Introduction. Tympanosclerosis is a commonly encountered entity within ENT clinics and primary care settings. Recognizing ear pathology is essential for correct management. Oftentimes the diagnosis is clear; however in certain cases further workup to rule out other more insidious disease processes is warranted. Case Report. We present a case of tympanosclerosis which presented as an ear mass without classic appearance of tympanosclerosis. Through imaging and biopsy the diagnosis of tympanosclerosis was made. The patient was treated surgically with good outcome. Discussion. Various ear pathologies, with different treatment algorithms, may present as clinically similar to one another. Differential diagnosis for this case included tympanosclerosis, cholesteatoma, or other middle ear masses. We review these entities and discuss their pathophysiology and implications on management.
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Τρίτη 30 Αυγούστου 2016
Tympanosclerosis Presenting as Mass: Workup and Differential
Diabetes mellitus, metformin and head and neck cancer
Head and neck cancer (HNC) includes tumours of the oral cavity, oropharynx, hypopharynx, and larynx. Nasopharyngeal cancer is also a HNC sub-site but is usually considered a separate disease with a distinct aetiology and particular characteristics [1]. Approximately 600,000 cases of HNC are diagnosed each year, and HNC accounts for 4% of cancer mortality worldwide [2]. More than 90% of HNC are squamous cell carcinoma [3]. The main risk factors associated with HNC are smoking and alcohol consumption, and the interaction between these factors can increase the risk of HNC [4].
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Nationwide epidemiological study of insomnia in Japan
Source:Sleep Medicine
Author(s): Osamu Itani, Yoshitaka Kaneita, Takeshi Munezawa, Kazuo Mishima, Maki Jike, Sachi Nakagome, Mikiko Tokiya, Takashi Ohida
BackgroundThis study was a nationwide epidemiological study of insomnia in Japan. It was conducted because very few studies on this topic have previously been performed for the general Japanese population.MethodsAn interview survey on symptoms of insomnia (difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep) and daytime dysfunction was conducted on the general nationwide population in the winter (February) and summer (August) of 2008. Data from 2614 participants who provided valid responses (age range 20–95 years, valid response rate 54.2%) were analyzed.ResultsThe prevalence of difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep was 8.3%, 5.8%, and 5.8%, respectively, in men, and 11.0%, 8.1%, and 7.4%, respectively, in women. The prevalence of insomnia was 12.2% in men and 14.6% in women, and the prevalence of insomnia with daytime dysfunction was 3.2% in men and 4.2% in women. The results of logistic regression analyses indicated that the factors aggravating insomnia for men were unemployment and having mental health issues, and for women they were being aged ≥70 years, completing fewer years of schooling, and having mental health issues. Seasonality and regionality in association with insomnia were also examined, but no significant associations were found.ConclusionIn the present survey, insomnia was defined by using criteria that were closer to the clinical diagnostic criteria (eg, coexistence of both difficulty resuming sleep and daytime dysfunction was considered). Therefore, it is believed that the results of this study were representative of the clinical actuality of insomnia in Japan.
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Brain imaging and networks in restless legs syndrome
Source:Sleep Medicine
Author(s): Giovanni Rizzo, Xu Li, Sebastiano Galantucci, Massimo Filippi, Yong Won Cho
Several studies provide information useful to our understanding of restless legs syndrome (RLS), using various imaging techniques to investigate different aspects putatively involved in the pathophysiology of RLS, although there are discrepancies between these findings.The majority of magnetic resonance imaging (MRI) studies using iron-sensitive sequences support the presence of a diffuse, but regionally variable low brain-iron content, mainly at the level of the substantia nigra, but there is increasing evidence of reduced iron levels in the thalamus. Positron emission tomography (PET) and single positron emission computed tomography (SPECT) findings mainly support dysfunction of dopaminergic pathways involving not only the nigrostriatal but also mesolimbic pathways. None or variable brain structural or microstructural abnormalities have been reported in RLS patients; reports are slightly more consistent concerning levels of white matter. Most of the reported changes were in regions belonging to sensorimotor and limbic/nociceptive networks. Functional MRI studies have demonstrated activation or connectivity changes in the same networks. The thalamus, which includes different sensorimotor and limbic/nociceptive networks, appears to have lower iron content, metabolic abnormalities, dopaminergic dysfunction, and changes in activation and functional connectivity. Summarizing these findings, the primary change could be the reduction of brain iron content, which leads to dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and in turn to a dysregulation of limbic and sensorimotor networks. Future studies in RLS should evaluate the actual causal relationship among these findings, better investigate the role of neurotransmitters other than dopamine, focus on brain networks by connectivity analysis, and test the reversibility of the different imaging findings following therapy.
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Impact of sleep on osteoporosis: Sleep quality is associated with bone stiffness index
Source:Sleep Medicine
Author(s): Nobuo Sasaki, Saeko Fujiwara, Hidehisa Yamashita, Ryoji Ozono, Kazushi Teramen, Yasuki Kihara
ObjectiveThe aim of the present study was to investigate the impact of sleep on osteoporosis.MethodsThe study used a baseline examination of the Hiroshima Sleep and Healthcare study, which was a cross-sectional and cohort study that addressed the association of sleep habits with lifestyle-related diseases. A total of 1032 participants (25−85 years of age) who underwent health examinations were included. Sleep habits, including its timing (bed time), quantity (time in bed [TIB]), and quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). The bone stiffness index (SI), a marker of osteoporosis, was measured using quantitative ultrasound systems.ResultsBed time (r = 0.065, p < 0.05), TIB (r = −0.064, p < 0.05), and global PSQI score (r = −0.126, p < 0.0001) significantly correlated with SI. Multiple regression analyses revealed that after adjusting for age, sex, body mass index, smoking, and alcohol intake, the global PSQI score (β = −0.053, p < 0.05) was significantly associated with SI, whereas bed time or TIB was not. Among each component of PSQI, sleep disturbances (β = −0.084, p < 0.005) were significantly associated with SI.ConclusionPoor sleep quality may be associated with osteoporosis. In particular, increased sleep disturbances may be a key factor in the association between poor sleep quality and osteoporosis.
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Sleep quality in temporomandibular disorder cases
Source:Sleep Medicine
Author(s): Ksenija Rener-Sitar, Mike T. John, Snigdha S. Pusalavidyasagar, Dipankar Bandyopadhyay, Eric L. Schiffman
ObjectiveThe aim of this study was to characterize self-reported sleep quality (SQ) in patients with temporomandibular disorder (TMD) and to compare their results with those of healthy controls.MethodsThe Pittsburgh Sleep Quality Index (PSQI) was used to measure SQ in a convenience sample of 609 TMD patients and 88 controls. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic nomenclature was used, but Axis I diagnoses were based on the consensus of two reliable criterion examiners and not the RDC/TMD algorithms. The PSQI scores for TMD patients were calculated also for the RDC/TMD Axis II measures assessing chronic pain and disability, depression, and nonspecific physical symptoms. PSQI scores of the TMD patients were compared with those from controls.ResultsTMD patients with 1 to 5 TMD diagnoses (n = 609) had a mean PSQI score of 7.0 (95% confidence interval [CI] = 6.7−7.4). In comparison, the mean score was 5.2 (95% CI = 4.6−5.9) for control subjects. For the subset of TMD patients with pain-free diagnoses (n = 113), the PSQI score was similar to controls with 5.1 (95% CI = 4.5−5.6), whereas it was significantly different for patients with pain-related diagnoses 7.5 (95% CI = 6.6−8.3; n = 87). Although the number of TMD diagnoses and participant age had some influence on SQ, psychosocial status and pain-related impairment assessed with RDC/TMD Axis II measures had the strongest association with SQ, in particular, dysfunctional chronic pain.ConclusionSQ is impaired in TMD patients with pain-related diagnoses, and even more in those with dysfunctional pain. This relationship between sleep and pain suggests that SQ should be assessed in TMD pain patients, especially in those with significant Axis II involvement.
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Notch1 regulates invasion and metastasis of head and neck squamous cell carcinoma by inducing EMT through c-Myc
As 50% of patients of head and neck squamous carcinoma (HNSCC) exhibit poor prognosis, the identification of new therapeutic targets is required. Recently, there have been several reports about the correlation between Notch1 and HNSCC, but the precise mechanism is still obscure. Therefore, in this study, we examined the involvement of Notch1 in HNSCC by using HNSCC cell lines and surgical specimens.
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