OtoLaryngology New Articles

Surgeon-performed Ultrasound Provides X-Marks-the-Spot Accuracy for Parathyroid Adenoma A good surgeon's eye, ultrasound performed in the office and OR, and the availability of an experienced multidisciplinary team turned life around for Mary Fitts, whose past had been a series of doctor visits and undiagnosed ailments dating back to the late 1990s. Early in the 2000s, she had a total thyroidectomy. Sometime later, she developed symptoms of hypercalcemia linked to hyperparathyroidism, but physicians at multiple institutions were unable to localize a parathyroid adenoma obscured by postoperative scarring. They deferred surgery, and her symptoms continued to worsen. "I developed severe brain fog and confusion," says Fitts, 68, who is retired from NASA in Clear Lake, Texas. "My performance on the job suffered. People would ask me questions, and I would be blank. My bones hurt deep inside, and there were days when I was so tired and in so much pain that I could barely get up the stairs to bed. I had a fair degree of depression because I didn't know what the problem was. After nearly 15 years of seeing doctors, I thought I'd run out of luck." After recognizing the complexity of her case, an ENT in Clear Lake referred her to Ron Karni, MD, an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery at UTHealth Medical School. "Like many people with high calcium levels, Mary had a little bit of this and that – problems that can vary from mental confusion and depression, to general aches and pains with no obvious cause, to recurrent kidney stones," Dr. Karni says. "She had the classic symptoms for parathyroid tumor, but the challenge is always how reliably we can localize the tumor before surgery. None of the previous studies she'd had at other institutions could determine with great certainty where the adenoma was. Because she'd had thyroid surgery years earlier, we knew we'd be working in a field of scar with high risk for damage to the larynx and other structures. This was a high-stakes case, and accuracy in pinpointing the adenoma was essential to success." Fitts listened while Dr. Karni reviewed her previous imaging studies and notes from other physicians. She concluded that she had found the right physician – since Dr. Karni focuses his practice on thyroid, parathyroid and head and neck oncologic surgery and also has certification in head and neck ultrasonography. He routinely uses ultrasound in cases of hyperparathyroidism to localize the parathyroid adenoma and facilitate minimally invasive surgery. In Fitts' case, Dr. Karni localized the tumor with office ultrasonography and then went a step further, using fine-needle aspiration and measurement of parathyroid hormone (PTH) in the aspirate as a preoperative localization procedure to confirm that the ultrasound finding was actually the adenoma. A pathologist reviewed the aspirate and confirmed that the specimen was parathyroid adenoma. Dr. Karni performing an in-office utrasound "That got us over hurdle number one – finding a tiny tumor in a field of scar," Dr. Karni says. "Hurdle number two was taking her to the OR and excising the adenoma. We've observed that when parathyroid tumors are identified on ultrasound before surgery, the surgery is successful in nearly all cases and can be performed through a small incision. It's like getting good intelligence before going into battle. Using ultrasound during the operation gives us X-marks-the-spot accuracy. Once we've located the tumor, the surgery itself is uncomplicated because we're removing a gland located only a centimeter or two under the skin." When the surgical team checked Fitts' PTH levels in the OR, they had dropped to normal, confirming that the tumor had been removed. The pathology report confirmed benign parathyroid adenoma. "In head and neck surgery, the degree of detail can make the difference between success and failure," Dr. Karni says. "Ultrasound is very easy for surgeons to perform because we know the anatomy, and because of our experience in dealing with anatomy during surgery, our view of the ultrasound study is different than a radiologist's. That's the beauty of surgeon-performed ultrasound – we know with near 100 percent certainty where the tumor is before we open in surgery." From Fitts' prospective, the surgery was a piece of cake. "I recovered quickly and my debilitating pain is gone," she says. "I'm no longer in a fog and have gotten my motivation back. Before the surgery, I didn't want to go anywhere or see anyone and I was really tired of seeing doctors. It's made a huge difference in the quality of my life. I spent a lot of time and money and was exposed to a lot of radiation that produced conflicting information. When Dr. Karni got out his ultrasound and found the tumor, I said to myself, 'This is the guy.' If I could say one thing to physicians, it's 'Know your tools.'" A good surgeon's eye, ultrasound performed in the office and OR, and the availability of an experienced multidisciplinary team turned life around for Mary Fitts, whose past had been a series of doctor visits and undiagnosed ailments dating back to the late 1990s. Early in the 2000s, she had a total thyroidectomy. Sometime later, she developed symptoms of hypercalcemia linked to hyperparathyroidism, but physicians at multiple institutions were unable to localize a parathyroid adenoma obscured by postoperative scarring. They deferred surgery, and her symptoms continued to worsen. "I developed severe brain fog and confusion," says Fitts, 68, who is retired from NASA in Clear Lake, Texas. "My performance on the job suffered. People would ask me questions, and I would be blank. My bones hurt deep inside, and there were days when I was so tired and in so much pain that I could barely get up the stairs to bed. I had a fair degree of depression because I didn't know what the problem was. After nearly 15 years of seeing doctors, I thought I'd run out of luck." After recognizing the complexity of her case, an ENT in Clear Lake referred her to Ron Karni, MD, an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery at UTHealth Medical School. "Like many people with high calcium levels, Mary had a little bit of this and that – problems that can vary from mental confusion and depression, to general aches and pains with no obvious cause, to recurrent kidney stones," Dr. Karni says. "She had the classic symptoms for parathyroid tumor, but the challenge is always how reliably we can localize the tumor before surgery. None of the previous studies she'd had at other institutions could determine with great certainty where the adenoma was. Because she'd had thyroid surgery years earlier, we knew we'd be working in a field of scar with high risk for damage to the larynx and other structures. This was a high-stakes case, and accuracy in pinpointing the adenoma was essential to success." Fitts listened while Dr. Karni reviewed her previous imaging studies and notes from other physicians. She concluded that she had found the right physician – since Dr. Karni focuses his practice on thyroid, parathyroid and head and neck oncologic surgery and also has certification in head and neck ultrasonography. He routinely uses ultrasound in cases of hyperparathyroidism to localize the parathyroid adenoma and facilitate minimally invasive surgery. In Fitts' case, Dr. Karni localized the tumor with office ultrasonography and then went a step further, using fine-needle aspiration and measurement of parathyroid hormone (PTH) in the aspirate as a preoperative localization procedure to confirm that the ultrasound finding was actually the adenoma. A pathologist reviewed the aspirate and confirmed that the specimen was parathyroid adenoma. "That got us over hurdle number one – finding a tiny tumor in a field of scar," Dr. Karni says. "Hurdle number two was taking her to the OR and excising the adenoma. We've observed that when parathyroid tumors are identified on ultrasound before surgery, the surgery is successful in nearly all cases and can be performed through a small incision. It's like getting good intelligence before going into battle. Using ultrasound during the operation gives us X-marks-the-spot accuracy. Once we've located the tumor, the surgery itself is uncomplicated because we're removing a gland located only a centimeter or two under the skin." When the surgical team checked Fitts' PTH levels in the OR, they had dropped to normal, confirming that the tumor had been removed. The pathology report confirmed benign parathyroid adenoma. "In head and neck surgery, the degree of detail can make the difference between success and failure," Dr. Karni says. "Ultrasound is very easy for surgeons to perform because we know the anatomy, and because of our experience in dealing with anatomy during surgery, our view of the ultrasound study is different than a radiologist's. That's the beauty of surgeon-performed ultrasound – we know with near 100 percent certainty where the tumor is before we open in surgery." From Fitts' prospective, the surgery was a piece of cake. "I recovered quickly and my debilitating pain is gone," she says. "I'm no longer in a fog and have gotten my motivation back. Before the surgery, I didn't want to go anywhere or see anyone and I was really tired of seeing doctors. It's made a huge difference in the quality of my life. I spent a lot of time and money and was exposed to a lot of radiation that produced conflicting information. When Dr. Karni got out his ultrasound and found the tumor, I said to myself, 'This is the guy.' If I could say one thing to physicians, it's 'Know your tools.'" Read More » Kunal Jain, MD joins the Department's Head and Neck Surgery Program Kunal S. Jain, MD has joined the UTHealth Medical School Department of Otorhinolaryngology-Head and Neck Surgery. As a fellowship-trained head and neck surgeon, with specific expertise in transoral robotic surgery and microvascular reconstruction, he will add strength to the department's rapidly growing head and neck oncology program. Dr. Jain received his bachelor's degree in economics at Cornell University, spending his junior year at the London School of Economics and Political Science in the United Kingdom. After earning his medical degree at The University of Texas Southwestern Medical Center in Dallas, he completed his internship in general surgery and his residency in otolaryngology-head and neck surgery at SUNY Upstate Medical University in Syracuse, New York. He joined the faculty of UTHealth and medical staff of Memorial Hermann-Texas Medical Center after completing a fellowship in head and neck oncology and reconstruction at the University of Pennsylvania in Philadelphia. Dr. Jain is a reviewer for Head and Neck. He has presented nationally and internationally, and has coauthored articles published in Head and Neck, The Laryngoscope, International Forum of Allergy and Rhinology, Cancer, Thyroid and other peer-reviewed journals. His clinical interests include treating patients with head and neck and thyroid cancer and advanced reconstruction and rehabilitation. His research interests include transoral robotic surgery for the oropharynx, and improving outcomes in head and neck cancer surgery patients with microvascular reconstruction. Read More » Transoral Robotic Surgery for Airway Obstruction in Pediatric Patients When the da Vinci® Surgical System was approved by the FDA in 2009 for transoral robotic surgery (TORS) for resection of tumors of the pharynx, UTHealth otolaryngologists affiliated with Memorial Hermann-Texas Medical Center were among the first in the country to offer cancer patients this innovative approach. Today, thanks to refinements in robotic technique, TORS is being used increasingly in the field of head and neck surgery, including pediatric airway surgery. In an article published in the November 2014 issue of The Laryngoscope, three faculty members and a resident at UTHealth Medical School reported their preliminary experience using TORS techniques in pediatric airway surgery. The retrospective chart review, one of the earliest in the literature, included all pediatric patients who underwent robotic airway surgery at Memorial Hermann-Texas Medical Center between August 2010 and December 2012. "The robot was originally developed for gynecological, prostate and open abdominal surgery, but in the past few years otolaryngologists have adapted it for use in head and neck surgery, particularly for oropharyngeal cancer," says Sancak Yuksel, MD, an assistant professor of otorhinolaryngology-head and neck surgery at UTHealth Medical School and the senior author of the article. "Although it's been primarily a tool for head and neck surgical oncologists, we've expanded its application to include treatment of sleep apnea, benign thyroid disease and other conditions. After reviewing our adult head and neck cancer surgeons' success in treating oropharyngeal cancer patients, we became interested in finding ways to improve our outcomes in the pediatric airway, which presents unique challenges for surgeons. Our goal is to adapt the technology further for pediatric patients." The article in The Laryngoscope reports on three pediatric patients: a 15-year-old boy with posterior glottic stenosis for which a robotic-assisted posterior cricoid split with cartilage graft placement was attempted but converted in the OR to an open technique; a six-year-old boy with Trisomy 21 who underwent robotic-assisted endoscopic repair of a type II laryngeal cleft, resulting in resolution of chronic aspiration and successful initiation of oral feeding; and a three-year-old girl who underwent robotic-assisted left posterior cordectomy and subtotal arytenoidectomy for idiopathic bilateral vocal cord paralysis, resulting in improved Passy-Muir valve tolerance. "We noted that while robotic pediatric airway surgery has potential advantages, it's not without limitations," says Soham Roy, MD, FACS, FAAP, director of pediatric otolaryngology at UTHealth Medical School and Children's Memorial Hermann Hospital, and an associate professor of pediatric otolaryngology-head and neck surgery at the medical school. "The robot was not specifically designed for airway procedures. We expect to see advancements in technology that will reduce the size and mass of the instruments and lead the way for innovations in airway surgery in children." The authors concluded that there are challenges and limitations to the widespread use of TORS in pediatric airway surgery and that larger prospective studies are needed to define indications for TORS and determine how to optimize its use in the pediatric airway. "We're pleased to be on the forefront of technology and among those leading the train on new developments in pediatric airway surgery," Dr. Roy says. "We also recognize that we're standing on the shoulders of those who've gone before us." Reference Ferrell JK, Roy S, Karni RJ, Yuksel S. Applications for transoral robotic surgery in the pediatric airway. The Laryngoscope. 2014 Nov;124(11):2630-5. Read More » Zi Yang Jiang, MD joins UTHealth Pediatric ENT Service The UTHealth Department of Otolaryngology is proud to announce that appointment of Zi Yang Jiang, MD, as an assistant professor. Together with Soham Roy, MD and Sancak Yuksel, Dr. Jiang will expand the pediatric otolaryngology service at Children's Memorial Hermann Hospital. Dr. Jiang completed his fellowship in pediatric otolaryngology-head and neck surgery at Children's Mercy Hospital and Clinics at the University of Kansas Medical Center in Kansas City, Missouri. A magna cum laude biology and chemistry graduate of the University of Illinois at Urbana-Champaign, Dr. Jiang received his medical degree at the University of Illinois at Chicago, where he was inducted into Alpha Omega Alpha Honor Medical Society. He completed his residency in otolaryngology-head and neck surgery at The University of Texas Southwestern Medical Center at Dallas. Recognized with numerous awards during his academic career, he has presented nationally and internationally and is the coauthor of articles published in peer-reviewed journals, including Otology & Neurotology, JAMA Otolaryngology-Head and Neck Surgery, and Otolaryngology Head and Neck Surgery, among others. His clinical and research interests include clinical outcomes and cost-effectiveness in otolaryngology, pediatric neck masses and airway surgery, and fetal-neonatal health. Read More » IFNγ-Inducible Chemokines Decrease upon Selenomethionine Supplementation in Women with Euthyroid Autoimmune Thyroiditis: Comparison between Two Doses of Selenomethionine (80 or 160 μg) versus Placebo Background: Several studies have suggested that selenium may influence the natural history of autoimmune thyroiditis (AIT). Recently, IFN#x03B3;-inducible chemokines (CXCL-9, -10 and -11) were shown to be elevated in AIT patients. Objective: This prospective, randomized, controlled study was conducted to evaluate the effect of two doses of selenomethionine (Semet; 80 or 160 µg/day) versus placebo in euthyroid women with AIT, in terms of reduction of anti-thyroid antibodies, CXCL-9, -10 and -11 and improvement of thyroid echogenicity, over 12 months. Patients and Methods: Sixty patients, aged 21-65 years, were equally randomized into 3 groups: placebo, 80 µg/day of Semet (80-Semet) or 160 µg/day of Semet (160-Semet). Results: Anti-thyroperoxidase antibody (TPOAb) levels remained unaffected by Semet supplementation; anti-thyroglobulin antibody levels showed a significant reduction in the 160-Semet and the placebo group at 12 months. No significant change in thyroid echogenicity, thyroid volume and quality of life was observed within and between the groups. Subclinical hypothyroidism was diagnosed in 2 patients of the placebo group versus 1 patient in each Semet group. Serum CXCL-9 and -10 were significantly reduced in both Semet groups at 6 and 12 months, while they remained unchanged or increased in the placebo group. CXCL-11, TNFα and IFN#x03B3; showed a transient decrease at 6 months in both Semet groups but returned nearly to the basal levels at 12 months. Conclusions: Semet supplementation had no positive effect on thyroid echogenicity or TPOAb in our patients. However, we observed a Semet-dependent downregulation of the IFN#x03B3;-inducible chemokines, especially CXCL-9 and -10, which may serve as helpful biomarkers in future selenium supplementation trials. Eur Thyroid J Read More » Traditional Chinese Medicine: Salvia miltiorrhiza Enhances Survival Rate of Autologous Adipose Tissue Transplantation in Rabbit Model Abstract Objective This study aimed to explore the influence of traditional Chinese medicines: Salvia miltiorrhiza on the survival of auto-transplantation of adipose tissue in a rabbit model. Methods Minced adipose tissue harvested from the scapular region was transplanted into the dorsum of the ears of New Zealand rabbits. The experimental groups were intra-peritoneally injected with S. miltiorrhiza for a total 4 weeks. The rabbits in control group were intra-peritoneally injected with normal saline. Plasma VEGF levels were assayed at week 1, 2, 4, 6, and 8 after fat tissue auto-transplantation in the dorsum of rabbit ears. Graft samples were collected and measured at week 2, 4, and 12. Survival rates were calculated, and histologic morphology was evaluated. The expression of CD31 was detected by means of immune-histochemical staining to observe neo-vascularization of the auto-transplanted fat tissue. Perilipin was detected by means of immune-histochemical staining to observe the survival of fat cells. Results At 12 weeks, the survival rates in the experimental group were statistically greater than that in the control group, respectively (p < 0.05). Plasma levels of VEGF in the experimental group at different time points were significantly higher than that in the control group (p < 0.05). Histologically, grafts in the experimental group showed better survival of adipocytes and neo-vascularization. By perilipin immuno-histochemical staining, the experimental group demonstrated better adipocyte survival. Conclusions In the rabbit model, S. miltiorrhiza can promote the neo-vascularization of adipose tissue grafts and significantly improves the survival rate of auto-transplanted adipose tissue. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Read More » Gynecomastia: Simultaneous Subcutaneous Mastectomy and Areolar Reduction with Minimal Inconspicuous Scarring Abstract Acceptable scar positioning on the anterior male chest is very limited. In Gynecomastia surgery, an obvious areolar incision is the most sensitive indicator of a previous operation; a less apparent scar is indispensable for the patient's psychological satisfaction. Whenever only areolar diameter reduction is required, the circumareolar incision must be performed in a position leaving the least conspicuous scar. Standard excision of an outer doughnut of areolar skin results in a visible and unnatural peri-areolar scar. The peri-nipple excision of areolar skin leaves the skin–areola junction undisturbed. When combined with a transverse areolar infra-nipple incision, access for subcutaneous mastectomy is facilitated. With this approach, risk of nipple vascular compromise is thought to be reduced, and necrosis of areolar pigmented skin virtually impossible. EBM Level V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Read More » Kommentar der Schriftleitung Laryngo-Rhino-Otol 2015; 94: 651-651 DOI: 10.1055/s-0035-1564169 Liebe Leserinnen und Leser, Video-Editorial www.thieme.de/lro [...] © Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text Read More » Stanzbiopsie Laryngo-Rhino-Otol 2015; 94: 658-659 DOI: 10.1055/s-0035-1564339 Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Full text Read More » Kopf-Hals-Tumoren – Mehr Selbstakzeptanz durch Liposuktion nach Therapie? Laryngo-Rhino-Otol 2015; 94: 654-655 DOI: 10.1055/s-0035-1552266 Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Full text Read More » Trockene Trommelperforation – Underlay- oder Inlay-Technik zur Defektdeckung? Laryngo-Rhino-Otol 2015; 94: 656-657 DOI: 10.1055/s-0035-1552267 Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Full text Read More » Fragen für die Facharztprüfung Laryngo-Rhino-Otol 2015; 94: 715-715 DOI: 10.1055/s-0035-1552268 Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Full text Read More » Postoperative Behandlung Laryngo-Rhino-Otol 2015; 94: 716-720 DOI: 10.1055/s-0035-1559765 © Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Full text Read More » Haftung des nicht operierenden Arztes wegen fehlerhafter Aufklärung Laryngo-Rhino-Otol 2015; 94: 695-696 DOI: 10.1055/s-0035-1548920 © Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Full text Read More » Prävalenz, Risikofaktoren und Diagnostik von Hörstörungen bei Frühgeborenen Sprache Stimme Gehör DOI: 10.1055/s-0035-1555805 Einleitung: Die Frühgeburt bringt ein deutlich gesteigertes Risiko der Ausbildung einer konnatalen Hörstörung mit sich. Der postnatalen Kontrolle der Hörfunktion muss daher bei allen Frühgeborenen besondere Aufmerksamkeit zuteil werden. Die vorgestellte Arbeit untersucht, inwieweit die aktuellen wissenschaftlichen Erkenntnisse hinsichtlich Prävalenz, Diagnostik, Therapie und in Bezug auf die Risikofaktoren von Hörstörungen bei Frühgeborenen praktische Anwendung finden. Material und Methoden: Die Behandlungsdaten von 126 im Arbeitsbereich Phoniatrie und Pädaudiologie der HNO-Universitätsklinik Magdeburg in den Jahren 2006–2011 untersuchten und behandelten ehemaligen Frühgeborenen wurden retrospektiv ausgewertet. Die zusätzliche Analyse aller Datensätze der Screeningzentrale (n=67 640) aus diesem Zeitraum ermöglicht Rückschlüsse auf die Gesamtanzahl und Prävalenz von Hörstörungen bei Frühgeborenen in Sachsen-Anhalt. Ergebnisse: Nahezu alle Frühgeborene erhalten, wie Reifgeborene, ein beidseitiges postnatales Hörscreening. Die Datenauswertung zeigt jedoch, dass die praktische Umsetzung im Detail oft nicht den in der G-BA-Richtlinie festgelegten Qualitätszielen entspricht. Bspw. erfolgt je nach Geburtsklinik keine regelhafte Anwendung der bei Frühgeborenen empfohlenen Screeningmethode (AABR) oder der richtliniengemäße Screening-und Therapiezeitpunkt wird nicht eingehalten. Diskussion: Die Evaluation der praktischen Umsetzung des universellen Neugeborenenhörscreenings wurde bereits zum Zeitpunkt der Einführung des Screeningprogrammes durch den G-BA geplant. Im Rahmen dieser Untersuchung sollte der praktischen Versorgung von Risikogruppen wie Frühgeborenen besondere Beobachtung gewidmet werden, um auf Basis der erhobenen Daten das Hörscreening – sowie die anschließende Diagnostik und Therapie-weiter zu vereinheitlichen. Unabhängig von der Geburtsklinik sollte gleichermaßen die Chance auf rechtzeitige Diagnostik und damit auf frühzeitige, prognostisch günstigere Therapie einer konnatalen Hörstörung bestehen. Durch schnelle postnatale Hörgerätversorgung können die Hörbahnreifung stimuliert und so potentiell Entwicklungsprobleme hinsichtlich der Hör-und Sprachentwicklung vermieden werden. [...] © Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text Read More » A Point About Stilettos Injuries from high heel shoes are seldom seen by plastic surgeons as they are more frequently encountered by doctors working in the Emergency Department or by our Orthopaedic colleagues. There are numerous reports of high heels in the medical literature but these reports typically describe the relationship between stilettos, poor posture and back pain1. Stilettos are known to significantly reduce ankle muscle movement, step length, total range of movement and balance control. Penetrating injuries from stiletto heels have also been described to the orbit2, the skull and cerebrum3. Read More » Near-infrared Fluorescent Swallow Test for Detection of the Alimentary Tract Anastomotic Leakage Jejunal free flap is one of the most common surgical options for reconstruction following total pharyngolaryngoesophagectomy (TPLE). Anastomotic leakage following the surgery is a serious condition and earlier detection is crucial. Contrast swallow test is commonly performed, but it is rather laborious and provides unclear image when minor leakage occurs near the sternum.1 To carry out swallow test more simply, we adopted ICG near-infrared fluorescent imaging.2-4 Read More » Using Radiological markers for Kirschner wire fixation of phalangeal fractures Many fracture configurations in hand surgery lend themselves to Kirschner wire (K wire) fixation. K wires are cheaper than plates and in many cases have comparable or even superior outcomes (1). Numerous applications are described in the literature and these include standard cross K wires for transverse phalangeal fractures, intraosseous wiring with oblique K wire fixation (2) and in some cases external dynamic systems such as the Suzuki frame (3). Read More » A Novel noninvasive three-dimensional volumetric analysisfor fat graft survival in facial recontouring using the 3L and 3M technique Autologous fat grafting for volume augmentation in soft tissue has grown in popularity in the plastic surgery. Read More » Endobronchial Malposition of Matthys Pleural Catheter: A Case Report THORAC CARDIOV SURG Reports DOI: 10.1055/s-0035-1564691 Background Matthys catheters (Matthys drainage A Set, Bösch Feinmechanik und Medizintechnik GmbH, Gottenheim, Germany) are thin catheters with an external diameter of 2.7 mm, which are often used in internal medicine to drain pleural effusions. After puncturing the pleural cavity with a hollow needle the Matthys catheter is advanced through it without resistance. Once the three-way tap on the catheter has been opened, the pleural effusion should flow out. Case Description In our case, the positioning of the Matthys catheter was thought to be completely straightforward but an X-ray check nonetheless revealed malposition. The catheter had been advanced surprisingly over the left upper lobe bronchus across the carina into the right upper lobe bronchus. No thoracic bleeding occurred. Conclusion Although the Matthys catheter was placed endobronchially, we removed it without air leakage. Fortunately, no further problems occurred. [...] Georg Thieme Verlag KG Stuttgart · New York Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text Read More » Alternative treatment of restless legs syndrome: an overview of the evidence for mind-body interventions, lifestyle interventions, and neutraceuticals • Regular physical activity should be recommended for treatment of RLS symptoms.• Oral iron should be considered for people with RLS who have low ferritin levels.• Preliminary data on many mind-body interventions, lifestyle interventions, and neutraceuticals suggests that high-quality RCTs are warranted. Read More » Allergic rhinitis and associated risk of migraine among children: a nationwide population-based cohort study Background Increased frequency of migraine was reported in adults with allergic rhinitis (AR). Although migraine is less common in children than in adults, it can begin in early childhood and persist into adulthood. We conducted this population-based cohort study to investigate the incidence and subsequent risk of migraine in children with AR. Methods From 2000 to 2007, 461,850 children with recently diagnosed AR and 460,718 non-AR controls were included in the study. By the end of 2008, incidences of migraine in both cohorts, the AR to non-AR cohort hazard ratios (HRs), and confidence intervals (CIs) were measured. Results The incidence of migraine during the study period was 3.2-fold higher in the AR cohort (95% CI, 2.97 to 3.46) than in the non-AR cohort (11.4 vs 3.49 per 10000 person-years). The risk was greater for boys than for girls, and for children aged <6 years. The HR for migraine in children with AR was 1.44 (95% CI, 1.31 to 1.58) for those with ≤2 annual AR-related medical visits, whereas, 14.8 (95% CI, 13.6 to 16.2) for those with >4 visits (p < 0.0001, the trend test). The risk of migraine development in the AR cohort was highest within the first year after AR diagnosis (HR 4.89; 95% CI, 3.98 to 6.00). Children with AR were more likely to have migraine without aura than migraine with aura. Conclusion Children with AR had a higher incidence and subsequent risk of migraine. Physicians should be more aware of migraine in children with AR who complain of headache. Read More » In reference to "Medical therapy vs surgery for recurrent acute rhinosinusitis" Read More » Odorant Metabolism Analysis by an Automated Ex Vivo Headspace Gas-Chromatography Method In the olfactory epithelium (OE), odorant metabolizing enzymes have the dual function of volatile component detoxification and active clearance of odorants from the perireceptor environment to respectively maintain the integrity of the tissues and the sensitivity of the detection. Although emphasized by recent studies, this enzymatic mechanism is poorly documented in mammals. Thus, olfactory metabolism has been characterized mainly in vitro and for a limited number of odorants. The automated ex vivo headspace gas-chromatography method that was developed here was validated to account for odorant olfactory metabolism. This method easily permits the measurement of the fate of an odorant in the OE environment, taking into account the odorant gaseous state and the cellular structure of the tissue, under experimental conditions close to physiological conditions and with a high reproducibility. We confirmed here our previous results showing that a high olfactory metabolizing activity of the mammary pheromone may be necessary to maintain a high level of sensitivity toward this molecule, which is critical for newborn rabbit survival. More generally, the method that is presented here may permit the screening of odorants metabolism alone or in mixture or studying the impact of aging, pathology, polymorphism or inhibitors on odorant metabolism. Read More » Endoscopic submandibular gland resection preserving great auricular nerve and periaural sensation The preservation of periaural sensation is one of the most important things to improve the postoperative quality of life after performing the surgical procedures via retroauricular approach. The aim of this study is to describe the surgical technique of endoscopic submandibular gland (SMG) resection through the potential plane between great auricular nerve (GAN) and sternocleidomastoid muscle (sub-GAN dissection) and to evaluate its technical feasibility and advantage. Read More » Acoustic Analyses of Prolonged Vowels in Young Adults With Friedreich Ataxia Finding measures that track disease progression and determine treatment efficacy is vital for appropriate management in Friedreich ataxia (FA). The purpose of this study was to determine which cepstral- and spectral-based measures extracted from prolonged vowels using Analysis of Dysphonia in Speech and Voice (ADSV) program discriminate between those who have FA and normal voice (NV) peers. Read More » Office-based Autologous Fat Injection Laryngoplasty for Vocal Process Granuloma To present the outcomes of office-based autologous fat injection laryngoplasty for the treatment of vocal process granuloma in conjunction with glottic insufficiency. Read More » Tumor necrosis factor α induces myofibroblast differentiation in human tongue cancer and promotes invasiveness and angiogenesis via secretion of stromal cell-derived factor-1 Tongue squamous cell carcinoma (TSCC) is the most common oral cancer and frequently leads to lymph node and distant metastasis [1]. Solid tumors, such as TSCC, have been increasingly recognized as a vastly complex entity of cancer cells, extracellular matrix, blood vessels, molecules and various stromal cells including fibroblasts, endothelial cells and inflammatory cells, which are collectively termed tumor microenvironment (TME) and cooperatively promote tumor growth, angiogenesis, invasion and dissemination [2–4]. Read More » Tumor necrosis factor α induces myofibroblast differentiation in human tongue cancer and promotes invasiveness and angiogenesis via secretion of stromal cell-derived factor-1 Tongue squamous cell carcinoma (TSCC) is the most common oral cancer and frequently leads to lymph node and distant metastasis [1]. Solid tumors, such as TSCC, have been increasingly recognized as a vastly complex entity of cancer cells, extracellular matrix, blood vessels, molecules and various stromal cells including fibroblasts, endothelial cells and inflammatory cells, which are collectively termed tumor microenvironment (TME) and cooperatively promote tumor growth, angiogenesis, invasion and dissemination [2–4]. Read More » Angiofibrolipoma of the larynx: Case report and literature review Abstract Background Angiofibrolipomas are one of the rarest variants of lipomas. Laryngeal origin of lipomatous tumors is also very rare. Methods The nature and severity of symptoms depend on the location and the size of the laryngeal tumors. However, pedunculated of a 28-cm long tumor with the point of origin on the left arytenoepiglottic fold reached down to the esophagus and. in spite of slight dysphagia. remained asymptomatic for many years. In this case, a narrowing of the digestive tract was masked by an adaptation to the presence of a slowly growing mass. Results After surgical removal of the tumor and 18-month follow-up, the patient remains asymptomatic. Nonetheless, taking into consideration a possibility of recurrence or malignance, a postoperative regular 5-year follow-up was recommended. Conclusion This case report illustrates the successful transoral resection of a polypoid-shaped angiofibrolipoma of the larynx. An easy and safe endoscopic procedure seemed to be successful in the case described. © 2015 Wiley Periodicals, Inc. Head Neck, 2015 Read More » Maintaining physical activity during head and neck cancer treatment: Results of a pilot controlled trial Abstract Background Concurrent chemoradiotherapy (concurrent CRT) to treat head and neck cancer is associated with significant reductions of weight, mobility, and quality of life (QOL). An intervention focusing on functional exercise may attenuate these losses. Methods We allocated patients to a 14-week functional resistance and walking program designed to maintain physical activity during cancer treatment (MPACT group; n = 11), or to usual care (control group; n = 9). Outcomes were assessed at baseline, and 7 and 14 weeks. Results Compared to controls, the MPACT participants had attenuated decline or improvement in several strength, mobility, physical activity, diet, and QOL endpoints. These trends were statistically significant (p < .05) in knee strength, mental health, head and neck QOL, and barriers to exercise. Conclusion In this pilot study of patients with head and neck cancer undergoing concurrent CRT, MPACT training was feasible and maintained or improved function and QOL, thereby providing the basis for larger future interventions with longer follow-up. © 2015 Wiley Periodicals, Inc. Head Neck, 2015 Read More » Severe epistaxis due to aberrant vasculature in a patient with STAT-1 mutation Abstract Background Signal transducer and activator 1 (STAT-1) mutations are rare and have been implicated in combined immunodeficiency, enhanced tumorigenesis, and vascular defects. Methods A 60-year-old woman with a novel STAT-1 mutation and resulting immunodeficiency, squamous cell carcinoma, and vascular disease presented with profuse epistaxis secondary to rupture of an aberrant artery that she developed in part because of this mutation. After unsuccessful posterior packing, embolization was initiated but subsequently aborted because of a bovine origin carotid artery and a history of multiple carotid dissections. Results After repeat posterior packing, hemostasis was achieved. No additional episodes of epistaxis occurred in the subsequent 13 months. Conclusion Vascular anomalies can present challenges in epistaxis management. In patients with conditions known to cause vascular anomalies, it is critical to obtain vascular imaging before intervention. © 2015 Wiley Periodicals, Inc. Head Neck, 2015 Read More » Comparison of hearing outcomes after treatment for early-stage external auditory canal cancer Abstract Background The purpose of this study was to compare the hearing outcomes after surgery with reconstruction of the external auditory canal in combination with tympanoplasty, radiotherapy (RT) alone, and surgery followed by postoperative RT for T1 to 2N0M0 external auditory canal cancer. Methods We performed a retrospective, single-institution review of consecutive patients with early-stage external auditory canal cancer treated with surgery and/or RT between April 1997 and August 2013. Audiological data included the pretreatment hearing thresholds and those obtained at 12 months after the completion of therapy. Results When we compared the functional gains for air-conduction pure-tone average thresholds and mean air-bone gaps, those in the surgery group (n = 10) were significantly higher than those in the RT (n = 13) and surgery + RT (n = 5) groups. Conclusion Adequate techniques for reconstruction of the external auditory canal in combination with tympanoplasty after complete surgical resection is useful for hearing preservation in addition to good survival outcomes. © 2015 Wiley Periodicals, Inc. Head Neck, 2015 Read More » Cardiovascular Risk Factors in Subclinical Hypothyroidism: A Case Control Study in Nepalese Population Objectives. To assess cardiovascular risk factors in Nepalese population with subclinical hypothyroidism as compared to age and sex matched controls. Materials and Methods. A case control study was conducted among 200 subjects (100 subclinical hypothyroid and 100 euthyroid) at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Demographic and anthropometric variables including systolic and diastolic blood pressure (BP) were taken. Blood samples were assayed for serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and high sensitivity C reactive protein (hs-CRP). Results. Subclinical hypothyroid patients had significantly higher diastolic BP, total cholesterol, LDL cholesterol, and hs-CRP than controls. The odds ratio of having hypercholesterolemia (>200 mg/dL), low HDL cholesterol (100 mg/dL), high hs-CRP (>1 mg/L), and high diastolic BP (>80 mmHg) and being overweight (BMI ≥ 23 Kg/m2) in subclinical hypothyroidism was 2.29 (95% CI; 1.2–4.38, ), 1.73 (95% CI; 0.82–3.62, ), 3.04 (95% CI; 1.66–5.56, ), 2.02 (95% CI; 1.12–3.64, ), 3.35 (95% CI; 1.72–6.55, ), and 0.9 (95% CI; 0.48–1.67, ), respectively, as compared to controls. Conclusion. Subclinical hypothyroid patients are associated with higher risk for cardiovascular disease than euthyroid subjects. Read More » Brown-Vialetto-Van Laere syndrome: two siblings with a new mutation and dramatic therapeutic effect of high-dose riboflavin Journal Name: Journal of Pediatric Endocrinology and Metabolism Issue: Ahead of print Read More » Comprehensive profiling of biological processes reveals twomajor prognostic subtypes in breast cancer Abstract Heterogeneity is the major obstacle to breast cancer target therapy. Classification of breast cancer with significant biological process may reduce the influence of heterogeneity of intrinsic tumor. We used survival analysis to filter 95 gene sets and classify 638 breast cancer samples into two subtypes based on those gene sets associated with prognosis. Clinical outcome of two subtypes were evaluated with disease-free survival, distant metastasis-free survival, and overall survival levels in three databases and ER+, PR+ HER2+, and TNBC groups. We established a novel classification with 95 prognostic gene sets. In the training and validation cohorts, the subtype 1 was characterized by significant gene sets associated with regulation of metabolic process and enzyme activity and predicted obviously improved clinical outcome than subtype 2, which was enriched by tumor cell division, mitosis, and cell cycle-related gene sets (P < 0.05). When evaluated prognostic impact of subtypes in ER+, PR+ HER2+, and TNBC groups, we found that patients in subtype 1 showed better prognosis in ER+ and PR+ groups (P < 0.05) but had no difference from prognosis of subtype 2 in HER2+ and TNBC groups. These findings may have implications in understanding of breast cancer and filtering effective therapeutic strategies for targeted therapy. Read More » Role of Helicobacter pylori on cancer of human adipose-derived mesenchymal stem cells and metastasis of tumor cells—an in vitro study Abstract Recent studies have shown that Helicobacter pylori has a special role in tropism of mesenchymal stem cells (MSCs) towards gastric tissues. This study aimed to find the effects of H. pylori on human adipose-derived mesenchymal stem cells (hA-MSCs) transforming toward cancer cells and also metastasis of tumor cells by synergic effects of H. pylori and gastric epithelial cells (AGS) on MSCs. The expressions of p53, bcl-2, MMP-2, and MMP-9 were examined in hA-MSCs by qRT-PCR technique. Our results demonstrated that H. pylori tries to improve the hA-MSCs carcinogenic activities by overexpression of bcl2 gene as an anti-apoptosis agent against the p53 gene expression as main apoptosis agent. In addition, it showed that H. pylori effects in metastatic activities of hA-MSCs by upregulation of related genes in this process. Perhaps, when hA-MSCs are attracted toward H. pylori chronic or ulcer infected tissues for their tissue healing function, they will be trapped under special gastric microenvironment. We demonstrated the direct and synergic effects of H. pylori in hA-MSCs through alteration of related genes involved in carcinogenesis processes. Hence, understanding of H. pylori-induced molecular pathogenesis could be a powerful strategy not only in identifying the origin and initiation of gastric cancer but also in the treatment of related disease and modification of stem cell therapy methods in the future. Read More » Decreased expression of p27 is associated with malignant transformation and extrathyroidal extension in papillary thyroid carcinoma Abstract Cell cycle regulatory proteins including p16, p27, and p53 are well studied in various cancers. However, their single or concurrent roles related with the clinicopathological parameters are not clearly recognized. We analyzed the expression of p16, p27, and p53 cell cycle regulatory proteins in papillary thyroid carcinoma (PTC). To determine the prognostic significance of cell cycle regulatory proteins, 107 PTCs were examined. We analyzed the individual expression of p16, p27, and p53 and their concurrent expressions, with the relationship to various clinicopathological parameters including differentiation from benign lesions. High expression of p16 and p53 and low expression of p27 were related with the distinguishing of PTC from benign lesions. In addition, normal thyroidal tissue showed higher p27 expression than nodular hyperplasia. In relation to extrathyroidal extension (ETE), the low expression of p27 was related with the presence of ETE. The low expression of p27 and high expression of p16 and p53 may affect the development of PTC. In addition, low p27 expression is related with the existence of ETE. Read More » Cancer stem cells in human digestive tract malignancies Abstract Digestive tract malignancies, including oral, pharyngeal, esophageal, gastric, and colorectal cancers, are among the top 10 most common cancers worldwide. In spite of using various treatment modalities, cancer patients still suffer from recurrence and metastasis of malignant cells. Cancer stem cells (CSCs) are undifferentiated and highly proliferative malignant cells with unique properties mediated by overexpression of stemness markers, metastasis-related proteins, drug transporters, and DNA repair machinery. Due to their salient characteristics, it has been suggested that CSCs are responsible for tumor initiation, progression, invasion, recurrence, and therapy resistance. Exploring different aspects of CSC biology has fueled a great enthusiasm in designing novel therapeutic strategies to help patients. For instance, identification of markers associated with digestive tract CSCs, such as CD44, CD133, CD24, EpCAM, LGR5, ALDH1, and BMI1, has made it possible to develop more accurate diagnosis approaches. In addition, specifically targeting CSCs by their markers imposes fewer side effects and improves therapeutic outcomes. Here, we focus on the current status of CSC biology in digestive tract cancers, with emphasis on CSC markers, and review achieved progress in eradication of digestive tract CSC cells. Read More » Risk Factors for Aspiration Pneumonia in Older Adults by Toshie Manabe, Shinji Teramoto, Nanako Tamiya, Jiro Okochi, Nobuyuki Hizawa Backgrounds Aspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly. Methodology and Principal Findings We conducted an observational study using data from a nationwide survey of geriatric medical and nursing center in Japan. The study subjects included 9930 patients (median age: 86 years, women: 76%) who were divided into two groups: those who had experienced an episode of aspiration pneumonia in the previous 3 months and those who had not. Data on demographics, clinical status, activities of daily living (ADL), and major illnesses were compared between subjects with and without aspiration pneumonia. Two hundred and fifty-nine subjects (2.6% of the total sample) were in the aspiration pneumonia group. In the univariate analysis, older age was not found to be a risk factor for aspiration pneumonia, but the following were: sputum suctioning (odds ratio [OR] = 17.25, 95% confidence interval [CI]: 13.16–22.62, p Conclusion The risk factors for aspiration pneumonia were sputum suctioning, deterioration of swallowing function, dehydration, and dementia. These results could help improve clinical management for preventing repetitive aspiration pneumonia. Read More » Oral Maxillary Exostosis Figure 1. Read More » Case 31-2015: A 29-Year-Old Man with Thymoma, Diarrhea, and Weight Loss Presentation of Case. Dr. Kimberly G. Blumenthal (Medicine): A 29-year-old man with metastatic thymoma was seen in the outpatient oncology clinic of this hospital because of intractable diarrhea of 1 month's duration. The patient had received a diagnosis of thymoma at another hospital 5 years… Read More » Daclizumab HYP versus Interferon Beta-1a in Relapsing Multiple Sclerosis Daclizumab is a humanized monoclonal antibody that binds to the alpha subunit (CD25) of the high-affinity interleukin-2 receptor. Daclizumab treatment prevents signaling through the high-affinity interleukin-2 receptor and increases the availability of interleukin-2 to signal at its intermediate… Read More » De Gruyter presents new open access pricing model to prevent "double dipping" Read More » News from the field Read More » Is it necessary to occlude the ear in bone-conduction testing at 4 kHz, in order to prevent air-borne radiation affecting the results? 10.3109/14992027.2015.1086029<br/>Maryanne Tate Maltby Read More » Cardiovascular risk factors and hearing loss: The HUNT study 10.3109/14992027.2015.1090631<br/>Bo Engdahl Read More » Dichotic listening training in children with autism spectrum disorder: A single subject design 10.3109/14992027.2015.1070308<br/>Inga Denman Read More » Prevalence of various etiologies of hearing loss among cochlear implant recipients: Systematic review and meta-analysis 10.3109/14992027.2015.1091094<br/>Niels Krintel Petersen Read More » Numerical analysis of three-dimensional acoustic propagation in the Catoche Tongue Analysis of modeled time series data is presented to provide insight into propagation physics of horizontally refracted sound in the Catoche Tongue region of the Gulf of Mexico. The analysis is motivated by the observation of out-of-plane arrivals in measured time series data. In particular, the extended duration of the refracted arrivals is shown to be caused by interaction with multiple locations along the steep sides of the Tongue. Comparison of the modeled time series is made to previous work by Sturm [J. Acoust. Soc. Am. 117(3), 1058–1079 (2005)], who examined the frequency dependence of out-of-plane modal arrivals for the wedge-shaped ocean. Read More » Calculation of an axial temperature distribution using the reflection coefficient of an acoustic wave This work verifies the idea that in principle it is possible to reconstruct axial temperature distribution of fluid employing reflection or transmission of acoustic waves. It is assumed that the fluid is dissipationless and its density and speed of sound vary along the wave propagation direction because of the fluid temperature distribution. A numerical algorithm is proposed allowing for calculation of the temperature distribution on the basis of known frequency characteristics of reflection coefficient modulus. Functionality of the algorithm is illustrated on a few examples, its properties are discussed. Read More » Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice Abstract Objective measures can be used to assist the clinician to diagnose and treat nasal obstruction and also to quantify nasal obstruction in research. Objective measurements of nasal obstruction are as important as objective measurements of lungfunction. PNIF, AR, and RM, with their specific peculiarity, assess different aspects of nasal obstruction. From the studies available in literature, it seems that these methods roughly correlate with each other and that all of them can be alternatively utilized very well in research as well as in clinical practice This review describes the various methods that can be used to measure nasal patency, airflow and resistance, mainly peak nasal inspiratory flow, rhinomanometry, and acoustic rhinometry. PNIF has been demonstrated to be reproducible and as good an indication of objective nasal patency as formal rhinomanometry and has the advantage to be cheap, simple, suitable for serial measurements and for home use even in the paediatric population. PNIF normative data are available for children, adults, and elderly subjects and the availability of unilateral PNIF normal values allows evaluation of nasal sides separately. Just as in the lower airways, objective and subjective evaluation give different information that together optimalize the diagnosis and treatment of our patients. We argue that PNIF should be used regularly in every outpatient clinic that treats patients with nasal obstruction. This article is protected by copyright. All rights reserved. Read More » Nociception-specific blink reflex: pharmacology in healthy volunteers Background: The physiology and pharmacology of activation or perception of activation of pain-coding trigeminovascular afferents in humans is fundamental to understanding the biology of headache and developing new treatments. Methods: The blink reflex was elicited using a concentric electrode and recorded in four separate sessions, at baseline and two minutes after administration of ramped doses of diazepam (final dose 0.07 mg/kg), fentanyl (final dose 1.11 μg/kg), ketamine (final dose 0.084 mg/kg) and 0.9 % saline solution. The AUC (area under the curve, μV*ms) and the latency (ms) of the ipsi- and contralateral R2 component of the blink reflex were calculated by PC-based offline analysis. Immediately after each block of blink reflex recordings certain psychometric parameters were assessed. Results: There was an effect due to DRUG on the ipsilateral (F 3,60  = 7.3, P < 0.001) AUC as well as on the contralateral (F 3,60  = 6.02, P < 0.001) AUC across the study.A significant decrement in comparison to placebo was observed only for diazepam, affecting the ipsilateral AUC. The scores of alertness, calmness, contentedness, reaction time and precision were not affected by the DRUG across the sessions. Conclusion: Previous studies suggest central, rather than peripheral changes in nociceptive trigeminal transmission in migraine. This study demonstrates a robust effect of benzodiazepine receptor modulation of the nociception specific blink reflex (nBR) without any μ-opiate or glutamate NMDA receptor component. The nociception specific blink reflex offers a reproducible, quantifiable method of assessment of trigeminal nociceptive system in humans that can be used to dissect pharmacology relevant to primary headache disorders. Read More » Numerical analysis of three-dimensional acoustic propagation in the Catoche Tongue Analysis of modeled time series data is presented to provide insight into propagation physics of horizontally refracted sound in the Catoche Tongue region of the Gulf of Mexico. The analysis is motivated by the observation of out-of-plane arrivals in measured time series data. In particular, the extended duration of the refracted arrivals is shown to be caused by interaction with multiple locations along the steep sides of the Tongue. Comparison of the modeled time series is made to previous work by Sturm [J. Acoust. Soc. Am. 117(3), 1058–1079 (2005)], who examined the frequency dependence of out-of-plane modal arrivals for the wedge-shaped ocean. Read More » Multiple and single snapshot compressive beamforming For a sound field observed on a sensor array, compressive sensing (CS) reconstructs the direction of arrival (DOA) of multiple sources using a sparsity constraint. The DOA estimation is posed as an underdetermined problem by expressing the acoustic pressure at each sensor as a phase-lagged superposition of source amplitudes at all hypothetical DOAs. Regularizing with an -norm constraint renders the problem solvable with convex optimization, and promoting sparsity gives high-resolution DOA maps. Here the sparse source distribution is derived using maximum a posteriori estimates for both single and multiple snapshots. CS does not require inversion of the data covariance matrix and thus works well even for a single snapshot where it gives higher resolution than conventional beamforming. For multiple snapshots, CS outperforms conventional high-resolution methods even with coherent arrivals and at low signal-to-noise ratio. The superior resolution of CS is demonstrated with vertical array data from the SWellEx96 experiment for coherent multi-paths. Read More » Jet pumps for thermoacoustic applications: Design guidelines based on a numerical parameter study The oscillatory flow through tapered cylindrical tube sections (jet pumps) is characterized by a numerical parameter study. The shape of a jet pump results in asymmetric hydrodynamic end effects which cause a time-averaged pressure drop to occur under oscillatory flow conditions. Hence, jet pumps are used as streaming suppressors in closed-loop thermoacoustic devices. A two-dimensional axisymmetric computational fluid dynamics model is used to calculate the performance of a large number of conical jet pump geometries in terms of time-averaged pressure drop and acoustic power dissipation. The investigated geometrical parameters include the jet pump length, taper angle, waist diameter, and waist curvature. In correspondence with previous work, four flow regimes are observed which characterize the jet pump performance and dimensionless parameters are introduced to scale the performance of the various jet pump geometries. The simulation results are compared to an existing quasi-steady theory and it is shown that this theory is only applicable in a small operation region. Based on the scaling parameters, an optimum operation region is defined and design guidelines are proposed which can be directly used for future jet pump design. Read More » Calculation of an axial temperature distribution using the reflection coefficient of an acoustic wave This work verifies the idea that in principle it is possible to reconstruct axial temperature distribution of fluid employing reflection or transmission of acoustic waves. It is assumed that the fluid is dissipationless and its density and speed of sound vary along the wave propagation direction because of the fluid temperature distribution. A numerical algorithm is proposed allowing for calculation of the temperature distribution on the basis of known frequency characteristics of reflection coefficient modulus. Functionality of the algorithm is illustrated on a few examples, its properties are discussed. Read More » A Submucosal True Vocal Fold Mass A man presented with sudden-onset, progressively worsening dysphonia, dry cough, sensation of a lump in his throat, and a progressively worsening voice; videostroboscopic examination revealed a broad-based submucosal mass in the anterior two-thirds of the right true vocal fold. What is the diagnosis? Read More » Ideal Candidate Selection for Surgical Salvage of HNSCC This study of patients with recurrent head and neck squamous cell carcinoma treated with salvage surgery recommends that medical comorbidity and age, primary T3/T4 stage, and disease-free interval be considered in selecting patients for surgical salvage. Read More » Cost of Hospice Use in Terminally Ill Patients With Head & Neck Cancer This retrospective cohort analysis uses data from the Surveillance, Epidemiology, and End Results–Medicare linked database to estimate monthly costs of all services used during the last months of life by patients with oral cavity and pharyngeal cancers. Read More » In-Office Laryngeal Injection Abstract Originally described more than a century ago, vocal fold injection in the awake, unsedated patient has returned to routine clinical use because of improved injectable materials and flexible laryngoscopy optics. The vocal fold may be injected via a number of approaches to remedy conditions of glottic insufficiency including vocal fold paralysis and paresis, atrophy, and scar. Its use in the treatment of treating benign mass lesions is an evolving topic. Trial injections may be performed in cases of uncertain benefit, a use which has revealed the importance of glottic insufficiency in an unexpected variety of complaints. Injection materials are generally well tolerated, although injection into the superficial tissues of the vocal folds is to be avoided. Although laryngeal injection in the awake patient demands some technical expertise and finesse, procedure completion rates are high with low rates of complications, comparable to injection under anesthesia. Read More » Cervicofacial Rhytidectomy After Radiotherapy This medical record review evaluates the risk for complications of cervicofacial rhytidectomy in a cohort of adults who had undergone previous radiotherapy for head and neck cancer. Read More » Incidence of Concussion in Patients With Isolated Mandible Fractures This study determines the rates of mild traumatic brain injury in patients who sustained isolated mandible fractures within 24 hours of presentation in the emergency department of a level I trauma center. Read More » Asking the Right Questions to Evaluate Mandibular Fractures "How is your occlusion?" "Where is your jaw pain?" These are the common questions we ask when evaluating a patient with mandibular trauma. But maybe what we should also be asking is "Do you have a headache?" "Have you been dizzy?" "How is your mentation?" Read More » Inferior Turbinoplasty for Nasal Obstruction in Children This review of medical records examines the safety and effectiveness of isolated inferior turbinoplasty in children with nasal obstruction. Read More » Learning Curves of Virtual Mastoidectomy This cohort study looks at the use of virtual reality simulation training of medical students in performing mastoidectomy with comparison of distributed vs mass practice and tutored vs nontutored sessions. Read More » Association of Hearing Impairment and Mortality This study uses data from the cross-sectional National Health and Nutrition Examination Survey to report that, in adults 70 years or older, moderate or more severe hearing impairment was significantly associated with a 54% increased risk of mortality. Read More » Epidemiology and Treatment of Malignant Submandibular Gland Tumors This cohort study of SEER data investigated the correlates of survival in patients with primary malignant tumors of the submandibular gland. Read More » Oral Appliance Therapy for Sleep-Disordered Breathing This prospective clinical trial reports on the parameters that are correlated with objectively measured compliance during oral appliance therapy in patients with sleep-disordered breathing. Read More » Trends in US Pediatric Otolaryngology Fellowship Training This trend analysis examines training and placement of pediatric otolaryngology graduates in fellowships over the past 10 years. Read More » Quality of Life in Endoscopic Sinus Surgery With Sleep Dysfunction This multisite cohort study of the effect of comorbid obstructive sleep apnea on chronic rhinosinusitis disease-specific quality of life and sleep dysfunction in patients with chronic rhinosinusitis following functional endoscopic sinus surgery found significant improvements after surgery. Read More » Removal of Detail From Table and Results In the article, "Safety of Adult Ambulatory Direct Laryngoscopy: Revisits and Complications," published online in JAMA Otolaryngology−Head & Neck Surgery on July 2, 2015, the detail provided in Table 2 and the related text in the Results section did not comply with the data use agreement for this data set from the Agency for Healthcare Research and Quality. As a result, detail on numbers of patients who experienced specific diagnoses/complications in Table 2 and the related text have been removed, and the article has been corrected online. The overall results and conclusions of the article are unchanged. Read More » Unusual Lacrimal Gland Tumor Epidemiology To the Editor Mallen-St Clair and colleagues provided a wealth of data in their recent article on the epidemiology and treatment of lacrimal gland tumors. The authors have unfortunately overlooked a flaw in the methods that significantly limits the utility of the data. In the Surveillance, Epidemiology, and End Results Program (SEER) database, tumors of both the lacrimal gland and lacrimal sac are coded C69.5. Read More » Vibratory Characteristics in Children After Airway Reconstruction This study of children evaluated for post–airway reconstruction dysphonia found that endoscopy was successfully completed in most but that vibratory characteristics were often not assessed adequately using videolaryngostroboscopy. Read More » Removal of Detail in Table and Results To the Editor On behalf of my coauthors, I write to request and explain the need for a correction to our article, "Safety of Adult Ambulatory Direct Laryngoscopy: Revisits and Complications," published online in JAMA Otolaryngology−Head & Neck Surgery on July 2, 2015. Read More » Brodsky and Friedman Grading Scales To the Editor We read the article by Kumar et al titled "The Reliability of Clinical Tonsil Size Grading in Children." We congratulate the authors on strong scientific work. We agree that it is both necessary and important that tonsillar grading scales are reproducible and consistent. Nonetheless, we strongly feel that the conclusions of the article are overstated and fail to recognize the correct clinical applications of the Friedman grading scale. Read More » October 2015 Issue Highlights Read More » Neck Dissection Impairment Index and Shoulder Functioning This cross-sectional study of patients with head and neck cancer who underwent selective neck dissection or modified radical neck dissection reports that more aggressive treatment was associated with worse shoulder function and quality of life. Read More » A Puzzle in the Carotid Space A young man presented with a painless gradually increasing swelling in the right side of the neck of 6 years' duration; a CT scan revealed a solid right carotid space mass with a few cystic areas and coarse specks of calcification. What is the diagnosis? Read More » A Mandibular Mass With Maxillary Erosion A woman in her 60s was referred for a large, left-sided, progressively enlarging mandibular mass; contrasted CT revealed an exophytic complex mass with areas of calcification and ossification inferiorly and a necrotic, cystic irregularly enhancing portion superiorly. What is the diagnosis? Read More » Submandibular Ectopic Parathyroid Glands This case series describes 3 patients with undescended symptomatic parathyroid adenomas that required reoperation or advanced imaging to localize. Read More » Comorbidity of poor sleep and primary headaches among nursing staff in north China Background: Sleep disorders and primary headaches are both more prevalent among nursing staff than in the general population. However, there have been no reports about the comorbidity of poor sleep and primary headaches among nursing staff. Methods: Stratified random cluster sampling was used to select 1102 nurses from various departments in three hospitals in north China. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The diagnosis of primary headaches including migraine, tension-type headache (TTH), and chronic daily headache (CDH) was based on the International Classification of Headache Disorders, 3rd edition (beta version) (ICHD-3-beta). Results: The response rate was 93 %. Among 1023 nurses, the prevalence of poor sleep was 56.7 %. Of these, 315 nurses (34.13 %) had poor sleep comorbid with primary headaches. The prevalence of poor sleep in the groups with CDH (82.1 %), migraine (78.9 %), and TTH (59.0 %) was significantly higher than that in the group without headaches (47.3 %) (all P < 0.05). Multivariate logistic regression revealed that rotating shifts and suffering headache were independent risk factors for poor sleep. Also, the 1-year prevalence of the three types of primary headache was significantly increased in the poor sleep group (migraine: 21.2 % vs. 7.2 %; TTH: 27.9 % vs. 24.9 %; CDH: 4.1 % vs. 1.1 %; P < 0.05). Compared with normal sleepers, nurses with poor sleep were 1.72 times more likely to have severe headache (OR: 1.72, 95 % CI: 1.14–2.57). Conclusion: Comorbidity of poor sleep and primary headaches among nursing staff is common. Therefore, sleep quality should be carefully evaluated in nurses with primary headaches. Read More » Three things I wish I knew BEFORE I introduced sleep apnea therapy into my practice. These patients have a medical problem, not a dental problem I will have to choose between treating the sleep problems first and their dental needs How to listen to the patient…and actually hear what they said! Treating patients for sleep apnea, snoring, and sleep related issues is one of my favorite procedures in my practice. It's incredibly rewarding. We get to change the quality of life for every patient. And the patients want us to help them. Our sleep patients actually look forward to coming to their appointments. But it didn't start out that way. Most dental procedures are pretty much isolated from the rest of the body.  A tooth has a cavity. All you have to do is get the tooth numb, remove the decay, restore the tooth, and adjust the bite. Problem solved. Very little if any of the rest of the body has been affected, either by the cavity or the filling. But with sleep apnea the entire body is affected in some way, both mentally and physically. If a patient does not get enough REM sleep they will be a frustrated patient. And if their body is starved for oxygen every night many of their internal systems will have issues. As dentist we have a tendency to see the teeth and forget about the rest of the body. With sleep apnea every part of the body both inside and out has to be factored in. If you're considering getting involved in treating sleep apnea don't let this scare you. I get it. You have been out of dental school for a while and most of the anatomy lessons have been replaced with bonding protocols and tooth prep guidelines. And I promise you it's not hard to learn again how the body works. Yes some lectures make it complicated. It's not. And the PSG or sleep study tells you most of what you need to know. And you will have to dedicate some time to learning how all the info from the sleep study ties together. There is a lot more to it than just the AHI number. Another issue you will have to deal with is all the medications patients are taking. It will amaze you! For dental patients our main concern is usually over dry mouth or clotting time when it comes to medications for medical problems. For sleep apnea patients many of the medications patients are taking help one area of the body but can also affect their sleep. You can have a dental patient stop taking their blood thinning medication so you can remove a wisdom tooth. You can't have a patient stop taking their cholesterol medicine even if it keeps them up all night so you can help them sleep. And then there is the anxiety patient taking antidepressants to help them fall asleep. Yes it does them to sleep. But it also suppresses the REM stage so the patient spends a lot of time in stage 1 which is light sleep. So they wake up from any stimulus all night long. What I didn't understand when I started treating sleep apnea is that there would be so many variables I would be confronted with for each patient. So I had a lot of failures or what I perceived as failures. In the dental world either you removed all the decay or you didn't. Fail. Success. In the medical world sometimes close is the best you can achieve. There are just too many variables you simply cannot control. I was not ready for that. So when I helped a patient get his AHI from a 65 to a 12 I felt I failed. An AHI of below 5 is considered healthy. But for an AHI 65 patient 100 lbs over weight, BMI 35, heart problems, diabetes, and CPAP intolerant an AHI of 12 is very much a success. Now that he is sleeping better, heart is not racing all night, he has more energy, etc I have given him his life back. And with more energy he will probably lose a few pounds and that will lower his AHI closer to below 5. I wish I had known from the beginning to accept that medical care is not as precise as dental care. Just too many variables both known and unknown that can't be controlled. These are medical patients, not dental patients. I am a dentist treating a medical problem with a dental device. Wish someone had told me this in the beginning. That last sentence leads me to the next thing I wish I had known when I started treating sleep apnea. Not every tooth needs to be fixed right now. Getting air into the body is more important than fixing a broken molar cusp that fractured off a decade ago. Patients were coming to me to treat their sleep apnea, a medical problem. And I went into a dental mindset and spent the first 30 minutes talking about their dental problems. In my mind it made sense to restore all their dental problems so the appliance would not have be altered if they had any dental work done. In the patients mind it didn't matter if their teeth were broken if they were not able to breath. Being able to breath and sleep at night was their priority. It wasn't mine. Because I am a dentist I couldn't help myself. I made their teeth the priority. And as you can imagine I lost a lot of sleep apnea patients because of this. Am I saying we make appliance to fit over periodontally involved teeth? Of course not. Every day in my dental practice I have to prioritize treatment based on my patient's finances, work schedule, etc. This is the same situation. I just didn't see it that way in the beginning. Now we show the new sleep apnea patient their digital radiographs and digital photographs that are part of my initial exam. When they look at the pictures they can see their teeth have problems. I say up front that I respect they did not come to me as a dentist to treat their teeth. And when they have some of their dental work done their appliance will need to be adjusted to fit over the new dental work. And that it's OK to treat their sleep apnea first. If I see some teeth with advanced bone loss or for some reason taking the appliance on and off may cause a problem I let them know. Sometimes the patient then chooses to let me or their own dentists restore their dental problems first. And sometimes I simply block out the undercuts on those teeth and move forward making the appliance. It's ok to treat the sleep apnea first. Actually in my opinion it's a bigger issue than the teeth. Wish someone had told me this in the beginning. And this leads me to the third thing I wish I had known. How to really listen to patients. Yeah that means closing my mouth and not trying to explain everything. My sleep apnea patients tell me every day that they wish their medical doctor would listen to them the way I do. They hate all their medications. They hate how they feel. They are confused as to what's being done. They still don't understand why that had to get a sleep study. They have so many questions and everyone keeps talking at them instead of to them.  One of the best things I have learned to do is start the conversation with a sleep patients by stating that today is only about answering any questions you have. They are usually hesitant at first. But once they realize you really intend to answer all their questions they truly begin to open up. I also read and explain to them any sleep study they have. It doesn't matter how old it is. Yes they will need a current study before I can start treatment. But many of my new patients are still angry and confused because no one told them why they had to get a study, what the study would be like, and then no one explained the results. The sleep physician just told them the AHI number and fitted them for a CPAP. That would have upset me too. Before you ask a patient to get a new sleep study it is a good idea to ask them how the first one went. Wish someone had told me this in thebeginning. Read More »