The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas

Publication date: Available online 31 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Isabela de Oliveira Amui, José Vicente Tagliarini, Emanuel C. Castilho, Mariângela de Alencar Marques, Yoshio Kiy, José Eduardo Corrente, Gláucia M.F.S. Mazeto
IntroductionEndogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce.ObjectiveTo assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma.MethodsThe medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence.ResultsPersistence/recurrence occurred in 27.6% of the cases. These patients were identified according to the following parameters: receiving more than one ¹³¹iodine dose (100% vs. 0%; p<0.0001); accumulated ¹³¹iodine dose (232.14±99.09 vs. 144±33.61mCi; p<0.0001); presented active disease in the last assessment (53.3% vs. 0%; p<0.0001); follow-up time (103.07±61.27 vs. 66.85±70.14 months; p=0.019); and 1st stimulated thyroglobulin (19.01±44.18 vs. 2.19±2.54ng/dL; p<0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio=1.242; 95% confidence interval: 1.022–1.509; p=0.029] and follow-up time (odds ratio=1.027; 95% confidence interval: 1.007–1.048; p=0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve=0.713 (p=0.019)].ConclusionThe first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.



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Downregulation of Notch4 – a prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma

Publication date: Available online 31 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): M.K. Harishankar, A. Mathan Mohan, A. Vinod Krishnan, Devi Arikketh
IntroductionOral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them.ObjectiveIn search of a critical diagnostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma, Notch4 receptor, one of the key regulatory molecules of the Notch signaling family has been aberrantly activated in the progression of several types of tumors. However its function in oral verrucous carcinoma remains unexplored. Thus the present study aims in determining the differential expression pattern of Notch4 in oral verrucous carcinoma and oral squamous cell carcinoma.MethodsTen patients reported positive for oral cancer (5 patients with oral verrucous carcinoma and 5 patients with oral squamous cell carcinoma). Five normal tissue samples were also obtained and evaluated for clinicopathological parameters and immunohistochemistry, western blotting and RT-PCR for Notch4 expression.ResultsOur results reveal that the expression of Notch4 was considerably high in oral squamous cell carcinoma lesions compared to normal tissue, whereas in oral verrucous carcinoma, irrespective of the clinicopathological features, complete regulação descendente of Notch4 was observed.ConclusionsThese preliminary findings strongly support the fact that Notch4 is downregulated in oral verrucous carcinoma and could be considered as a suitable prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma. This distinguishing marker can help in improving therapeutic options in patients diagnosed with oral verrucous carcinoma.



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The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas

Publication date: Available online 31 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Isabela de Oliveira Amui, José Vicente Tagliarini, Emanuel C. Castilho, Mariângela de Alencar Marques, Yoshio Kiy, José Eduardo Corrente, Gláucia M.F.S. Mazeto
IntroductionEndogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce.ObjectiveTo assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma.MethodsThe medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence.ResultsPersistence/recurrence occurred in 27.6% of the cases. These patients were identified according to the following parameters: receiving more than one ¹³¹iodine dose (100% vs. 0%; p<0.0001); accumulated ¹³¹iodine dose (232.14±99.09 vs. 144±33.61mCi; p<0.0001); presented active disease in the last assessment (53.3% vs. 0%; p<0.0001); follow-up time (103.07±61.27 vs. 66.85±70.14 months; p=0.019); and 1st stimulated thyroglobulin (19.01±44.18 vs. 2.19±2.54ng/dL; p<0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio=1.242; 95% confidence interval: 1.022–1.509; p=0.029] and follow-up time (odds ratio=1.027; 95% confidence interval: 1.007–1.048; p=0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve=0.713 (p=0.019)].ConclusionThe first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.



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The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas

Publication date: Available online 31 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Isabela de Oliveira Amui, José Vicente Tagliarini, Emanuel C. Castilho, Mariângela de Alencar Marques, Yoshio Kiy, José Eduardo Corrente, Gláucia M.F.S. Mazeto
IntroductionEndogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce.ObjectiveTo assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma.MethodsThe medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence.ResultsPersistence/recurrence occurred in 27.6% of the cases. These patients were identified according to the following parameters: receiving more than one ¹³¹iodine dose (100% vs. 0%; p<0.0001); accumulated ¹³¹iodine dose (232.14±99.09 vs. 144±33.61mCi; p<0.0001); presented active disease in the last assessment (53.3% vs. 0%; p<0.0001); follow-up time (103.07±61.27 vs. 66.85±70.14 months; p=0.019); and 1st stimulated thyroglobulin (19.01±44.18 vs. 2.19±2.54ng/dL; p<0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio=1.242; 95% confidence interval: 1.022–1.509; p=0.029] and follow-up time (odds ratio=1.027; 95% confidence interval: 1.007–1.048; p=0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve=0.713 (p=0.019)].ConclusionThe first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.



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Genetic Hearing Loss: A Comprehensive Review

Hearing loss can be attributed to a variety of inherited and environmental noises (medications, infections, etc.). In recent decades, our improved understanding of genetics, molecular biology, and audiologic pathways has led to the discovery of a variety of Hereditary Hearing Impairments (HHI). HHI can be categorized as syndromic HL and non-syndromic HL, in which HL is associated with other pathophysiological manifestations. Currently, greater than 300 syndromic HLs are recognized, while more than 100 chromosomal loci and 40 genes are attributed for non-syndromic HLs. Improved understanding of the genes impaired in HL, including their structure and function, will soon lead to improvements in screening and possibly treatments. The following is a review of genetic HL where we discuss the definition, classifications, etiology, epidemiology, recognized syndromes, genetics, diagnostics, and screening methods of HL.

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Ménière's Disease: Current and Potential New Objective Measures Using Electrocochleography

The characteristic manifestations of Ménière's disease (MD) are mainly subjective, making MD difficult for physicians to diagnose without objective confirmation. A classic electrophysiologic technique for objective diagnosis of MD is electrocochleography (ECochG) to slow stimulus rates. This review will provide information regarding the sensitivity, specificity, and limitations of the conventional click and frequency specific ECochG measures. In addition, the paper will discuss two novel, promising techniques: fast click ECochG with the use of continuous loop averaging deconvolution (CLAD) and the auditory nerve overlapped waveform (ANOW). These new techniques may offer a new way in diagnosing MD through assessing neural adaptation and function of the apical half of the cochlear spiral.

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Coordinator's Column

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A Review of Human Immunodeficiency Virus on the Auditory System

There are an increasing number of large-scale studies on the association between human immunodeficiency virus (HIV) and hearing loss; these studies include both HIV-infected adults from horizontal disease transmission to HIV-infected children from vertical disease transmission in utero. With advances in HIV treatment approaches, this disease has become a chronic health condition rather than a terminal health condition. Based on recent data in this area, mechanisms within the auditory system are at risk based on HIV status. HIV-infected children have poorer hearing compared to perinatally exposed to HIV, but uninfected children. HIV-infected children also have poorer hearing compared to HIV-unexposed, uninfected children. HIV-infected adults also have poorer hearing compared with HIV-uninfected adults. Individuals with greater HIV disease severity had poorer hearing than HIV-infected individuals with lesser HIV disease severity. Auditory brainstem response data demonstrate poor waveform morphology, lower peak amplitude, increased peak and interpeak latencies in HIV-infected individuals. Conversely, distortion product otoacoustic emission data are similar for HIV-infected and HIV-uninfected individuals status. Taken together, differences in hearing sensitivity based on HIV status may be a result of auditory neural function, although large-scale studies are currently ongoing to further examine these risk factors of HIV on the auditory system.

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Intelligibility of Synthetic Speech for Normal-Hearing and Hearing-Impaired Listeners

This study examined the perceived intelligibility of synthetic speech. Participants were adults aged 49–69, one group with normal hearing and one group with acquired sensorineural hearing impairment. Word lists were presented in two speech types: DECtalk (a high-quality speech synthesizer) and a natural male speaker. Results revealed differences between groups, with normal-hearing listeners scoring higher than hearing-impaired listeners, and between speech types, with higher scores for natural speech than for synthesized speech. There was no significant interaction of hearing level and speech type.

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Comments on "Concomitant Speech and Language Disorders in Stuttering Children: A Critique of the Literature"

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Genetic Hearing Loss: A Comprehensive Review

Hearing loss can be attributed to a variety of inherited and environmental noises (medications, infections, etc.). In recent decades, our improved understanding of genetics, molecular biology, and audiologic pathways has led to the discovery of a variety of Hereditary Hearing Impairments (HHI). HHI can be categorized as syndromic HL and non-syndromic HL, in which HL is associated with other pathophysiological manifestations. Currently, greater than 300 syndromic HLs are recognized, while more than 100 chromosomal loci and 40 genes are attributed for non-syndromic HLs. Improved understanding of the genes impaired in HL, including their structure and function, will soon lead to improvements in screening and possibly treatments. The following is a review of genetic HL where we discuss the definition, classifications, etiology, epidemiology, recognized syndromes, genetics, diagnostics, and screening methods of HL.

http://article/19/2/64/2475846/Genetic-Hearing-Loss-A-Comprehensive-Review

Ménière's Disease: Current and Potential New Objective Measures Using Electrocochleography

The characteristic manifestations of Ménière's disease (MD) are mainly subjective, making MD difficult for physicians to diagnose without objective confirmation. A classic electrophysiologic technique for objective diagnosis of MD is electrocochleography (ECochG) to slow stimulus rates. This review will provide information regarding the sensitivity, specificity, and limitations of the conventional click and frequency specific ECochG measures. In addition, the paper will discuss two novel, promising techniques: fast click ECochG with the use of continuous loop averaging deconvolution (CLAD) and the auditory nerve overlapped waveform (ANOW). These new techniques may offer a new way in diagnosing MD through assessing neural adaptation and function of the apical half of the cochlear spiral.

http://article/19/2/44/2475844/M%C3%A9ni%C3%A8res-Disease-Current-and-Potential-New

Spoken and Written English Errors of Postsecondary Students with Severe Hearing Impairment

This investigation compared the spoken and written English errors of 20 hearing-impaired postsecondary students with intelligible speech and poor English language. Error categories used to assess the language samples were function, content, and structure. Spoken and written performances were distinguished only by a greater number of function word errors in writing samples. A trend toward greater complexity in writing was also found. Implications for instruction are discussed.

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A Review of Human Immunodeficiency Virus on the Auditory System

There are an increasing number of large-scale studies on the association between human immunodeficiency virus (HIV) and hearing loss; these studies include both HIV-infected adults from horizontal disease transmission to HIV-infected children from vertical disease transmission in utero. With advances in HIV treatment approaches, this disease has become a chronic health condition rather than a terminal health condition. Based on recent data in this area, mechanisms within the auditory system are at risk based on HIV status. HIV-infected children have poorer hearing compared to perinatally exposed to HIV, but uninfected children. HIV-infected children also have poorer hearing compared to HIV-unexposed, uninfected children. HIV-infected adults also have poorer hearing compared with HIV-uninfected adults. Individuals with greater HIV disease severity had poorer hearing than HIV-infected individuals with lesser HIV disease severity. Auditory brainstem response data demonstrate poor waveform morphology, lower peak amplitude, increased peak and interpeak latencies in HIV-infected individuals. Conversely, distortion product otoacoustic emission data are similar for HIV-infected and HIV-uninfected individuals status. Taken together, differences in hearing sensitivity based on HIV status may be a result of auditory neural function, although large-scale studies are currently ongoing to further examine these risk factors of HIV on the auditory system.

http://article/19/2/55/2475845/A-Review-of-Human-Immunodeficiency-Virus-on-the

Taxonomies in Biology, Phonetics, Phonology, and Speech Motor Control

This article begins with a review explaining the different purposes of biological taxonomies. Taxonomic units are often dependent on the purpose for which the taxonomy has been constructed. Biological taxonomies provide an analogy that we use to emphasize some of the distinctions among the units of phonetic transcription systems, competence phonologies, and performance phonologies. The units of both phonology and phonetic transcription are considered as possible units of the speech motor system, and some of the difficulties of this assumption are explained. Although phonemic units, like units of phonetic transcription, are useful for many purposes, it is not theoretically necessary to use units derived as part of competence phonologies in systems attempting to explain phonological performance or speech motor performance. In this regard, we challenge the concept of coarticulation, because it is based on assumptions about the role of phonological or phonetic units in speech motor control. We offer an integrated perspective that has implications for research in speech motor control and deficits of the speech motor system. We see speech motor deficits as distinct from, yet possibly interacting with, phonological deficits.

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Intelligibility of Synthetic Speech for Normal-Hearing and Hearing-Impaired Listeners

This study examined the perceived intelligibility of synthetic speech. Participants were adults aged 49–69, one group with normal hearing and one group with acquired sensorineural hearing impairment. Word lists were presented in two speech types: DECtalk (a high-quality speech synthesizer) and a natural male speaker. Results revealed differences between groups, with normal-hearing listeners scoring higher than hearing-impaired listeners, and between speech types, with higher scores for natural speech than for synthesized speech. There was no significant interaction of hearing level and speech type.

http://article/55/4/751/1775652/Intelligibility-of-Synthetic-Speech-for

Fast Mapping of Words in Event Contexts by Children with Down Syndrome

Fast mapping of novel words for objects was compared in 48 children and adolescents with Down syndrome (ages 5:6-20:6), who were delayed in expressive language acquisition compared to mental age, and 48 normally developing children matched for mental age (chronological ages 2:0-6:0). Normal and Down syndrome groups did not differ in their ability to infer a connection between the novel word and referent (100% vs. 100%), to comprehend the novel word after a single exposure (83% vs. 73%), and to recall the location in which they hid the novel referent (83% vs. 75%). Nor did they differ in their ability to produce the novel word correctly (at least two out of three phonemes in order: 48% vs. 40%). When retested after an hour of other activity, only the production task showed a significant, and comparable, decrement. Comparing youngest and oldest quarters of each group showed improved memory for location in both, improved comprehension in the Down syndrome group, and improved production in the control group. Adults (n=12), in contrast, performed perfectly on all tasks except the delayed word production. Neither intelligibility differences nor use of real word labels accounts for the failure to find a difference between groups. Fast mapping skills were unrelated to expressive language deficit in these children with Down syndrome.

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Effects of Repair Strategies on Visual Identification of Sentences

This investigation determined whether information elicited by repair strategies enhances an individual's ability to lipread a misperceived sentence. Five groups of subjects were each assigned one of five repair strategies: (a) asking the talker to repeat a sentence, (b) simplify it, (c) rephrase it, (d) say an important keyword, and (e) speak two sentences. Subjects viewed sentences spoken by six different talkers. When a subject did not recite a sentence verbatim, the talker performed the assigned repair strategy and then repeated the original sentence. A control group of subjects saw only the original sentence repeated twice. All five test groups demonstrated a significantly greater improvement for the second presentation score (referenced to the first presentation score) than the control group. The benefits provided by the repair strategies were independent of the talker, and benefits did not differ significantly among the groups.

http://article/55/4/621/1775639/Effects-of-Repair-Strategies-on-Visual

The Relationship between Communication Problems and Psychological Difficulties in Persons with Profound Acquired Hearing Loss

Communication strategies, accommodations to deafness, and perceptions of the communication environment by profoundly deaf subjects were correlated with indices of psychosocial adjustment to determine whether accommodations to deafness could play a role in the presence of psychological difficulties among deaf persons. Persons with postlingually acquired profound deafness were administered the Communication Profile for the Hearing Impaired (CPHI) and several standardized tests of psychological functioning and adjustment. Inadequate communication strategies and poor accommodations to deafness reported on the CPHI were associated with depression, social introversion, loneliness, and social anxiety. Limited communication performance at home and with friends was related to both social introversion and the experience of loneliness; perceived attitudes and behaviors of others correlated with depression as well as loneliness. In general, the pattern of correlations obtained suggests that specific communication strategies and accommodations to deafness, rather than deafness per se, may contribute to the presence of some psychological difficulties in individuals.

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The Iowa Articulation Norms Project and its Nebraska Replication

The purpose of the Iowa Articulation Norms Project and its Nebraska replication was to provide normative information about speech sound acquisition in these two states. An assessment instrument consisting of photographs and a checklist form for narrow phonetic transcription was administered by school-based speech-language pathologists to stratified samples of children in the age range 3–9 years. The resulting data were not influenced by the demographic variables of population density (rural/urban), SES (based on parental education), or state of residence (Iowa/Nebraska); however, sex of the child exerted a significant influence in some of the preschool age groups. The criteria used to determine acceptability of a production appeared to influence outcomes for some speech sounds. Acquisition curves were plotted for individual phoneme targets or groups of targets. These curves were used to develop recommended ages of acquisition for the tested speech sounds, with recommendations based generally on a 90% level of acquisition. Special considerations were required for the phonemes /n s z/.

http://article/55/4/779/1775656/The-Iowa-Articulation-Norms-Project-and-its

Spoken and Written English Errors of Postsecondary Students with Severe Hearing Impairment

This investigation compared the spoken and written English errors of 20 hearing-impaired postsecondary students with intelligible speech and poor English language. Error categories used to assess the language samples were function, content, and structure. Spoken and written performances were distinguished only by a greater number of function word errors in writing samples. A trend toward greater complexity in writing was also found. Implications for instruction are discussed.

http://article/55/4/628/1775640/Spoken-and-Written-English-Errors-of-Postsecondary

Response to Hamre

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Taxonomies in Biology, Phonetics, Phonology, and Speech Motor Control

This article begins with a review explaining the different purposes of biological taxonomies. Taxonomic units are often dependent on the purpose for which the taxonomy has been constructed. Biological taxonomies provide an analogy that we use to emphasize some of the distinctions among the units of phonetic transcription systems, competence phonologies, and performance phonologies. The units of both phonology and phonetic transcription are considered as possible units of the speech motor system, and some of the difficulties of this assumption are explained. Although phonemic units, like units of phonetic transcription, are useful for many purposes, it is not theoretically necessary to use units derived as part of competence phonologies in systems attempting to explain phonological performance or speech motor performance. In this regard, we challenge the concept of coarticulation, because it is based on assumptions about the role of phonological or phonetic units in speech motor control. We offer an integrated perspective that has implications for research in speech motor control and deficits of the speech motor system. We see speech motor deficits as distinct from, yet possibly interacting with, phonological deficits.

http://article/55/4/596/1775637/Taxonomies-in-Biology-Phonetics-Phonology-and

Generalized Learning of Receptive and Expressive Action-Object Responses by Language-Delayed Preschoolers

This study examined the effectiveness of matrix-training procedures in teaching action + object utterances in both the receptive and expressive language modalities. The subjects were 4 developmentally delayed preschool boys who failed to produce spontaneous, functional two-word utterances. A multiple baseline design across responses with a multiple probe technique was employed. Subjects were taught 4–6 of 48 receptive and 48 expressive responses. Acquisition of a word combination rule was facilitated by the use of familiar lexical items, whereas subsequent acquisition of new lexical knowledge was enhanced by couching training in a previously trained word combination pattern. Although receptive knowledge was not sufficient for the demonstration of corresponding expressive performance for most of the children, only minimal expressive training was required to achieve this objective. For most matrix items, subjects responded receptively before they did so expressively. For 2 subjects, when complete receptive recombinative generalization had not been achieved, expressive training facilitated receptive responding. The results of this study elucidate benefits to training one linguistic aspect (lexical item, word combination pattern) at a time to maximize generalization in developmentally delayed preschoolers.

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Tabletop Versus Microcomputer-Assisted Speech Management: Response Evocation Phase

This is the third in a series of studies on the use of microcomputers with speech-delayed children. Two repeated-measures designs (n=15) and five case studies were completed to compare tabletop management at early and late stages of the response development phase with two comparable, computer-assisted drill-and-practice activities. Discrimination of correct articulatory responses was mediated by the clinician in all modes, rather than by speech recognition hardware, but all contingent reinforcement in the computer modes was presented by animation graphics. The two computer modes were identical except for the addition of fantasy involvement in one of the modes. Findings indicated that the three modes of intervention were equally effective, efficient, and engaging. Subject-level analyses suggested that microcomputer software has excellent potential to engage children in drill-and-practice for late-phase response evocation, when the target sound is stimulable, but limited usefulness with young children at early-phase response evocation, when specific articulatory behaviors need to be cued. Discussion considers learning, child, and hardware/software factors in microcomputer-assisted speech management.

http://article/55/4/635/1775641/Tabletop-Versus-MicrocomputerAssisted-Speech

Fast Mapping of Words in Event Contexts by Children with Down Syndrome

Fast mapping of novel words for objects was compared in 48 children and adolescents with Down syndrome (ages 5:6-20:6), who were delayed in expressive language acquisition compared to mental age, and 48 normally developing children matched for mental age (chronological ages 2:0-6:0). Normal and Down syndrome groups did not differ in their ability to infer a connection between the novel word and referent (100% vs. 100%), to comprehend the novel word after a single exposure (83% vs. 73%), and to recall the location in which they hid the novel referent (83% vs. 75%). Nor did they differ in their ability to produce the novel word correctly (at least two out of three phonemes in order: 48% vs. 40%). When retested after an hour of other activity, only the production task showed a significant, and comparable, decrement. Comparing youngest and oldest quarters of each group showed improved memory for location in both, improved comprehension in the Down syndrome group, and improved production in the control group. Adults (n=12), in contrast, performed perfectly on all tasks except the delayed word production. Neither intelligibility differences nor use of real word labels accounts for the failure to find a difference between groups. Fast mapping skills were unrelated to expressive language deficit in these children with Down syndrome.

http://article/55/4/761/1775654/Fast-Mapping-of-Words-in-Event-Contexts-by

Comment on "Methodological Variables Affecting Phonational Frequency Range in Adults"

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The Relationship between Communication Problems and Psychological Difficulties in Persons with Profound Acquired Hearing Loss

Communication strategies, accommodations to deafness, and perceptions of the communication environment by profoundly deaf subjects were correlated with indices of psychosocial adjustment to determine whether accommodations to deafness could play a role in the presence of psychological difficulties among deaf persons. Persons with postlingually acquired profound deafness were administered the Communication Profile for the Hearing Impaired (CPHI) and several standardized tests of psychological functioning and adjustment. Inadequate communication strategies and poor accommodations to deafness reported on the CPHI were associated with depression, social introversion, loneliness, and social anxiety. Limited communication performance at home and with friends was related to both social introversion and the experience of loneliness; perceived attitudes and behaviors of others correlated with depression as well as loneliness. In general, the pattern of correlations obtained suggests that specific communication strategies and accommodations to deafness, rather than deafness per se, may contribute to the presence of some psychological difficulties in individuals.

http://article/55/4/656/1775642/The-Relationship-between-Communication-Problems

Partner Sensitivity to Communication Behavior of Young Children with Developmental Disabilities

Aspects of partner sensitivity to communication behaviors of 24 presymbolic children with developmental disabilities were examined. The children were grouped according to their movement abilities (normal vs. abnormal patterns) and communication status (intentional vs. preintentional). Participating communication partners were those with whom the children interacted on a regular basis and included their mothers, early childhood special educators, and speech-language pathologists. Procedures were developed whereby the partners served as informants in order to provide information regarding (a) recognition of the children's communicative cues and (b) consistency of cue recognition and descriptions across partners. Results indicated wide individual variability in the partners' basic recognition abilities as well as their consistency with each other. Further, the observed variations could not be attributed to the children's movement and communication abilities. It was concluded that sensitivity, as measured in the present investigation, was highly partner-child specific, with some children likely to be exposed to more optimal interactions than others.

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Generalized Learning of Receptive and Expressive Action-Object Responses by Language-Delayed Preschoolers

This study examined the effectiveness of matrix-training procedures in teaching action + object utterances in both the receptive and expressive language modalities. The subjects were 4 developmentally delayed preschool boys who failed to produce spontaneous, functional two-word utterances. A multiple baseline design across responses with a multiple probe technique was employed. Subjects were taught 4–6 of 48 receptive and 48 expressive responses. Acquisition of a word combination rule was facilitated by the use of familiar lexical items, whereas subsequent acquisition of new lexical knowledge was enhanced by couching training in a previously trained word combination pattern. Although receptive knowledge was not sufficient for the demonstration of corresponding expressive performance for most of the children, only minimal expressive training was required to achieve this objective. For most matrix items, subjects responded receptively before they did so expressively. For 2 subjects, when complete receptive recombinative generalization had not been achieved, expressive training facilitated receptive responding. The results of this study elucidate benefits to training one linguistic aspect (lexical item, word combination pattern) at a time to maximize generalization in developmentally delayed preschoolers.

http://article/55/4/665/1775643/Generalized-Learning-of-Receptive-and-Expressive

Patient Compliance with Cleft Palate Team Regimens

A cleft palate team's prescribed regimen requires prompt and continued compliance in order to meet the management objectives and to justify the large investment of professional time. The purposes of this clinical investigation were to determine the rate of compliance with the recommendations made by a cleft palate team for its patients and to identify variables associated with compliance. A subject was defined as the person(s) who could best respond to questions concerning the management of the team's patient. Each subject was interviewed using a questionnaire. The mean patient compliance rate was 64.4%, and noncompliance with specific recommendations ranged from 12.5% to 100%. Using Jones and Caldwell's (1981) classification, 17.1% of the patients were classified as compliers, 78% as partial compliers, and 4.9% as noncompliers. The best predictor of compliance was a set of nine variables.

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Comment on "Methodological Variables Affecting Phonational Frequency Range in Adults"

http://article/55/4/804/1775662/Comment-on-Methodological-Variables-Affecting

Partner Sensitivity to Communication Behavior of Young Children with Developmental Disabilities

Aspects of partner sensitivity to communication behaviors of 24 presymbolic children with developmental disabilities were examined. The children were grouped according to their movement abilities (normal vs. abnormal patterns) and communication status (intentional vs. preintentional). Participating communication partners were those with whom the children interacted on a regular basis and included their mothers, early childhood special educators, and speech-language pathologists. Procedures were developed whereby the partners served as informants in order to provide information regarding (a) recognition of the children's communicative cues and (b) consistency of cue recognition and descriptions across partners. Results indicated wide individual variability in the partners' basic recognition abilities as well as their consistency with each other. Further, the observed variations could not be attributed to the children's movement and communication abilities. It was concluded that sensitivity, as measured in the present investigation, was highly partner-child specific, with some children likely to be exposed to more optimal interactions than others.

http://article/55/4/679/1775644/Partner-Sensitivity-to-Communication-Behavior-of

Patient Compliance with Cleft Palate Team Regimens

A cleft palate team's prescribed regimen requires prompt and continued compliance in order to meet the management objectives and to justify the large investment of professional time. The purposes of this clinical investigation were to determine the rate of compliance with the recommendations made by a cleft palate team for its patients and to identify variables associated with compliance. A subject was defined as the person(s) who could best respond to questions concerning the management of the team's patient. Each subject was interviewed using a questionnaire. The mean patient compliance rate was 64.4%, and noncompliance with specific recommendations ranged from 12.5% to 100%. Using Jones and Caldwell's (1981) classification, 17.1% of the patients were classified as compliers, 78% as partial compliers, and 4.9% as noncompliers. The best predictor of compliance was a set of nine variables.

http://article/55/4/740/1775651/Patient-Compliance-with-Cleft-Palate-Team-Regimens

Oncocytic carcinoma of the salivary glands: A Danish national study

To present a Danish national series of oncocytic carcinoma (OC) patients, including data on treatment, recurrence and survival.

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Oncocytic carcinoma of the salivary glands: A Danish national study

To present a Danish national series of oncocytic carcinoma (OC) patients, including data on treatment, recurrence and survival.

from ORL via alkiviadis.1961 on Inoreader http://ift.tt/2yk7N5W

Factors affecting the effect of physical rehabilitation therapy for synkinesis as a sequela to facial nerve palsy

To investigate factors affecting the effect of physical rehabilitation therapy for synkinesis as a sequela to facial nerve palsy.

from ORL via alkiviadis.1961 on Inoreader http://ift.tt/2lAze5j

Oncocytic carcinoma of the salivary glands: A Danish national study

To present a Danish national series of oncocytic carcinoma (OC) patients, including data on treatment, recurrence and survival.

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No Racial Difference in Rehabilitation Therapy Across All Post-Acute Care Settings in the Year Following a Stroke [Original Contributions]

Background and Purpose—Black stroke survivors experience greater poststroke disability than whites. Differences in post-acute rehabilitation may contribute to this disparity. Therefore, we estimated racial differences in rehabilitation therapy utilization, intensity, and the number of post-acute care settings in the first year after a stroke.Methods—We used national Medicare data to study 186 168 elderly black and white patients hospitalized with a primary diagnosis of stroke in 2011. We tabulated the proportion of stroke survivors receiving physical, occupational, and speech and language therapy in each post-acute care setting (inpatient rehabilitation facility, skilled nursing facility, and home health agency), minutes of therapy, and number of transitions between settings. We then used generalized linear models to determine whether racial differences in minutes of physical therapy were influenced by demographics, comorbidities, thrombolysis, and markers of stroke severity.Results—Black stroke patients were more likely to receive each type of therapy than white stroke patients. Compared with white stroke patients, black stroke patients received more minutes of physical therapy (897.8 versus 743.4; P<0.01), occupational therapy (752.7 versus 648.9; P<0.01), and speech and language therapy (865.7 versus 658.1; P<0.01). There were no clinically significant differences in physical therapy minutes after adjustment. Blacks had more transitions (median, 3; interquartile range, 1–5) than whites (median, 2; interquartile range, 1–5; P<0.01).Conclusions—There are no clinically significant racial differences in rehabilitation therapy utilization or intensity after accounting for patient characteristics. It is unlikely that differences in rehabilitation utilization or intensity are important contributors to racial disparities in poststroke disability.

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Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin [Original Contributions]

Background and Purpose—Few data exist on the long-term outcomes of patients with spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA) thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation receiving oral anticoagulation. We explored the relationship between these 3 echocardiographic findings and clinical outcomes, and the comparative efficacy and safety of apixaban and warfarin for each finding.Methods—Patients from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either transthoracic or transesophageal echocardiography were compared with patients with none of these findings on transesophageal echocardiography.Results—A total of 1251 patients were included: 217 had SEC, 127 had LA/LAA thrombus, 241 had CAP, and 746 had none. The rates of stroke/systemic embolism were not significantly different among patients with and without these echocardiographic findings (hazard ratio, 0.96; 95% confidence interval, 0.25–3.60 for SEC; hazard ratio, 1.27; 95% confidence interval, 0.23–6.86 for LA/LAA thrombus; hazard ratio, 2.21; 95% confidence interval, 0.71–6.85 for CAP). Rates of ischemic stroke, myocardial infarction, cardiovascular death, and all-cause death were also not different between patients with and without these findings. For patients with either SEC or CAP, there was no evidence of a differential effect of apixaban over warfarin. For patients with LA/LAA thrombus, there was also no significant interaction, with the exception of all-cause death and any bleeding where there was a greater benefit of apixaban compared with warfarin among patients with no LA/LAA thrombus.Conclusions—In anticoagulated patients with atrial fibrillation and risk factors for stroke, echocardiographic findings do not seem to add to the risk of thromboembolic events.Clinical Trial Registration—URL: http://ift.tt/PmpYKN. Unique identifier: NCT00412984.

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Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke [Original Contributions]

Background and Purpose—Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy.Methods—We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed.Results—A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23–5.56; P=0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04–1.13; P<0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36–85.96; P=0.025) were associated with good outcome.Conclusions—In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.

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Cerebral Near-Infrared Spectroscopy [Brief Reports]

Background and Purpose—Regional brain oxygen saturation (rSO2) changes, assessed by cerebral near-infrared spectroscopy, are likely influenced by cerebral hemodynamic fluctuations induced by thrombectomy of acute proximal occlusion. We studied the correlations between rSO2 and baseline magnetic resonance imaging perfusion parameters and the relationship between rSO2 changes, recanalization, and clinical outcome.Methods—Seventeen acute ischemic stroke patients, treated with mechanical thrombectomy, were monitored using bilateral near-infrared spectroscopy before, during, and continuously for 24 hours after the procedure. All patients had baseline brain magnetic resonance imaging with perfusion weighted imaging.Results—rSO2 was only correlated with baseline Tmax (ρ=−0.42; P<0.05) and mean transit time (ρ=−0.45; P<0.05) within forehead explored areas. Before thrombectomy, an interhemispheric rSO2 difference was noted, and this diminished over time when recanalization had occurred (median [interquartile range], −8 [−12 to −5] to 3 [−3 to 7]; P=0.01). rSO2 changes were not correlated with clinical outcome.Conclusions—rSO2 was merely correlated with baseline Tmax and mean transit time magnetic resonance imaging perfusion parameters. Multiple sites recording beyond frontal pole explored areas may provide more relevant correlation with hemodynamic parameters.

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Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation [Original Contributions]

Background and Purpose—Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8).Methods—Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months.Results—Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size.Conclusions—Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.

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Letter to editor: Current and future techniques for human papilloma virus (HPV) testing in oropharyngeal squamous cell carcinoma

(Source: European Archives of Oto-Rhino-Laryngology)

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Why does the acquired cholesteatoma trigger resorption of the temporal bone?

(Source: European Archives of Oto-Rhino-Laryngology)

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Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall

In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It pr ovides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-f lap may be indicated. (Source: European Archives of Oto-Rhino-Laryngology)

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The role of subtotal petrosectomy in cochlear implant recipients

AbstractDescribe the indications and outcome of subtotal petrosectomy for cochlear implant recipients. Tertiary care referral center. This is a retrospective study of all subtotal petrosectomies and cochlear implants performed between January 2012 and December 2014. We review the charts of these patients collecting the following data: age, gender, otologic history, audiologic tests, indication of subtotal petrosectomy, data of surgery, surgical and immediate complications, late complications and follow-up of for at least 2.5 years. 12 cases of subtotal petrosectomies with cochlear implantation in 11 patients were performed during this period; 2 children and 10 adults. The indication for a cochlear implant was in 10 cases bilateral severe to profound sensorineural hearing loss and in the re...

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Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients

AbstractThis retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Me...

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Assessment of laryngopharyngeal reflux and the shape of the Eustachian tube should be considered in chronic rhinosinusitis with nasal polyps and chronic otitis media

(Source: European Archives of Oto-Rhino-Laryngology)

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CO 2 laser stapedotomy safety: influence of laser energy and time on bone-conduction hearing levels

AbstractTotal laser energy in CO2 stapedotomy depends on the laser settings and the amount of applications. It is unclear if the amount of total laser energy affects bone-conduction hearing thresholds and if possible effects are temporary or permanent. Alterations of bone-conduction hearing thresholds after single or multiple-shot CO2 laser stapedotomy were analyzed between 1 and 3  weeks and 1.5–6 months after primary (n = 501) or revision surgeries (n = 153) and correlated to time, laser energy, frequency, surgical technique, and pathology encountered in revision stapedotomy. In both time periods, most patients showed a lower bone-conduction threshold in the four-tone puretone average (PTA) at frequencies of 0.5, 1, 2, and 3 kHz that furthe r improved over time. Between 1 an...

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Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery

AbstractAnaplastic carcinoma of the thyroid gland (ATC) is one of the most aggressive cancers in humans. With insufficient treatment, the disease most often leads to death in suffocation. From 2002, our treatment strategy has been hyperfractionated accelerated radiotherapy (HART) with high doses (64  Gy) to the neck, followed by surgery 4–8 weeks later if feasible, with the aim to gain control in the neck. After a pathology review, 51 patients were diagnosed with ATC in the period 2002–2014 in the south-east of Norway. Thirty-one received HART, and we present a study of these patients, wi th death in suffocation as the primary endpoint and survival as the second. No patients treated with HART died in suffocation. Six had a tracheostomy during their course of disease, of whom four wer...

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Surgical management of primary hyperparathyroidism

In conclusion, synchronous thyroid surgery was carried out in a quarter of all parathyroidectomy procedures performed for treatment of primary hyperparathyroidism. Coincidental thyroid pathology was c ommon. The limitations of pre-operative imaging in reliably locating involved parathyroid tissue are demonstrated and the importance of considering the potential need to perform thyroid surgery during parathyroidectomy and obtaining appropriate informed consent. (Source: European Archives of Oto-Rhino-Laryngology)

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Reply to the Letter to the Editor regarding “Etiopathogenesis of bone resorption in acquired middle ear cholesteatoma”

(Source: European Archives of Oto-Rhino-Laryngology)

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Reply to commentary to: factors influencing endoscopic dacryocystorhinostomy outcome

(Source: European Archives of Oto-Rhino-Laryngology)

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Reply to Letter to the Editor in reference to “The transotic approach for vestibular schwannoma: indications and results”

AbstractThis communication is the response to letter to the editor in reference to "The transotic approach for vestibular schwannoma: indications and results". (Source: European Archives of Oto-Rhino-Laryngology)

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Prevention and management of vascular complications in middle ear and cochlear implant surgery

The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patien...

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Reply to the letter to the editor concerning “Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty”

(Source: European Archives of Oto-Rhino-Laryngology)

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Reliability and validity of the German version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (D-OAR)

AbstractThe outcome of aesthetic rhinoplasty is determined by the patient 's subjective satisfaction with the nasal appearance which is difficult to assess. The Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (OAR) is a brief and reliable instrument to assess the influence of the subjective nasal appearance on quality of life in patients undergoing aesthetic rhinoplasty. Preoperative application of this questionnaire reveals important aspects and possible disturbances of the body image which could be negative predictors concerning the result. On the other hand, it represents an appropriate tool to assess the postoperative outcome. The aim of this study was to determine the validity, reliability and responsiveness of the adapted German version of the OAR (D-OAR). The...

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Central mucoepidermoid carcinoma: an up-to-date analysis of 147 cases and review of prognostic factors

To integrate the available data published on central mucoepidermoid carcinoma (CMC) into a comprehensive analysis of its clinical aspects, histology, treatment, and prognostic factors.

http://ift.tt/2zVJc3u

The localization and risk factors of squamous cell carcinoma in the oral cavity: A study of 1501 cases

Head and neck cancer is the tenth leading cause of cancer mortality. Ninety percent of tumours in the oral cavity are squamous cell carcinomas. Information about the exact localisation of OSCC is missing in the literature. In the present study, we retrospectively analysed a total of 1501 OSCC patients, who were treated between 1975 and 2009. The purpose of this study was to examine the localisation of OSCC tumours and to analyse the influence of various parameters on tumour localisation. 71.5% of these patients were male and 28.5% were female.

http://ift.tt/2hrVV7r

Three-dimensional changes of scleral show after surgical treatment of endocrine orbitopathy

Surgery in endocrine orbitopathy should address exophthalmos and adjunct stigmata such as increased lid aperture and scleral show. Secondary to decompression, rehabilitative surgical treatment such as blepharoplasty is routinely used to achieve this goal. Until now, however, there has been no investigation to measure the effect of decompression surgery on scleral show and lid aperture 3-dimensionally.

http://ift.tt/2zWIi78

Donor site morbidity after vascularized fibula free flap: gait analysis during prolonged walk conditions

The aim of this study was to determine the effect of vascularized fibula free flap (VFFF) harvest on gait variables during the six-minute walk test (6MWT). Eleven patients who had undergone VFFF harvest and 11 healthy peers participated in this case–control study. The main evaluation consisted of the collection of gait variables using the GAITRite system during three periods of the 6MWT: beginning (0–1min), middle (2:30–3:30min), and end (5–6min). The 6MWT was significantly shorter in the VFFF group than in the reference group (−31%, P<0.001).

http://ift.tt/2xGCQnP

A novel mutation of the EYA4 gene associated with post-lingual hearing loss in a proband is co-segregating with a novel PAX3 mutation in two congenitally deaf family members

This work was aimed at establishing the molecular etiology of hearing loss in a 9-year old girl with post-lingual non-syndromic mild sensorineural hearing loss with a complex family history of clinically heterogeneous deafness.

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Psychometric Properties of Voice Activity Participation Profile—Persian Version (VAPPP)

Individuals with voice disorders may experience limits in activity and restricted participation in daily activities. The aim of this study was to investigate the psychometric properties of the Voice Activity Participation Profile—Persian Version (VAPPP), a questionnaire which specifically investigates activity limitation and participation restriction in Persian-speaking individuals with voice disorders.

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Procedural Motor Learning in Children With Specific Language Impairment

Purpose

Specific language impairment (SLI) is a developmental disorder that affects language and motor development in the absence of a clear cause. An explanation for these impairments is offered by the procedural deficit hypothesis (PDH), which argues that motor difficulties in SLI are due to deficits in procedural memory. The aim of this study was to test the PDH by examining the procedural motor learning abilities of children with and without SLI.

Method

Thirteen children with SLI and 14 age-matched typically developing children completed the following procedural measures: (a) a knot-tying task as a measure of motor sequencing and (2) a mirror-drawing task as a measure of visual–motor adaptation.

Results

Although children with SLI produced significantly more errors on certain knot-tying tasks, they performed comparably on others. Also, children with SLI performed comparably with typically developing children on the mirror-drawing task.

Conclusions

The PDH requires reframing. The sequence learning deficits in SLI are modest and specific to more difficult tasks. Visual–motor adaptation, on the other hand, appears to be unaffected in SLI.

http://article/doi/10.1044/2017_JSLHR-L-16-0457/2661619/Procedural-Motor-Learning-in-Children-With

Procedural Motor Learning in Children With Specific Language Impairment

Purpose

Specific language impairment (SLI) is a developmental disorder that affects language and motor development in the absence of a clear cause. An explanation for these impairments is offered by the procedural deficit hypothesis (PDH), which argues that motor difficulties in SLI are due to deficits in procedural memory. The aim of this study was to test the PDH by examining the procedural motor learning abilities of children with and without SLI.

Method

Thirteen children with SLI and 14 age-matched typically developing children completed the following procedural measures: (a) a knot-tying task as a measure of motor sequencing and (2) a mirror-drawing task as a measure of visual–motor adaptation.

Results

Although children with SLI produced significantly more errors on certain knot-tying tasks, they performed comparably on others. Also, children with SLI performed comparably with typically developing children on the mirror-drawing task.

Conclusions

The PDH requires reframing. The sequence learning deficits in SLI are modest and specific to more difficult tasks. Visual–motor adaptation, on the other hand, appears to be unaffected in SLI.

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Procedural Motor Learning in Children With Specific Language Impairment

Purpose

Specific language impairment (SLI) is a developmental disorder that affects language and motor development in the absence of a clear cause. An explanation for these impairments is offered by the procedural deficit hypothesis (PDH), which argues that motor difficulties in SLI are due to deficits in procedural memory. The aim of this study was to test the PDH by examining the procedural motor learning abilities of children with and without SLI.

Method

Thirteen children with SLI and 14 age-matched typically developing children completed the following procedural measures: (a) a knot-tying task as a measure of motor sequencing and (2) a mirror-drawing task as a measure of visual–motor adaptation.

Results

Although children with SLI produced significantly more errors on certain knot-tying tasks, they performed comparably on others. Also, children with SLI performed comparably with typically developing children on the mirror-drawing task.

Conclusions

The PDH requires reframing. The sequence learning deficits in SLI are modest and specific to more difficult tasks. Visual–motor adaptation, on the other hand, appears to be unaffected in SLI.

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The Frequency and Nature of Communication Between School-Based Speech-Language Pathologists and Caregivers of Children With Language Impairment

Purpose

The present study investigates the extent to which school-based speech-language pathologists (SLPs) communicate with the caregivers of children with language impairment and the factors that are significantly associated with frequent communication. In addition, this study investigates the extent to which frequent SLP–caregiver communication is associated with change in language and literacy abilities of children.

Method

To address the study aims, weekly communication logs from 73 SLPs, serving 3–5 children with language impairment in grades K-2, were collected for a complete academic year. Logs detailed the frequency and nature of SLP–caregiver communication. Information regarding children's age, language ability, and socioeconomic status were gathered at study onset; additionally, SLPs completed a questionnaire about their work experience and current work conditions (e.g., caseload size and job satisfaction). Finally, children were administered grammar, vocabulary, and early literacy assessments at the beginning and end of the academic year.

Results

Descriptive results indicate that (a) the most common type of communication was via homework, (b) children's socioeconomic status was related to communication frequency, and (c) increased SLP–caregiver communication related to increased grammar gains over the academic year.

Conclusion

These results suggest that SLP–caregiver communication may be important for children's language outcomes; further studies exploring ways to support these communicative efforts are warranted.

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Randomized Controlled Trial of a Novel Device for Tinnitus Sound Therapy During Sleep

Purpose

The aim of this study was to determine if a customized stimulus from the Otoharmonics Levo System reduces tinnitus perceptions and reactions for people with bothersome tinnitus.

Method

Sixty participants were randomized to 1 of 3 groups that used sound therapy devices during sleep that differed in their acoustic stimulus: (a) tinnitus-matched (TM), (b) noise stimulus (NS), and (c) bedside sound generator (BSG). Outcome measures were the Tinnitus Functional Index (TFI), numeric rating scale of tinnitus loudness, and tinnitus loudness match. A Bayesian hierarchical model was fit to estimate the differences in treatment efficacy among groups.

Results

Average tinnitus reactions and perceptions improved across treatment groups. We are at least 87% certain that treatment with TM or NS reduces mean TFI compared to treatment with BSG, with an estimated relative efficacy of 4.5–5 points greater reduction. We are at least 95% certain that treatment with TM results in greater reduction in mean numeric rating scale (NRS) of tinnitus loudness compared to the other groups, with an estimated relative efficacy of about 0.75 points greater reduction.

Conclusions

This study offers some support for greater average improvement in reactions to tinnitus with TM or NS devices compared to the BSG device. The TM group, compared to the BSG and NS groups, showed a greater reduction in ratings of tinnitus loudness on the NRS on average.

Supplemental Material

http://ift.tt/2h0o2h3

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Randomized Controlled Trial of a Novel Device for Tinnitus Sound Therapy During Sleep

Purpose

The aim of this study was to determine if a customized stimulus from the Otoharmonics Levo System reduces tinnitus perceptions and reactions for people with bothersome tinnitus.

Method

Sixty participants were randomized to 1 of 3 groups that used sound therapy devices during sleep that differed in their acoustic stimulus: (a) tinnitus-matched (TM), (b) noise stimulus (NS), and (c) bedside sound generator (BSG). Outcome measures were the Tinnitus Functional Index (TFI), numeric rating scale of tinnitus loudness, and tinnitus loudness match. A Bayesian hierarchical model was fit to estimate the differences in treatment efficacy among groups.

Results

Average tinnitus reactions and perceptions improved across treatment groups. We are at least 87% certain that treatment with TM or NS reduces mean TFI compared to treatment with BSG, with an estimated relative efficacy of 4.5–5 points greater reduction. We are at least 95% certain that treatment with TM results in greater reduction in mean numeric rating scale (NRS) of tinnitus loudness compared to the other groups, with an estimated relative efficacy of about 0.75 points greater reduction.

Conclusions

This study offers some support for greater average improvement in reactions to tinnitus with TM or NS devices compared to the BSG device. The TM group, compared to the BSG and NS groups, showed a greater reduction in ratings of tinnitus loudness on the NRS on average.

Supplemental Material

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http://article/doi/10.1044/2017_AJA-17-0022/2661617/Randomized-Controlled-Trial-of-a-Novel-Device-for

The Impact and Influence of JAMA Facial Plastic Surgery

Meaningful and influential articles written by leading thought leaders in the field are the lifeblood of a journal. I am pleased to announce that the Impact Factor (IF) of JAMA Facial Plastic Surgery has reached a new high of 2.70 (up 58% from last year's IF of 1.74). This places our journal near the top of all journals in our comparative group of journals that publish similar content. Although this metric is imperfect, it is often recognized by the scientific and publishing community as one important measure of comparing journals in its scientific impact and influence. Recall that IF is calculated by counting all of the citations to every article published in a journal divided by the number of full-length articles (Original Investigations, Special Communications, Reviews) published in that journal during the 2 preceding years.

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September-October Issue Highlights

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Safety and Efficacy of Bilateral Submental Cryolipolysis

This nonrandomized interventional cohort study investigates the safety and efficacy of cryolipolysis for reduction of lateral and central submental fat.

http://ift.tt/2z0XPTT

Capsular Contracture in Silicone Implant Rhinoplasty

This case series study examines the immunohistochemical features of capsular contracture in patients who have undergone silicone implant rhinoplasty.

http://ift.tt/2z7mHLY

Perceived Benefits of Facial Rejuvenation Beyond Restoring Youth

This survey study examines whether face-lift and upper facial rejuvenation surgery improve observer ratings of age, attractiveness, success, and health.

http://ift.tt/2z463Li

Emerging Goals in Aesthetic Medicine

I applaud Bater et al on their significant contribution in this issue of JAMA Facial Plastic Surgery to the growing body of literature further shaping and defining what the ultimate goal in aesthetic medicine is and should be. During the past decade, we have witnessed an evolution in aesthetic medicine, progressing from medieval standards of success defined by Eurocentrically oriented and canonized somatic ideals to a modern-day aspiration of enhanced social and psychological well-being. Let me be frank: those seeking cosmetic treatments are, at their core, desiring more than a straightened dorsum, a reduced cervical angle, or a projected mentum. They also—and perhaps more importantly—desire the self-satisfying and externally perceived benefits that result from the perception of idealized forms. It is the impression of beauty, whether elicited from the self, another, or both, from which our patients appreciate the aesthetic interventions we offer to them.

http://ift.tt/2z8IgvJ

Association of Mental Health Status With Perception of Nasal Function

This cross-sectional study assesses the association of poor mental health with perception of nasal function.

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A New Nasal Septum Splint

This Surgical Pearl describes a new type of splint designed to sit extremely caudally along the septum, to be left in place for 2 to 3 weeks postoperatively, and to replace other methods of posterior septal angle fixation to the nasal spine.

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Neurovascular Characteristics of Facial Skin After Rhytidectomy

This study describes the change in epidermal nerve fibers, neurotransmitters, vasculature, and mast cells in facial skin following primary and revision face-lifts.

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Duration of Facial Paralysis in Studies of Emotion and Well-Being—Reply

In Reply We appreciate Chaiet and Carpenter's thoughtful contribution regarding our recently published article "Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients."

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Anatomy and Surgical Approaches to the Rabbit Nasal Septum

This ex vivo study examines the anatomy and approaches to rabbit septal surgery.

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A Cautious but Optimistic Opinion of Submental Cryolipolysis

The increasing consumer demand for minimally invasive or noninvasive procedures has driven a burgeoning industry of technological advances that cater to this desire. Neck adiposity is an emerging area of interest, driven in large part by the US Food and Drug Administration's clearance of injectable deoxycholic acid in April 2015, along with a juggernaut of related marketing endeavors. As surgeons, we must always be wary of noninvasive methods that might make bold claims, using surgical methods of cervical fat reduction as the criterion standard by which to judge any new entrants into the competitive field. However, we must also embrace methods that may undoubtedly serve as adjuncts, alternatives, or replacements for surgical techniques when they are truly viable. With that spirit, I commend the article in this issue of JAMA Facial Plastic Surgery on submental cryolipolysis by Bernstein and Bloom, who have sought to quantifiably evaluate both the aesthetic improvement and the patients' subjective perception of their results and the nature of their experience. The article serves to expand the current limited body of literature exploring this new application of cryolipolysis.

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Two-Dimensional Threshold for Perception of Artificial-Appearing Lips

This survey study characterizes the quantitative measurements for the perceptual threshold of artificial- and unnatural-appearing lips.

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Don’t Miss the Fourth Dimension of the Nasal Airway

Nasal obstruction as a symptom is supposedly simple to grasp, with the nasal airway being easy to inspect and objective measures for both its resistance and diameter at hand. Because the nasal cavity is also amenable to enlargement through straightforward surgical procedures, a permanently blocked nose ought to be easy to fix. Yet, how often are physicians intrigued by patient dissatisfaction after surgery with what must be considered a success after nasal endoscopy? Little is known about the incidence of postoperative dissatisfaction after septoplasty, with no failures to be seen or measured. One reason for an incongruent appraisal of the outcome of surgery may be that reducing the cause of nasal obstruction or the sensation of nasal fullness to a septal deviation or mucosal edema and to swelling may be simplistic in light of the advances in our understanding of nasal pathologic conditions and mucosal neural regulation. Few studies have shown highly correlated associations of the sensation of nasal fullness with any of the objective parameters measured in routine clinical practice. The cause may be that the sensation of fullness is the computational end product of a complex neurologic integrative process. This process encompasses interoceptive sensation on the basis of the currently assessed severity relative to other competing sensory and emotional stimuli. Recollections of the difficulties experienced in breathing through the nose in the recent and more distant past also play a role. The sensation of fullness or blockage attributed to the nasal mucosa is a highly integrated interpretation of afferent information from multiple subsets of nociceptive and other neurons, with the perception of cooling during inspiration likely playing a central role.

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Association of Diet With Skin Histological Features in UV-B–Exposed Mice

This animal model study examines the influence of a calorie-restricted diet and an obesity diet in mice exposed to long-term UV-B irradiation to assess if there is an association between diet and histopathological response to UV-B irradiation.

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Nonsurgical Rhinoplasty

This Surgical Pearl demonstrates how fillers can be used to add volume to the soft tissues of the nose.

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Association of Velopharyngeal Insufficiency With Quality of Life

This study uses the Velopharyngeal Insufficiency Effects on Life Outcomes instrument to assess the association of improved speech with quality of life in patients who underwent secondary speech surgery.

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Negative and Positive Online Patient Reviews of Physicians

This study explores reasons for both excellent and poor patient reviews on websites rating physicians.

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Patterns of Change in Facial Skeletal Aging

This case series study of 14 adults documents patterns of change in the facial skeleton and develops a methodology for measuring these changes.

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New Year’s greetings

Publication date: Available online 27 October 2017
Source:Brain and Development
Author(s): Masashi Mizuguchi




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A de novo p.Arg756Cys mutation in ATP1A3 causes a distinct phenotype with prolonged weakness and encephalopathy triggered by fever

Publication date: Available online 21 October 2017
Source:Brain and Development
Author(s): Yuji Nakamura, Ayako Hattori, Mitsuko Nakashima, Daisuke Ieda, Ikumi Hori, Yutaka Negishi, Naoki Ando, Naomichi Matsumoto, Shinji Saitoh
Patients with a mutation at Arg756 in ATP1A3 have been known to exhibit a distinct phenotype, characterized by prolonged weakness and encephalopathy, triggered by febrile illness. With only eight reports published to date, more evidence is required to correlate clinical features with a mutation at Arg756. Here we report an additional case with an Arg756Cys mutation in ATP1A3. A four-year-old boy showed mild developmental delay with recurrent paroxysmal episodes of weakness and encephalopathy from nine months of age. Motor deficits, which included bilateral hypotonia, ataxia, dysmetria, limb incoordination, dysarthria, choreoathetosis, and dystonia, were observed from one year and three months. Whole-exome sequencing detected a heterozygous de novo variant at c.2266C>T (p.Arg756Cys) in ATP1A3. The episodic course and clinical features of this case were consistent with previously reported cases with mutations at Arg756. Furthermore, his phenotype of marked ataxia was more similar to that of an Arg756Cys patient with relapsing encephalopathy and cerebellar ataxia syndrome, than to those with Arg756His and Arg756Leu mutations. This report therefore provides evidence of genotype-phenotype correlations in ATP1A3-related disorders as well as in patients with mutations at Arg756 in ATP1A3.



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GRIN2A mutations in epilepsy-aphasia spectrum disorders

Publication date: Available online 19 October 2017
Source:Brain and Development
Author(s): Xiaoling Yang, Ping Qian, Xiaojing Xu, Xiaoyan Liu, Xiru Wu, Yuehua Zhang, Zhixian Yang
ObjectiveEpilepsy-aphasia spectrum (EAS) are a group of epilepsy syndromes denoting an association between epilepsy, speech disorders and the EEG signature of centrotemporal spikes. Mutations in the GRIN2A gene, encoding the NMDA glutamate receptor α2 subunit were reported in focal epilepsy with speech disorder. We aimed to explore the role of GRIN2A mutations in patients with centrotemporal spikes related epileptic syndromes in a Chinese cohort.MethodsPatients with Landau-Kleffner syndrome (LKS), epileptic encephalopathy with continuous spike-and-wave during sleep (ECSWS), atypical benign partial epilepsy (ABPE), and benign epilepsy with centrotemporal spikes (BECTS) were recruited. GRIN2A mutation screening was performed using PCR and Sanger sequencing.Results122 patients, including 9 LKS, 26 ECSWS, 42 ABPE and 45 BECTS were enrolled. The mean age of seizure or aphasia onset was 5 years, ranging from 10 months to 11 years. Heterozygous GRIN2A mutations were detected in four patients (G760S, D1385Y, C455Y and C231R) GRIN2A mutation was found in 11.1% (1 out of 9 cases) of LKS, and in 7.1% (3 out of 42 cases) of ABPE, but in none with ECSWS and BECTS. No GRIN2A mutation was found in patients with a family history of febrile seizures or epilepsy.ConclusionGRIN2A mutation is a genetic cause in less than 11% patients with LKS or ABPE. GRIN2A gene is a rare causative gene in Chinese patients with EAS, suggesting the possibility of other gene involved in the pathogenesis.



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Is vatiquinone truly beneficial for Leigh syndrome?

Publication date: Available online 18 October 2017
Source:Brain and Development
Author(s): Josef Finsterer, Sinda Zarrouk-Mahjoub




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Developmental trend of children with Down’s syndrome – How do sex and neonatal conditions influence their developmental patterns?

Publication date: Available online 18 October 2017
Source:Brain and Development
Author(s): Sayaka Aoki, Yuko Yamauchi, Keiji Hashimoto
ObjectiveThis study investigated factors that would influence developmental trend of children with Down's syndrome (DS) in three different domains (motor, cognitive, language), specifically focusing on the effect of sex and neonatal conditions, including preterm birth, low birth weight, and congenital heart disease (CHD).MethodsThe participants were 158 children with DS (mean age at the initial test = 25.5 months) receiving clinical service at a rehabilitation center in Yokohama, Japan. Kyoto Scale of Psychological Development was used to measure developmental level, which derive total developmental age (DA), Posture-motor DA, Cognitive-adaptive DA, and Language-social DA. For the analyses, a multilevel model for change was adopted, as the model allowed us to investigate intrapersonal growth and the between-personal factors that are associated with individual differences in the pattern of growth.ResultsThe developmental speed of children with DS was found to be slower than that of typical children in all the three developmental domains assessed (i.e., the estimated coefficient of the slope for chronological age on DA was less than 1). DS Girls developed significantly faster than boys in non-verbal cognitive and language abilities. Low birth weight and CHD had a significant negative impact on development of non-verbal cognitive abilities for boys, but had a somewhat positive effect for girls.ConclusionAs was shown in previous studies, the result of this study indicated that the children with DS develop slower than non-disabled children. Low birth weight and CHD were found to influence developmental trend of children with DS, differently for boys and girls.



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Three children of meningoencephalitis with Kikuchi necrotizing lymphadenitis

Publication date: Available online 16 October 2017
Source:Brain and Development
Author(s): Joung-Hee Byun, Su Eun Park, Sang Ook Nam, Young A Kim, Young Mi Kim, Gyu Min Yeon, Yun-Jin Lee
BackgroundKikuchi necrotizing lymphadenitis (KNL) is a rare and benign cause of lymphadenopathy, most often cervical. The etiology of KNL remains unknown. Central nervous system (CNS) involvement, such as in meningoencephalitis, is a very rare clinical manifestation of KNL, especially in children.Case reportsA 12-year-old boy presented with unilateral cervical lymphadenopathy and fever. Histopathological findings led to the diagnosis of KNL. He revisited due to severe headache and vomiting one week later. Cerebrospinal fluid (CSF) analysis demonstrated pleocytosis (lymphocytic 57%), high protein (312 mg/dL) and low CSF/serum glucose ratio (52/121 mg/dL.) The next day, he had a seizure. Brain MRI revealed increased signal involving posterior area of both hemisphere. Another 17-year-old boy presented with headache for 7 days and behavioral and personality changes. He had a history of cervical lymphadenopathy two weeks ago. CSF analysis demonstrated lymphocytosis, high protein and low glucose ratio. MRI revealed the involvement of right cerebellum and posterior brainstem. A biopsy of one cervical lymphadenopathy demonstrated the findings of KNL. A 15-year-old girl presented with fever, headache, and cervical pain lasting 10 days. CSF analysis demonstrated pleocytosis (lymphocytic 95%), high protein and low CSF/serum glucose ratio. Histopathological findings of lymph node were suggestive of KNL. Above three patients were undertaken the steroid therapy and recovered fully without neurological dysfunction.ConclusionsRecognition of CNS involvement in KNL may help evaluate the patients of acute meningitis/encephalitis with regional lymphadenopathy, thereby avoiding unnecessary treatment.



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Commonalities and differences in the neural representations of English, Portuguese, and Mandarin sentences: When knowledge of the brain-language mappings for two languages is better than one

Publication date: December 2017
Source:Brain and Language, Volume 175
Author(s): Ying Yang, Jing Wang, Cyntia Bailer, Vladimir Cherkassky, Marcel Adam Just
This study extended cross-language semantic decoding (based on a concept's fMRI signature) to the decoding of sentences across three different languages (English, Portuguese and Mandarin). A classifier was trained on either the mapping between words and activation patterns in one language or the mappings in two languages (using an equivalent amount of training data), and then tested on its ability to decode the semantic content of a third language. The model trained on two languages was reliably more accurate than a classifier trained on one language for all three pairs of languages. This two-language advantage was selective to abstract concept domains such as social interactions and mental activity. Representational Similarity Analyses (RSA) of the inter-sentence neural similarities resulted in similar clustering of sentences in all the three languages, indicating a shared neural concept space among languages. These findings identify semantic domains that are common across these three languages versus those that are more language or culture-specific.



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Spread the word: MMN brain response reveals whole-form access of discontinuous particle verbs

Publication date: December 2017
Source:Brain and Language, Volume 175
Author(s): Jeff Hanna, Bert Cappelle, Friedemann Pulvermüller
The status of particle verbs such as rise (…) up as either lexically stored or combinatorially assembled is an issue which so far has not been settled decisively. In this study, we use the mismatch negativity (MMN) brain response to observe neurophysiological responses to discontinuous particle verbs. The MMN can be used to distinguish between whole-form storage and combinatorial processes, as it is enhanced to stored words compared to unknown pseudowords, whereas combinatorially legal strings elicit a reduced MMN relative to ungrammatical ones. Earlier work had found larger MMNs to congruent than to incongruent verb-particle combinations when particle and verb appeared as adjacent elements, thus suggesting whole-form storage at least in this case. However, it is still possible that particle verbs discontinuously spread out across a sentence would elicit the combinatorial, grammar-violation response pattern instead. Here, we tested the brain signatures of discontinuous verb-particle combinations, orthogonally varying congruence and semantic transparency. The results show for the first time brain indices of whole-form storage for discontinuous constituents, thus arguing in favour of access to whole-form-stored lexical elements in the processing of particle verbs, irrespective of their semantic opacity. Results are discussed in the context of linguistic debates about the status of particle verbs as words, lexical elements or syntactically generated combinations. The explanation of the pattern of results within a neurobiological language model is highlighted.



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Neural oscillatory mechanisms during novel grammar learning underlying language analytical abilities

Publication date: December 2017
Source:Brain and Language, Volume 175
Author(s): Olga Kepinska, Ernesto Pereda, Johanneke Caspers, Niels O. Schiller
The goal of the present study was to investigate the initial phases of novel grammar learning on a neural level, concentrating on mechanisms responsible for individual variability between learners. Two groups of participants, one with high and one with average language analytical abilities, performed an Artificial Grammar Learning (AGL) task consisting of learning and test phases. During the task, EEG signals from 32 cap-mounted electrodes were recorded and epochs corresponding to the learning phases were analysed. We investigated spectral power modulations over time, and functional connectivity patterns by means of a bivariate, frequency-specific index of phase synchronization termed Phase Locking Value (PLV). Behavioural data showed learning effects in both groups, with a steeper learning curve and higher ultimate attainment for the highly skilled learners. Moreover, we established that cortical connectivity patterns and profiles of spectral power modulations over time differentiated L2 learners with various levels of language analytical abilities. Over the course of the task, the learning process seemed to be driven by whole-brain functional connectivity between neuronal assemblies achieved by means of communication in the beta band frequency. On a shorter time-scale, increasing proficiency on the AGL task appeared to be supported by stronger local synchronisation within the right hemisphere regions. Finally, we observed that the highly skilled learners might have exerted less mental effort, or reduced attention for the task at hand once the learning was achieved, as evidenced by the higher alpha band power.



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Assessment of laryngopharyngeal reflux and the shape of the Eustachian tube should be considered in chronic rhinosinusitis with nasal polyps and chronic otitis media

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Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients

Abstract

This retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Merchant's scale. Hearing results as measured by air–bone gap and the incidence of adverse events were assessed as secondary outcomes. Thirty-two ears (44%) in the control group (n = 73) achieved complete control of infection at the most recent postoperative clinic visit vs 17 (74%) in the S53P4 obliteration group (n = 23). Comparing these outcomes yielded an odds ratio (OR) of 3.6 (p = 0.012, 95% CI 1.3–10.3). Complete failure to manage infection significantly differed (p = 0.048) between the control group (11 ears; 15%) and the S53P4 obliteration group (0 ears). No adverse events were observed in either group. Pre- and postoperative ABG results did not differ significantly between groups. Obliteration of the mastoid cavity using BAG S53P4 along with mastoidectomy in patients with chronically discharging NC-COM significantly improves the achievement of a dry and safe ear as compared to mastoidectomy alone. Importantly, no adverse events were observed with S53P4 BAG obliteration.

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Reply to the Letter to the Editor regarding “Etiopathogenesis of bone resorption in acquired middle ear cholesteatoma”

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Letter to editor: Current and future techniques for human papilloma virus (HPV) testing in oropharyngeal squamous cell carcinoma

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Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery

Abstract

Anaplastic carcinoma of the thyroid gland (ATC) is one of the most aggressive cancers in humans. With insufficient treatment, the disease most often leads to death in suffocation. From 2002, our treatment strategy has been hyperfractionated accelerated radiotherapy (HART) with high doses (64 Gy) to the neck, followed by surgery 4–8 weeks later if feasible, with the aim to gain control in the neck. After a pathology review, 51 patients were diagnosed with ATC in the period 2002–2014 in the south-east of Norway. Thirty-one received HART, and we present a study of these patients, with death in suffocation as the primary endpoint and survival as the second. No patients treated with HART died in suffocation. Six had a tracheostomy during their course of disease, of whom four were dependent on a tracheal cannula when they died. The best median survival, 19 months, was obtained in the 13 patients where both radiotherapy and surgery were possible as primary treatments. Only surgery came out as a prognostic factor for survival in multivariate analysis. Patients surviving more than 2 years were characterised by having surgery with R0 resection and no or small residual foci of ATC in the specimens. Stage 4C patients survived 3 months only.

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Endoscopic management of petrous apex cholesteatoma

Abstract

We describe a technique for approaching petrous apex cholesteatoma using combined lateral microscopic/endoscopic approaches, and discuss the utility of endoscopy in managing matrix inside the petrous apex. In our two cases, total view inside the petrous apex was achieved under endoscopy without mobilizing the internal carotid artery, and the matrix was successfully removed. Neither patient has presented with postoperative recurrence thanks to the wide-angle endoscopic view inside the petrous apex. Since the number of patients was small, comparisons with microscopic treatments are not yet valid, but endoscopes could offer a helpful tool for operating inside the petrous apex.

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Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall

Abstract

Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan–Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi² test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.

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The role of subtotal petrosectomy in cochlear implant recipients

Abstract

Describe the indications and outcome of subtotal petrosectomy for cochlear implant recipients. Tertiary care referral center. This is a retrospective study of all subtotal petrosectomies and cochlear implants performed between January 2012 and December 2014. We review the charts of these patients collecting the following data: age, gender, otologic history, audiologic tests, indication of subtotal petrosectomy, data of surgery, surgical and immediate complications, late complications and follow-up of for at least 2.5 years. 12 cases of subtotal petrosectomies with cochlear implantation in 11 patients were performed during this period; 2 children and 10 adults. The indication for a cochlear implant was in 10 cases bilateral severe to profound sensorineural hearing loss and in the remaining 2 cases was asymmetric hearing loss or unilateral hearing loss. The reason for performing a subtotal petrosectomy was chronic otitis media with or without cholesteatoma, radical cavities from previous surgeries or electrode extrusion of previously implanted devices. All cases were performed in one stage. One patient had an infectious complication that required revision surgery and finally an explantation. No other complications are described. Subtotal petrosectomy combined with cochlear implantation is a procedure required in certain situations. It is an effective and safe procedure for managing middle ear problems and creating a safe cavity to receive a cochlear implant either in adults and children.

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