volume of injected material remaining in three rabbits was 0, 61, and 124 mm3 (average 62 mm3), an 82% difference in volume of material between animals sacrificed at 4 weeks versus 12 weeks.
Conclusions
Injection laryngoplasty using micronized AlloDerm induces a lymphocytic inflammatory response after injection in a rabbit model. Though a significant amount of material remains after 4 weeks, by 12 weeks the majority has been reabsorbed.
Level of Evidence
NA Laryngoscope, 2016
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Antiangiogenic antibody improves melanoma detection by fluorescently labeled therapeutic antibodies
Objective
Evaluate if vascular normalization with an antiangiogenic monoclonal antibody improves detection of melanoma using fluorescently labeled antibody-based imaging.
Study Design
Preclinical.
Methods
Panitumumab and control IgG were covalently linked to a near-infrared fluorescent probe (IRDye800CW). Immunodeficient mice with ear xenografts of melanoma cell lines (A375 and SKMEL5) were systemically injected (200 μg, tail vein) with either IgG-IRDye800CW, panitumumab-IRDye800CW, or a combination (bevacizumab [5mg/kg], administered 72 hours prepanitumumab-IRDye800CW) (n = 5). Primary tumors were imaged with open-field (LUNA, Novadaq, Toronto, Ontario, Canada) and closed-field (Pearl, LI-COR Biosciences, Lincoln, NB) imaging devices. Postresection, the concentration of labeled antibody within the tumor (μg/g) was calculated using normalized standards.
Results
The mean fluorescence within the melanoma tumors was greater for the combination group compared to panitumumab alone for both cell lines (P < 0.001). The tumor-to-background ratio (TBR) for the A375 tumors was greater for the combination (3.4–7.1) compared to the panitumumab alone (3.2–5.0) (P = 0.04). The TBR for SKMEL5 tumors was greater for the combination (2.4–6.0) compared to the panitumumab alone (2.2–3.9) (P = 0.02). Within A375 tumors, the concentration was lower for panitumumab (0.51 μg/g) compared to combination group (0.68 μg/g) (P = 0.036). Within SKMEL5 tumors, the concentration was lower for panitumumab (0.0.17 μg/g) compared to combination group (0.35 μg/g) (P = 0.048). Residual tumor (1.0–0.2 mg) could be differentiated from background in both panitumumab and combination groups. For both cell lines, panitumumab and combination groups had greater mean fluorescence of the tumor compared to control IgG.
Conclusion
The addition of antiangiogenic therapy improves uptake of fluorescently labeled monoclonal antibodies within melanoma tumors. Clinical translation could improve detection of melanoma intraoperatively, reducing positive margins and sparing normal tissue.
Level of Evidence
N/A. Laryngoscope, 2016
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The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency
Objectives/Hypothesis
To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency.
Study Design
Prospective clinical pilot study.
Methods
After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre-/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic-aerodynamic analysis).
Results
In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre- and postoperative findings were not significant.
Conclusions
The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case.
Level of Evidence
4 Laryngoscope, 2016
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Blinded randomized controlled study of a web-based otoscopy simulator in undergraduate medical education
Objectives/Hypothesis
OtoTrain is a Web-based otoscopy simulator that has previously been shown to have face and content validity. The objective of this study was to evaluate the effectiveness of this Web-based otoscopy simulator in teaching diagnostic otoscopy to novice learners
Study Design
Prospective, blinded randomized control trial.
Methods
Second-year medical students were invited to participate in the study. A pretest consisted of a series of otoscopy videos followed by an open-answer format assessment pertaining to the characteristics and diagnosis of each video. Participants were then randomly divided into a control group and a simulator group. Following the pretest, both groups attended standard otology lectures, but the simulator group was additionally given unlimited access to OtoTrain for 1 week. A post-test was completed using a separate set of otoscopy videos. Tests were graded based on a comprehensive marking scheme. The pretest and post-test were anonymized, and the three evaluators were blinded to student allotment.
Results
A total of 41 medical students were enrolled in the study and randomized to the control group (n = 20) and the simulator group (n = 21). There was no significant difference between the two groups on their pretest scores. With the standard otology lectures, the control group had a 31% improvement in their post-test score (mean ± standard error of the mean, 30.4 ± 1.5) compared with their pretest score (23.3 ± 1.8) (P < .001). The simulator group had the addition of OtoTrain to the otology lectures, and their score improved by 71% on their post-test (37.8 ± 1.6) compared to their pretest (22.1 ± 1.9) (P < .001). Comparing the post-test results, the simulator group had a 24% higher score than the control group (P < .002). Inter-rater reliability between the blinded evaluators was excellent (r = 0.953, P < .001).
Conclusions
The use of OtoTrain increased the diagnostic otoscopic performance in novice learners. OtoTrain may be an effective teaching adjunct for undergraduate medical students.
Level of Evidence
1b. Laryngoscope, 2016
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Current molecular profile of juvenile nasopharyngeal angiofibroma: First comprehensive study from India
Objective
An attempt is made to analyze the molecular behavior of juvenile nasopharyngeal angiofibroma (JNA).
Study Design
Case Series
Methods
Quantification of mRNAs expression was undertaken through real-time polymerase chain reaction in JNA (9–24) samples for VEGF-A, basic fibroblast growth factor (b-FGF), platelet-derived growth factor PDGF-A, KIT proto-oncogene receptor tyrosine kinase (c-Kit), Avian myelomatosis viral oncogene homolog (c-Myc), Harvey rat sarcoma viral oncogene homolog (H-Ras), tumor suppressor gene TP53, and androgen receptor and interleukin 6 (IL-6). The β-catenin expression was evaluated by western blot in 16 samples. Nasal polyp was taken as control.
Results
A significantly increased (P < 0.01) expression of c-myc, VEGFA, bFGF, PDGFA, c-kit, and TP53 was seen, along with enhanced expression of β-catenin. A massive enhancement of H-Ras expression was seen for the first time. Androgen receptor expression was no different, whereas IL-6 despite showing upregulation trend was not significant.
Conclusion
The enhanced expressions of various markers suggest their potential role in JNA. Although the biological significance of c-kit, c-myc, and one of the novel markers H-Ras has yet to be defined, their significant expression may have a therapeutic importance.
Level of Evidence
NA. Laryngoscope, 2016
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Predicting revision sinus surgery in allergic fungal and eosinophilic mucin chronic rhinosinusitis
Background
Chronic rhinosinusitis consists of several disease processes. Eosinophilic mucin is found in the subtypes of allergic fungal sinusitis (AFS) and eosinophilic mucin chronic rhinosinusitis (EMCRS). These entities frequently require surgical intervention and have high recurrence rates.
Objective
We aimed to determine factors in patients with AFS and EMCRS that may be associated with a higher rate of revision surgeries. Our hypothesis is that patients who have polyps, high Lund-Mackay score (LMS), and fungus may have higher revision rates.
Study Design
Retrospective cohort study.
Methods
This is a retrospective analysis of 117 patients identified over a 5-year period (2005–2009) with the diagnosis of AFS or EMCRS. Contingency tables were created to obtain the odds ratios estimates, and 95% confidence intervals were used to access the association between the outcome (having revision surgery or not) and other clinical binary predictors.
Results
Twenty-six of 117 (22%) of the study patients underwent revision surgery. Within the 2-year follow-up period, an additional five of 26 (19%) required another revision surgery. Average LMS was slightly higher in those who underwent revision surgery (16 vs. 13) on a scale of 0 to 24, with an overall mean score of 18 and standard deviation of 6.82 for the whole sample (117). Other factors evaluated were the presence of fungus, polyps, eosinophilic mucin, and the eosinophilic count and medical therapy received.
Conclusion
The presence of eosinophilic mucin was significantly associated a higher rate of revision surgery.
Level of Evidence
4. Laryngoscope, 2016
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Otolaryngology workforce analysis
Objectives/Hypothesis
The number of trained otolaryngologists available is insufficient to supply current and projected US health care needs. The goal of this study was to assess available databases and present accurate data on the current otolaryngology workforce, examine methods for prediction of future health care needs, and explore potential issues with forecasting methods and policy implementation based on these predictions.
Study Design
Retrospective analysis of research databases, public use files, and claims data.
Methods
The total number of otolaryngologists and current practices in the United States was tabulated using the databases of the American Academy of Otolaryngology–Head and Neck Surgery, American Medical Association, American Board of Otolaryngology, American College of Surgeons, Association of American Medical Colleges, National Center for Health Statistics, and Department of Health and Human Services. Otolaryngologists were identified as surgeons and classified into surgical groups using a combination of AMA primary and secondary self-reported specialties and American Board of Medical Specialties certifications. Data gathered were cross-referenced to rule out duplications to assess total practicing otolaryngologists. Data analyzed included type of practice: 1) academic versus private and 2) general versus specialty; and demographics: 1) urban versus rural, 2) patient age, 3) reason for visit (referral, new, established, surgical follow-up), 4) reason for visit (diagnosis), and 5) payer type.
Results
Analysis from the above resources estimates the total number of otolaryngologists practicing in the United States in 2011 to be 12,609, with approximately 10,522 fully trained practicing physicians (9,232–10,654) and 2,087 in training (1,318 residents and 769 fellows/others). Based on 2011 data, workforce projections would place the fully trained and practicing otolaryngology workforce at 11,088 in 2015 and 12,084 in 2025 unless changes in training occur. The AAO-HNS Physicians Resource Committee performed an extensive analysis of collated data from multiple sources in 2014 and identified 10,800 practicing otolaryngologists and 2,087 in training. It is estimated that the current attrition rate is approximately 306 otolaryngologists per year. Percentage distribution of office visits by patient age was found to be 20% <15 years old, 7% 15 to 24 years old, 21% 25 to 44 years old, 32% 45 to 64 years old, 11% 65 to 74 years old, and 10% ≥75 years old. Reason for visit was 34% new, 29% chronic, 17% chronic with exacerbation, and 15% pre- or postsurgical follow-up. The top diagnoses consisted of otitis media, chronic sinusitis, and impacted cerumen. Payer mix consisted of 59% private insurance, 19% Medicare, and 12% Medicaid/Children's Health Insurance Program.
Conclusions
Despite past findings and predictions of 8,000 to 8,500 otolaryngologists practicing in the United States, collated data from above resources places the total at 12,887, with 10,800 fully trained and practicing in 2014. This 30% to 50% underestimation of the otolaryngology workforce has an impact on future predictions and resource utilization analysis. Even when this correction is considered, the available trained otolaryngologists required to serve the otolaryngologic health care needs of the US population are still insufficient and understaffed. The impact of an aging population and the estimated 30 to 47 million newly insured citizens under the 2010 Patient Protection and Affordable Care Act are also unprecedented variables that must be considered. Further analysis of differences in physician productivity and geographic population density, and model formation of current otolaryngology workforce utilization, are needed to predict future public health needs.
Level of Evidence
NA Laryngoscope, 2016
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Postural orthostatic tachycardia syndrome for the otolaryngologist
Objective
To describe the postural orthostatic tachycardia syndrome (POTS), including clinical presentation, pathophysiology, diagnostic methods, and current management models.
Data Sources
PubMed, Cochrane Library were searched for articles available prior to October 30, 2015.
Methods
Review of the available English-language literature.
Results
Postural orthostatic tachycardia syndrome presentation is discussed, along with underlying associated physiology for POTS and recommended nonpharmacologic and pharmacologic management strategies.
Conclusion
Postural orthostatic tachycardia syndrome patients commonly present with complaints of postural lightheadedness, or dizziness, which can be associated with various other conditions. Nonpharmacologic and pharmacologic treatment methods are available to improve the underlying pathophysiology of the disorder. Laryngoscope, 2016
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Frequency and specific characteristics of the incomplete partition type III anomaly in children
Objectives/Hypothesis
To determine the frequency of the incomplete partition type III anomaly and the genetic and clinical features associated with POU3F4 mutations in children with hearing loss.
Study Design
Retrospective case series from 2000 to 2014 at the National Hospital Organization Tokyo Medical Center and collaborating hospitals.
Methods
A total of 1,004 patients (from 938 families) who had hearing loss by 10 years of age and had undergone computed tomography scanning of their temporal bones were enrolled in this genetic, clinical, and radiological study.
Results
The incomplete partition type III anomaly was identified in six patients (0.6%), each of whom had an enlargement of the vestibular aqueduct at the end close to the vestibule. The six patients also had POU3F4 variants, and a genetic analysis revealed frameshift deletions in three patients, a missense variant in two patients of the same family, and a large deletion in one patient. Three of the six patients with POU3F4 variants were sporadic cases, and in one patient the genetic mutation occurred de novo.
Conclusions
It was indicated that POU3F4 mutations can be predicted by incomplete partition type III anomaly by radiological examination of the inner ear. All six of the patients showed mixed hearing loss, but none showed fluctuations in hearing, which may be related to the lack of vestibular aqueduct enlargement at the operculum.
Level of Evidence
4 Laryngoscope, 2016
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Does formal research training lead to academic success in otolaryngology?
Objectives/Hypothesis
To evaluate whether formalized research training is associated with higher researcher productivity, academic rank, and acquisition of National Institutes of Health (NIH) grants within academic otolaryngology departments.
Methods
Each of the 100 civilian otolaryngology program's departmental websites were analyzed to obtain a comprehensive list of faculty members credentials and characteristics, including academic rank, completion of a clinical fellowship, completion of a formal research fellowship, and attainment of a doctorate in philosophy (PhD) degree. We also recorded measures of scholarly impact and successful acquisition of NIH funding.
Results
A total of 1,495 academic physicians were included in our study. Of these, 14.1% had formal research training. Bivariate associations showed that formal research training was associated with a greater h-index, increased probability of acquiring NIH funding, and higher academic rank. Using a linear regression model, we found that otolaryngologists possessing a PhD had an associated h-index of 1.8 points higher, and those who completed a formal research fellowship had an h-index of 1.6 points higher. A PhD degree or completion of a research fellowship was not associated with a higher academic rank; however, a higher h-index and previous acquisition of an NIH grant were associated with a higher academic rank. The attainment of NIH funding was three times more likely for those with a formal research fellowship and 8.6 times more likely for otolaryngologists with a PhD degree.
Conclusion
Formalized research training is associated with academic success in otolaryngology. Such dedicated research training accompanies greater scholarly impact, acquisition of NIH funding, and a higher academic rank.
Level of Evidence
N/A. Laryngoscope, 2016
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Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments
Objectives/Hypothesis
Endoscopic management of bilateral vocal fold paralysis (BVFP) includes cordotomy and arytenoidectomy, and has become a well-accepted alternative to tracheostomy. However, the costs and quality-of-life benefits of endoscopic management have not been examined with formal economic analysis. This study undertakes a cost-effectiveness analysis of tracheostomy versus endoscopic management of BVFP.
Study Design
Cost-effectiveness analysis.
Methods
A literature review identified a range of costs and outcomes associated with surgical options for BVFP. Additional costs were derived from Medicare reimbursement data; all were adjusted to 2014 dollars. Cost-effectiveness analysis evaluated both therapeutic strategies in short-term and long-term scenarios. Probabilistic sensitivity analysis was used to assess confidence levels regarding the economic evaluation.
Results
The incremental cost effectiveness ratio for endoscopic management versus tracheostomy is $31,600.06 per quality-adjusted life year (QALY), indicating that endoscopic management is the cost-effective short-term strategy at a willingness-to-pay (WTP) threshold of $50,000/QALY. The probability that endoscopic management is more cost-effective than tracheostomy at this WTP is 65.1%. Threshold analysis demonstrated that the model is sensitive to both utilities and cost in the short-term scenario. When costs of long-term care are included, tracheostomy is dominated by endoscopic management, indicating the cost-effectiveness of endoscopic management at any WTP.
Conclusions
Endoscopic management of BVFP appears to be more cost-effective than tracheostomy. Though endoscopic cordotomy and arytenoidectomy require expertise and specialized equipment, this model demonstrates utility gains and long-term cost advantages to an endoscopic strategy. These findings are limited by the relative paucity of robust utility data and emphasize the need for further economic analysis in otolaryngology.
Level of Evidence
NA Laryngoscope, 2016
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Surgery-based versus radiation-based treatment strategy for a high metabolic volume laryngeal cancer
Objective/Hypothesis
We previously reported that the metabolic tumor volume (MTV) of a primary tumor was an independent prognostic factor for survival in laryngeal carcinoma treated by radiotherapy (RT)-based protocol. The purpose of this study was to evaluate the difference in survival outcomes between surgery-based and RT-based treatment in patients with a MTV laryngeal cancer.
Study Design
An individual retrospective cohort study.
Methods
We reviewed the records of 63 patients with laryngeal cancer showing a primary tumor with a high MTV value (≥ 4.9 mL). The patients were separated into two groups by primary treatment strategy: 22 patients were included in the surgery group, and 41 patients were included in the RT group. Clinical factors and treatment modalities were analyzed for their association with survival.
Results
Multivariate analysis, including age, sex, subsite, T classification, nodal metastasis, and treatment modality, showed that the subsite (hazard ratio [HR] 2.55, P = 0.043) and treatment modality (HR 3.98, P = 0.019) were independent predictors for survival. The Kaplan-Meier curves for 2-year relapse-free survival rates and overall survival rates for patients in the surgery and RT groups were 74.2% versus 38.8% (P = 0.025) and 80.1% versus 66.7% (P = 0.078).
Conclusions
Patients with a high metabolic volume laryngeal cancer treated by a surgery-based protocol showed better relapse-free survival and overall survival than did those undergoing RT-based treatment. Pretreatment MTV assessment could be useful in planning the treatment strategy for patients with a laryngeal cancer.
Level of Evidence
2b. Laryngoscope, 2016
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Secreted P-glycoprotein is a noninvasive biomarker of chronic rhinosinusitis
Objective
The discovery of noninvasive biomarkers of chronic rhinosinusitis (CRS) is critical to enable our ability to provide prognostic information and targeted medical therapy. Epithelial P-glycoprotein (P-gp) is overexpressed in CRS and exists in an extracellular, secreted form. The objective of this study was to determine whether secreted P-gp concentrations are elevated in CRS and can be used to predict disease severity.
Methods
Institutional review board-approved study examining mucus concentrations of P-gp in 36 patients (10 control, 16 CRS without nasal polyps [CRSsNP], and 10 CRS with nasal polyps [CRSwNP]). P-gp concentrations were determined by enzyme-linked immunosorbent assay and normalized to total protein (TP). Clinical indices of disease severity, including the Sino-Nasal Outcomes Test (SNOT-22) and Lund-Mackay score, were collected for all patients.
Results
Secreted P-gp concentration was significantly higher in CRS versus control patients (mean ± standard deviation; 247.8 ± 224.8 vs. 102.4 ± 81.7 pcg P-gp/μg TP, P = 0.022). A threshold value of 250 pcg/μg TP was used to differentiate low versus high secretors. High P-gp secretors with CRS (sNP and wNP, n = 9) demonstrated significantly higher SNOT-22 and Lund-Mackay scores (57.1 ± 7.9 and 13.9 ± 7.3) versus low secretors (38.3 ± 23.9 and 6.8 ± 7.3; P = 0.030 and P = 0.013, respectively) and had a significantly higher proportion of CRSwNP (66.7%) versus the low secretors (23.5%, n = 17, P = 0.046).
Conclusion
P-gp secretion levels are significantly elevated in patients with CRS. High P-gp secretion is associated with a higher incidence of CRSwNP and confers worse subjective and objective measures of disease severity. The presence of elevated P-gp secretion may therefore represent a novel noninvasive biomarker of CRS and could be used to predict patients who may benefit from P-gp inhibitory therapeutic strategies.
Level of Evidence
N/A. Laryngoscope, 2016
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Voice Therapy Effect on Mutational Falsetto Patients: A Vocal Aerodynamic Study
Source:Journal of Voice
Author(s): Fa-Ya Liang, Xiao-Ming Huang, Liang Chen, Yu-Zhang Huang, Xue-Yuan Zhang, Jin-Hui Su, Ya-Jing Wang, Jin-Shan Yang, Yi-Qing Zheng, Xiang-Sheng Mei, Zhong Guan
ObjectiveThe study aims to evaluate the effectiveness of voice therapy (VT) and analyze the vocal aerodynamic characteristics in mutational falsetto (MF) patients.MethodsFrom October 2010 through May 2014, 26 patients with MF at Sun Yat-sen Memorial Hospital were studied retrospectively. Vocal assessment, including the 10-item Voice Handicap Index (VHI-10), fundamental frequency (F0), and vocal aerodynamic parameters (subglottic pressure [SGP]), aerodynamic power [AP], mean expiratory airflow, and maximum phonation time [MPT]), was proceeded before and after VT.ResultsBefore VT, the mean F0, AP, and SGP of MF patients were significantly higher than Control Group, whereas mean MPT was significantly shorter. After a 4-week VT, the mean F0, AP, and SGP were decreased, and the mean MPT was significantly increased compared with the measurements obtained before VT. After the 4-week VT, the VHI-10 scores in 21 patients reverted to normal Control Group's level (Effective Subgroup), whereas the VHI-10 scores in the other 5 patients remained higher than the normal Control Group (Ineffective Subgroup). Subgroup analysis showed the mean AP and SGP of the Ineffective Subgroup were similar to the Control Group, whereas the Effective Subgroup showed higher AP and SGP. After the 4-week VT, MPT in both the Effective Subgroup and Ineffective Subgroup increased significantly, but AP and SGP in the Ineffective Subgroup did not change significantly.ConclusionVT is an effective treatment for MF patients with laryngeal hyperfunction. Most MF patients can return to normal voice in 4 weeks. Vocal aerodynamic examination can help in predicting the VT effect and deciding the treatment plan. MF patients without laryngeal hyperfunction may need longer VT period or other adjuvant treatment.
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Τρίτη 30 Αυγούστου 2016
Characteristics and Trends in Hypnotics Consumption in the Largest Health Care System in Israel
Objectives. To quantify and characterize hypnotics consumption habits among adult patients insured by Clalit Health Services (CHS), the largest health care provider in Israel, in 2000 and 2010. Methods. A retrospective analysis of CHS computerized pharmacy records. Data were collected for all patients over the age of 18 years who were prescribed hypnotics in 2000 and in 2010. Results. Sleep medications were consumed by 8.7% of the adult CHS population in 2000 and by 9.6% in 2010. About one-quarter of consumers were treated for more than 6 months in both years. Multiple sleeping drugs were consumed more often in 2010 (45.2%) than a decade before (22%). While in 2000 benzodiazepines accounted for 84.5% of hypnotics, in 2010 this was reduced to 73.7% (). Of all patients treated for longer than 6 months only 11% in 2000 and 9% in 2010 required a dose escalation suggesting the absence of tolerance. Conclusions. Nine percent of the Israeli population consumes hypnotics. There is a major increase in prescription of combination of medications between 2000 and 2010, with an increase in Z class medications use and reduction in benzodiazepines. Most patients chronically treated did not escalate dosage, suggesting the absence of tolerance.
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Binary mixture of Satureja hortensis and Origanum vulgare subsp. hirtum essential oils: in vivo therapeutic efficiency against Helicobacter pylori infection
Abstract
Background
Helicobacter pylori can cause many gastrointestinal and also extra-gastrointestinal disorders and is a major risk factor for gastric carcinoma and MALT lymphoma. Currently, numerous antibiotic-based therapies are available; however, these therapies have numerous drawbacks, mainly due to increasing prevalence of antibiotic resistant strains. Thus, there is an urgent need to develop novel therapeutic agents against H. pylori infections.
Materials and Methods
In this study, the anti-H. pylori activity of 2:1 mixture of Satureja hortensis and Origanum vulgare subsp. hirtum essential oils (2MIX) was investigated in vivo. After screening in vitro cytotoxicity of 2MIX on mammalian cell lines, the therapeutic efficiency was studied in a mouse model, where changes in H. pylori colonization were detected by PCR and histology of gastric samples. The immune reaction of mice was tested based on cytokine and chemokine production, and the in vivo toxicity of 2MIX was also investigated by measuring ALT and AST enzyme activities and Cyp3a11 and HO-1 mRNA levels in livers of mice.
Results
2MIX had not shown in vitro cytotoxicity against cell lines, only the highest concentration caused significant decrease in their survival rates. In the in vivo experiments, 2MIX successfully eradicated the pathogen in 70% of the mice. We could not detect toxicity or altered cytokine and chemokine balance after in vivo treatments in mice.
Conclusions
These results show that 2MIX is effective in reducing H. pylori colonization suggesting that this essential oil mixture has great potential as a new, effective, and safe therapeutic agent against H. pylori.
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Voice Therapy Effect on Mutational Falsetto Patients: A Vocal Aerodynamic Study
Publication date: Available online 30 August 2016
Source:Journal of Voice
Author(s): Fa-Ya Liang, Xiao-Ming Huang, Liang Chen, Yu-Zhang Huang, Xue-Yuan Zhang, Jin-Hui Su, Ya-Jing Wang, Jin-Shan Yang, Yi-Qing Zheng, Xiang-Sheng Mei, Zhong Guan
ObjectiveThe study aims to evaluate the effectiveness of voice therapy (VT) and analyze the vocal aerodynamic characteristics in mutational falsetto (MF) patients.MethodsFrom October 2010 through May 2014, 26 patients with MF at Sun Yat-sen Memorial Hospital were studied retrospectively. Vocal assessment, including the 10-item Voice Handicap Index (VHI-10), fundamental frequency (F0), and vocal aerodynamic parameters (subglottic pressure [SGP]), aerodynamic power [AP], mean expiratory airflow, and maximum phonation time [MPT]), was proceeded before and after VT.ResultsBefore VT, the mean F0, AP, and SGP of MF patients were significantly higher than Control Group, whereas mean MPT was significantly shorter. After a 4-week VT, the mean F0, AP, and SGP were decreased, and the mean MPT was significantly increased compared with the measurements obtained before VT. After the 4-week VT, the VHI-10 scores in 21 patients reverted to normal Control Group's level (Effective Subgroup), whereas the VHI-10 scores in the other 5 patients remained higher than the normal Control Group (Ineffective Subgroup). Subgroup analysis showed the mean AP and SGP of the Ineffective Subgroup were similar to the Control Group, whereas the Effective Subgroup showed higher AP and SGP. After the 4-week VT, MPT in both the Effective Subgroup and Ineffective Subgroup increased significantly, but AP and SGP in the Ineffective Subgroup did not change significantly.ConclusionVT is an effective treatment for MF patients with laryngeal hyperfunction. Most MF patients can return to normal voice in 4 weeks. Vocal aerodynamic examination can help in predicting the VT effect and deciding the treatment plan. MF patients without laryngeal hyperfunction may need longer VT period or other adjuvant treatment.
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Binary mixture of Satureja hortensis and Origanum vulgare subsp. hirtum essential oils: in vivo therapeutic efficiency against Helicobacter pylori infection
Abstract
Background
Helicobacter pylori can cause many gastrointestinal and also extra-gastrointestinal disorders and is a major risk factor for gastric carcinoma and MALT lymphoma. Currently, numerous antibiotic-based therapies are available; however, these therapies have numerous drawbacks, mainly due to increasing prevalence of antibiotic resistant strains. Thus, there is an urgent need to develop novel therapeutic agents against H. pylori infections.
Materials and Methods
In this study, the anti-H. pylori activity of 2:1 mixture of Satureja hortensis and Origanum vulgare subsp. hirtum essential oils (2MIX) was investigated in vivo. After screening in vitro cytotoxicity of 2MIX on mammalian cell lines, the therapeutic efficiency was studied in a mouse model, where changes in H. pylori colonization were detected by PCR and histology of gastric samples. The immune reaction of mice was tested based on cytokine and chemokine production, and the in vivo toxicity of 2MIX was also investigated by measuring ALT and AST enzyme activities and Cyp3a11 and HO-1 mRNA levels in livers of mice.
Results
2MIX had not shown in vitro cytotoxicity against cell lines, only the highest concentration caused significant decrease in their survival rates. In the in vivo experiments, 2MIX successfully eradicated the pathogen in 70% of the mice. We could not detect toxicity or altered cytokine and chemokine balance after in vivo treatments in mice.
Conclusions
These results show that 2MIX is effective in reducing H. pylori colonization suggesting that this essential oil mixture has great potential as a new, effective, and safe therapeutic agent against H. pylori.
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Progression of Brain Network Alterations in Cerebral Amyloid Angiopathy [Original Contribution]
Background and Purpose—
We recently showed that cerebral amyloid angiopathy (CAA) is associated with functionally relevant brain network impairments, in particular affecting posterior white matter connections. Here we examined how these brain network impairments progress over time.
Methods—Thirty-three patients with probable CAA underwent multimodal brain magnetic resonance imaging at 2 time points (mean follow-up time: 1.3±0.4 years). Brain networks of the hemisphere free of intracerebral hemorrhages were reconstructed using fiber tractography and graph theory. The global efficiency of the network and mean fractional anisotropies of posterior–posterior, frontal–frontal, and posterior–frontal network connections were calculated. Patients with moderate versus severe CAA were defined based on microbleed count, dichotomized at the median (median=35).
Results—Global efficiency of the intracerebral hemorrhage–free hemispheric network declined from baseline to follow-up (–0.008±0.003; P=0.029). The decline in global efficiency was most pronounced for patients with severe CAA (groupxtime interaction P=0.03). The decline in global network efficiency was associated with worse executive functioning (β=0.46; P=0.03). Examination of subgroups of network connections revealed a decline in fractional anisotropies of posterior–posterior connections at both levels of CAA severity (–0.006±0.002; P=0.017; groupxtime interaction P=0.16). The fractional anisotropies of posterior–frontal and frontal–frontal connections declined in patients with severe but not moderate CAA (groupxtime interaction P=0.007 and P=0.005). Associations were independent of change in white matter hyperintensity volume.
Conclusions—Brain network impairment in patients with CAA worsens measurably over just 1.3-year follow-up and seem to progress from posterior to frontal connections with increasing disease severity.
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Clinicopathology of Immunoglobulin G4-Related Chronic Sclerosing Sialadenitis: A Single-Center Study
Objectives
To investigate the clinicopathologic characteristics of patients with immunoglobulin G4–related chronic sclerosing sialadenitis (IgG4-RCSS), a recently recognized disease.
Study DesignCase series with chart review and pathology study.
SettingsTertiary care hospital.
Subjects and MethodsWe evaluated chronic sialadenitis specimens obtained over 11 years using pathologic examination and IgG4 immunohistochemistry staining. The specimens were assigned a revised diagnosis of IgG4-RCSS or chronic sialadenitis not otherwise specified, and clinicopathologic data from each group were compared.
ResultsOf the 84 patients, 21 were diagnosed with IgG4-RCSS and 63 with chronic sialadenitis not otherwise specified. IgG4-RCSS patients were older (68.2 ± 13.9 vs 54.2 ± 15.8 years, P = .001), predominantly male (85.7% vs 61.9%, P = .036), and more likely to present with painless swelling (75% vs 44.3%, P = .001) and bilateral involvement (52.4% vs 6.3%, P < .001). Ratio of IgG4-positive plasma cells to IgG-positive plasma cells in IgG4-RCSS tissues was 0.81 ± 0.14. The mean value of serum IgG4 in IgG4-RCSS patients was 918.8 mg/dL.
ConclusionIgG4-RCSS is more common in older male patients and frequently presents with bilateral involvement. Informing head and neck surgeons of the clinical features of IgG4-RCSS and promoting a combined approach of clinical evaluation, imaging, and biopsy can improve the accuracy of preoperative diagnoses.
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Is There a Need for Repeat Radiologic Examination of Children with Esophageal Coin Foreign Body?
Objectives
To determine factors associated with the passage of coins. To determine the need for repeat preoperative chest x-ray (CXR) for esophageal coin foreign body.
SettingAcademic tertiary care center.
DesignCase series with chart review.
Subjects and MethodsPatient information was retrieved from an Institutional Review Board–approved database. We identified 1359 children with esophageal coin foreign bodies from 2001 to 2013. Patients with both initial diagnostic and immediate preoperative CXR were included.
ResultsA total of 406 patients met inclusion criteria. The average age was 47 months (range, 1.8-194 months). On preoperative CXR, the position changed in 29 patients (7%). Age, type of coin, and location of coin were all statistically significant factors affecting the passage of the coin (P < .0001). Coins in the distal esophagus were 9.3 times more likely to pass than coins in the proximal esophagus. The longer the object was in the esophagus, the less likely it was to pass.
ConclusionsThis study characterizes when esophageal coins may pass. Age, type of coin, location of coin at initial x-ray, and length of time are all important considerations to determine if the coin will pass. This information may be used to counsel families about the likelihood of coins to pass and whether repeat x-ray is necessary prior to surgical removal. Additionally, it may be more cost-effective to obtain repeat films in select patients and prevent those from going to the operating theater who are more likely to pass the coin spontaneously.
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Feeding Tube Utilization in Patients with Salivary Gland Malignancies
Objectives
To evaluate feeding tube utilization in patients with salivary gland malignancies (SGMs).
Study DesignCase series with planned data collection.
SettingThe University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Subjects and MethodsPatients (N = 287) were sampled from an epidemiologic SGM registry during a 12-year period. Feeding tube history was retrospectively reviewed. Patients with outside locoregional therapy or palliative treatment were excluded. Enteral feeding and length of dependence were analyzed as a function treatment modality and site of SGM.
ResultsOf 287 patients, 79 (28%) required temporary nasogastric tube feeding (median duration: 13 days, interquartile range: 6-21). Among those 79, 30 (10% of total cohort) required conversion to percutaneous gastrostomy tube (G-tube). Median G-tube duration was 4.8 months (interquartile range: 3.7-13.1). G-tube placement was necessary only in patients receiving multimodality therapy (P < .001), and among those, 50% with SGMs arising from pharyngeal/laryngeal sites required G-tube, as compared with 8% to 19% of SGMs arising from all other sites (P < .01). At a median follow-up of 2.4 years, 9 (3%) of all SGM patients were G-tube dependent, but 14% (3 of 22) with laryngeal/pharyngeal sites treated with multimodality therapy remained chronically G-tube dependent.
ConclusionWhile almost 30% of SGM survivors require a temporary nasogastric tube, G-tube utilization is uncommon, in roughly 10% of SGM overall. G-tube utilization appears exclusive to patients treated with multimodality therapy, and chronic gastrostomy remains high (14%) in patients with minor gland cancers arising in the pharynx/larynx, suggesting impetus for dysphagia prophylaxis in these higher-risk subsets, similar to patients treated for squamous cancers.
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Medications for Allergic Rhinitis: An Opportunity for Quality Improvement?
Objectives
Adherence to the allergic rhinitis clinical practice guideline is being considered as a potential focus for national performance metrics. To help inform this discussion, we assessed patient- and clinician-reported medication administration among nationally representative populations of patients with allergic rhinitis.
Study DesignCross-sectional analyses.
Setting and SubjectsHome health assessments, ambulatory visits.
MethodsParticipants in the National Health and Nutrition Examination Survey and the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey were assessed. The primary outcomes were the percentage of patients reporting receipt of antihistamines and/or nasal steroids among those with allergy-related symptoms and the percentage for whom a clinician administered these medications when diagnosing allergic rhinitis. Secondary outcomes included assessments of those with worse quality of life, confirmatory allergy testing, and leukotriene receptor antagonist use.
ResultsWithin the National Health and Nutrition Examination Survey, an estimated 29.2 million patients were diagnosed with "hay fever," while 92.2 million were diagnosed with "allergies." Patients with symptoms of allergic rhinitis reported that antihistamines or nasal steroids were prescribed in 21.1% to 24.0% of cases. Leukotriene receptor antagonists were given to 1.7% of those without asthma or use of other allergy medications. Within the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey, observations representing 149.5 million visits for allergic rhinitis demonstrated that nasal steroids were administered in 29.6% of cases, while nonsedating and sedating antihistamines were given in 22.4% and 17.2%, respectively.
ConclusionsDespite a high prevalence of allergic rhinitis, per patient report and clinician entry, a substantial number of affected patients do not receive antihistamines and nasal steroids.
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Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis
Objective
To use combined pre- and postsurgical olfactory outcomes to assess the impact of endoscopic sinus surgery on chronic rhinosinusitis–related olfactory impairment.
Data SourcesCINAHL, Cochrane, OVID, EMBASE, PubMed, and SCOPUS. Each database was searched from inception up to October 2015.
Review MethodsStudies were included that reported subjective or objective olfactory data in chronic rhinosinusitis patients before and after endoscopic sinus surgery.
ResultsThirty-one studies were used in the meta-analysis. Weighted mean differences of olfactory measures demonstrated significant improvement in mixed CRS patients (those with and without polyps) through visual analog scales (–0.83, P = .001), altered taste/smell item on Sinonasal Outcome Test (–1.32, P < .00001), 40-item Smell Identification Test (3.49, P = .0010), and Sniffin' Sticks identification (0.34, P = .03). Chronic rhinosinusitis mixed patients demonstrated nonsignificant improvements via Sniffin' Sticks threshold (1.60, P = .16) and Brief Smell Identification Test (0.20, P = .32). When separated, polyp patients and dysosmic patients experienced the highest levels of olfactory improvement. Polyp patients improved by 7.87 (P = .006) on the 40-item Smell Identification test, 11.54 (P < .0001) with the Sniffin' Sticks total score, and 2.57 (P < .00001) through Sniffin' Sticks identification. Dysosmic patients improved by 5.75 via the 40-item Smell Identification Test (P = .0001).
ConclusionEndoscopic sinus surgery improves nearly all subjective and objective measures of olfaction in chronic rhinosinusitis patients. Patients with nasal polyposis or preoperative olfactory dysfunction improve to a greater degree.
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New MA Recruits Join the School – See the Photos!
Last Thursday (8/25/2016), SLHS welcomed the new Master's students at the annual pizza party! Our new recruits for the MA education program in speech-language pathology are excited to join the school! They were able to mingle with the second year MA students, doctoral students, and faculty, and learn more about life in SLHS.
Welcome to the new recruits!
[See image gallery at slhs.sdsu.edu]
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Middle ear ventilation status postoperatively after translabyrinthine resection of vestibular schwannoma with mastoid obliteration and Eustachian tube occlusion: is the Eustachian tube enough to ventilate the middle ear without the mastoid air cell system?
Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in th...
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Propofol inhibits carbachol-induced chloride secretion by directly targeting the basolateral K+ channel in rat ileum epithelium
Abstract
Background
Propofol is a widely used intravenous general anesthetic. Acetylcholine (ACh) is critical in controlling epithelial ion transport. This study was to investigate the effects of propofol on ACh-evoked secretion in rat ileum epithelium.
Methods
The Ussing chamber technique was used to investigate the effects of propofol on carbachol (CCh)-evoked short-circuit currents (Isc).
Key Results
Propofol (10−2–10−6 mol/L) attenuated CCh-evoked Isc of rat ileum mucosa in a dose-dependent manner. The inhibitory effect of propofol was only evident after application to the serosal side. Pretreatment with tetrodotoxin (TTX, 0.3 μmol/L, n=5) had no effect on propofol-induced inhibitory effect, whereas serosal application of K+ channel inhibitor, glibenclamide, but not, an ATP-sensitive K+ channel inhibitor, largely reduced the inhibitory effect of propofol. In addition, pretreatment with either hexamethonium bromide (HB, nicotinic nACh receptor antagonist) or Cl− channel blockers niflumic acid and cystic fibrosis transmembrane conductance regulator (inh)-172 did not produce any effect on the propofol-induced inhibitory effect.
Conclusions & Inferences
Propofol inhibits CCh-induced intestinal secretion by directly targeting basolateral K+ channels.
The aim of this study was to investigate the effects of propofol on carbachol (CCh)-evoked short-circuit currents (Isc). The results show that propofol inhibits CCh-induced intestinal secretion by directly targeting basolateral K+ channels.
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Proton pump inhibitor monotherapy and the risk of cardiovascular events in patients with gastro-esophageal reflux disease: a meta-analysis
Abstract
Background and Purpose
Proton pump inhibitors (PPIs) are commonly used as potent gastric acid secretion antagonists for gastro-esophageal disorders and their overall safety in patients with gastro-esophageal reflux disease (GERD) is considered to be good and they are well-tolerated. However, recent studies have suggested that PPIs may be a potential independent risk factor for cardiovascular adverse events. The aim of our meta-analysis was to examine the association between PPI monotherapy and cardiovascular events in patients with GERD.
Methods
A literature search involved examination of relevant databases up to July 2015 including PubMed, Cochrane Library, EMBASE, and ClinicalTrial.gov, as well as selected randomized controlled trials (RCTs) reporting cardiovascular events with PPI exposure in GERD patients. In addition, the pooled risk ratio (RR) and heterogeneity were assessed based on a fixed effects model of the meta-analysis and the I2 statistic, respectively.
Key Results
Seventeen RCTs covering 7540 patients were selected. The pooled data suggested that the use of PPIs was associated with a 70% increased cardiovascular risk (RR=1.70, 95% CI: [1.13–2.56], P=.01, I2=0%). Furthermore, higher risks of adverse cardiovascular events in the omeprazole subgroup (RR=3.17, 95% CI: [1.43–7.03], P=.004, I2=25%) and long-term treatment subgroup (RR=2.33, 95% CI: [1.33–4.08], P=.003, I2=0%) were found.
Conclusion & Inferences
PPI monotherapy can be a risk factor for cardiovascular adverse events. Omeprazole could significantly increase the risk of cardiovascular events and, so, should be used carefully.
In the light of the results of our meta-analysis, PPI therapy is associated with a 70% increased risk of cardiovascular events in patients with GERD. Omeprazole could significantly increase the risk of cardiovascular events. Thus, we believe that doctors should be advised to carefully consider the use of PPIs in clinical situations, and try to choose the best treatment option for each patient.
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Effect of the premedication with oral clonidine on surgical comfort in patients undergoing fess due to advanced nasal polyposis: A randomized double blind clinical trial
The obejective of this randomized double blind study was to evaluate effect of the premedication with oral clonidine on blood pressure, cleaning of surgical site and bleeding in the ESS performed due to advanced NP.
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Middle ear ventilation status postoperatively after translabyrinthine resection of vestibular schwannoma with mastoid obliteration and Eustachian tube occlusion: is the Eustachian tube enough to ventilate the middle ear without the mastoid air cell system?
Abstract
Background
Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in this process; however, the extent that each of these factors contributes to overall middle ear ventilation is unknown. The objective of this study was to determine if the ET alone can maintain normal middle ear pressure without the MACS. To do this, we reviewed subjects who had their MACS completely removed with translabyrinthine (TL) surgery for vestibular schwannoma.
Methods
A retrospective chart review was done to collect pre and postoperative tympanometry data from patients who underwent resection of vestibular schwannoma. Data from the operative side was compared to the non-operative side at 2 years post-op.
Results
Twenty-four patients were included in this study. Of these, 63 % achieved a type A tympanogram at 2 years post-op in the TL resection group, implying an ability to maintain middle ear pressure in the absence of a mastoid cavity. Because some had negative pressures post TL resection, the average change in pre and postoperative pressure was -37.5 daPa for the operative side and 7.8 daPa for the non-operative side. This was significantly different.
Discussion
The difference for change in pre and postoperative pressure and compliance between operative and non-operative side might be expected from the ET plugging during TL resection. However, more interesting are those patients in whom the ET presumably reopens, and in these subjects, despite having no mastoid compartment at all, and the space obliterated with fat, they were still able to maintain normal ventilation of the middle ear space.
Conclusion
Our findings imply that the ET alone is adequate to ventilate at least the reduced middle ear space following TL surgery in most subjects, and perhaps in 100 % if the ET hadn't been plugged during surgery. Hence, the mastoid air cell system, even when healthy, is not needed to maintain air in the middle year cleft.
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Long-term safety and efficacy of bilastine following up to 12 weeks or 52 weeks of treatment in Japanese patients with allergic rhinitis: Results of an open-label trial
Bilastine is a novel second-generation antihistamine. This open-label, single-arm, phase III study evaluated the safety and efficacy of long-term treatment with bilastine in Japanese patients with seasonal (SAR) or perennial allergic rhinitis (PAR).
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Prognostic role of negative plasma EBV DNA level in patients with NPC
I read with great interest the study published by Lu et al. [1]. Authors very nicely evaluated the prognostic effect of combining tumor volume with pre-treatment plasma Epstein-Barr virus DNA (EBV DNA) in patients treated with intensity-modulated radiotherapy in nasopharyngeal carcinoma (NPC) patients. Briefly, they analyzed 3 different threshold values for probable prognostic role of gross tumor volume of nasopharynx and plasma EBV DNA level. They found that 20cc and 6800 copies/mL are threshold values for a statistically significant difference.
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Nationwide epidemiological study of insomnia in Japan
• A Japanese nationwide epidemiological study of insomnia with new criteria.• The prevalence of insomnia was 12.2% in men and 14.6% in women.• Insomnia-associated factors (men): unemployment, and poor mental health.• Insomnia-associated factors (women): age, years of schooling, and poor mental health.• There were no significant associations between insomnia and season or region.
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Sleep quality in temporomandibular disorder cases
• The prevalence of poor sleep quality was 60.3% in temporomandibular disorder (TMD) patients.• Sleep quality was significantly impaired in TMD patients with dysfunctional pain.• Sleep quality was similar in TMD patients with pain-free diagnoses and healthy controls.• Sleep quality assessment is suggested in TMD patients with pain-related diagnoses.• Sleep quality assessment is highly recommended when dysfunctional pain is present.
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Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975–2012) – A socioeconomic perspective
Cancers of the oral cavity and oropharynx are amongst the most common cancers worldwide, with approximately 442,760 incident cases and 241,418 deaths reported in 2012 [1]. Collectively, these head and neck cancers are the seventh most common in terms of incidence and the ninth most common cause of death in the world [2].
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A cohort study into head and neck cancer mortality in Belgium (2001–11): Are individual socioeconomic differences conditional on area deprivation?
Previous studies have observed substantial geographic differences in incidence of and premature mortality from head and neck cancer (HNC) in Belgium [1–3]. Higher premature mortality (ages 1–74) from HNC has been observed in the southern part of Belgium (the Walloon Region) compared with the northern part (the Flemish Region) [1]. At a lower geographic level, the spatial pattern of premature HNC mortality follows a clear spatial pattern of low mortality in the north-eastern districts and high mortality parallel to the French border [2].
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Quantitative body mass characterization before and after head and neck cancer radiotherapy: A challenge of height-weight formulae using computed tomography measurement
Patients with head and neck cancer (HNC) commonly experience major weight loss, both prior to and during therapy, which is associated with poor functional and survival outcomes. Weight loss in cancer patients result from both cancer-associated metabolic states, as well as cancer treatment toxicity sequelae. For HNC, the latter are especially pronounced, and include mucositis, xerostomia, dysphagia and nausea/vomiting. These symptoms can lead to poor oral intake and weight loss, with a resultant change in body composition.
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Low etiologic fraction for human papillomavirus in larynx squamous cell carcinoma
Human papillomavirus (HPV) type 16 is an established cause of oropharyngeal squamous cell carcinoma (OPSCC) [1]. However, two meta-analyses and worldwide surveys observe substantial variability in the proportion of OPSCC attributable to HPV infection across geographic regions [2,3]. Of considerable public health interest is the proportion of non-oropharyngeal, head and neck squamous cell carcinomas (HNSCC) that may be attributable to HPV infection, as they may be theoretically preventable with HPV vaccines.
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Dyslexia Limits the Ability to Categorize Talker Dialect
Purpose
The purpose of this study was to determine whether the underlying phonological impairment in dyslexia is associated with a deficit in categorizing regional dialects. Method
Twenty adults with dyslexia, 20 school-age children with dyslexia, and 40 corresponding control listeners with average reading ability listened to sentences produced by multiple talkers (both sexes) representing two dialects: Midland dialect in Ohio (same as listeners' dialect) and Southern dialect in Western North Carolina. Participants' responses were analyzed using signal detection theory. Results
Listeners with dyslexia were less sensitive to talker dialect than listeners with average reading ability. Children were less sensitive to dialect than adults. Under stimulus uncertainty, listeners with average reading ability were biased toward Ohio dialect, whereas listeners with dyslexia were unbiased in their responses. Talker sex interacted with sensitivity and bias differently for listeners with dyslexia than for listeners with average reading ability. The correlations between dialect sensitivity and phonological memory scores were strongest for adults with dyslexia. Conclusions
The results imply that the phonological deficit in dyslexia arises from impaired access to intact phonological representations rather than from poorly specified representations. It can be presumed that the impeded access to implicit long-term memory representations for indexical (dialect) information is due to less efficient operations in working memory, including deficiencies in utilizing talker normalization processes.from #Audiology via xlomafota13 on Inoreader http://ift.tt/2bA2Fu5
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Screening for Language Delay: Growth Trajectories of Language Ability in Low- and High-Performing Children
Purpose
This study investigated the stability and growth of preschool language skills and explores latent class analysis as an approach for identifying children at risk of language impairment. Method
The authors present data from a large-scale 2-year longitudinal study, in which 600 children were assessed with a language-screening tool (LANGUAGE4) at age 4 years. A subsample (n = 206) was assessed on measures of sentence repetition, vocabulary, and grammatical knowledge at ages 4, 5, and 6 years. Results
A global latent language factor showed a high degree of longitudinal stability in children between the ages of 4 to 6 years. A low-performing group showing a language deficit compared to their age peers at age 4 was identified on the basis of the LANGUAGE4. The growth-rates during this 2-year time period were parallel for the low-performing and 3 higher performing groups of children. Conclusions
There is strong stability in children's language skills between the ages of 4 and 6 years. The results demonstrate that a simple language screening measure can successfully identify a low-performing group of children who show persistent language weaknesses between the ages of 4 and 6 years.from #Audiology via xlomafota13 on Inoreader http://ift.tt/2bzOjPf
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m-TOR inhibitor as potential radiosensitizer for head and neck squamous cell carcinoma: A case report of an organ transplant patient and review of the literature
Publication date: Available online 30 August 2016
Source:Oral Oncology
Author(s): Amaury Daste, Erwan de Mones, Charles Dupin, Louis François, Alain Ravaud, Laurence Digue
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Involving Patients in Weighting Benefits and Harms of Treatment in Parkinson's Disease
by Marieke G. M. Weernink, Janine A. van Til, Jeroen P. P. van Vugt, Kris L. L. Movig, Catharina G. M. Groothuis-Oudshoorn, Maarten J. IJzerman
IntroductionLittle is known about how patients weigh benefits and harms of available treatments for Parkinson's Disease (oral medication, deep brain stimulation, infusion therapy). In this study we have (1) elicited patient preferences for benefits, side effects and process characteristics of treatments and (2) measured patients' preferred and perceived involvement in decision-making about treatment.
MethodsPreferences were elicited using a best-worst scaling case 2 experiment. Attributes were selected based on 18 patient-interviews: treatment modality, tremor, slowness of movement, posture and balance problems, drowsiness, dizziness, and dyskinesia. Subsequently, a questionnaire was distributed in which patients were asked to indicate the most and least desirable attribute in nine possible treatment scenarios. Conditional logistic analysis and latent class analysis were used to estimate preference weights and identify subgroups. Patients also indicated their preferred and perceived degree of involvement in treatment decision-making (ranging from active to collaborative to passive).
ResultsTwo preference patterns were found in the patient sample (N = 192). One class of patients focused largely on optimising the process of care, while the other class focused more on controlling motor-symptoms. Patients who had experienced advanced treatments, had a shorter disease duration, or were still employed were more likely to belong to the latter class. For both classes, the benefits of treatment were more influential than the described side effects. Furthermore, many patients (45%) preferred to take the lead in treatment decisions, however 10.8% perceived a more passive or collaborative role instead.
DiscussionPatients weighted the benefits and side effects of treatment differently, indicating there is no "one-size-fits-all" approach to choosing treatments. Moreover, many patients preferred an active role in decision-making about treatment. Both results stress the need for physicians to know what is important to patients and to share treatment decisions to ensure that patients receive the treatment that aligns with their preferences.
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Gastric pull-up reconstruction after treatment for advanced hypopharyngeal and cervical esophageal cancer
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): Y. Marion, G. Lebreton, C. Brévart, T. Sarcher, A. Alves, E. Babin
ObjectivesIn advanced hypopharyngeal and cervical esophageal carcinoma, the choice of reconstruction technique after total circumferential pharyngolaryngectomy (TCPL) remains controversial. We studied results of digestive tract reconstruction using gastric pull-up, concomitant or secondary to TCPL or after failure of reconstruction.Material and methodsTwenty-four patients treated by gastric pull-up after TCPL for advanced hypopharyngeal or cervical esophageal carcinoma between December 1998 and January 2011 were retrospectively reviewed.ResultsTwo-year survival was 37.5% (n=9). Thirty-day mortality was 4.1% (n=1), but 3 more patients died before discharge. Perioperative morbidity was 54.1% (n=13), including 9 fistulas (37.5%). Seventeen patients (71%) recovered oral feeding.ConclusionGastric pull-up is an interesting reconstruction technique after TCPL with invasion of the esophageal mouth, allowing comfortable oral feeding, but with non-negligible morbidity and mortality. Long-term survival is not high, partly due to the unfavorable prognosis of advanced hypopharyngeal and cervical esophageal tumor. The present high rate of fistula raises doubts for this surgery as second-line reconstruction after primary failure.
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Primary rhabdomyosarcoma of the thyroid in an adult with auricular thrombosis
Publication date: Available online 29 August 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): B. Febrero, I. Oviedo, A. Ríos, J.M. Rodríguez
IntroductionRhabdomyoscarcoma (RMS) is the most common soft-part tumour in children, however, it is infrequent in adults. Thyroid involvement is exceptional and only four cases have been reported: two primary RMS in children and another two cases in young adults with RMS metastasis to the thyroid. We report the first case in the literature of a primary adult RMS with thyroid involvement and superior vena cava syndrome.Case presentationA 67-year-old male was admitted for an oedema of the arm extending to the laterocervical region. Computed tomography showed a 6cm mass in the hemithyroid with venous thrombosis to the auricle. Fine-needle aspiration was compatible with Bethesda category III. Surgery revealed a stone-hard consistency thyroid. An intraoperative biopsy showed an undifferentiated neoplasia, and no additional surgical intervention was undertaken. The patient died 48hours later. Definitive histology showed a RMS.DiscussionVenous thrombosis due to a thyroid tumour is infrequent. The scarce information in the literature recommends that thyroid carcinomas with auricular thrombosis be resected as soon as they are diagnosed. However, in cases of anaplastic or poorly differentiated carcinomas is controversial. Had there been a preoperative diagnosis in the histology in our case, surgery would not have been indicated.
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