Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?—Reply

In Reply We thank Dr Bradley for his commentary regarding our recently published article, "Serial In-Office Intralesional Steroid Injections in Airway Stenosis." We agree with his comment highlighting how advances in one discipline can forward another, and that the treatment of scarring has been well studied. Applying proven treatments for scarring in other locations of the body is prudent, and we foresee the application of a number of newer treatments for scarring (ie, flourourocil) in airway stenosis. We acknowledge the lack of a true control group in this particular study. In addition, we appreciate that it is not clear how many total injections are required to effect positive changes for any given patient. With future evaluation of a larger cohort, we anticipate elucidating this more clearly and will likely be able to target different etiologic subgroups more specifically. Recognizing that intralesional steroid injections for airway stenosis will not be a panacea, patients with different etiologies of subglottic stenosis will need to be treated slightly differently, tailoring treatment to the patient's disease. We use intralesional steroid injections largely in 3 different ways. The first is as an adjuvant after an endoscopic procedure; this is done for patients in all etiologic subgroups. For patients in the traumatic subgroup for whom intralesional steroid injection is effective (ie, without significant cartilage collapse), ongoing intervention may not be required because they do not have a relapsing disorder. On the other hand, patients with inflammatory causes of stenosis, who have a high chance of recurrence, can benefit from adjuvant injections after surgery as well as maintenance injections for early recurrence. Recent reports aimed at identifying the etiology of idiopathic subglottic stenosis (iSGS), have suggested a local, inflammatory, immune response. The early stage of recurrence in both iSGS and rheumatologic-types of stenosis is granulation and erythema in the subglottis, followed by healing with fibrosis. Intervention with intralesional steroid injections (or potentially another immune modulator) at this early stage may alter wound healing, avoid scar formation, and therefore circumvent the need for surgical intervention. Several studies have shown efficacy, safety, and tolerance in patients with iSGS in addition to reducing the need for surgical treatment. Last, as previously observed, we have seen steroid injections dissolve scar tissue that has already formed, therefore obviating the need for surgical intervention in some patients when presenting without critical stenosis. Investigating alternative treatments for scarring is relevant in subglottic stenosis, but we also suggest exploring ways to pharmacologically modulate the inflammatory phase of the disease.

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Extending the Ear-Kidney Association to Presbycusis

Understanding the causes of presbycusis is a major goal of health research because it is such a common human condition. The ear-kidney association has been known at least since the early 20th century, when the Alport and branchio-oto-renal syndromes were described. It was also noted that the cochlea and kidney share the presence of pericytes and podocytes in the glomeruli and inner ear, indicating similarities in microcirculation. The ear and kidney have in common some forms of organ-specific toxic effects (eg, due to treatment with aminoglycosides or cisplatin), and both organs are actively engaged in ion transport functions to maintain homeostasis. On the other hand, there has been little evidence that the ear-kidney association might be important in presbycusis.

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Hearing Aid Use and Health Care Costs Among Older Adults

A number of studies have attempted to quantify the cost of hearing loss, including ones using the same data source but an earlier time. A systematic review that summarized many of these findings documented the financial results of hearing loss, but also highlighted the variability across studies and lack of standardization of how hearing loss is defined when using large data sets. Fewer data are available, however, on whether the use of hearing aids (HAs) mitigates, attenuates, or contributes to these costs. Given the lack of data, the increasing numbers of older adults who might benefit from the use of HAs and the current lack of health care coverage for hearing health care, Mahmoudi et al is exploring an important topic in this issue of JAMA Otolaryngology–Head and Neck Surgery. Elucidating the outcomes of HA use on health care costs could provide valuable data for those designing health care policy. The findings are interesting, yet raise a number of issues that could inform data interpretation as well as highlight additional research priorities.

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Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?

To the Editor "Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow."—William Pollard

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Cystatin C and 20-Year Incidence of Hearing Impairment

This longitudinal, population-based study uses data from the Epidemiology of Hearing Loss Study to investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of hearing impairment in a cohort of middle-aged and older adults.

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Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

This population-based cohort study of older adults with hearing loss evaluates the association of hearing aid use and health care use and cost.

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Effect of Perioperative Gabapentin Use in Patients Undergoing Head and Neck Mucosal Surgery

This randomized clinical trial investigates the effect of perioperative gabapentin treatment vs placebo on postsurgical pain in patients undergoing head and neck mucosal surgery.

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Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?—Reply

In Reply We thank Dr Bradley for his commentary regarding our recently published article, "Serial In-Office Intralesional Steroid Injections in Airway Stenosis." We agree with his comment highlighting how advances in one discipline can forward another, and that the treatment of scarring has been well studied. Applying proven treatments for scarring in other locations of the body is prudent, and we foresee the application of a number of newer treatments for scarring (ie, flourourocil) in airway stenosis. We acknowledge the lack of a true control group in this particular study. In addition, we appreciate that it is not clear how many total injections are required to effect positive changes for any given patient. With future evaluation of a larger cohort, we anticipate elucidating this more clearly and will likely be able to target different etiologic subgroups more specifically. Recognizing that intralesional steroid injections for airway stenosis will not be a panacea, patients with different etiologies of subglottic stenosis will need to be treated slightly differently, tailoring treatment to the patient's disease. We use intralesional steroid injections largely in 3 different ways. The first is as an adjuvant after an endoscopic procedure; this is done for patients in all etiologic subgroups. For patients in the traumatic subgroup for whom intralesional steroid injection is effective (ie, without significant cartilage collapse), ongoing intervention may not be required because they do not have a relapsing disorder. On the other hand, patients with inflammatory causes of stenosis, who have a high chance of recurrence, can benefit from adjuvant injections after surgery as well as maintenance injections for early recurrence. Recent reports aimed at identifying the etiology of idiopathic subglottic stenosis (iSGS), have suggested a local, inflammatory, immune response. The early stage of recurrence in both iSGS and rheumatologic-types of stenosis is granulation and erythema in the subglottis, followed by healing with fibrosis. Intervention with intralesional steroid injections (or potentially another immune modulator) at this early stage may alter wound healing, avoid scar formation, and therefore circumvent the need for surgical intervention. Several studies have shown efficacy, safety, and tolerance in patients with iSGS in addition to reducing the need for surgical treatment. Last, as previously observed, we have seen steroid injections dissolve scar tissue that has already formed, therefore obviating the need for surgical intervention in some patients when presenting without critical stenosis. Investigating alternative treatments for scarring is relevant in subglottic stenosis, but we also suggest exploring ways to pharmacologically modulate the inflammatory phase of the disease.

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Extending the Ear-Kidney Association to Presbycusis

Understanding the causes of presbycusis is a major goal of health research because it is such a common human condition. The ear-kidney association has been known at least since the early 20th century, when the Alport and branchio-oto-renal syndromes were described. It was also noted that the cochlea and kidney share the presence of pericytes and podocytes in the glomeruli and inner ear, indicating similarities in microcirculation. The ear and kidney have in common some forms of organ-specific toxic effects (eg, due to treatment with aminoglycosides or cisplatin), and both organs are actively engaged in ion transport functions to maintain homeostasis. On the other hand, there has been little evidence that the ear-kidney association might be important in presbycusis.

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Hearing Aid Use and Health Care Costs Among Older Adults

A number of studies have attempted to quantify the cost of hearing loss, including ones using the same data source but an earlier time. A systematic review that summarized many of these findings documented the financial results of hearing loss, but also highlighted the variability across studies and lack of standardization of how hearing loss is defined when using large data sets. Fewer data are available, however, on whether the use of hearing aids (HAs) mitigates, attenuates, or contributes to these costs. Given the lack of data, the increasing numbers of older adults who might benefit from the use of HAs and the current lack of health care coverage for hearing health care, Mahmoudi et al is exploring an important topic in this issue of JAMA Otolaryngology–Head and Neck Surgery. Elucidating the outcomes of HA use on health care costs could provide valuable data for those designing health care policy. The findings are interesting, yet raise a number of issues that could inform data interpretation as well as highlight additional research priorities.

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Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?

To the Editor "Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow."—William Pollard

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Cystatin C and 20-Year Incidence of Hearing Impairment

This longitudinal, population-based study uses data from the Epidemiology of Hearing Loss Study to investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of hearing impairment in a cohort of middle-aged and older adults.

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via IFTTT

Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

This population-based cohort study of older adults with hearing loss evaluates the association of hearing aid use and health care use and cost.

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via IFTTT

Effect of Perioperative Gabapentin Use in Patients Undergoing Head and Neck Mucosal Surgery

This randomized clinical trial investigates the effect of perioperative gabapentin treatment vs placebo on postsurgical pain in patients undergoing head and neck mucosal surgery.

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Volunteering Could Equal Better Well Being

Whether you are feeling excited to get more involved, or glad that your volunteering time has concluded with this year's convention there is mounting evidence to support that the simple act of volunteering may positively impact your well-being.  A 2016 longitudinal study found that participants who regularly partook in volunteer activities experienced greater mental well-being ratings using the General Health Questionnaire.

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Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty

This Surgical Pearl discusses preoperative photographing and morphing for predictable profiles in rhinoplasty.

https://ift.tt/2vO9wiV

A Closer Look at the Analgesic Regimen After Rhinoplasty—Reply

In Reply We thank Kendall and Castro-Alves for taking the time to read and critically analyze our article. Their commentary was very insightful and thought provoking. First, to directly answer their inquiries, we did not use a consistent standardized intraoperative or perioperative pain regimen, although that would have been desirable. In large medical center and academic medical center hospitals, and especially now with large anesthesia groups, the ability to have the same anesthesia team even throughout a single case is difficult because different anesthesiologists and certified registered nurse anesthetists continually come in and out of the operating room to spell one another for breaks and leave at shift changes so that the person who started the anesthesia portion is often not the same as who ends the case and extubates the patient. We agree that pain management should be discussed and coordinated with the anesthesiology team, and this should be a proactive venture that is highly dependent on the ability of local anesthesia to quell the need for intravenous medications during the case.

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A Closer Look at the Analgesic Regimen After Rhinoplasty

To the Editor We read with great interest the article of Patel and colleagues in a recent issue of the JAMA Facial Plastic Surgery. The authors performed a retrospective study of 62 patients who underwent rhinoplasty, and they proposed a multifaceted pain control program to manage postoperative pain and ascertain the balance between controlling pain and avoiding overprescribing narcotics. The authors should be commended for performing a study in an important topic (eg, opioid consumption) in patients undergoing outpatient surgery. The current emphasis on the need to improve postoperative pain using multimodal analgesic strategies makes the topic very relevant in perioperative medicine.

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A 3-Dimensional–Printed Short-Segment Template Prototype for Mandibular Fracture Repair

This feasibility study explores the potential application of a 3-dimensional–printed short-segment mandibular template in the management of complex mandibular fractures.

https://ift.tt/2r1QLnv

Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Migraine Headache, Migraine Surgery, and Cosmetic Temple Filler Injection

Background: Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. In their experience performing frontal nerve decompression on migraine patients, the authors noticed a previously undescribed accessory nerve and vessel in the frontotemporal area, and report its implication in migraine surgery and cosmetic filler injection. Methods: A retrospective review of 113 patients who underwent frontal migraine decompression surgery at the University of Texas Southwestern Medical Center from July of 2011 to May of 2016 was performed. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance, and topographic measurements were correlated with endoscopic location of the nerve. Results: This frontotemporal nerve was present in 55 percent, and the bilateral incidence was 57 percent of those. An accompanying vessel was also present in 81 percent of nerve complexes. Both nerve and vessel varied in size. A large vessel was present in 8 percent of all patients, and a medium vessel was present in 20 percent. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus. Conclusions: The identification and proper avulsion neurectomy of this newly described sensory frontotemporal nerve may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.

https://ift.tt/2HuZkBi

Mechanical versus Hand-Sewn Venous Anastomoses in Free Flap Reconstruction: A Systematic Review and Meta-Analysis

Background: Venous complications are the primary reason for flap loss in massive defect reconstructions; therefore, the quality and reliability of microvascular anastomoses are significant. The aim of this systematic review was to evaluate venous anastomotic time, the venous complication rate, and the flap failure rate with the mechanical anastomotic coupling device versus the hand-sewn technique in venous anastomoses of microvascular free flap operations. Methods: Chinese and English databases were searched for eligible articles published between their inception and July of 2017. The pooled relative risk was calculated for dichotomous variables, and the weighted mean difference was calculated for continuous data. Whether to use the fixed effects or random effects model depended on the heterogeneity evaluation among the studies. Results: Twelve studies were selected, including 3788 flaps (mechanical anastomotic coupling device, n = 1667; hand-sewn, n = 2121). Using the mechanical anastomotic coupling device significantly decreased venous anastomotic time (weighted mean difference, −13.50; 95 percent CI, −17.09 to −9.91; p

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Reply: Postoperative Patient- and Parent-Reported Outcomes for Children with Congenital Hand Differences A Systematic Review

No abstract available

https://ift.tt/2FgEpfr

Discussion: Evaluating the July Phenomenon in Plastic Surgery A National Surgical Quality Improvement Program Analysis

No abstract available

https://ift.tt/2KgUV2x

Aseptic Freeze-Dried versus Sterile Wet-Packaged Human Cadaveric Acellular Dermal Matrix in Immediate Tissue Expander Breast Reconstruction: A Propensity Score Analysis

Background: Although multiple acellular dermal matrix sources exist, it is unclear how its processing impacts complication rates. The authors compared complications between two preparations of human cadaveric acellular dermal matrix (freeze dried and ready-to-use) in immediate tissue expander breast reconstruction to analyze the effect of processing on complications. Methods: The authors retrospectively reviewed all alloplastic breast reconstructions with freeze-dried or ready-to-use human acellular dermal matrices between 2006 and 2016. The primary outcome measure was surgical-site occurrence defined as seroma, skin dehiscence, surgical-site infection, or reconstruction failure. The two groups were compared before and after propensity score matching. Results: The authors included 988 reconstructions (freeze-dried, 53.8 percent; ready-to-use, 46.2 percent). Analysis of 384 propensity score–matched pairs demonstrated a slightly higher rate of surgical-site occurrence (21.4 percent versus 16.7 percent; p = 0.10) and surgical-site infection (9.6 percent versus 7.8 percent; p = 0.13) in the freeze-dried group than in the ready-to-use group, but the difference was not significant. However, failure was significantly higher for the freeze-dried versus ready-to-use group (7.8 percent versus 4.4 percent; p = 0.050). Conclusions: This is the largest study comparing the outcomes of alloplastic breast reconstruction using human acellular dermal matrix materials prepared by different methods. The authors demonstrated higher early complications with aseptic, freeze-dried matrix than with sterile ready-to-use matrix; reconstructive failure was the only outcome to achieve statistical significance. The authors conclude that acellular dermal matrix preparation has an independent impact on patient outcomes in their comparison of one company's product. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

https://ift.tt/2FgElwd

Preoperative and Postoperative Assessment of Rectus Abdominis Muscle Size and Function following DIEP Flap Surgery

Background: Prospective evaluation of rectus abdominis muscle function after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is limited. Elimination of muscle harvest with this procedure is theoretically associated with preservation of rectus abdominis function and minimization of abdominal wall morbidity. In this study, the authors evaluate the change in rectus abdominis muscle size and function after DIEP flap surgery. Methods: Patients undergoing unilateral DIEP flap surgery were recruited prospectively. Using computed tomography, the change in preoperative to postoperative rectus abdominis muscle size was compared between the operative side rectus abdominis muscle and the contralateral, nonoperative control rectus abdominis. Postoperative muscle integrity and contractility were evaluated using ultrasound by comparing the change in rectus abdominis muscle dimensions between contractile and relaxed states. The BREAST-Q was used to score patients' subjective satisfaction. Clinical and radiographic hernia rates were also calculated. Results: Analysis of 26 paired rectus abdominis muscles revealed no significant change in muscle size from preoperative to postoperative values. Furthermore, dimensional change from contractile to relaxed states postoperatively was similar for paired operative and nonoperative rectus abdominis muscles. BREAST-Q scores indicated a high degree of satisfaction in abdominal well-being, breast satisfaction, and surgical experience domains. There were no clinical or radiographic abdominal wall hernias noted. Conclusions: The DIEP flap is an effective surgical procedure with minimal abdominal wall morbidity that is associated with no measurable loss in rectus abdominis size and contractile function postoperatively. Patients are highly satisfied with their abdominal function postoperatively using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?

Background: Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Methods: Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Results: Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p

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Medial Row Perforators Are Associated with Higher Rates of Fat Necrosis in Bilateral DIEP Flap Breast Reconstruction

No abstract available

https://ift.tt/2KcDnEN

The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer

Background: Contralateral prophylactic mastectomy may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of contralateral prophylactic mastectomy in women with early-stage unilateral breast cancer. Given finite health care resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. Methods: Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with contralateral prophylactic mastectomy and immediate breast reconstruction were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups. Results: A total of 2343 women were identified who met our inclusion criteria, with 1295 undergoing unilateral mastectomy and 1048 undergoing contralateral prophylactic mastectomy. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and contralateral prophylactic mastectomy (39 percent versus 42 percent; p = 0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. Contralateral prophylactic mastectomy with reconstruction was an additional $11,872 in expenditure (p

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ASPS/PSF Sponsored Symposia and Workshops

No abstract available

https://ift.tt/2Khyf2u

Discussion: The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer

No abstract available

https://ift.tt/2JpHKLB

Photoacoustic Tomography Shows the Branching Pattern of Anterolateral Thigh Perforators In Vivo

Summary: The distal branching pattern of perforators is associated with thin anterolateral thigh flap failure. The purpose of this study was to investigate the feasibility of using photoacoustic tomography as a diagnostic imaging modality to identify anterolateral thigh perforators and their branching patterns in the subcutaneous layer. Ten thighs in five healthy men were studied. The anterolateral aspect of the midthigh was examined using photoacoustic tomography. The correlation between photoacoustic tomography and ultrasound findings was evaluated. To determine the detectability of photoacoustic tomography by depth, the depth of vessels in the stem portion was compared to the depth of the deep fascia measured by ultrasound. Branching patterns of vessels in the adipose and suprafascial layers were evaluated by three-dimensional observation. A total of 18 perforators were visualized by photoacoustic tomography. Photoacoustic tomography and ultrasound had comparable diagnostic potential for the detection of perforators. Photoacoustic tomography visualized microvessels in the subcutaneous layer, especially those in oblique or horizontal orientations. The estimated mean depth of visualized vessels was 9 mm; the maximum depth was 13 mm. There was a strong correlation between the depth of visualized vessels in the stem portion and the depth of the deep fascia. Three-dimensional observation of photoacoustic tomographic images showed the branching morphology of perforators. This study showed the applicability of photoacoustic tomography to identification of the branching patterns of anterolateral thigh perforators in vivo, although limited visualization of subfascial vessels is a technical issue. The authors believe that photoacoustic tomography has the potential to be a new imaging modality for thin anterolateral thigh flap surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

https://ift.tt/2KijZXh

Validated Outcomes in the Grafting of Autologous Fat to the Breast: The VOGUE Study. Development of a Core Outcome Set for Research and Audit

Background: Autologous fat grafting is an important part of the reconstructive surgeon's toolbox when treating women affected by breast cancer and subsequent tumor extirpation. The debate over safety and efficacy of autologous fat grafting continues within the literature. However, work performed by the authors' group has shown significant heterogeneity in outcome reporting. Core outcome sets have been shown to reduce heterogeneity in outcome reporting. The authors' goal was to develop a core outcome set for autologous fat grafting in breast reconstruction. Methods: The authors published their protocol a priori. A Delphi consensus exercise among key stakeholders was conducted using a list of outcomes generated from their previous work. These outcomes were divided into six domains: oncologic, clinical, aesthetic and functional, patient-reported, process, and radiologic. Results: In the first round, 55 of 78 participants (71 percent) completed the Delphi consensus exercise. Consensus was reached on nine of the 13 outcomes. The clarity of the results and lack of additional suggested outcomes deemed further rounds to be unnecessary. Conclusions: The VOGUE Study has led to the development of a much-needed core outcome set in the active research front and clinical area of autologous fat grafting. The authors hope that clinicians will use this core outcome set to audit their practice, and that researchers will implement these outcomes in their study design and reporting of autologous fat grafting outcomes. The authors encourage journals and surgical societies to endorse and encourage use of this core outcome set to help refine the scientific quality of the debate, the discourse, and the literature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

https://ift.tt/2FgDZpn

Peak: How to Master Almost Anything

No abstract available

https://ift.tt/2KgUkOl

Reply: Smaller Diameter Anastomotic Coupling Devices Have Higher Rates of Venous Thrombosis in Microvascular Free Tissue Transfer

No abstract available

https://ift.tt/2Kj56nl

Evaluating Platelet-Rich Therapy for Facial Aesthetics and Alopecia: A Critical Review of the Literature

Background: Despite the growing popularity of platelet-rich plasma, existing evidence supporting its efficacy remains controversial due to the lack of large-scale studies and standardized protocols for preparation and application. This article reviews its use in facial rejuvenation, fat grafting, acne scarring, and androgenic alopecia. Emphasis is placed on comparing methods of platelet-rich plasma preparation and application across studies. Methods: A systematic review was performed for articles published between 2006 and 2015. All clinical studies and case reports that addressed platelet-rich plasma alone and/or in combination with fat grafting for facial rejuvenation, acne scarring, or androgenic alopecia were included. Results: Of the 22 articles included in the analysis, seven studies used platelet-rich plasma alone for facial rejuvenation, seven in combination with fat grafting, two for treatment of acne scarring, and six for treatment of androgenic alopecia. Individual study procedures, means of evaluation, and significant results are summarized. Although the majority of studies in this review report positive results, significant variation exists in preparation protocols and in the number and frequency of clinical treatments. Conclusions: The majority of studies report positive results for all indications evaluated in this review, but the procedure is limited by the lack of a standardized method for preparation and application of platelet-rich plasma. The extent to which significant variability in platelet-rich plasma preparation and/or application methods may affect clinical outcomes is not completely clear. In the interim, we present a consolidation of platelet-rich plasma treatment techniques and outcomes currently in use to help guide physicians in their clinical practice.

https://ift.tt/2JwLFGj

Reply: Vectra 3D Imaging for Quantitative Volumetric Analysis of the Upper Limb A Feasibility Study for Tracking Outcomes of Lymphedema Treatment

No abstract available

https://ift.tt/2HxnQxy

Cheek Volumization and the Nasolabial Fold

Background: The impression that cheek filling results in longitudinal shortening ("lift") of the skin and elevation of the nasolabial crease or nasolabial fold has become common within the facial injection community but remains unsubstantiated. Methods: In this study, 77 patients were evaluated before and after injection of the cheeks with a hyaluronic acid filler using a three-dimensional camera system. Results: A constant pattern of skin expansion away from the center of the injection and perpendicular to the surface of the skin was observed. A subgroup of 37 patients without differences in their preinjection and postinjection facial expression were analyzed by direct comparison and failed to demonstrate lateral traction (or "pull") on the intervening skin from the cheek injection site to the nasolabial crease. Furthermore, there was no photographic difference in the nasolabial fold or nasolabial crease. The only patients who demonstrated photographic improvement of the medial face were those who had filler placed directly in the transition between the lateral nasolabial fold and cheek (nasojugal crease). Conclusions: Filling the cheek with 3 cc of volume does not create traction forces or move the skin between the site of injection and the nasolabial crease. It is likely that expanding the nasojugal crease is the direct visual cue that leads to perceived improvement in the nasolabial fold.

https://ift.tt/2KcDlwF

Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

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Acute and chronic effects of exposure to the juvenile hormone analog fenoxycarb during sexual reproduction in Daphnia magna

Abstract

Recent studies have demonstrated that insect growth regulating insecticides are able to affect reproductive endpoints in zooplankton species at very low levels. For the cyclic parthenogenetic water flea Daphnia, most of this research has focused on the asexual part of the life cycle and induction of male offspring. Even though Daphnia and many other aquatic invertebrates rely on sexual reproduction and subsequent production of dormant eggs to recover from environmentally harsh conditions, much less is known about the effects of toxicants on the sexual reproductive phase. Using fenoxycarb as a model pesticide, we exposed male and female neonate Daphnia magna, under conditions inducing a switch to sexual reproduction, and tested for effects on dormant egg (ephippia) production and sex ratio of parthenogenetic offspring. Subsequently, we assessed whether fenoxycarb exposure affected the quality of the produced dormant eggs and viability of the hatchlings. Our results showed that exposure to sub-lethal concentrations of fenoxycarb caused a sharp decrease in parthenogenetic reproduction, while inducing male offspring. Dormant egg production was marginally negatively affected, but survival and fitness of the hatched individuals were not significantly affected. This indicates that under pesticide stress, surviving adult females invested in sexual reproduction at the expense of parthenogenetic reproduction. Exposure to toxicants during the sexual reproductive phase, could affect the active aquatic phase as well as the dormant phase in natural zooplankton populations. This indicates the need for further ecotoxicological research and development of test protocols taking into account the full life cycle of zooplankton species.

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Toxicity prediction and assessment of an environmentally realistic pesticide mixture to Daphnia magna and Raphidocelis subcapitata

Abstract

In a regulatory perspective addressing the cumulative effect of co-occurring chemicals is the first and most important step in providing a more realistic hazard assessment of chemical cocktails to both man and environment. This study was conducted to show if joint effects on the immobilisation of the crustacean Daphnia magna and on the growth inhibition of algae Raphidocelis subcapitata follow additivity (concentration addition (CA) or independent action (IA) predictions) or if there is an interaction between chemicals in the organisms upon exposure to an environmentally realistic mixture of chlorpyrifos and terbuthylazine, with expected different molecular sites of action. A pattern of antagonism at lower doses and synergism at higher doses was found for acute immobility data, while no deviation from the additive conceptual models was observed in the algae inhibition test. Results in relation to the relevant set of regulatory acceptable concentrations (RACs) and environmental quality standards (EQSs) derived for individual chlorpyrifos and terbuthylazine were evaluated.

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Response to “Immune-mediated cholangitis: is it always nivolumab’s fault?”

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Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges

Abstract

The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying  reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.

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Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

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Immunotherapy in Combination With Chemoradiation in Patients With Advanced Solid Tumors

Conditions:   Carcinoma, Squamous Cell of Head and Neck;   Carcinoma, Non-Small-Cell Lung;   Small Cell Lung Carcinoma
Interventions:   Drug: Durvalumab;   Drug: Tremelimumab;   Drug: Cisplatin (dose level 4);   Drug: Cisplatin (dose level 3);   Drug: Carboplatin (dose level 1);   Drug: Carboplatin (dose level 2);   Drug: Etoposide (dose level 1);   Drug: Etoposide (dose level 2);   Drug: Paclitaxel;   Drug: Pemetrexed;   Radiation: External beam radiation (dose level 1);   Radiation: External beam radiation (dose level 2);   Radiation: External beam radiation (hyperfractionated);   Drug: Cisplatin (dose level 1);   Drug: Cisplatin (dose level 2);   Radiation: External beam radiation (standard)
Sponsor:   AstraZeneca
Not yet recruiting

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Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges

Abstract

The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying  reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.

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Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

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Combining Intraoral Scans, Cone Beam Computed Tomography and Face Scans: The Virtual Patient

Purpose: The aim of this literature review was to provide an update on the current scientific knowledge in the field of 3D virtual patient science and to identify a possible easy, smart, and affordable method to combine different file formats obtained from different digital devices. Methods: Electronic searches of the Medline database was performed, up to May 2017, for articles dealing with the construction of a 3D virtual patient; the matching of data acquired with different digital devices (cone beam computed tomography, CBCT; face scanner, FS; intraoral scanner, IOS; and desktop scanner, DS) was considered. The inclusion of studies was based on the superimposition of at least 2 different digital sources. Results: Twenty-five studies were selected for subsequent examination. Only 3 studies analyzed the feasibility of superimposition of 3 different types of 3D data (CBCT + FS + IOS/DS). The most frequently used matching procedure was between CBCT and FS and CBCT and IOS/DS. Conclusion: The procedure of superimposition of data from CBCT, IOS, and FS is currently feasible and it is now possible to create a 3D "virtual patient" to better diagnose, plan the treatment, and communicate with patients. Address correspondence and reprint requests to Francesco Guido Mangano, DDS, PhD, Piazza Trento 4, 22015 Gravedona (Como), Italy; E-mail: francescomangano1@mclink.net Received 6 November, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges

Abstract

The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying  reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.

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A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear inv olvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chanc es of early diagnosis and hence children can be rehabilitated early, making a marked change in their future. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

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A neglected reddish penile patch: A wolf in sheep's clothing.

A neglected reddish penile patch: A wolf in sheep's clothing.

Indian J Urol. 2018 Apr-Jun;34(2):155-157

Authors: Murugavaithianathan P, Devana SK, Vaiphei K, Mavuduru R, Bora GS

Abstract
Microinvasive squamous cell carcinoma (SCC) is a known premalignant lesion of carcinoma cervix. It is also reported from other sites such as the oral cavity, larynx, and vulva. Microinvasive SCC is very rarely reported from the penis. We report the occurrence of microinvasive SCC in a long-standing erythematous lesion of glans penis in a patient, with extensive metastasis. We emphasize the need for awareness among patients and urologists about the premalignant lesions of penis and prompt treatment of such lesions to prevent possible spread of the disease.

PMID: 29692512 [PubMed]

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Overcoming wound complications in head and neck salvage surgery.

Overcoming wound complications in head and neck salvage surgery.

Auris Nasus Larynx. 2018 Apr 21;:

Authors: Kwon D, Genden EM, de Bree R, Rodrigo JP, Rinaldo A, Sanabria A, Rapidis AD, Takes RP, Ferlito A

Abstract
BACKGROUND: Loco-regional treatment failure after radiotherapy with or without chemotherapy and/or prior surgery represents a significant portion of head and neck cancer patients. Due to a wide array of biological interactions, these patients have a significantly increased risk of complications related to wound healing.
METHODS: Review of the current literature was performed for wound healing pathophysiology, head and neck salvage surgery, and wound therapy.
RESULTS: The biology of altered wound healing in the face of previous surgery and chemoradiotherapy is well described in the literature. This is reflected in multiple clinical studies demonstrating increased rates of wound healing complications in salvage surgery, most commonly in the context of previous irradiation. Despite these disadvantages, multiple studies have described strategies to optimize healing outcomes. The literature supports preoperative optimization of known wound healing factors, adjunctive wound care modalities, and microvascular free tissue transfer for salvage surgery defects and wounds.
CONCLUSION: Previously treated head and neck patients requiring salvage surgery have had a variety of disadvantages related to wound healing. Recognition and treatment of these factors can help to reverse adverse tissue conditions. A well-informed approach to salvage surgery with utilization of free vascularized or pedicled tissue transfer as well as optimizing wound healing factors is essential to obtaining favorable outcomes.

PMID: 29692326 [PubMed - as supplied by publisher]

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Relationship Between Audio-Vestibular Functional Tests and Inner Ear MRI in Meniere’s Disease

Objectives: Meniere's disease is an inner ear disorder generally attributed to an endolymphatic hydrops. Different electrophysiological tests and imaging techniques have been developed to improve endolymphatic hydrops diagnosis. The goal of our study was to compare the sensitivity and the specificity of delayed inner ear magnetic resonance imaging (MRI) after intravenous injection of gadolinium with extratympanic clicks electrocochleography (EcochG), phase shift of distortion product otoacoustic emissions (shift-DPOAEs), and cervical vestibular-evoked myogenic potentials (cVEMP) for the diagnosis of Meniere's disease. Design: Forty-one patients, with a total of 50 affected ears, were included prospectively from April 2015 to April 2016 in our institution. Patients included had definite or possible Meniere's disease based on the latest American Academy of Otolaryngology-Head and Neck Surgery guidelines revised in 2015. All patients went through delayed inner ear MRI after intravenous injection of gadolinium (three dimension-fluid attenuated inversion recovery sequences), pure-tone audiometry, extratympanic clicks EcochG, shift-DPOAEs, and cVEMP on the same day. Endolymphatic hydrops was graded on MRI using the saccule to utricle ratio inversion defined as when the saccule appeared equal or larger than the utricle. Results: Abnormal EcochG and shift-DPOAEs in patients with definite Meniere's disease (DMD) were found in 68 and 64.5%, respectively. The two methods were significantly associated in DMD group. In DMD group, 25.7% had a positive MRI. The correlation between MRI versus EcochG and MRI versus shift-DPOAEs was not significant. MRI hydrops detection was correlated with hearing loss. Finally, 22.9% of DMD group had positive cVEMP. Conclusions: EcochG and shift-DPOAEs were both well correlated with clinical criteria of Meniere's disease. Inner ear MRI showed hydrops when hearing loss was higher than 35 dB. The shift-DPOAEs presented the advantage of a rapid and easy measurement if DPOAEs could be recorded (i.e., hearing threshold

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Intraoperative pediatric acupuncture is widely accepted by parents

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): James W. Ochi, Andrew C. Richardson
ObjectiveMedical acupuncture is increasingly recognized for reducing postoperative pain, nausea and emergence agitation. Anesthetic induction is an ideal time to perform acupuncture in an effort to reduce the adverse side effects of surgery. Acupuncture is safe, inexpensive and does not lengthen the duration of anesthesia. There are however no published reports of how often patients will choose intraoperative acupuncture when given the opportunity to do so.MethodsA retrospective review of all surgical procedures performed by one surgeon over 12 months was done. This yielded 401 unique patients ranging in age from 3 months to 21 years with a mean of 6 years. Five of these patients had emergent surgery and 396 patients had scheduled surgery; there were a total of 822 surgical procedures performed on these individuals. Intraoperative acupuncture was offered only to the scheduled surgical patients.Results388 of 396 (98%) parents chose to have intraoperative acupuncture done for their child. No complications of acupuncture were encountered.ConclusionThese results demonstrate strong acceptance of intraoperative acupuncture by parents. We hope this report encourages surgeons to become trained in medical acupuncture.



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Head and neck presentation of Gardner Syndrome: A pediatric case series

Gardner Syndrome (GS), now known to be a variant of familial adenomatous polyposis (FAP), is a rare but serious genetic syndrome characterized by colonic polyposis, osteomas and other soft tissue tumors [1]. The WHO criteria for diagnosis of Gardner Syndrome are any of the following: 1) 100 or more colorectal polyps, 2) APC gene germline mutation, or 3) family history of FAP and at least one osteoma, epidermoid cyst, or desmoid tumor [2]. GS also has more prominent extra-colonic manifestations than other variants of FAP [3]. (Source: International Journal of Pediatric Otorhinolaryngology)

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Assessment of posterior choanal obstruction caused by adenoidal hypertrophy: Intra-operative mirror versus rigid nasendoscopic examination

The aim of the study is to compare the degree of posterior choanal obstruction caused by adenoidal hypertrophy intra-operatively, when assessed by mirror versus rigid nasendoscopic examination, in children undergoing adenoidectomy. (Source: International Journal of Pediatric Otorhinolaryngology)

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Rigid endoscope-assisted orotracheal intubation for vallecular cyst surgery in neonates and young infants

To investigate the outcomes of rigid endoscope-assisted orotracheal intubation (REI) in neonates and young infants with difficult airway conditions as an alternative intubation technique when more specific airway instruments are not available in most developing countries, and to evaluate the safety and advantages of this method. (Source: International Journal of Pediatric Otorhinolaryngology)

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Preventive nasal bacteriotherapy for the treatment of upper respiratory tract infections and sleep disordered breathing in children

The purpose of this prospective study was to assess the effectiveness and safety of Streptococcus salivarius 24SMBc administered as a nasal spray in children affected by recurring infections of the upper airways, adenotonsillar hypertrophy, and sleep disordered breathing (SDB). (Source: International Journal of Pediatric Otorhinolaryngology)

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Identification of Pathogenic Genes of Nonsyndromic Hearing Loss in Uyghur Families Using Massively Parallel DNA Sequencing Technique.

Identification of Pathogenic Genes of Nonsyndromic Hearing Loss in Uyghur Families Using Massively Parallel DNA Sequencing Technique.

Dis Markers. 2018;2018:5298057

Authors: Chen Y, Lu Y, Kuyaxi P, Cheng J, Zhao J, Zhao Q, Musha P, Zhang H, Yuan H

Abstract
We aim to identify the mutations of deafness genes using massively parallel DNA sequencing in the 12 Uyghur families. SNPscan method was used to screen against the 124 sites in the common deafness genes in probands. Subjects with SNPscan negativity were subject to massively parallel DNA sequencing for the sequencing of 97 genes known to be responsible for hearing loss. Eight families (66.7%) showed biallelic mutations in probands, including MYO15A mutation (6892C>T in J02 family, 9514C>T/7894G>T in J07 family, and 9514C>T in J16 family), MYO7A mutation (1258A>T in J03 family), TMC1 mutation (773G>A in J09 family and 1247T>G/1312G>A in J11 family), and PCDH15 mutation (4658delT in J08 and J13 families). Six novel types of mutation were identified including 6892C>T, 9514C>T/7894G>T, and 9514C>T in MYO15A gene, 1258A>T in MYO7A, 773G>A in TMC1, and 4658delT in PCDH15. The ratio of nonsense mutation and frameshift mutation was comparatively high. All these indicated that the mutation types reported in this study were rare. In conclusion, rare deafness genes were identified in the Uyghur families using massively parallel DNA sequencing, part of which were suggested to be related to the pathogenesis of the disease.

PMID: 29692870 [PubMed - in process]

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Surgical simulation and applicant perception in otolaryngology residency interviews

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Differential reorganisation of cutaneous elastic fibres: a comparison of the in vivo effects of broadband ultraviolet B versus solar simulated radiation

Photochem. Photobiol. Sci., 2018, Advance Article
DOI: 10.1039/C7PP00412E, Paper

Open Access

  This article is licensed under a Creative Commons Attribution 3.0 Unported Licence.

Nisamanee Charoenchon, Lesley E. Rhodes, Suzanne M. Pilkington, Mark D. Farrar, Rachel E. B. Watson
Long-term exposure of human skin to ultraviolet radiation (UVR) in sunlight negatively impacts its appearance and function.
To cite this article before page numbers are assigned, use the DOI form of citation above.
The content of this RSS Feed (c) The Royal Society of Chemistry

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Long-Term Hearing Outcomes following Stapedotomy in Patients with Otosclerosis and Preoperative Small Air-Bone Gap

Objectives: To assess the long-term effectiveness of stapedotomies performed on patients with otosclerosis and preoperative small air-bone gaps (ABGs). Methods: Retrospective study comparing the 10-year postoperative hearing outcomes after primary stapedotomies in patients with small (≤20 dB) and large ABGs (#x3e; 20 dB). Ninety out of 175 stapedotomies (22 and 68 in the small and large ABG groups, respectively) were monitored with long-term follow-ups. Results: Ten years after the operation, hearing measurements were similar for both groups, although a significant decline of bone conduction thresholds was evident (p = 0.007 and p #x3c; 0.001, respectively). An improvement of ≥10 dB in the postoperative ABG (clinical improvement) was achieved only in the large ABG group. Conclusions: Even though long-term hearing levels will evolve similarly in patients with ≤20 and #x3e; 20 dB preoperative ABGs, the lack of clinical improvement found in the small ABG group is not in favor of an early surgery.
Audiol Neurotol 2017;22:350–355

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Vibrant Soundbridge Implantation: Floating Mass Transducer Coupled with the Stapes Head and Embedded in Fat

Subtotal petrosectomy may be performed for refractory chronic middle ear diseases, such as massive cholesteatoma or recurrent otitis media. It involves permanent obliteration of the operative cavity, thus precluding the chance to restore conductive hearing via traditional inertial ossicular prostheses. The Vibrant Soundbridge (VSB) is an alternative option for hearing rehabilitation. Vibrant energy is delivered into the inner ear via a floating mass transducer (FMT), which can be coupled with any part of the middle ear acoustic transmission structure. To restore the hearing of a young woman with cholesteatoma, we combined subtotal petrosectomy with obliteration of the cavity and VSB implantation with an FMT coupled to the stapes head. Two years of follow-up demonstrated excellent auditory rehabilitation, improved sound source localization ability, and a lower speech recognition threshold. This study showed that the FMT works well in an obliterated cavity, and the experience acquired through this successful exploration is worth disseminating.
ORL 2018;80:159–164

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Vibrant Soundbridge Implantation: Floating Mass Transducer Coupled with the Stapes Head and Embedded in Fat

Subtotal petrosectomy may be performed for refractory chronic middle ear diseases, such as massive cholesteatoma or recurrent otitis media. It involves permanent obliteration of the operative cavity, thus precluding the chance to restore conductive hearing via traditional inertial ossicular prostheses. The Vibrant Soundbridge (VSB) is an alternative option for hearing rehabilitation. Vibrant energy is delivered into the inner ear via a floating mass transducer (FMT), which can be coupled with any part of the middle ear acoustic transmission structure. To restore the hearing of a young woman with cholesteatoma, we combined subtotal petrosectomy with obliteration of the cavity and VSB implantation with an FMT coupled to the stapes head. Two years of follow-up demonstrated excellent auditory rehabilitation, improved sound source localization ability, and a lower speech recognition threshold. This study showed that the FMT works well in an obliterated cavity, and the experience acquired through this successful exploration is worth disseminating.
ORL 2018;80:159–164

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Drug Induced Sleep Endoscopy Identification of Adenoid Regrowth in Pediatric Obstructive Sleep Apnea

Objective. To establish the incidence and possible contributing factors leading to adenoid regrowth in children with pediatric sleep apnea using drug induced sleep endoscopy (DISE). Methods. Children treated for obstructive sleep apnea following previous adenoidectomy were evaluated using DISE. Adenoid regrowth was scored by the same attending physician using a 5-point grading scale. Age, sex, body mass index (BMI) percent for age, polysomnogram results, initial adenoid size before adenoidectomy, and postoperative complications were evaluated. Results. Fifty-six patients (age range 22 months to 16 years) met inclusion criteria. Twenty-five children (44.6%) had Grade 2 adenoid or larger. Mean age at the time of DISE was 7.11 years, with an average of 1.75 years since initial adenoidectomy. Mean preadenoidectomy size based on intraoperative nasopharyngeal mirror assessment was Grade 2.55 (95% CI 2.30–2.79). Adenoid size at time of sleep endoscopy was Grade 1.64 (95% CI 1.30–1.98). Characteristics associated with adenoid regrowth were higher body mass index for age percentile at time of endoscopy (), initial adenoid size (), and time between initial adenoidectomy and endoscopy (). Conclusions. Body mass index for age percentile, initial adenoid size, and time between initial adenoidectomy and drug induced sleep endoscopy correlate with regrowth in childhood obstructive sleep apnea.

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Drug Induced Sleep Endoscopy Identification of Adenoid Regrowth in Pediatric Obstructive Sleep Apnea

Objective. To establish the incidence and possible contributing factors leading to adenoid regrowth in children with pediatric sleep apnea using drug induced sleep endoscopy (DISE). Methods. Children treated for obstructive sleep apnea following previous adenoidectomy were evaluated using DISE. Adenoid regrowth was scored by the same attending physician using a 5-point grading scale. Age, sex, body mass index (BMI) percent for age, polysomnogram results, initial adenoid size before adenoidectomy, and postoperative complications were evaluated. Results. Fifty-six patients (age range 22 months to 16 years) met inclusion criteria. Twenty-five children (44.6%) had Grade 2 adenoid or larger. Mean age at the time of DISE was 7.11 years, with an average of 1.75 years since initial adenoidectomy. Mean preadenoidectomy size based on intraoperative nasopharyngeal mirror assessment was Grade 2.55 (95% CI 2.30–2.79). Adenoid size at time of sleep endoscopy was Grade 1.64 (95% CI 1.30–1.98). Characteristics associated with adenoid regrowth were higher body mass index for age percentile at time of endoscopy (), initial adenoid size (), and time between initial adenoidectomy and endoscopy (). Conclusions. Body mass index for age percentile, initial adenoid size, and time between initial adenoidectomy and drug induced sleep endoscopy correlate with regrowth in childhood obstructive sleep apnea.

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Acid‐regulated gene expression of Helicobacter pylori: Insight into acid protection and gastric colonization

Helicobacter, EarlyView.


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Pediatric Helicobacter pylori gastropathy demonstrates a unique pattern of gastric foveolar hyperplasia

Helicobacter, EarlyView.


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Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance

Helicobacter, EarlyView.


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Surgical simulation and applicant perception in otolaryngology residency interviews

The Laryngoscope, EarlyView.


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Surgical simulation and applicant perception in otolaryngology residency interviews

The Laryngoscope, EarlyView.


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A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.

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A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.

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A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.

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Bromelain‐based enzymatic debridement of chronic wounds: A preliminary report

International Wound Journal, EarlyView.


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Frontal sinus schwannoma

Publication date: Available online 25 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Petersen, L. Gilain, A. Coutu, N. Saroul
IntroductionNasal sinus schwannomas are rare tumors, particularly in the frontal sinus.Case reportThe authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage.DiscussionThe pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex.



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Frontal sinus schwannoma

Publication date: Available online 25 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Petersen, L. Gilain, A. Coutu, N. Saroul
IntroductionNasal sinus schwannomas are rare tumors, particularly in the frontal sinus.Case reportThe authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage.DiscussionThe pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex.



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A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.

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A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.

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Unexpected Response Profiles Seen in Hepatitis C Virus-Infected Patients Treated with Sofosbuvir Plus Ribavirin: Five Case Reports

Viral Immunology, Ahead of Print.


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Development of full sweet, umami, and bitter taste responsiveness requires Regulator of G protein Signaling-21 (RGS21)

Abstract

The mammalian tastes of sweet, umami, and bitter are initiated by activation of G protein-coupled receptors (GPCRs) of the T1R and T2R families on taste receptor cells. GPCRs signal via nucleotide exchange and hydrolysis, the latter hastened by GTPase-accelerating proteins (GAPs) that include the Regulators of G protein Signaling (RGS) protein family. We previously reported that RGS21, uniquely expressed in Type II taste receptor cells, decreases the potency of bitter-stimulated T2R signaling in cultured cells, consistent with its in vitro GAP activity. However, the role of RGS21 in organismal responses to GPCR-mediated tastants was not established. Here, we characterized mice lacking the Rgs21 fifth exon. Eliminating Rgs21 expression had no effect on body mass accumulation (a measure of alimentation), fungiform papillae number and morphology, circumvallate papillae morphology, and taste bud number. Two-bottle preference tests, however, revealed that Rgs21-null mice have blunted aversion to quinine and denatonium, and blunted preference for monosodium glutamate, the sweeteners sucrose and SC45647, and (surprisingly) NaCl. Observed reductions in GPCR-mediated tastant responses upon Rgs21 loss are opposite to original expectations, given that loss of RGS21 -- a GPCR signaling negative regulator -- should lead to increased responsiveness to tastant-mediated GPCR signaling (all else being equal). Yet, reduced organismal tastant responses are consistent with observations of reduced chorda tympani nerve recordings in Rgs21-null mice. Reduced tastant-mediated responses and behaviors exhibited by adult mice lacking Rgs21 expression since birth have thus revealed an underappreciated requirement for a GPCR GAP to establish the full character of tastant signaling.

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Temporal Modulation Detection Depends on Sharpness of Spatial Tuning

AbstractPrior research has shown that in electrical hearing, cochlear implant (CI) users ' speech recognition performance is related in part to their ability to detect temporal modulation (i.e., modulation sensitivity). Previous studies have also shown better speech recognition when selectively stimulating sites with good modulation sensitivity rather than all stimulation sites. Site selection based on channel interaction measures, such as those using imaging or psychophysical estimates of spread of neural excitation, has also been shown to improve speech recognition. This led to the question of whether temporal modulation sensitivity and spatial selectivity of neural excitation are two related variables. In the present study, CI users' modulation sensitivity was compared for sites wit...

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A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent

Purpose of review The overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line. Recent findings Nearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a 'deafness free Tamil Nadu' by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation. Summary Opening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh. Correspondence to Prof. Mohan Kameswaran, Department of Neurotology and Auditory Implants, Madras ENT Research Foundation, No. 1, First Cross Street, Off. Second Main Road, Raja Annamalai Puram, Chennai 600028, Tamil Nadu, India. Tel: +91 44 24311411x412x413x414x415; fax: +91 4424311416; e-mail: merfmk30@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent

Purpose of review The overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line. Recent findings Nearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a 'deafness free Tamil Nadu' by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation. Summary Opening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh. Correspondence to Prof. Mohan Kameswaran, Department of Neurotology and Auditory Implants, Madras ENT Research Foundation, No. 1, First Cross Street, Off. Second Main Road, Raja Annamalai Puram, Chennai 600028, Tamil Nadu, India. Tel: +91 44 24311411x412x413x414x415; fax: +91 4424311416; e-mail: merfmk30@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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President's address: Integrity, unity, and our common sense of purpose with the ALA

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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The fragility of statistically significant findings from randomized trials in head and neck surgery

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Table of contents

The Laryngoscope,Volume 128, Issue 5, Page iii-vii, May 2018. (Source: The Laryngoscope)

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Masthead

The Laryngoscope,Volume 128, Issue 5, Page i-ii, May 2018. (Source: The Laryngoscope)

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Co ‐culture of adipose‐derived stem cells and chondrocytes on three‐dimensionally printed bioscaffolds for craniofacial cartilage engineering

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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