Editorial Board
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5Table of Contents
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5Guidelines for Contributing Authors
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5Creation of a 3D printed temporal bone model from clinical CT data
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Joss Cohen, Samuel A. Reyes
Purpose Generate and describe the process of creating a 3D printed, rapid prototype temporal bone model from clinical quality CT images. Materials and methods We describe a technique to create an accurate, alterable, and reproducible rapid prototype temporal bone model using freely available software to segment clinical CT data and generate three different 3D models composed of ABS plastic. Each model was evaluated based on the appearance and size of anatomical structures and response to surgical drilling. Results Mastoid air cells had retained scaffolding material in the initial versions. This required modifying the model to allow drainage of the scaffolding material. External auditory canal dimensions were similar to those measured from the clinical data. Malleus, incus, oval window, round window, promontory, horizontal semicircular canal, and mastoid segment of the facial nerve canal were identified in all models. The stapes was only partially formed in two models and absent in the third. Qualitative feel of the ABS plastic was softer than bone. The pate produced by drilling was similar to bone dust when appropriate irrigation was used. Conclusion We present a rapid prototype temporal bone model made based on clinical CT data using 3D printing technology. The model can be made quickly and inexpensively enough to have potential applications for educational training.Silver sucrose octasulfate nasal applications and wound healing after endoscopic sinus surgery: a prospective, randomized, double-blind, placebo-controlled study
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Giancarlo Ottaviano, Stella Blandamura, Elena Fasanaro, Niccolo' Favaretto, Lovato Andrea, Luciano Giacomelli, Andrea Bartolini, Claudia Staffieri, Rosario Marchese-Ragona, Gino Marioni, Alberto Staffieri
Objectives The aim of the present prospective, randomized, double-blind, and placebo-controlled investigation (approved by the Ethical Committee of Padova University Hospital [Italy]) was to assess the effect of a nasal gel containing a combination of silver sucrose octasulfate and potassium sucrose octasulfate (Silsos gel® [SG]) in wound healing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis in terms of: nasal symptoms (SNOT22), endoscopic appearance of the sinonasal mucosa (Lund–Kennedy score), nasal air flow (anterior active rhinomanometry), evidence of mucosal inflammatory processes (nasal cytology and histology), and microbiological growth. Methods Thirty-four patients with chronic rhinosinusitis were randomized on a 1:1 ratio to receive after ESS either SG or placebo (contained only the excipients [carbopol and propylene glycol] in the same concentrations as in SG). Results/conclusions Judging from the present prospective investigation on patients who underwent ESS for chronic rhinosinusitis, treatment with SG seems to enable a significantly faster improvement in specific symptoms (assessed on the validated SNOT22 scale) than placebo. Patients treated with SG also had a quicker improvement in the endoscopic appearance of their nasal mucosa after ESS than patients treated with placebo. These endoscopic improvements in the SG group were also confirmed at the long-term follow-up, while the same did not apply to the placebo-treated group.Combined approach sialendoscopy for management of submandibular gland sialolithiasis
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Nofrat Schwartz, Inbal Hazkani, Sivan Goshen
Purpose Sialolithiasis is the primary cause of obstructive sialadenitis, affecting the submandibular gland in 80–90% of cases. Sialendoscopy has dramatically changed the diagnosis and management of salivary gland diseases. However, in cases in which endoluminal removal via sialendoscopy is not successful, a combined approach using a limited intraoral incision under guidance of sialendoscopy can facilitate stone removal. We reviewed our institution's experience with combined approach sialendoscopy and evaluated its role in managing sialolithiasis of the submandibular gland. Materials and methods Retrospective study of the treatment of sialolithiasis in the submandibular gland via combined approach sialendoscopy from January 2010 through March 2014. Demographics, clinical data, intraoperative findings and post-operative course were reviewed. Results Most sialoliths (56.5%) were over 10 mm in size and were in the hilus of the gland (56%). The success rate of the combined approach was 87%. No significant complications were documented. Symptoms resolved in 75.7% of patients; however, this did not correlate with placement of an intraductal stent (p=0.7) or steroid irrigation (p=0.1). An overall gland preservation rate of 94.9% was achieved. Conclusions Combined approach sialendoscopy offers a minimally invasive technique for treating refractory sialolithiasis not amenable to removal via sialendoscopy alone. The procedure is well-tolerated, performed under local anesthesia with low morbidity and a high success rate.Myhre-LAPs syndrome and intubation related airway stenosis: keys to diagnosis and critical therapeutic interventions
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Michael S. Oldenburg, Christopher D. Frisch, Noralane M. Lindor, Eric S. Edell, Jan L. Kasperbauer, Erin K. O'Brien
Objectives Myhre-LAPS syndrome is a recently recognized disease caused by a mutation in the SMAD4 gene. This results in a range of pathology including laryngotracheal stenosis, arthropathy, prognathism and short stature, or LAPS syndrome. We aim to delineate the role of intubation in development of airway stenosis in these patients as well as provide insight into diagnosis and management of this syndrome. Herein we present four patients with Myhre-LAPS syndrome complicated by airway stenosis and perform a systematic review of all cases of Myhre-LAPS syndrome with reported airway pathology. Study design Retrospective review Methods All patients diagnosed with Myhre-LAPS syndrome and airway stenosis at a single institution from 1981 to 2014 were reviewed. Results Four patients (4F, median age 42) were identified that met inclusion criteria. Initial presenting signs included progressive shortness of breath, dyspnea on exertion and respiratory distress. All four (100%) patients had multi-level airway stenosis most commonly in the subglottic and glottic regions and all patients had undergone at least one endotracheal intubation prior to presentation. One patient with a history of nasal tracheal intubation presented with nasal obstruction and was found to have choanal as well as subglottic stenosis. Two of the four (50%) patients are tracheostomy tube dependent, 1/4 (25%) died of a fatal cardiac arrhythmia and 1/4 (25%) has had 6 endoscopic treatments for subglottic stenosis in 4 years with rapid symptom recurrence.Conclusions Myhre-LAPS syndrome is characterized by progressive systemic fibrosis and patients are diagnosed by characteristic findings of prognathism, short stature, abnormal facies, and thick skin among other abnormalities. Airway management is complicated by recurrent, refractory subglottic stenosis often preceded by elective intubation as well as maxillary hypoplasia, trismus, and limited neck extension. Endotracheal intubation and surgical intervention should be approached with caution in these patients and multidisciplinary care teams are necessary to address all manifestations of this syndrome.Endoscopic culture-directed antibiotic therapy: Impact on patient symptoms in chronic rhinosinusitis
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Zi Yang Jiang, Yann-Fuu Kou, Pete S. Batra
Background Endoscopically guided cultures are frequently employed to guide antimicrobial therapy in refractory chronic rhinosinusitis (CRS) patients. The objective of this study was to determine the impact of culture-directed antibiotics on patient symptoms. Methods Retrospective review was conducted of 105 adult CRS patients undergoing evaluation in the ambulatory clinic of tertiary care academic medical center. Results The most common microbes were Staphylococcus aureus (29.5%), Pseudomonas aeruginosa (23.8%) and methicillin-resistant S. aureus (11.4%). Normal respiratory flora or no growth was found in 19% of patients. Culture results changed antibiotic choices in 77% of patients. Statistically significant change in total SNOT-20 scores and all 4 subdomains was noted, with improvement being clinically meaningful in the rhinologic subdomain (−1.10, p<0.0001). Repeat purulence was only noted in 5 cases (4.8%). Multivariate regression analysis demonstrated that concurrent use of oral steroids was independently associated with improvement in the rhinologic subdomain (p=0.0041). The mean length of follow-up was 37days. Length of follow-up (14–30, 31–60, 61–90days) did not statistically impact SNOT-20 scores. Conclusion Endoscopic-derived sinus cultures are associated with clinically meaningful change in the rhinologic subdomain of SNOT-20 scores, and repeat purulence was infrequently noted at follow-up. Further prospective studies are needed to better delineate the role of cultures in CRS management.Level of evidence 4.The improvement of internal consistency of the Acoustic Voice Quality Index
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Ben Barsties, Youri Maryn
Purpose This investigation aims to explore the improvement of the relatively new hoarseness severity quantification method, called Acoustic Voice Quality Index (AVQI), which measures the concatenation of continuous speech (CS) and sustained phonation (SP) segments. Earlier investigations indicated that the proportion of the SP is more dominant in the final AVQI result than the CS. Method Sixty voice samples were selected with different voice pathologies and equal distribution of hoarseness severity ranged from normal to severe. Every voice sample varied in three different durations: voice duration-one (VD-1) with seventeen syllables text plus three seconds of SP, voice duration-two (VD-2) with customized length of CS plus three seconds of SP, and voice duration-three (VD-3) with a whole text plus three seconds SP. All voice samples were perceptually judged on overall voice quality by five experienced voice clinicians. AVQI's precision and concurrent validity were assessed in all three VDs. Finally, the internal consistency across all three VDs was analyzed. Results No significant differences were found in the perceptual evaluation of overall voice quality across all three VDs by acceptable rater reliability. The concurrent validity distinguished in all three VDs as a marked degree of correlation (i.e., ranged from rs =0.891 to rs =0.929) with no significant differences across all three VDs. The best precision was found in VD-2. Finally, the internal consistency showed in VD-2 a balanced out impact of the final AVQI score with no significant differences from both speech tasks. Conclusion Although AVQI currently uses the speech material of VD-1, the present study demonstrated the best results in VD-2 (i.e., precision and internal consistency). These features of VD-2 facilitate higher representativity and improve the validity of this objective diagnostic instrument.Negative suction approach to remove living leeches from the nasal cavity
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Qian Cai, Qiujian Chen, Ping Han, Faya Liang, Peiliang Lin
Objective To explore a method for removing a living leech from the nasal cavity. Materials and methods A total of 5 patients with nasal leech were examined. Nasal endoscopy revealed the presence of a wriggling leech in the nasal cavities of each of these patients. A negative suction tube with an inner diameter of 3 mm and a negative pressure of 30–40 kp was used to remove these leeches. In each case, this suction tube was aimed at the free end of the leech, and the leech was gradually and slowly sucked into the tube. The suckers of the removed leeches were examined to ensure that no leech fragments remained within each patient. Results In all 5 cases, the intact leech was successfully removed. No surgical complications occurred. Conclusions The negative suction method can successfully remove nasal leeches.The effects of dynamic laryngeal movements on pitch control
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Yong Tae Hong, Ki Hwan Hong, Je-Pyo Jun, Pyung Han Hwang
Background and Objectives Extralaryngeal structures have been known to not only play an important role in swallowing, but also have a significant influence on the voice during phonation. The aim of this study is to evaluate the effect of dynamic laryngeal movements on pitch control. Subjects and Methods Videofluoroscopic examinations were analyzed. To accurately analyze the sequence of these movements, the recorded images were digitized using a computer program. The moving distances of the hyoid bone, thyroid cartilage, and cricoid cartilage were analyzed, and they were compared to the cricothyroid distance during pitch elevation. Results The vertical movements of the hyoid bone, and cricoid and thyroid cartilages had an impact on the increase in the pitch with a decrease in the cricothyroid distance. All Ad-R 2 values for distance of the hyoid bone, and cricoid and thyroid cartilages were above 0.9, which showed a higher explanatory power than the cricothyroid distance, showing an Ad-R 2 value of 0.4. Conclusions Upward movements of the larynx had a more dominant effect on pitch elevation than the cricothyroid distance. We suspect that the pitch is more affected by the antero-vertical movements of the larynx than the horizontal movement by cricothyroid muscle in human study.External osteotomy in rhinoplasty: Piezosurgery vs osteotome
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Giancarlo Tirelli, Margherita Tofanelli, Federica Bullo, Max Bianchi, Massimo Robiony
Purpose To achieve the desired outcome in rhinoplasty depends on many factors. Osteotomy and surgical reshaping of nasal bones are important steps that require careful planning and execution. The availability of different tools raises the question of which one provides significant advantages for both technique and surgical outcome. Our prospective randomized pilot study compared the outcome of post-traumatic rhinoplasty performed with two different external techniques: ultrasound osteotomic cut using the Piezosurgery Medical Device (Mectron, Carasco, Italy) and traditional external osteotomy. Material and methods Forty-four lateral osteotomies of the nasal wall were performed in twenty-two patients. In twelve patients the osteotomies were conducted with a 2-mm traditional osteotome (control group), while in the remaining ten patients these were done with the Piezosurgery Medical Device (experimental group). Results At the postoperative evaluation, significantly lower pain, edema and ecchymosis were noticed in the experimental group (p<0.05). Moreover, the endoscopic evaluation showed fewer mucosal injuries in the experimental group (p<0.05), whereas bleeding, symmetry of the pyramid and presence of external scars, were similar in the two groups. Conclusions In the present study, Piezosurgery Medical Device allowed for safe lateral osteotomies in rhinoplasty preliminarily demonstrating the potential to reduce some of the most frequent complications of rhinoplasty.Omalizumab therapy for refractory allergic fungal rhinosinusitis patients with moderate or severe asthma
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Eng Cern Gan, Al-Rahim R. Habib, Alykhan Rajwani, Amin R. Javer
Purpose 1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory allergic fungal rhinosinusitis (AFRS) patients with moderate or severe asthma. 2. To determine if omalizumab therapy reduces the usage of corticosteroids or antifungal therapy in AFRS patients Method: Design The clinical charts of patients with AFRS with moderate or severe asthma who received at least three subcutaneous injections of omalizumab therapy between 1st January 2012 and 1st May 2014 were retrospectively reviewed. These patients had undergone bilateral functional endoscopic sinus surgery (FESS) and failed adjunct medical treatments (oral or topical corticosteroids and/or antifungal therapy) prior to omalizumab therapy. Results Seven patients met the inclusion criteria and were included in this study. The mean age of the patients was 48.14. The average number of subcutaneous omalizumab injections was 7.57 (range 6–11) with a mean dosage of 287mg (range 225–375mg). The mean pre-omalizumab treatment Sino-Nasal Outcome Test-22 (SNOT-22) score was 52.14 while the mean post-omalizumab treatment SNOT-22 score was 35.86 (31% improvement). The mean pre-omalizumab therapy Phillpott–Javer endoscopic score (over the last one year before omalizumab therapy) was 36 while the mean post-omalizumab therapy endoscopic score (from the last clinic visit) was 14 (61% improvement). Omalizumab therapy reduced the dependence of AFRS patients on corticosteroid and antifungal treatments. Conclusion Omalizumab therapy can be considered as a potential adjunct for the treatment for patients with refractory AFRS with moderate or severe asthma. However, larger prospective studies to confirm the findings of this study will be required.Management of cervical esophageal and hypopharyngeal perforations
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Joseph Zenga, Daniel Kreisel, Vladimir M. Kushnir, Jason T. Rich
Purpose Evidence is limited for outcomes of surgical versus conservative management for patients with cervical esophageal or hypopharyngeal perforations. Methods Patients with cervical esophageal or hypopharyngeal perforations treated between 1994 and 2014 were identified using an institutional database. Outcomes were compared between patients who underwent operative drainage and those who had conservative management with broad-spectrum antibiotics and withholding oral intake. Results Twenty-eight patients were identified with hypopharyngeal or cervical esophageal perforations, mostly due to iatrogenic (nasogastric tube placement, endoscopy, endotracheal intubation) injuries (68%). Fourteen were treated initially with conservative management and 14 with initial surgery. Six patients failed conservative treatment and two patients failed surgical treatment. Patients managed conservatively who had eaten between injury and diagnosis (p =0.003), those who had 24hours or more between the time of injury and diagnosis (p =0.026), and those who showed signs of systemic toxicity (p =0.001) were significantly more likely to fail conservative treatment and require surgery. No variables were significant for treatment failure in the surgical group. Of the 20 patients who ultimately underwent a surgical procedure, two required a second procedure. Conclusion Patients who have eaten between the time of perforation and diagnosis, have 24hours or more between injury and diagnosis, and those that show signs of systemic toxicity are at higher risk of failing conservative management and surgical drainage should be considered. For patients without these risk factors, a trial of conservative management can be attempted.Endoscopically-derived bacterial cultures in chronic rhinosinusitis: A systematic review
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Thunchai Thanasumpun, Pete S. Batra
Background Culture-directed antibiotic therapy represents an important component in the management paradigm of chronic rhinosinusitis (CRS). The objective of this study was to systematically review the literature to assess culture yield of the most common aerobic and anaerobic pathogens. Methods A total of 43 studies between 1975 and 2010 were included. Results The composite data comprised 3528 patients with 6005 total culture specimens. The cultures were obtained in operating room in 33 (76.7%) and clinic in 10 (23.3%) of the studies, respectively. The most common site of culture was the maxillary sinus in 18 (41.9%) of the studies. The most common assay techniques reported were swab in 19 (44.2%) and aspirate in 12 (27.9%) studies. The most common gram positive aerobes reported were coagulase negative Staphylococcus and Staphylococcus aureus in 630 (34.7%) and 481 (26.5%) of the cultures, respectively. The most common gram negative aerobes included Haemophilus influenzae and Pseudomonas aeruginosa in 245 (27.0%) and 198 (21.6%) cultures, respectively. The most common anaerobes reported were Peptostreptococcus species in 156 (19.6%) and Bacteroides species in 153 (19.2%) cultures. Conclusion This study provides a composite snapshot of the literature accrued on the microbiology of CRS. It should serve to apprise clinicians on the most common aerobic and anaerobic organisms in CRS patients when employing culture-directed antimicrobial therapy.External-beam radiation therapy for malignant paraganglioma of the head and neck
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Philip Gilbo, Aiza Tariq, Christopher G. Morris, William M. Mendenhall
Background Malignant paragangliomas of the head and neck are very rare tumors of the neuroendocrine cells associated with the peripheral nervous system. There are limited data available to help guide treatment of these tumors and the role of radiation therapy (RT) is not well-defined. This article briefly reviews the pathology, clinical presentation, and treatment modalities of these tumors and reviews our institutional experience in treating this malignancy. Patients and methods From November 1993 through May 2005, 5 patients with 5 malignant paragangliomas of the jugular bulb and carotid body were treated with RT at the University of Florida to a median dose of 70Gy at 1.8Gy per fraction. Mean and median follow-up times are 12.8years and 14.4years, respectively. Results We were able to achieve significant disease-free intervals of >10years for 3 of 5 patients and >5years for 4 of 5 patients. Of the 2 patients who failed treatment, 1 recurred 7.3years after the RT salvage treatment following combination surgery and RT at another institution, and 1 experienced distant metastasis 2.8years after treatment without obvious recurrence of local disease. Conclusion Malignant paragangliomas are a very rare entity whose main treatment modality has yet to be well established. Overall, data concerning outcomes are sparse, but particularly data on the role of RT in the treatment of these difficult tumors. We recommend doses to 70Gy at 2Gy per once-daily fraction as an adjuvant treatment with surgery to both remove the source of disease and provide microscopic control. Patients with incompletely resectable tumors are treated with RT alone.Endoscopic surgical management of inspiratory stridor in newborns and infants
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Jeffrey Cheng, Lee P. Smith
Objective Compare the incidence of endoscopic surgical treatment of patients with laryngomalacia to other aerodigestive pathology who may present with similar symptoms. Methods Consecutive case series with chart review of endoscopic surgical intervention in infants, aged 12months or less, presenting with inspiratory stridor, in the absence of syndromic condition or prior history of intubation. Results A total of 30 patients were identified. The average age at the time of surgical intervention was 2.7months. Endoscopic surgical management was directed at laryngomalacia (70%), vallecular cysts (23.3%), and anterior glottic webs (6.7%). All patients had nearly immediate resolution of the stridor and feeding difficulties. None required revision surgery, modified diets, or alternative means of enteric nutrition. Conclusions Laryngomalacia was the most commonly encountered surgical indication for stridulous newborns and infants with severe symptoms. Like most previous descriptions, patients responded well to supraglottoplasty. Vallecular cysts accounted for about one-quarter of the infants treated. Clinicians should carefully consider the presence of other airway pathology, which may mimic laryngomalacia, in non-syndromic infants without a previous history of intubation. Endoscopic surgical management may be safe and effective.Percutaneous ultrasound-guided alcohol ablation of solitary parathyroid adenoma in a patient with primary hyperparathyroidism
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Ameen Z. Alherabi, Osama A. Marglani, Mohamed G. Alfiky, Mohamed M. Raslan, Bandar Al-Shehri
Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a single parathyroid adenoma, which represents the most common cause of chronic hypercalcemia. However, in few cases, surgery may be technically difficult or risky. We report the use of percutaneous ultrasound-guided alcohol ablation of a parathyroid adenoma as an alternative to surgery in an 88-year-old male patient with significant medical comorbidities.Features of coexisting granulomatosis with polyangiitis in a patient with pemphigus vulgaris: a case report
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Cather M. Cala, Naveed Sami
Pemphigus vulgaris (PV) and granulomatosis with polyangiitis (Wegener's or GPA) are two rare autoimmune disorders. Both can involve the upper airways, and diagnosis can be difficult in the absence of extra-airway symptoms. We report the case of a patient with well-controlled PV but persistent upper respiratory tract symptoms. Further evaluation revealed perforation of the nasal septum and elevated serologies consistent with GPA. The patient improved with rituximab treatments. This case demonstrates that alternative concomitant diagnosis should be considered in patients with symptoms suggestive of recalcitrant PV and/or GPA, since these patients may require more aggressive initial treatment.Isolated congenital maxillomandibular synechiae
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Eric W. Cerrati, Omar H. Ahmed, Scott M. Rickert
Introduction Congenital maxillomandibular syngnathia, or fusion of the jaws, is a rare condition that has a broad spectrum of presentations. The restricted mouth opening can lead to issues with feeding, swallowing, and respiration resulting in failure to thrive and temporomandibular joint ankylosis. Early recognition and treatment is necessary for proper growth and development. Case report We report a 1-day-old male with isolated bilateral soft tissue alveolar fibrous bands. He presented with difficulty feeding secondary to trismus. No bony or muscular involvement in the synechiae was noted and the remainder of the physical exam was unremarkable. The bilateral alveolar synechiae were divided under local anesthesia using surgical scissors. The patient immediately showed improvement in mouth opening and had resolution of his feeding problems. He is now gaining weight and developing appropriately. Discussion The accompanying review of the literature demonstrates only 11 cases worldwide of isolated maxillomandibular fusion. Depending upon the composition of the synechiae, simple surgical division under local anesthesia can be curative.Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Ryan P. Goepfert, Chienying Liu, William R. Ryan
Background Retropharyngeal metastases are uncommon but a well-known location for regional spread of well-differentiated thyroid carcinoma (WDTC). Surgeon-performed, trans-oral ultrasound (SP-TO-US) and trans-oral robot-assisted surgical (TORS) excision represent a unique combination of technology and techniques in the treatment of isolated retropharyngeal thyroid metastases. Patient findings A patient with a history of T3N1b papillary thyroid carcinoma (PTC) previously treated with total thyroidectomy, left central and lateral neck dissection, and radioactive iodine presented with progressive elevations in serum thyroglobulin (Tg) from baseline of 0.2 to 0.6μg/L. She was found to have an isolated 2.6cm left retropharyngeal nodal metastasis on MRI that was confirmed to be PTC on fine needle aspiration biopsy. She underwent SP-TO-US for identification of the node in the operating room immediately prior to TORS excision. There were no complications. Additional radioactive iodine was administered. Post-treatment iodine scans revealed resolution of avid uptake in left retropharynx and return of Tg to 0.2μg/L. Summary The combination of SP-TO-US and TORS represents a novel combination of technology and technique for treatment of isolated retropharyngeal metastasis in WDTC. Trans-oral ultrasound allows for rapid localization of the lesion in relation to the adjacent neurovascular structures in the parapharynx while the robot-assisted approach affords a safe and effective dissection through the improved visualization and dexterity in a small working space. Our patient had no complications and only short-term dysphagia that resolved after temporary diet alteration. Risks and long-term morbidities associated with classical approaches to the retropharynx including trans-cervical and trans-mandibular, particularly in a previously dissected field, are avoided through this trans-oral approach. Conclusions Retropharyngeal metastases are a known location for regional spread of WDTC and are amenable to evaluation and biopsy using TO-US by both surgical and non-surgical providers. In cases where lateral neck dissection has already been performed or when traditional transcervical or transmandibular approaches to the retropharynx represent a comparatively extensive procedure for isolated metastases, SP-TO-US and TORS are safe and effective combination for surgical management of disease.Sudden sensorineural hearing loss after non-otologic surgery
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Joshua Cody Page, Bob Peters
Sudden sensorineural hearing loss following non-otologic surgery is a rare event described in the medical literature. Cardiopulmonary bypass surgery is most commonly associated with this type of hearing loss. Our case report and review of the literature describe two cases with postoperative hearing loss – neither of which are cardiac surgeries – making them exceedingly rare in the medical literature. Regardless of the rarity of this unfortunate event, the possibility for permanent hearing loss is a potentially devastating unanticipated complication and one that all surgeons should be aware.Ipsilateral single stage conversion from BAHA to cochlear implant
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Shawn Li, Emily N. Hrisomalos, Maroun T. Semaan, Cliff A. Megerian
Profound unilateral sensorineural hearing loss is an indication for the placement of a bone anchored hearing aid. In a few unfortunate patients who later develop contralateral hearing loss, a cochlear implant becomes a good option. We present our experience in these cases and discuss our technique for single stage conversion from a bone anchored hearing aid to a cochlear implant.Persistent, severe post-thrombolysis angioedema: Simple management of a difficult problem
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Andrew Foreman, Tara He, Yvonne Chan, Ralph Gilbert, Patrick Gullane
Post-thrombolysis orolingual angioedema in the setting of managing acute stroke is reported in the literature as most often being mild and self-limiting. We present a case of severe angioedema resulting in persistent macroglossia, representing a different end of the spectrum of disease than that referenced in the literature. Despite the severity of the tongue edema in our case, it did resolve with a relatively simple intervention. In addition to highlighting that post-thrombolysis angioedema can be potentially life threatening, this report reviews the pathophysiology of this condition and discusses management options for macroglossia in this setting.Erratum to "Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint" [(American Journal of Otolaryngology) vol. 36 (2015) 106–113]
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Kritika Joshi, Benjamin Huang, Lori Scanga, Craig Buchman, Bhishamjit S. CheraPrognostic factors of head and neck sarcomas
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Bobby A. Tajudeen, Maie St. JohnEffect of nasal packs in septoplasty
2015-08-25 08:40:35 AM
Publication date: September–October 2015
Source:American Journal of Otolaryngology, Volume 36, Issue 5
Author(s): Erkan Eski, Ismail YilmazCone beam CT paranasal sinuses versus standard multidetector and low dose multidetector CT studies
2015-08-25 08:40:35 AM
Publication date: Available online 24 August 2015
Source:American Journal of Otolaryngology
Author(s): Janan Al Abduwani, Laura Zilinkiene, Steve Colley, Shahzada Ahmed
Cone-beam computed tomography (CBCT) is a promising modality for quick outpatient imaging with lower radiation dose and less metal artifact when compared to conventional CT (MDCT) scans. This article will be providing evidence on the diagnostic and treatment-planning applications of CBCT in sinus imaging, mainly, in patients with chronic sinusitis for surgical planning. Which retrospectively assessed 21 patients over a period of one year at Queen Elisabeth Hospital, Birmingham, UK. The main objective was to compare the absorbed dose of radiation from CBCT and conventional (CT), and to compare the clarity and image quality for important structures in sinus anatomy in patients with sinus disease meriting CT scan imaging. Results of the mean effective dose of twenty-one consecutive CBCTs of paranasal sinuses were 0.27mSv (range 0.05 - 0.48mSv). This dose was approximately 40% lower when compared to a similar cohort of standard MDCT examinations and 30% lower when compared to low dose sinus CT scans. The visualization of high-contrast bone morphology on CBCT was comparable to standard sinus CT, allowing clear delineation of the principal surgically relevant osseous structures. Soft tissue visibility was however limited. We concluded that, CBCT scan provides a fast and efficient alternative to conventional CT with substantial radiation dose reduction and low dose MDCT techniques. However for more advanced sinus disease, conventional CT scan is preferable. Objectives The main objective was to compare the absorbed dose in the Cone Beam computed tomography (CBCT) and conventional (CT) and to compare the clarity and image quality for important structures in sinus anatomy Design Retrospective scan reviewSetting We compared both the image characteristics and the effective dose used in CBCT and conventional MDCT sinus imaging, performed at Queen Elizabeth Hospital Birmingham over a 1year period Participants Patient with sinus disease meriting CT scan imaging Main outcome measure Comparison of effective dose exposure and image quality Results The mean effective dose of twenty one consecutive CBCTs of paranasal sinuses performed in our institution over a one year period was 0.27mSv (range 0.05 - 0.48mSv).The dose was approximately 40% lower when compared to a similar cohort of standard MDCT examinations and 30% lower when compared to low dose sinus CT scans. The visualization of high-contrast bone morphology on CBCT was comparable to standard sinus CT, allowing clear delineation of the principal surgically relevant osseous structures. Soft tissue visibility was however limited. Conclusion Cone beam CT scan is a quick and efficient alternative to conventional CT with substantial radiation dose reduction over conventional and low dose MDCT techniques. However for more advanced sinus disease, conventional CT scan is preferable.Impact of adenotonsillectomy on ADHD and nocturnal enuresis in children with chronic adenotonsillar hypertrophy
2015-08-25 08:40:35 AM
Publication date: Available online 23 August 2015
Source:American Journal of Otolaryngology
Author(s): Battal Tahsin Somuk, Hasan Bozkurt, Göksel Göktaş, Osman Demir, Levent Gürbüzler, Ahmet Eyibilen
Objective Children with chronic adenotonsillar hypertrophy (CAH) are more likely to have symptoms of attention deficit hyperactivity disorder (ADHD) and enuresis nocturna (EN) and benefit from surgery. The aim of this study was to evaluate the effect of adenotonsillectomy on ADHD and EN symptoms in children with CAH. Study DesignCross-sectional study was conducted. Setting Parent-based questionnaires. Methods Parents of children with CAH were given Turgay DSM-IV based child and adolescent behavior disorders screening and rating scale (T-DSM-IV) and nocturnal enuresis questionnaire (NEQ) before and six months after adenotonsillectomy. Inattention (IA) and hyperactivity-impulsivity (HI) subscores of T-DSM-IV were used in the present study. The rates of ADHD and EN were compared before and after surgery. Results A total of 75 children between 5-16 years of age and their families participated the study. All 75 families completed T-DSM-IV and NEQ. Mean IA (5.69 ± 4.88 versus 4.46 ± 4.40) and HI (6.53 ± 5.60 versus 5.93 ± 5.45) scores as well as total ADHD scores (12.22 ± 8.99 versus 10.42 ± 8.70) improved significantly after surgery. This significance was found to be statistically important (p<0.05). Furthermore 26 of the subjects were diagnosed with primer EN before adenotonsillectomy and 14 of these enuretic children had total remission six months after surgery. The frequency of EN dropped from 34.7% to 16.0% and this remission rate was found to be statistically significant (p<0.05). Conclusion Children with CAH had high frequency of ADHD and EN symptoms in the present study. Adenotonsillectomy was found to be effective in improvement of these symptoms.Hypoglossal Nerve Stimulation Rescue Surgery After Multiple Multilevel Procedures for Obstructive Sleep Apnea
2015-08-25 08:40:35 AM
Publication date: Available online 18 August 2015
Source:American Journal of Otolaryngology
Author(s): Madeleine Strohl, Kingman Strohl, J. Martin Palomo, Diana Ponsky
Hypoglossal nerve stimulation (HNS) is a new procedure offered for the treatment of moderate-to-severe obstructive sleep apnea (OSA) that has been shown to decrease the severity and symptoms of OSA in select patients. We report on a case of a patient with persistent symptoms and findings of OSA despite a history of multiple multilevel procedures, including an uvulopalatopharyngoplasty (UPPP) with revision, a genioglossus advancement, and a maxillomandibular advancement. The patient then underwent HNS with significant improvement of his symptoms and severity. The success of this patient's HNS surgery demonstrates that we need to examine where HNS fits into the approach to surgery for OSA. There could be benefit to considering cranial nerve stimulation earlier than conventional approaches for select patients.Predictive value of E-cadherin and Ep-CAM in cervical lymph node metastasis of supraglottic larynx carcinoma
2015-08-25 08:40:35 AM
Publication date: Available online 18 August 2015
Source:American Journal of Otolaryngology
Author(s): M.D. Ali Bayram, İmdat Yüce, Sedat Çağlı, Özlem Canöz, Ercihan Güney
Objective To evaluate the value of E-cadherin and epithelial cell adhesion molecule (Ep-CAM) expression in laryngeal biopsy materials for predicting cervical lymph node metastasis in patients with supraglottic laryngeal carcinoma. Methods All patients participating in the study were selected from among the surgically treated patients at the department of Otolaryngology, Head and Neck Surgery, Erciyes University School of Medicine between 1991 and 2005. The study consisted of thirty patients who had pathologically metastatic lymph nodes (pN+ group) and 30 age-, sex-, T value- and differentiation matched patients without pathologically metastatic lymph nodes (pN0 group). Immunohistochemical studies were performed with E-cadherin and Ep-CAM antibodies on representative tumor sections collected from paraffin sections of laryngeal biopsy materials. The expression of E-cadherin and Ep-CAM were compared between the pN0 and pN+ groups. The association between immunostaining of E-cadherin and Ep-CAM was also evaluated. Results There was no significant difference between the two groups in terms of E-cadherin and Ep-CAM expression. There was also a very poor agreement between the expression of E-cadherin and Ep-CAM. Conclusion Multi-institutional and multidisciplinary immunohistochemical studies conducted with standardized methodology and also with more patient participation may help to obtain more specific results.Three-Week Loading of the 4.5mm Wide Titanium Implant in Bone anchored Hearing Systems
2015-08-25 08:40:35 AM
Publication date: Available online 18 August 2015
Source:American Journal of Otolaryngology
Author(s): Jack J. Wazen, Seilesh Babu, Julie Daugherty, Aaron Metrailer
Purpose The purpose of this study is to assess implant stability, implant loss, adverse skin reactions and quality of life benefit following surgical implantation and early processor loading (3-weeks post implantation) of the Oticon Ponto 4.5mm osseointegrated auditory implant. This study also investigates the relationship between the type of post-operative skin reactions and the gender, BMI and medical co-morbidities of participants. Materials/MethodsUsing a prospective, multicenter design, thirty adult patients 18years or older who met medical and audiological candidacy for an osseointegrated auditory bone-anchored hearing device were evaluated. They underwent simultaneous implantation of the Oticon 4.5mm wide implant and a 3.75mm sleeper implant. Sound processor loading occurred at three weeks post-implantation. Implant stability was measured using Radio Frequency Analysis (RFA) at surgery, 1, 3, 6, 12, 26 and 52weeks. The Glasgow Benefit Inventory was used to assess quality of life benefit at 12 and 52weeks following implantation. Results The results show a positive linear trend in implant stability measures in all subjects over time. There have been no implant losses with early 3-week loading. Skin reactions were limited to grade 0 and 1 of the modified Holger's grading scale. Due to the limited incidence of complications, no conclusion can be made regarding the relationship between patient demographic data and soft tissue reaction. Conclusion Our findings confirm the safety and efficacy of early loading of the Oticon 4.5mm wide implant. Participants showed satisfaction with the earlier use of their processor with no added complications after one year post-implantation.Utility of basic fibroblast growth factor in the repair of blast-induced total or near-total tympanic membrane perforations: A pilot study
2015-08-25 08:40:35 AM
Publication date: Available online 18 August 2015
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou, Zihan Lou, Yongmei Tang, Jian Xiao
Objective A pilot study was performed to investigate the utility of basic fibroblast growth factor (bFGF) in the repair of blast-induced total or near-total tympanic membrane perforations (TMPs). Study design Prospective clinical study. Setting Tertiary university hospital. Subjects and methods Patients who fulfilled the inclusion criteria were treated with 0.10–0.15 mL of bFGF solution applied directly to total or near-total TMPs once daily until the perforations closed or for a maximum of 6 months. The treatment response was monitored via serial otoendoscopy, and audiometric outcomes were evaluated. Results Complete TMP closure was achieved in 16 of 17 patients with a blast-induced total or near-total TMP. The mean closure time was 28.4 ± 10.9 days. The improvement in hearing from pre- to post-treatment was statistically significant. There were no complications or adverse outcomes. Conclusions The direct application of bFGF to blast-induced total or near-total TMPs is a promising, minimally invasive alternative to conventional tympanoplasty, with a comparable success rate. As reported in the literature, the closure rate was higher than achieved with spontaneous healing. There was no effect of the inverted edge on healing outcome. The use of bFGF in this setting has immediate therapeutic applications for military personnel with blast-induced TMPs who are stationed in isolated, remote environments.In Vitro Analysis of a Novel Controlled Release System Designed for Intratympanic Administration of N-Acetylcysteine: a Preliminary Report
2015-08-25 08:40:35 AM
Publication date: Available online 12 August 2015
Source:American Journal of Otolaryngology
Author(s): Zafer Ciftci, Mahmut Deniz, Ibrahim Yilmaz, Halide Gunes Ciftci, Duygu Yasar Sirin, Erdogan Gultekin
The aim of this in-vitro experimental study was to design a novel drug delivery system that may permit controlled release of N-acetylcysteine (NAC) following intratympanic administration. The system was composed of two different solutions that attained a hydrogel form within seconds after getting into contact with each other. The authors performed swelling, pH and temperature tests and analysis of controlled release of NAC from this novel controlled release system. For the structure and porosity analysis of the hydrogel, an environmental scanning electron microscope (SEM) was used. The diameter of designed hydrogel showed an increase when pH was increased. In addition, in comparison to acidic values, the pore diameter of the hydrogel increased significantly especially in physiological level. The increase in the pore diameter was also directly proportional to the increase in temperature. Spectrophotometric analysis showed that the amount of NAC released into the medium was statistically significant (p= 0.038, t=−2.18, 95% CI; DF: 27). SEM analysis of the samples revealed a smooth surface topography and numerous porous structures. The authors are of the opinion that the designed hydrogel may be used as an alternative method for intratympanic delivery of NAC for otoprotective purposes. The disadavantages of intratympanic injection of the drug in its liquid form, including leakage through eustachian tube, restraining the patient in an uncomfortable position, necessity for repetitive injections and dose dependent inflammation of the middle ear epithelium, may also be avoided. Further in vivo studies should be conducted to assess its tolerability and effectivity.What is the optimal diagnostic pathway in tuberculous lymphadenitis in the face of increasing resistance: cytology or histology?
2015-08-25 08:40:35 AM
Publication date: Available online 8 August 2015
Source:American Journal of Otolaryngology
Author(s): Sheneen Meghji, Charles Edward Buckland Giddings
Background The London Borough of Newham has the highest rates of Tuberculosis (TB) within Europe (116 per 100,000). There is a lack of guidance in lymph node (LN) TB on how to best to obtain a positive culture, which is the gold standard in the face of increasing mycobacterial resistance. Methods An individual cohort study was carried out via a prospective local TB database capturing 90 cases of cervical LN TB over 34 months. We compared the diagnostic efficacy of fine needle aspiration (FNA) and excision biopsy of LN. Results FNA cytology revealed granulomata in 49%, acid-fast bacilli (AFB) in 8.6% and a positive culture in 40%. LN excision showed granulomata in 97.6%, AFB in 17.1% and a positive culture in 70.1%. There was an 18% resistance to first-line antimicrobials. Conclusions We describe our experience and suggest an algorithm for the culture of TB organisms to avoid a lengthy diagnostic process.Effect of Mastoid Drilling on the Distortion Product Otoacoustic Emissions in the Non Operated Ear
2015-08-25 08:40:35 AM
Publication date: Available online 6 August 2015
Source:American Journal of Otolaryngology
Author(s): Vijendra S. Shenoy, Siddharth Vanka, Raghavendra A. Rao, Vishnu Prasad, Panduranga M. Kamath, Jayashree Bhat
Objective To monitor the effect of mastoid drilling on the non-operated ear distortion product otoacoustic emissions. Materials and Methods Distortion product otoacoustic emissions (DPOAE) were measured at frequencies of f 2 = 2, 3, 4 and 5 kHz, and a frequencyratio f 1 /f 2 = 1.22. DPOAEs were measured in 49 cases, pre and post-operatively who underwent mastoid drilling procedures, compared with each other and with 49 controls who underwent myringoplasty and myringotomy procedures. Results Amplitudes of DPOAEsdecreased significantly in those who underwent mastoidectomies over all the measured frequencies in the immediate post-operative period but had recovered by the seventh post operative day. Conclusion Drill induced noise can cause temporary decrease in the DPOAEs postoperatively and hence temporary hearing loss for a period of one week.Methylene blue staining in the parotid surgery: randomized trial, 144 patients
2015-08-25 08:40:35 AM
Publication date: Available online 5 August 2015
Source:American Journal of Otolaryngology
Author(s): Michael Vaiman, Basel Jabarin, Rani Abuita
Objective to investigate usefulness of the methylene blue staining for parotid gland surgery. Study designrandomized, prospective controlled trial. Methods The study analyzed 144 surgical operations (2000-2014) for parotidectomy. The cases were randomly divided into two groups: Group 1 (n=70) for surgeries with methylene blue staining, and Group 2 (n=74) for surgeries without staining. Surgical complications like temporary facial weakness, permanent facial nerve injury, and Frey's syndrome were taken for comparison between groups as well as rate of tumor recurrence. Results Temporary facial weakness and Frey's syndrome occurred almost evenly in both groups (p=0.34, p=0.68 respectively). Permanent facial nerve injury was significantly lower in the Group with staining (p=0.032) and the decline of rate of tumor recurrence was even more significant (p=0.007).Conclusion Intravital staining with methylene blue in parotidectomies simplifies the operation and could assist in better visualization that leads to (1) rapid and precise localization of the tumor, (2) preservation of the facial nerve, and (3) complete removal of the gland tissue in cases with malignancy. This technique reduces the rate of recurrence in cases with malignant tumors.Delayed recurrence of sinonasal rhinosporidiosis
2015-08-25 08:40:35 AM
Publication date: Available online 5 August 2015
Source:American Journal of Otolaryngology
Author(s): Leon Chen, Darren Buonocore, Beverly Wang, Abtin TabaeeOrbital Compartment Syndrome During Endoscopic Drainage of Subperiosteal Orbital Abscess
2015-08-25 08:40:35 AM
Publication date: Available online 5 August 2015
Source:American Journal of Otolaryngology
Author(s): Anna See, Eng Cern Gan
Background Orbital compartment syndrome is a rare ocular emergency requiring immediate intervention to prevent vision loss. It can arise due to a variety of causes including trauma, neoplasms and retrobulbar hemorrhage during endoscopic sinus surgery. Lateral canthotomy and inferior cantholysis is a well-known therapeutic procedure to rapidly relieve raised intraocular pressures. Case report We report a case of a subperiosteal orbital abscess due to acute maxillary sinusitis that underwent endoscopic drainage. Intraoperatively, he developed raised intraocular pressure following irrigation of the maxillary sinus and manual pressure on the malar abscess, necessitating emergent lateral canthotomy and inferior cantholysis. ConclusionTo our knowledge, this is the first reported case of orbital compartment syndrome following sinonasal irrigation and malar pressure in the English literature. This case will serve as a reminder to the sinus surgeon of the potential danger of transmitted pressure from the paranasal sinus or malar soft tissue into the orbital compartment.Improved therapeutic effectiveness by combining recombinant p14ARF with antisense complementary DNA of EGFR in laryngeal squamous cell carcinoma
2015-08-25 08:40:35 AM
Publication date: Available online 5 August 2015
Source:American Journal of Otolaryngology
Author(s): Feng Liu, JinTao Du, Junming Xian, Yafeng Liu, Shixi Liu, Yan Lin
Purpose The tumor suppressor p14ARF and proto-oncogene epidermal growth factor receptor (EGFR) play important roles in the development of laryngeal squamous cell carcinoma (LSCC). This study was aimed to determine whether combining recombinant p14ARF with antisense complementary DNA of EGFR could improve the therapeutic effectiveness in LSCC. Materials and methods After human larynx cancer cells (Hep-2) were infected with recombinant adenoviruses (Ad-p14ARF and Ad-antisense EGFR) together or alone in vitro, the proliferation and cell cycle distribution of Hep-2 cells were detected by MTT assay and flow cytometer analysis, respectively. Furthermore, the antitumor effects of recombinant adenoviruses together or alone on Hep-2 xenografts were examined in vivo. The levels of P14ARF and EGFR expressed in Hep-2 cells and xenografts were determined by western blot assay. Results Ad-p14ARF combining with Ad-antisense EGFR markedly inhibited the Hep-2 proliferation compared with alone (P=0.001, P=0.002 respectively). Combination of Ad-p14ARF and Ad-antisense EGFR led to the proportion of Hep-2 cells in G0/G1 phases increased by up to 86.9%. The down-expression of EGFR protein and overexpression of P14ARF protein were observed in vitro and in vivo, and this effect was preserved when Ad-p14ARF was combined with Ad-antisense EGFR. Besides, Ad-p14ARF plus Ad-antisense EGFR significantly (P<0.05) increased the antitumor activity against Hep-2 tumor xenografts comparing with Ad-p14ARF or Ad-antisense EGFR alone. Conclusion Combination Ad-p14ARF with Ad-antisense EGFR significantly increased the antitumor responses in LSCC. An effectively potential gene therapy to prevent proliferation of LSCC was provided.A Rare Location for Sarcoma Metastasis: The Temporal Bone
2015-08-25 08:40:35 AM
Publication date: Available online 5 August 2015
Source:American Journal of Otolaryngology
Author(s): Ömer Hızlı, Ahmet Salduz, Serdar Kaya, Michael M. Paparella, Sebahattin Cureoglu
Skeletal sarcoma metastasis is relatively rare; moreover, for this type of metastasis, the temporal bone is also a rare location. The temporal bone appears to be affected by metastatic tumors in discrete histopathologic patterns, with characteristic clinical presentations. In this study, we analyzed the records of 6 patients with skeletal sarcoma metastasis to the temporal bone, with an emphasis on histopathologic sections of human temporal bones. The most common site of sarcoma metastasis in the temporal bone was petrous apex in our series. Physicians should keep in mind that a sarcoma patient may manifest with ear findings due to temporal bone metastasis.Primary Tuberculosis of Thyroid
2015-08-25 08:40:35 AM
Publication date: Available online 26 July 2015
Source:American Journal of Otolaryngology
Author(s): Ashish Varghese, Swati Suneha, Ashok Shaha
Tuberculosis (TB) of the thyroid gland, either in its primary or secondary form, is an extremely rare occurrence. It is infrequent even in countries with high incidence and prevalence of pulmonary and extrapulmonary TB. We report here a case of primary tuberculosis of thyroid presenting to us with sudden onset thyroid swelling since 20 days.Case presentation and images of a lingual osseous choristoma in a pediatric patient
2015-08-25 08:40:35 AM
Publication date: Available online 26 July 2015
Source:American Journal of Otolaryngology
Author(s): James K. Stanford, James C. Spencer, J. Mark Reed
Since its original description in 1913, fewer than 100 lingual osseous choristomas have been reported in the literature, thus, prevalence is unknown. We describe a case of an 11 year old male who was seen in consultation after an incidental left posterior tongue mass was discovered on exam. The patient's presentation of an asymptomatic, hard, pedunculate posterior tongue lesion is typical; however, if one is to believe the proposed congenital remnant theory in regards to the etiology of this benign tumor, it is curious that no mention was made of a lesion of the tongue on prior evaluations by his pediatrician nor on the otolaryngologic examinations performed 3 and 6 years prior to the most recent presentation. Included with the case description are interesting radiographs, intra-operative photos, gross specimen photo and microscopic images.Removal of the split thickness skin graft from the skin paddle of the donor site: a single institution's experience
2015-08-25 08:40:35 AM
Publication date: Available online 26 July 2015
Source:American Journal of Otolaryngology
Author(s): Michael D. Olson, Eric J. Moore, Daniel L. Price
Purpose Radial forearm free flaps (RFFF) and fibular osteocutaneous flaps (FOF) are mainstays of head and neck reconstruction. Removal of the donor tissue often leaves a soft tissue defect requiring a split thickness skin graft (STSG) for coverage. The purpose of this study is to evaluate the potential to reduce the morbidity of removal of the STSG from a second site. Materials and Methods We report a series of 9 patients who had the STSG taken from the free flap donor skin paddle as an alternative to removal from the standard distant sight. Results 9/9 (100%) flaps were successful transferred with no primary or secondary loss of the flap. 8/9 (89%) of STSG were successfully harvested from the donor skin paddle. Postoperative complications included infection and partial STSG loss (2/9, 22%). Conclusions This study demonstrates the feasibility and reduced morbidity associated with removal of the STSG from the donor flap skin paddle in addition to the placement of a de-epithelialized free flap in head and neck reconstruction patients. Given this research, which supports the previously published research on this topic, this technique could be considered in an effort to reduce morbidity in patients undergoing head and neck reconstruction using the RFFF and FOF.Correlation between the Dizziness Handicap Inventory and Balance Performance during the Acute Phase of Unilateral Vestibulopathy
2015-08-25 08:40:35 AM
Publication date: Available online 26 July 2015
Source:American Journal of Otolaryngology
Author(s): Eun Jin Son, Dong-Hee Lee, Jeong-Hoon Oh, Jae-Hyun Seo, Eun-Ju JeonSurvival of T4aN0 and T3N+ laryngeal cancer patients: a retrospective institutional study and systematic review
2015-08-25 08:40:35 AM
Publication date: Available online 16 July 2015
Source:American Journal of Otolaryngology
Author(s): Nadim Khoueir, Nayla Matar, Chadi Farah, Evana Francis, Bassam Tabchy, Amine Haddad
Objective We aim to assess the correlation of tumor and nodal staging to survival in pT3N+ and T4aN0 laryngeal cancer with subgroup analysis within stage IVa (pT4N0 and pT3N2) Study design Retrospective cohort study with systematic review of the literature. Setting Hotel Dieu de France University Hospital (tertiary referral center)Subjects and Methods Laryngeal cancer patients' registries were reviewed from 1998 to 2012 selecting pT3N+ and pT4aN0 patients treated by primary total layngectomy. Overall survivals were compared using Log rank and Kaplan-Meier analysis . A systematic review was performed by 2 reviewers including all the articles reporting the outcome of these categories of patients. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. Results Thirteen T3N+ patients and 19 T4aN0 patients treated by primary total laryngectomy were included. Five-year overall survival for T3N+, T3N2 and T4aN0 were respectively 33%, 32.1% and 73.7%. Due to the small sample, the difference was not significant.The systematic review revealed three articles reporting overall survival outcome for the T4N0 group and 6 articles for the T3N+. At 5 years, the survival ranged from 62.5% to 73% in T4N0 and from 32.2% to 77% in T3N+. Conclusion In advanced stage laryngeal cancer, T4aN0 tend toward a better survival than T3N+ especially when compared to T3N2 although they are grouped in the same TNM stage IVa.A genetic marker of the ACKR1 gene is present in patients with Type II congenital smell loss who have type I hyposmia and hypogeusia
2015-08-25 08:40:35 AM
Publication date: Available online 15 July 2015
Source:American Journal of Otolaryngology
Author(s): William A. Stateman, Alexandra B. Knöppel, Willy A. Flegel, Robert I. Henkin
Purpose Our previous study of Type II congenital smell loss patients revealed a statistically significant lower prevalence of an FY (ACKR1, formerly DARC) haplotype compared to controls. The present study correlates this genetic feature with subgroups of patients defined by specific smell and taste functions. Methods Smell and taste function measurements were performed by use of olfactometry and gustometry to define degree of abnormality of smell and taste function. Smell loss was classified as anosmia or hyposmia (types I, II or III). Taste loss was similarly classified as ageusia or hypogeusia (types I, II or III). Based upon these results patient erythrocyte antigen expression frequencies were categorized by smell and taste loss with results compared between patients within the Type II group and published controls. Results Comparison of antigen expression frequencies revealed a statistically significant decrease in incidence of an Fyb haplotype only among patients with type I hyposmia and any form of taste loss (hypogeusia). In all other patient groups erythrocyte antigens were expressed at normal frequencies. Conclusions Data suggest that Type II congenital smell loss patients who exhibit both type I hyposmia and hypogeusia are genetically distinct from all other patients with Type II congenital smell loss. This distinction is based on decreased Fyb expression which correlated with abnormalities in two sensory modalities (hyposmia type I and hypogeusia). Only patients with these two specific sensory abnormalities expressed the Fybantigen (encoded by the ACKR1 gene on the long arm of chromosome 1) at frequencies different from controls.In response to: Comparison of temporal fascia and cartilage grafts in pediatric tympanoplasties
2015-08-25 08:40:35 AM
Publication date: Available online 11 July 2015
Source:American Journal of Otolaryngology
Author(s): Sule DemirciDelayed facial palsy after tympanomastoid surgery: a report of 15 cases
2015-08-25 08:40:35 AM
Publication date: Available online 9 July 2015
Source:American Journal of Otolaryngology
Author(s): Peng Xu, Weiwei Liu, Wenna Zuo, Daowen Wang, Hongqin Wang
Objective To analyze potential aetiology and outcomes of delayed facial palsy (DFP) after tympanomastoid surgery. Methods Fifteen cases of DFP out of 1582 cases after tympanomastoid surgery were reviewed,and the potential causes and outcomes were analyzed. Results 9 out of 15 patients (60%) had fallopian canal dehiscence and facial nerve exposure in contrast to 323 of 1567 patients (20.6%) without DFP, with significant difference (P<0.01). Chorda tympani was cut or overstretched in 4 cases. There were two cases with herpes labialis and IgM antibody against varicella-zoster virus. All patients fully recovered within two months. Conclusion Fallopian canal dehiscence and facial nerve exposure was a risk factor of DFP after tympanomastoid surgery, and chorda tympani injury and viral reactivation may be triggering factors of DFP. The outcomes DFP after tympanomastoid surgery were excellent.In reference to: Endoscopic transcanal removal of symptomatic external auditory canal exostoses
2015-08-25 08:40:35 AM
Publication date: Available online 9 July 2015
Source:American Journal of Otolaryngology
Author(s): Douglas Hetzler
Δευτέρα 24 Αυγούστου 2015
American Journal of Otolaryngology
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