Impact of coexistent thyroiditis on clinical outcome in papillary thyroid carcinoma with high preoperative serum antithyroglobulin antibody: a retrospective cohort study
H-Y Nam, H.Y Lee, G.C Park, 2015-08-19 14:26:22 PM
Abstract
Objectives
The aim of this study was to investigate the impact of coexistent chronic lymphocytic thyroiditis (CLT) on changes in serum antithyroglobulin antibody (TgAb) and clinical outcome in papillary thyroid carcinoma (PTC) patients with high preoperative serum TgAb.
Design
A retrospective cohort study.
Setting
University teaching hospital.
Participants
Thirty-seven PTC patients with high preoperative serum TgAb level (≥ 100 U/ml) were evaluated. All patients underwent total thyroidectomy followed by high-dose I-131 ablation.
Main outcome measures
Percent changes of TgAb between pre-treatment and post-treatment, and disease-free survival were calculated.
Results
Twenty-two patients (59.5%) had coexistent CLT and seven had residual/recurrent tumors. There was a higher proportion of females among the patients with CLT compared to those without CLT (95.5% vs. 66.7%; P = 0.0306). There were trends toward more aggressive pathologies, such as tumor size, extrathyroidal extension, surgical margin, and lymph node stage, in PTC without CLT than in that with coexistent CLT. Pre-treatment and post-treatment TgAb were all higher in PTC with coexistent CLT. But, percent changes of TgAb between pre-treatment and post-treatment were no significant difference between PTC with and without CLT (P <0.05). Patients with coexistent CLT showed a significantly lower residual/recurrent tumor rate than those without CLT (4.5% vs. 40%; P = 0.0113).
Conclusion
Residual/recurrent tumor rate was lower in PTC patients with coexistent CLT than in those without CLT.
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The Glasgow Benefit Inventory: A systematic review of the use and value of an otorhinolaryngological generic Patient Recorded Outcome Measure [PROM]
J Hendry, A Chin, IRC Swan, MA Akeroyd, GG Browning, 2015-08-19 14:26:22 PM
Abstract
Background
The Glasgow Benefit Inventory (GBI) is a validated, generic PROM widely used in otolaryngology [ORL] to report change in quality of life post intervention.
Objectives of review
To date no systematic review has made.
a quality assessment of reporting of GBI outcomes.
a comparison between GBI outcomes for different interventions and objectives.
an evaluation of subscales in describing the area of benefit.
commented on its value in clinical practice and research.
Type of Review
Systematic review
Search Strategy
'Glasgow Benefit Inventory' and 'GBI' were used as key words to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating GBI paper between 1996 and January 2015.
Evaluation method.
Papers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality GBI data were identified for statistical comparisons. Papers with less than 50% follow-up were excluded.
Results
118 eligible papers were identified for inclusion.
A national audit paper [n= 4325] showed that the GBI gave a range of scores across the specialty, being greater for surgical intervention than medical intervention or 'reassurance'.
Fourteen papers compared one form of surgery versus another form of surgery. In all but one study, there was no difference between the GBI scores [or of any other outcome] The most likely reason was lack of power.
Two papers took an epidemiological approach and used the GBI scores to predict benefit. One was for tonsillectomy where duration of sore throat episodes and days with fever were identified on multivariate analysis to predict benefit albeit the precision was low. However, the traditional factor of number of episodes of sore throat was not predictive. The other was surgery for chronic rhinosinusitis where those with polyps on univariate analysis had greater benefit than those without.
Forty-three papers had a response rate of > 50% and gave sufficient GBI total and subscales for meta-analysis. For five of the 11 operation categories [vestibular schwanoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery] that were most likely to have a single clear clinical objective, score data had low to moderate heterogeneity. The value in the GBI having both positive and negative scores was shown by an overall negative score for the management of vestibular schwanomma.
The other 6 operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages [98% and 99%] most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes.
Five papers also reported the number of patients that had no or negative benefit; a potentially a more clinically useful outcome to report.
GBI sub-scores for tonsillectomy were significantly different from ear surgery suggesting different areas of benefit
Conclusions
The GBI has been shown to differentiate the benefit between surgical and medical ORL interventions as well as 'reassurance' Reporting benefit as percentages with negative, no and positive benefit would enable better comparisons between different interventions with varying objectives and pathology. This could also allow easier evaluation of factors that predict benefit.
Meta-analysis data is now available for comparison purposes for vestibular schwanomma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery. Fuller report of the GBI outcomes for non-surgical ORL interventions is encouraged.
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Outpatient based injection laryngoplasty for the management of unilateral vocal fold paralysis - clinical outcomes from a UK centre
Hassan Mohammed, Liam Masterson, Samir Gendy, Ramez Nassif, 2015-08-19 14:26:22 PM
Abstract
Objective
To assess voice outcomes in patients undergoing vocal fold injection (VFI) augmentationlaryngoplasty in a clinic-based setting
Methods
A prospective study of patients with unilateral vocal cord palsy undergoingRadiesse® vocal cord augmentation. We used the ten-item voice handicap index (VHI-10) as a postal survey before and after the intervention.
Results
A total of 43 patients were referred to our ENT clinic from June 2011 to October 2014 with unilateral vocal cord palsy. The majority were referredfrom the oncology department with mediastinal tumours. Fifteen patients dieddue to complications of malignant disease. Twenty-one patients responded to our survey.VHI-10scores were analyzed using one-way analysis of variance (ANOVA)and the results suggest a sustained improvement before and after the intervention (pre-injection versus 3 months post-injection p<0.01; pre-injection versus 6 months post-injection p<0.033).
Conclusion
This is the largest case series of patients who had a local anaesthetic vocal cord injection with calcium hydroxlapaptite using the trans-thyrohyoid approach. Early data would suggest that the results are similar to injections performed under general anesthesia when performed by an experienced laryngologist. VFI in a clinic-based (awake) setting has the distinct advantage of providing instant feedback of vocal fold closure and voice outcome during the procedure, avoiding general anesthesia with its inherent risks and cost and also the limitations of difficult exposure.
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Evolution of a UK endoscopic anterior skull base Pituitary service-the first 123 patients
Paul Nix, Atul Tyagi, Nick Phillips, 2015-08-19 14:26:22 PM
Abstract
Pituitary tumours account for a major proportion of intracranial tumours with most being benign adenomas1. The field of pituitary surgery has constantly evolved over the last century and more recently with the introduction of the Hopkins Rod2. An anterior endoscopic skull base team has been popularised greatly by the Pittsburgh team and established in Leeds in 20093.
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Non-invasive Assessment and Symptomatic Improvement of the Obstructed Nose (NASION): a physiology-based patient-centred approach to treatment selection and outcomes assessment in nasal obstruction
SAR Nouraei, JS Virk, H Kanona, M Zatonski, EF Koury, P Chatrath, 2015-08-19 14:26:22 PM
Abstract
Objectives
To evaluate the impact of selecting treatment for nasal obstruction on the basis of a structured physiology-based assessment protocol on patient outcomes.
Design
Prospective longitudinal study.
Setting
District general hospital.
Participants
A population of 71 patients with a mean age of 33 years, containing 36 males, who presented with nasal obstruction for consideration of nasal surgery. All patients underwent a structured clinical assessment, skin-prick allergy testing, and oral-nasal flow-volume loop examination. 51 patients completed follow-up and mean follow-up was 11 months.
Main outcome measures.
NOSE, SNOT-22 and NASION scales.
Results
6 patients had conservative treatment, 28 had septal/turbinate surgery and 17 underwent nasal valve surgery. Mean NOSE score fell from 68±18 to 39±31 following treatment. Mean SNOT-22 score fell from 47±20 to 29±26 following treatment. The difference between pre-treatment and post-treatment NOSE and SNOT-22 scores were statistically significant. Success rate of septal/turbinate surgery in patients without nasal allergy was 88% and this fell to 42% in patients undergoing septal/turbinate surgery who also had nasal allergy. Presence of nasal allergy was the only independent predictor of treatment failure. Patients with nasal valve surgery reported significantly greater symptomatic improvement following surgery. The newly formed NASION scale demonstrated internal consistency with a Cronbach α of 0.9 and excellent change-responsiveness and convergent validity with correlation coefficients of 0.64 and 0.77 against treatment-related changes in SNOT-22 and NOSE scales respectively.
Conclusions
Successful surgical outcomes can be achieved with the use of a structured history, clinical evaluation and physiological testing. Flow-volume loops can help elucidate the cause of nasal obstruction. The newly formed NASION scale is a validated retrospective single time-point patient outcome measure.
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Recurrent Laryngeal Nerve Identification in Thyroidectomy by Intra-operative Staining with Methylene Blue in Forty Six Patients
Ahmad Abdel Fattah Nofal, Mohammad Waheed El-Anwar, 2015-08-19 14:26:22 PM
Abstract
- During total thyroidectomy in 46 patients (92 lobes), recurrent laryngeal nerve (RLN) was recognized on one side by visual identification alone, and on the other side combined with methylene blue (MB) nerve staining.
- The RLN sheath was stained blue by MB in a concentration of 2:8 (MB: saline solution), which identify the RLN within the suspected structures.
- The mean lobectomy duration, and the incidence of postoperative vocal cord palsy were significantly lowered with MB staining without reported complications.
- Intraoperative RLN identification by MB is a safe, cheap, and readily available method.
- RLN identification by MB can make thyroidectomy dissection more rapid and easier.
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Surfactant proteins A and D are related to severity of the disease, pathogenic bacteria and comorbidity in patients with chronic rhinosinusitis with and without nasal polyps
Barbora Uhliarova, Jana Kopincova, Marian Adamkov, Martin Svec, Andrea Calkovska, 2015-08-19 14:26:22 PM
Abstract
Background
Surfactant proteins (SP) A and D play a critical role in innate defence of respiratory mucosa. Although numerous studies have focused on the importance of surfactant in the lower airways, relatively little is known about its role in the upper respiratory system.
Methods
The prospective study was conducted with 61 subjects divided into patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with chronic rhinosinusitis without nasal polyps (CRSsNP) and healthy controls. SP-A and SP-D were detected in nasal lavage fluid (NALF) by ELISA and in nasal mucosa by immunohistochemical staining. Severity of the diseases assessed by preoperative CT score, presence of comorbidity (allergy and bronchial asthma) and bacterial culture from the middle nasal meatus were evaluated.
Results
In nasal mucosa, SPs were localized in ciliated cells of the surface epithelium and serous acini of the submucosal glands. Stronger expression of SPs in submucosal glands was observed in CRSwNP and CRSsNP groups in comparison to controls. In patients with CRSsNP and more severe form of the disease higher levels of SP-A and SP-D in NALF and stronger immunoreactivity of these proteins in nasal mucosa was detected. Identification of pathogenic bacteria was associated with higher levels of SP-A and SP-D in NALF and nasal mucosa in patients with CRSsNP and control group. Presence of allergy was associated with stronger expression of SP-A in submucosal glands in all CRS patients and with decreased levels of both SPs in NALF in CRSsNP patients.
Conclusions
Surfactant proteins A and D play an important role in innate host defence of upper respiratory tract. Different expression of these proteins in patients with chronic rhinosinusitis indicates possible novel target of therapy in these patients.
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Radiological study of the anatomy of the keystone area of the nasal septum using computed tomography to aid septal surgery
S Carr, V Twigg, S Mirza, 2015-08-19 14:26:22 PM
Abstract
Objectives
An optimum septoplasty result may require complete detachment of the superior osseocartilaginous junction (OCJ), but this may lead to disruption of the keystone area with loss of nasal support and consequent supratip depression deformity.
The aim of this study was to analyse normal keystone anatomy using CT scan images and to estimate the incidence of risk of supratip depression when completely detaching the OCJ.
Design
Retrospective study.
Setting
Tertiary referral centre.
Participants
Adult patients who underwent CT paranasal sinuses prior to transsphenoidal hypophysectomy in a tertiary referral centre between 2009-2013.
Main Outcome Measures
Length of the keystone area. A length of <5mm and certain anatomical configurations were considered at risk of a supratip depression with complete detachment of the OCJ.
Results
CT scans of 91 patients were reviewed. The mean keystone length was 9.04mm (range 0-23mm). Twenty nine (32%) cases were at risk of supratip depression.
Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.37) (n=26) were associated with a shorter keystone area (p=0.0051).
Conclusions
Thirty-two per cent of patients have keystone anatomy on radiology predisposing them to supratip depression with complete detachment of the OCJ. Relatively shorter nasal bones were significantly associated with a shorter, higher risk keystone area. In cases with a high septal deviation undergoing a septoplasty, a pre-operative CT enables the surgeon to assess the keystone area and determine whether it is safe to completely detach the OCJ.
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Participation in sport and physical activity in head and neck cancer survivors: associations with quality of life
Luke Sammut, Lisa R Fraser, Matthew J Ward, Tahwinder Singh, Nimesh N Patel, 2015-08-19 14:26:22 PM
Abstract
Background
Head and neck cancer (HNC) and its treatment is associated with significant side effects which can affect quality of life (QOL). Physical activity (PA) is known to improve a number of QOL measures. We aimed to determine the prevalence of PA pre- and post-treatment of HNC, and to determine associations with QOL.
Methods
A questionnaire based survey of 172 patients pre- and post-treatment for HNC.
Results
62.2% of patients met current UK PAguidelines pre-treatment, reducing to 40.1% following treatment. There was a significant decrease in Metabolic equivalent task minutes/week post-treatment, with 71% of participants reporting less PA after diagnosis (p<0.001). Swimming and cycling remained the two most practised sports. There was a positive correlation between the post-treatment PA and QOL (p<0.001).
Conclusion
These data suggest that PA may improve QOL following treatment for HNC. We believe that further studies are warranted.
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Comparison of calcium alginate and carboxymethyl cellulose for nasal packing after endoscopic sinus surgery: a prospective, randomised, controlled single-blinded trial
Do-Yang Park, Hyo Jin Chung, Nam Suk Sim, Kwang Hee Jo, Da Hee Kim, Chang-Hoon Kim, Joo-Heon Yoon, 2015-08-19 14:26:22 PM
Abstract
Objectives
Calcium alginate is a biodegradable gel-transforming agent widely used for nasal packing. It can reduce pain and improve comfort. However, few randomised controlled trials have compared the efficacy of calcium alginate nasal packing with that of other biodegradable gel-transforming materials.
Design
Prospective, randomised, single-blinded controlled study.
Setting
Yonsei University Severance Hospital, a tertiary academic medical centre.
Participants
Twenty seven patients (54 nostrils) with chronic rhinosinusitis who were scheduled for bilateral endoscopic sinus surgery were enrolled. After surgery, one nostril was packed with calcium alginate and the other with carboxymethyl cellulose. Only patients with an intersinus chronic rhinosinusitis severity score difference of ≤ 1 were included.
Main outcome measures
Visual analogue scale (VAS) scores for postoperative pain, discomfort from nasal discharge, and pain during packing removal were analysed. Two independent rhinologists who were blinded to the assessments separately scored adhesions, oedema, and infection by endoscopic digital photography at 1, 4, and 8 weeks postoperatively.
Results
There were no significant differences in VAS scores for postoperative pain, discomfort from nasal discharge, or pain during packing removal between calcium alginate packings and carboxymethyl cellulose packings. Inter-rater variability of adhesion, oedema, and infection scores was acceptable. Adhesion severity and oedema scores at 4 weeks were significantly lower with calcium alginate packing than with carboxymethyl cellulose. Infection severity scores also tended to be lower with calcium alginate than with carboxymethyl cellulose, but the difference was not significant.
Conclusions
Calcium alginate nasal packing is associated with reduced severity of oedema and adhesions after endoscopic sinus surgery.
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Quality of life after different procedures for regional control in oral cancer patients: Cross-sectional survey
T.M. Govers, W.H. Schreuder, W.M.C. Klop, J.P.C. Grutters, M.M. Rovers, M.A.W. Merkx, R.P. Takes, 2015-08-19 14:26:22 PM
Abstract
Objectives
To examine health utilities in patients with cT1-2 oral cavity squamous cell carcinoma following different diagnostic and treatment modalities for the neck, and to investigate the relation between shoulder morbidity and health utility.
Design
cross-sectional survey.
Setting
Two Dutch hospitals.
Participants
Four subgroups of patients with oral cavity cancer who underwent watchful waiting, sentinel lymph node biopsy, elective supraomohyoid neck dissection, or therapeutic modified radical neck dissection
Main outcome measures
Patients received the EuroQol-5D-3L questionnaire and the shoulder disability questionnaire. Mean health utility, Visual analogue scale, and Shoulder disability scores were calculated.
Results
181 patients (62%) returned the questionnaires. Mean health utilities, adjusted for age, gender and time after diagnosis, were 0.804, 0.863, 0.834 and 0.794 for the watchful waiting, sentinel lymph node biopsy, supraomohyoid neck dissection and modified radical neck dissection subgroups, respectively. Mean shoulder disability scores (higher score means more shoulder complaints) for these subgroups were 8.64, 10.57, 18.92 and 33.66. Patients with shoulder complaints had a mean utility of 0.78 while patients without shoulder complaints had a mean utility of 0.90.
Conclusions
This study shows that more invasive procedures appear to result in lower health utility. The high health utility for patients after sentinel lymph node biopsy supports a role for this procedure in oral cancer patients.
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Evaluation of the antioxidant effects of melatonin on the larynx mucosa of rats exposed to environmental tobacco smoke
Zehra Donmez, Özgür Yigit, Suat Bilici, Nevra Dursun, Mehmet Gul, Sevgi Durna Dastan, Hafize Uzun, 2015-08-19 14:26:22 PM
Abstract
Objectives
This study's aim was to investigate the effect of melatonin in terms of mitigating the effects of smoking on the laryngeal mucosa of rats exposed to environmental tobacco smoke.
Design
Rats were divided into four groups: Melatonin+ Smoking group exposed to smoke with melatonin; Smoking group exposed to smoke without melatonin; Saline group not exposed to smoke without melatonin; Melatonin group not exposed to smoke with melatonin. CuZn-superoxide dismutase (CuZn-SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were evaluated in plasma and tissues. Tissues were also examined the changes of squamous hyperplasia, keratosis, parakeratosis, and epithelial hyperplasia by light microscope and the ultrastructural changes by electron microscope.
Results
Tissue SOD, CAT, and GSH-Px activities were significantly higher in Saline and Melatonin groups than Melatonin+Smoking and Smoking groups. Plasma CuZn-SOD and CAT activities were significantly higher in Saline and Melatonin groups than Smoking group. Plasma GSH-Px showed no significant difference. The rate of epithelial hyperplasia was significantly higher in Smoking group than the other groups. The rate of parakeratosis was significantly higher in Smoking group than the other groups. The epithelial cells in Melatonin+Smoking group displayed normal cell structure similar to those in Saline group under electron microscope.
Conclusions
The study shows that smoking induces substantial pathological changes in the laryngeal mucosa and melatonin may have some beneficial effects in partially reversing smoking-induced laryngeal injury by inducing the expression of antioxidants; biochemical and histological outcomes also support these findings due to preventing tissue damage in laryngeal mucosa exposed to smoke.
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Relationship between Tinnitus and Suicidal Behavior in Korean Men and Women: a Cross-sectional Study
Jae-Hyun Seo, Jun-Myung Kang, Se-Hwan Hwang, Kyung-do Han, Young-Hoon Joo, 2015-08-19 14:26:22 PM
Abstract
Objectives
The current study investigated the prevalence of suicidal ideation and behavior in a representative sample of South Koreans with or without tinnitus.
Design
A cross-sectional study.
Setting
Based on data from the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES)
Participants
The study included 17,446 Korean individuals.
Main outcome measures
Participants provided demographic, socioeconomic, and behavioral information, as well as responses to questionnaires assessing the presence and severity of tinnitus, mental health status regarding stress, depression, and suicidal ideation and attempts. In the univariate analysis, the Rao-Scott chi-square test and logistic regression analysis were used to test the association between tinnitus and risk factors. Simple and multiple linear regression analyses were used to examine the association between tinnitus and mental status.
Results
A total of 20.9% and 1.2% of participants with tinnitus, and 12.2% and 0.6% of those without, reported suicidal ideation and attempts, respectively (p < 0.0001 and p = 0.001). Participants reporting suicide attempts showed a higher proportion of severe annoying (6.0%) and irritating (11.8%) tinnitus than those with suicidal ideation (1.4% and 10.2%, respectively). Risks for experiencing tinnitus were significantly associated with suicidal ideation and attempts after adjusting for confounding variables.
Conclusion
The present study has important implications for enhanced screening and evaluation of mental health status and suicidal ideation/behavior among tinnitus patients.
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Ondontogenic Sinusitis an underappreciated diagnosis: Our experience
Samuel Cartwright, Claire Hopkins, 2015-08-19 14:26:22 PM
Abstract
Ondontogenic sinusitis is a significant albeit seemingly neglected cause of maxillary sinusitis.
ENT diagnosis focused on the osteomeatal complex obstruction as the cause of maxillary sinus disease.
Patients undergoing sinus surgery at a London tertiary centre were examined retrospectively for odontogenic cause.
An incidence equating to around 10% was found.
We suggest a mnemonic as an aide memoire.
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Differential Expression of LOXL4 in Normal and Tumor Tissue Samples of Laryngeal Squamous Cell Carcinoma
Mehmet Yilmaz, Ilknur Suer, Omer Faruk Karatas, Harun Cansiz, Mustafa Ozen, 2015-08-19 14:26:22 PM
Abstract
Objective
Head and neck cancer is the sixth most common cancer in worldwide with an increasing incidence rate in recent years. LOXL4 is expressed in several tissues and its expression has been shown to display a significant correlation with local lymph node metastasis. In this study, we aimed to explore the LOXL4 expression level in metastatic and non-metastatic LSCC tissues and to determine its prognostic significance.
Study Design
Basic science research study.
Setting
University hospital.
Participants
A total of 40 patients were included in the study.
Main Outcome Measure
LOXL4 expression status in metastatic, non-metastatic LSCC and normal tissue samples was investigated by quantitative real time PCR.
Results
We demonstrated that LOXL4 was significantly overexpressed in LSCC tumor tissue samples in comparison to the corresponding normal tissues (p<0.001), however, no significant relationship has been found between LOXL4 expression and either the metastatic potential or the T classification of the specimens.
Conclusions
Although expression of LOXL4 is not statistically associated with neck metastases, we showed that LOXL4 expression significantly increased in laryngeal cancer.
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One-year swallowing outcomes following Transoral Laser Microsurgery +/- Adjuvant Therapy versus Primary Chemoradiotherapy for Advanced Stage Oropharyngeal Squamous Cell Carcinoma
James O'Hara, Diane Goff, Helen Cocks, James Moor, Chris Hartley, Colin Muirhead, Joanne Patterson, 2015-08-19 14:26:22 PM
Abstract
Objectives
To assess the between group change in swallowing function from baseline to 12 months following treatment, for patients treated for resectable stage III and IVA oropharyngeal squamous cell carcinoma. To assess the within group change in swallowing function between 3 months and 12 months following treatment.
Design
Non-randomised cohort study.
Setting
A single head and neck cancer unit with oncology services held at the nearby regional treatment centre.
Participants
25 patients treated with Transoral Laser Microsurgery +/- adjuvant (chemo)radiotherapy (TLM) observed alongside an historic cohort of 33 patients treated with (chemo)radiotherapy (CRT).
Main Outcome Measures
The patient reported MD Anderson Dysphagia Inventory (MDADI), an objective timed Water Swallow Test (WST), and the clinician rated normalcy of diet subsection of the Performance of Swallowing Scale (PSS).
Results
Between baseline and 12 months, patients treated with primary CRT demonstrated greater deterioration in swallowing function compared to TLM for all 3 swallowing measures. Between 3 and 12 months, the only significant change was an improvement in PSS scores in the CRT group.
Conclusions
This is the first study to report the results of a complimentary set of swallowing measures for patients treated with TLM, observed alongside a cohort of CRT patients. The preliminary results suggest a benefit in swallowing function for TLM over CRT during the year following treatment.
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High-Flow Oxygen, A Primary Oxygenation Technique for Endolaryngeal Airway Surgery: Our Experience with 10 Patients
Idris Samad, Michael Phelps, Vinciya Pandian, Simon R.A. Best, Lee M. Akst, Mahmood Jaberi, Jerry Stonemetz, Alexander T. Hillel, 2015-08-19 14:26:22 PM
Abstract
Ventilation methods for endolaryngeal airway surgery require a compromise between adequate oxygenation and operative visualization.
High-flow oxygen represents a novel oxygenation technique for endolaryngeal airway surgery that provides a clear operative view and uninterrupted operative time, while maintaining high oxygen saturation levels.
This feasibility study details our experience with high-flow oxygen in 10 patients using minimum oxygen saturation levels, maximum carbon dioxide level, and procedural length as measurable outcomes.
High-flow oxygen was demonstrated to be a safe and efficacious oxygenation technique for endolaryngeal balloon dilation procedures, through high minimum oxygenation saturation levels and minimal complications.
Additional benefits of high-flow oxygen include the ability to be performed with readily available operative room equipment, as well as providing greater opportunity for resident teaching and training.
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Effectiveness of Anatomic Criteria for Predicting Parotid Tumour Location
Jae-Yeong Kim, Hyung Chae Yang, Sung-Su Lee, Hong Chan Kim, Dong Joo Shin, Yong Beom Cho, Hyong-Ho Cho, 2015-08-19 14:26:22 PM
Abstract
Objective
We evaluated the accuracy, positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of eight anatomic landmarks to differentiate parotid deep lobe tumours from superficial lobe tumours; the lateral margin of the retromandibular vein (RMV), a straight line from the facial nerve trunk (FN trunk) to the mandibular ramus (FN line), a straight line from the FN trunk to the RMV (tRMV), a straight line from the FN trunk to the lateral margin of the masseter (tMasseter), a straight line from the ipsilateral vertebral posterior end to the RMV (U-line), an arc with a radius of 8.5 mm centred on the mandibular ramus (Conn's arc), a straight line from the lateral surface of the masseter muscle to the lateral margin of the RMV (rMasseter) and an angle from the FN line, tumour and the lateral margin of the masseter muscle (FTM angle).
Methods
A total of 181 patients with a parotid gland tumour who underwent parotidectomy at a tertiary hospital were identified retrospectively from May 2005 to May 2013. Preoperative computed tomography and intraoperative findings were compared to evaluate each landmark.
Results
rMasseter (accuracy: 85.5%, PPV: 90.0%, NPV: 85.12%, specificity: 98.1%, sensitivity: 22.2%) and tMasseter (accuracy: 86.3%, PPV: 80.0%, NPV: 87.1%, specificity: 97.1%, sensitivity: 44.4%) showed superior results as diagnostic criteria.
Conclusion
rMasseter and tMasseter were useful as anatomic landmarks to differentiate a parotid deep lobe tumour from a superficial lobe tumour.
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Spreading Patterns, Prognostic factors and Treatment Outcomes of Nasopharyngeal Papillary Adenocarcinoma and Salivary Gland-type Carcinomas
Lizhi Liu, Youming Zhang, Yong Chen, Li Li, 2015-08-19 14:26:22 PM
Abstract
Objectives
In this study, we aim to analyze the different spreading patterns, prognostic factors and treatment outcomes of nasopharyngeal papillary adenocarcinoma (NPAC) and salivary gland-type carcinomas (NPCs).
Design, Setting and Participant
The current study report on a retrospective analysis of oncologic outcome of 76 pathologically confirmed consecutive cases of nasopharyngeal adenocarcinomas (NAC), including 31 NPAC, 33 adenoid cystic carcinomas (ACC) and 12 mucoepidermoid carcinomas (MEC).
Main outcome measure
Overall survival rates (OS) and disease-free survival rates (DFS).
Results
In 12 patients with cranial nerve (CN) palsy, there were ACC (n=9), NPAC (n=2) and MEC (n=1) (p=0.016). CT/MRI detected CN involvements were found in 22 patients. Lymph node metastasis were observed in 25.8% of NPAC (n=8), 12.1% of ACC (n=4) and 8.3% of MEC (n=1). Significant differences were observed in 5-year overall survival rates (OS) and disease-free survival rates (DFS) between patients with and without CT/MRI-detected CN involvement (p=0.002 and p=0.002, respectively), and similar results were found between patients with and without lymph node metastasis (p=0.002 and p=0.018, respectively). In 37 patients with early stage disease (stage I-II), significant differences were observed in 5-year OS and DFS rates between the surgical and non-surgical treated groups (p=0.031 and p=0.012, respectively). In 39 patients with advanced stage disease (stage III-IV), significant or marginally differences were observed in DFS and OS between the chemoradiotherapy group and non-chemoradiotherapy group (p=0.007 and p=0.062, respectively).
Conclusions
ACC has a higher CN invasion than NPAC and MEC, and NPAC has the highest rate of lymphatic metastases. CT/MRI detected CN involvements and lymph node metastasis indicate a negative impact on the prognosis. The outcome of surgical patients in our series is encouraging in early stage NPAC and NPCs, and chemoradiotherapy may be the optimal treatment for the advanced stage patients.
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A service evaluation of HDU related adenotonsillectomy cancellations in one hundred and sixty-nine children at a University Teaching Hospital
Philippe F D Bowles, Andrew Moore, Neil Dezoysa, Simon Watts, 2015-08-19 14:26:22 PM
Abstract
Obstructive Sleep Apnoea (OSA) affects around 2% of children1-4 and is characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction causing disruption to normal ventilation during sleep.1, 5 The cardiorespiratory and neurodevelopmental sequelae of OSA are well recognised, with adenotonsillectomy (AT) remaining the mainstay of treatment. Chronic nocturnal hypoxia and resultant depression of the central ventilatory drive puts a proportion of this patient group at risk of post-operative respiratory complications.1 While consensus exists that children with severe OSA should be monitored post-operatively, including in some cases elective admission to a paediatric high dependency (HDU) or intensive care units (PICU), guidance regarding the specific level of care required is lacking. 3,4,6-8 Demand for paediatric critical care resources typically exceeds availability creating a clinical dilemma in the routine advanced booking of such facilities for elective procedures for which they may ultimately not be required.
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The Antia - Buch Flap Revisited
Sherilyn Tay, Dariush Nikkhah, TC Teo, 2015-08-19 14:26:22 PM
Abstract
The authors describe the use of a modified Antia - Buch flap for middle and upper third defects of the helical rim. They describe technical steps to minimize cupping and contour irregularities in a series of 32 patients. These easily reproducible modifications can comfortably reconstruct the ear with defects of up to 40mm with minimal change in projection.
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Trismus in patients with head and neck cancer. Etiopathogenesis, diagnosis and management
Alexander D. Rapidis, Pieter U. Dijkstra, Jan L.N. Roodenburg, Juan P. Rodrigo, Alessandra Rinaldo, Primož Strojan, Robert P. Takes, Alfio Ferlito, 2015-08-19 14:26:22 PM
Abstract
Background
Trismus indicates severely restricted mouth opening of any etiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of the present study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in head and neck cancer patients.
Objective of review
Trismus is frequently seen in patients suffering from malignant tumors of the head and neck. The reported prevalence of trismus in those patients varies considerably in the literature and ranges from 0-100% depending on the tumor site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with trismus after tumor treatment, it is important to determine whether the trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up.
Conclusions
Mouth opening after radiotherapy decreases on average by approximately 20% compared to mouth opening prior to radiotherapy. The prevalence of trismus increases with increasing doses of radiotherapy to mastication structures. The use of Intensity Modulated Radiotherapy seems to lower the percentage and severity of radiotherapy induced trismus. Treatment of trismus can be conservative (either medical or with physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of trismus, rather than its treatment, is the most important objective.
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The Impact of Septoplasty on Health-Related Quality of Life in Paediatric Patients
Katherine Anderson, Krista Ritchie, Jill M. Chorney, Michael Bezuhly, Paul Hong, 2015-08-19 14:26:22 PM
Abstract
Objectives
To assess the impact that septoplasty had on health-related quality of life (HRQoL) in paediatric patients and to determine if there were patient characteristics that predicted better outcomes.
Setting
Academic paediatric otolaryngology practice.
Design
Retrospective cohort study.
Participants and Measures
All paediatric patients who underwent septoplasty during the study period were included. The current HRQoL was assessed using the Paediatric Quality of Life Inventory (PedsQL). The Glasgow Children's Benefit Inventory (GCBI) was used to evaluate the perceived change in HRQoL following septoplasty.
Results
A total of 29 patients (16 boys, mean age 13 years) and their caregivers responded (response rate of 72.5%). There was a statistically significant improvement in HRQoL following septoplasty, as demonstrated by the positive mean GCBI subscoresand the total GCBI score (35.1, SD= 28.4). The total mean PedsQL score for child-self report was 95.2 (SD = 6.9) and for parent-proxy report was 91.8 (SD = 8.6), which indicated good current HRQoL. The enhancement in HRQoL post-septoplasty was moderately correlated with self-reported degree of nasal obstruction pre-septoplasty (r=0.621 for total GCBI).Also, there were differences in GCBI scores between the groups of children who wanted to have the surgery versus those who did not want to have the surgery.
Conclusions
There was a significant positive change in HRQoL following paediatric septoplasty in our study population. Children who reported more severe nasal obstruction and those who wanted to have the surgery were more likely to experience enhancement of HRQoL following their surgery.
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Bone Mineral Density Measurements in Otosclerosis Using Dual-Energy X-Ray Absorptiometry
S B Tonuk, S Koybasi, Y O Bicer, S Alkan Temel, 2015-08-19 14:26:22 PM
Abstract
Objectives
This study aims to evaluate patients with otosclerosis with respect to bone mineral density (BMD)at different regions of interest (ROI), using dual energy X-Ray absorptiometry (DXA).
Design
Cross-sectional controlled study.
Setting
Tertiary referral hospital.
Participants
The patients with a definite diagnosis of otosclerosis confirmed intraoperatively were defined as the study group (n=30). The control group consisted ofvolunteer, healthy subjects with normal hearing (n=43).
Main outcome measures
Following an audiometric evaluation, a venous blood sample was obtained and a single BMD measurement using DXA was applied to each participant.
Results
The mean BMD, T and Z scores were higher in the otosclerosis group than in the control group in all the regions considered, but not significantly; only the L2-L3lateral BMD and its T and Z scores were significant(P=0.036,P=0.029, and P=0.036, respectively).
Conclusion
This study shows that the BMD doesnot decrease in the presence of otosclerosis despite its genetic and metabolic relevance with osteoporosis. Concerning theL2-L3lateral BMD measurements,the BMD increased in otosclerosis.
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Enhanced recovery after surgery (ERAS) for head and neck surgery: A prospective interventional study
Margaret Jean Coyle, Barry Main, Ceri Hughes, Rachel Craven, Rachel Alexander, Graham Porter, Steve Thomas, 2015-08-19 14:26:22 PM
Abstract
Objectives
To describe the development of an enhanced recovery after surgery (ERAS) protocol for people undergoing surgery for head and neck cancer.
Design
Service improvement project.
Participants
Head and neck oncology patients.
Methods
The programme was developed in a series of structured meetings over a 6 month period. Stakeholders included oral and maxillofacial surgeons, otolaryngologists, anaesthetists, dieticians, physiotherapists, speech and language therapists (SALT) and nursing staff. Based on evidence within current literature and a consensus among the group an ERAS programme for head and neck surgery patients was formulated. A 12 month study of compliance with the ERAS programme was undertaken from February 2014 - January 2015.
Results
The process has resulted in the realisation of a head and neck ERAS programme. Key elements include a patient diary, nutritional optimisation, avoiding tracheostomy when possible, goal directed fluid therapy intraoperatively and a specific head and neck postoperative pain management protocol.
Overall compliance was high. Important areas showed lower levels of compliance- only 55% of people were given an explanation of the ERAS programme pre-operatively, 75% took pre-operative carbohydrate drinks, 10% had individualised goal directed fluid therapy, 13% avoided post-operative opiates and 7% were mobilised in the first 24 hours after surgery. The mean length of hospital stay was 14.55 days (sd 7.48)
Conclusions
The ERAS programme developed is now embedded in the care pathway for people undergoing head and neck cancer surgery in our unit. The mean length of hospital stay has reduced since the introduction of the programme.
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The Bonebridge Bone Conduction Hearing Implant: Indication criteria, surgery and a systematic review of the literature
Georg Mathias Sprinzl, Astrid Wolf-Magele, 2015-08-19 14:26:22 PM
Abstract
Background
Hearing aids and implants employing bone conduction stimulation have a long tradition in the treatment of conductive or mixed hearing loss, with their indications being extended in the 2000s to include single sided deafness. Existing percutaneous bone conduction implants (BCI) provide significant audiological gain but are associated with a high rate of complications. This has led to the development of passive transcutaneous BCIs, however audiological benefit may be compromised. An active transcutaneous BCI, the Bonebridge, was recently introduced and first implanted in 2011 as part of a clinical trial.
Objective of review
To introduce and assess the safety and effectiveness of the Bonebridge for individuals with conductive or mixed hearing loss, and single sided deafness.
Type of review
Systematic review.
Search strategy
the Cochrane Library, PubMed and OVIDSP (MEDLINE) and EMBASE were searched to identify papers on the Bonebridge published as of June 2014. No exclusion criteria were set on publication language, study design or reported outcomes. The literature found was supplemented by presentations from relevant conferences.
Evaluation method
Study selection, data extraction and study quality assessment was carried out by a single reviewer with any uncertainties resolved with consulting a second reviewer. Studies were synthesized narratively and results were tabulated.
Results
A total of 29 studies, 17 published and 12 presentations, were identified. The highest quality evidence was from three single arm trials. In those assessing the safety of implantation, 6 out of 117 patients experienced a minor adverse event with superficial revision surgery being required in one case. Studies demonstrated improved hearing thresholds and speech recognition with the Bonebridge when compared to no aiding in adults and children with either type of hearing loss. This was reflected in high device satisfaction rates. Data collected in the second year of device use further suggest the benefit to remain constant.
Conclusion
The transcutaneous bone conduction implant system Bonebridge provides a valuable and stable audiological benefit to patients suffering from conductive or mixed hearing loss and single sided deafness. With its active transcutaneous design the Bonebridge offers a lower complication rate to percutaneous systems and higher and more reliable hearing gain compared to other transcutaneous or percutaneous systems. Moreover the fast activation of the implant system enables the recipient of the system to benefit in a short time frame postoperatively from the intervention.
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The Sino Nasal Outcome Test 22 score in persons without chronic rhinosinusitis
B. Lange, T. Thilsing, J. Baelum, A D. Kjeldsen, 2015-08-19 14:26:22 PM
Abstract
Objectives
To determine the Sino Nasal Outcome Test 22 (SNOT 22) score in persons without chronic rhinosinusitis.
Design and setting
As part of a trans-European study selected respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis according to EPOS.
Participants
A total of 366 persons participated at the clinical visit and of these 268 did not have chronic rhinosinusitis. All participants completed the SNOT 22.
Main Outcome measures
The SNOT 22.
Results
The SNOT 22 score ranged from 0-67 with a mean score of 10.5 (CI: 9.1 – 11.9) and the median score was 7. Persons with allergic rhinitis and blue collar workers had a significant higher score.
Conclusion
The median value of 7 is taken as the normal SNOT 22 score in persons without CRS and can be used as a reference in clinical settings and research. Allergic rhinitis and occupation affects SNOT 22 in persons without CRS.
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A prospective observational study of 50 paediatric suction diathermy adenoidectomy cases to determine the potential safety of a two hour discharge time
Matthew Cherko, Tapas Goswami, Khalid Ghufoor, 2015-08-19 14:26:22 PM
Adenoidectomy may be considered as a separate entity to (adeno)tonsillectomy with regards to minimum post-operative recovery times due it's relative increased safety.
The aim of this study was to evaluate the safety of shortening the minimum recovery period following suction diathermy adenoidectomy from four hours to two.
The majority of children will meet conventional 'safe for discharge' criteria after just two hours of recovery.
There needs to be cohesion between the surgical, anaesthetic and nursing teams to identify children appropriate for early discharge.
By shortening the minimum recovery time, there is a beneficial impact on resource management as well as patient and parent satisfaction.
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The effect of caudal septoplasty on nasal angle parameters: a report on 69 cases
K.J Song, E.J Lee, J.M Lee, G.H Jo, K.S Kim, 2015-08-19 14:26:22 PM
Many surgeons are afraid of correcting the caudal septum because of the difficulties in surgical techniques and the fear of external deformities after surgery.
Even though various techniques on caudal septoplasty have been presented, external morphologic changes have not been objectively evaluated.
We measured four nasal angles because these values can sensitively reflect any alteration in external nose shape and can be consistently obtained from photographs.
There was no significant statistical difference in nasal angle parameters.
Nasal obstruction was also subjectively and objectively improved after caudal septoplasty.
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Does the EarPopper® device improve hearing outcomes in children with persistent otitis media with effusion? A randomised single-blinded controlled trial
A Banigo, A Hunt, T Rourke, O Whiteside, C Aldren, 2015-08-19 14:26:22 PM
Abstract
Objective
To provide an independent evaluation of the efficacy and safety of the EarPopper® in improving hearing outcomes in children with Otitis Media with Effusion (OME) and reducing the ventilation tube insertion rate.
Study Design
Randomised single-blinded controlled trial.
Setting
The Ear Nose and Throat Department of a district general hospital (Heatherwood and Wexham Park).
Participants and Methods
Twenty nine children aged between 4 and 11 years diagnosed with persistent OME lasting at least 3 months, with an average hearing of 25dBHL or worse in the better ear were randomised to a treatment or control group for seven weeks using random computer-generated codes. Syndromic children, children with developmental delay, previous grommets and cleft palate were excluded. The audiologists were blinded at the final post-treatment audiogram.
Results
After the seven week period, the mean improvement in air conduction across all frequencies was 10.9dBHL in the treatment group (p<0.001) and 3.6dBHL in the control group (p=0.201). At every frequency the treatment group had larger improvements in air conduction, the largest being at 4kHz where the mean air conduction in both ears improved by 14.8dBHL. Compliance with the Ear Popper was over 90%, the only side effect reported being discomfort in the ears immediately after use which resolved and did not affect compliance. The ventilation tube insertion rate was 53.3% in the treatment group and 78.6% in the control group. Median follow-up time for all patients is 47.7 months.
Conclusion
Our study shows that the EarPopper® is a safe effective treatment option for children with hearing loss from persistent OME, and it reduces the rate of ventilation tube insertion. More studies with larger sample sizes are required to support our findings.
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How we do it: Locating the posterior semicircular canal in occlusion surgery for refractory benign paroxysmal positional vertigo: a cadaveric temporal bone study
L Hamilton, S Keh, P M Spielmann, S S M Hussain, 2015-08-19 14:26:22 PM
Abstract
Posterior semicircular canal (PSCC) occlusion surgery is a recognised treatment for refractory benign paroxysmal positional vertigo (BPPV).
The posterior canal is buried within the petrous bone and can be difficult to locate.
We aimed to define the position of the PSCC within the temporal bone by assessing the distance from the lateral semicircular canal and the short process of the incus to the PSCC in ten cadaver bones.
We present for the first time, reliable landmarks which can be used in the transmastoid approach for PSCCO surgery.
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Endoscopic Polypectomy in the Clinic (EPIC): A Pilot Cost-Effectiveness Analysis
Luke Rudmik, Kristine A. Smith, Shaun Kilty, 2015-08-19 14:26:22 PM
Abstract
Objective
The purpose of this pilot economic evaluation is to assess the cost-effectiveness of the endoscopic polypectomy in the clinic (EPIC) procedure compared to formal endoscopic sinus surgery (ESS) for the treatment of select chronic rhinosinusitis (CRS) patients with nasal polyposis.
Design
Cost-effectiveness analysis using a Markov decision tree model with a 30-year time horizon. The two comparative treatment groups were: 1) EPIC and 2) ESS. Costs and effects were discounted at a rate of 3.5%. A probabilistic sensitivity analysis was performed.
Setting
Economic perspective of the Canadian government third party payer.
Participants
CRS patients with nasal polyposis who have predominantly isolated symptoms of nasal obstruction with or without olfactory loss.
Main Outcome Measures
Incremental cost per quality adjusted life year (QALY).
Results
Over a time period of 30 years, the reference case demonstrated that the ESS strategy cost a total of $21,345 and produced 13.17 QALYs while the EPIC strategy cost a total of $5,591 and produced 12.93 QALYs. The ESS vs. EPIC incremental cost effectiveness ratio was $65,641/QALY. The probability that EPIC is cost-effective compared to ESS at a maximum willingness-to-pay threshold of $30,000 and $50,000/QALY is 66% and 60%, respectively.
Conclusion
Outcomes from this study have demonstrated that the EPIC procedure may be a cost-effective treatment strategy for 'select' patients with nasal polyposis. Data from this study was obtained from a small pilot trial and we feel the results warrant a future randomized controlled trial to strengthen the outcomes.
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A prospective study evaluating cochlear implant management skills: development and validation of the Cochlear Implant Management Skills (CIMS) survey
Rebecca J Bennett, Dona MP Jayakody, Robert H Eikelboom, Dunay S Taljaard, Marcus D Atlas, 2015-08-19 14:26:22 PM
Abstract
Objective
To investigate the ability of cochlear implant recipients to physically handle and care for their hearing implant device(s) and to identify factors that may influence skills. In order to assess device management skills a clinical survey was developed and validated on a clinical cohort of cochlear implant recipients.
Design
Survey development and validation. A prospective convenience cohort design study.
Setting
Specialist hearing implant clinic.
Participants
Forty-nine postlingually deafened, adult cochlear implant recipients, at least 12 months post-operative.
Main Outcome Measures
Survey test-retest reliability, inter-observer reliability and responsiveness. Correlations between management skills and participant demographic, audiometric, clinical outcomes and device factors.
Results
The Cochlear Implant Management Skills survey was developed, demonstrating high test-retest reliability (0.878), inter-observer reliability (0.972) and responsiveness to intervention (skills training) [t(20) = -3.913, p=0.001]. Cochlear Implant Management Skills survey scores range from 54.69% to 100% (mean: 83.45%, SD: 12.47). No associations were found between handling skills and participant factors.
Conclusions
This is the first study to demonstrate a range in processor handling skills in cochlear implant recipients and offers clinicians and researchers a tool to systematically and objectively identify shortcomings in cochlear implant recipients' device handling skills.
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Anatomical reposition of incus after transmastoid facial nerve decompression using bone cement: preliminary results in 17 patients
Mohamed Rashad Ghonim, Yousef Kamel Shabana, Bassem Ashraf, Mohammed Abdelbadie Salem, 2015-08-19 14:26:22 PM
Abstract
In transmastoid facial decompression, Incudostapedial disarticulation can lead to an ABG up to 60 dB, thus ossiculoplasty should be done to restore hearing
The use of glass ionomer cements in otologic surgery seems promising with comparable hearing results to incus interposition
During cement ossiculoplasty, middle ear mucosa, facial nerve should be covered with pieces of sponge.
Many studies focused on the surgical technique and outcome of facial improvement after transmastoid decompression, but no studies described the way or discussed hearing results after incus reposition
Anatomical reposition of incus using bone cement is easy, cheap and safe technique with excellent hearing results
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Quality of life and functional outcomes following Pharyngolaryngectomy: a systematic review of literature
Sridhayan Mahalingam, Rajeev Srinivasan, Patrick Spielmann, 2015-08-19 14:26:22 PM
Abstract
Background
The long-term prognosis of hypopharyngeal cancer is poor. Surgery necessitates Pharyngolaryngectomy with flap reconstruction. For such patients it is important that functional outcomes are preserved in order to maintain a respectable quality of life.
Objective of review
To identify the functional outcomes following pharyngolaryngectomy with respect to quality of life, speech and swallow through a systematic review of literature.
Search strategy
Searches of EBM databases, and literature databases using key words: pharyngolaryngectomy, laryngopharyngectomy, swallow, dysphagia, speech and dysphonia from 1970 to August 2014. Articles were screened for relevance using pre-determined inclusion and exclusion criteria.
Evaluation method
Articles reviewed by authors and data compiled in tables for analysis.
Results
No previous systematic reviews assessing functional outcomes were identified. Seventeen studies reported speech outcomes (576 patients) and fifteen reported swallow outcomes (1076 patients). The data suggests that patients who underwent trachea-oesophageal puncture developed more favourable speech outcomes than those rehabilitated using other measures. Overall stricture incidence was 11.4% and 6.5% of patients required long-term enteral nutrition. Four studies used validated speech measures, and three used validated swallow measures. They suggest an overall level of perceived impairment in quality of life. Speech and swallow outcomes were significantly poorer than patients who underwent Total Laryngectomy.
Conclusions
Overall, there is an impairment in speech and swallow outcomes following pharyngolaryngectomy, however the exact extent is unclear. There is a need for a general consensus on assessment measures and prospective multicenter studies to be conducted. The present study compiles the available data to improve caregiver and patient awareness of functional outcomes.
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Temperature rises in the round window caused by various light sources during insertion of rigid endoscopes: an experimental animal study
Rıza Dundar, Hüsamettin Bulut, Ahmet Yükkaldıran, Osman kadir Güler, Yunus Demirtaş, İsmail İynen, Ferhat Bozkuş, Fatih Kemal Soy, 2015-08-19 14:26:22 PM
Abstract
Objectives
The instruments used in endoscopic surgery include rigid endoscopes of different diameters and angles, sources of light, and monitors. In this study, we explored temperature rises in the round window caused by insertion of rigid endoscopes of different diameters into the middle ear; the endoscopes were fitted with different light sources.
Design
An experimental animal study.
Setting
We subjected seven guinea pigs to simulated otological surgery at room temperature. We monitored body temperatures, along with temperature rises caused by the use of 0° rigid endoscopes of diameters 3 or 4 mm, fitted with light sources including a halogen light, a light-emitting diode (LED), and a xenon light. Data were collected every second from a sensor placed in the round window.
Results
Rigid endoscopes caused the temperature of the tympanum to rise when xenon and halogen light sources were used, regardless of endoscope diameter. However, the temperature rise was less when a LED light source was employed.
Conclusion
The endoscopic instruments used in middle ear surgery caused the temperature of the round window to rise. The rise varied with endoscope diameter and the type of light source used.
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A purely synthetic and biodegradable material for repair of CSF rhinorrhoea
Pavol Surda, Irfan Syed, Prince Cheriyan Modayil, Sarah Ann Little, Abbad Toma, 2015-08-19 14:26:22 PM
Abstract
Background
TissuePatchDural (TPD, previously known as OBEX) is a purely synthetic and biodegradable material with an adhesive surface. It has a multi-laminated structure containing patented reactive polymers providing fast and strong chemical bonding of the patch with the underlying biological surface.
Method
TPD was used for endoscopic repair of Cerebrospinal fluid (CSF) rhinorrhoea in four patients. The site of a leak was identified pre-operatively using radiological investigations. Surgical technique, postoperative complications and outcomes were analysed.
Results
The size of the bony defects ranged from 4 to 20 mm. None of our patients had postoperative CSF leakage. No postoperative complications or foreign body reactions were observed. The follow-up period ranged from 21 to 39 months.
Conclusion
The use of TPD for CSF rhinorrhoea repair is a novel technique. It reduces the morbidity associated with harvesting of autologous grafts and shortens the operating time. The inherent adhesive properties and transparency of this sealant film makes the surgical handling and placement easier. This is the first case series reporting endoscopic endonasal use of TPD in the published literature of patients who have been treated for CSF rhinorrhoea.
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SNOT-22: Translation, cultural adaptation and validation in portugal
Ditza Vilhena, Delfim Duarte, Gustavo Lopes, 2015-08-19 14:26:22 PM
Abstract
Objectives
SNOT-22 (Sino-Nasal Outcome Test-22) is a questionnaire that evaluates the specific Quality of Life (QoL) in Chronic Rhinosinusitis (CRS), and was widely used in scientific literature. The aim of our study was to translate and culturally adapt SNOT-22 for the Portuguese reality, and validate the version obtained for use in Portugal.
Design
We translate SNOT-22 into European Portuguese according to the methodology recommended by the scientific literature. After translation, we proceeded with the evaluation of the questionnaire regarding its feasibility, reliability (internal consistency and test-retest reproducibility) and discriminant validity. Statistical analysis was performed using SPSS 22.0.
Setting
Patients treated at a single institute.
Participants
We applied SNOT-22 questionnaire to 15 volunteers with no nasal or sinus disease and to 50 patients with CRS.
Main Outcome measures
feasibility, reliability (internal consistency and test-retest reproducibility) and discriminant validity
Results
We observed good internal consistency, with general Cronbach's ? coefficient of 0.935, good test-retest reproducibility (32.5 vs. 32, p <0.001), with Pearson coefficient of 0.99 (p<0.001) and Cohen Kappa coefficient of 0.898. The discriminant validity of the Portuguese version of SNOT-22 was confirmed by applying the Mann-Whitney test (p <0.001).
Conclusions
Until now, there were no validated questionnaires to evaluate QoL in patients with CRS in Portugal. Translation and validation of SNOT-22 in Portugal will allow a more consistent assessment of the specific QoL of these patients and the comparison with international data. Thus, we recommend this version for use with the Portuguese population with CRS.
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Traumatic Ossicular Disruption with Intact Tympanic Membrane: Treatment Modalities in 42 patients
Mohamed Rashad Ghonim, Yousef Kamel Shabana, Bassem Ashraf, Mohammed Abdelbadie Salem, 2015-08-19 14:26:22 PM
Keypoints
• Conductive hearing loss after head trauma due to an ossicular lesion is suspected if not-resolved after 6 months, with a persistent air-bone gap greater than 30 dB.
• The most common ossicular lesions are incudostapedial joint dislocation, incus dislocation and stapes lesions. Isolated malleus and incus fractures are rare.
• Three main treatment modalities for ossiculoplasty were used according to the type of lesion: Teflon piston from incus to inner ear, anatomical reconstruction using ionomeric bone cement and malleus relocation technique with bone cement as adjuvant.
• In incudostapedial dislocation or minimal incus long process damage, repair using ionomeric bone cement was used. For stapes lesions, a teflon piston was used. When the incus is absent or severely affected, a malleus relocation technique with bone graft was used.
• The use of Bone Cement as adjuvant can improve the functional outcome of ossiculoplasty.
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The outcome of septorhinoplasty surgery on olfactory function
Premjit S Randhawa, Natalie Watson, Matthias Lechner, Lulu Ritchie, Natasha Choudhury, Peter J Andrews, 2015-08-19 14:26:22 PM
Abstract
Objectives
To assess olfactory outcomes in patients undergoing septorhinoplasty surgery in our unit.
Design
Prospective cohort study.
Setting
The Royal National Throat Nose and Ear Hospital, London.
Participants
Forty-three patients undergoing functional septorhinoplasty (Males = 26; mean age = 34.1 ± 12.2) were recruited into the study.
Main outcome measures
The primary outcome of olfactory function was assessed using 'Sniffin sticks'. Our secondary outcomes were assessment of patient quality of life using the disease specific Sino-nasal Outcome Test-23 questionnaire (SNOT-23) and a visual analogue scale for sense of smell. These measures were repeated at 12 weeks post operatively.
Results
There was a significant change in the Sniffin' sticks score post-operatively (8.3 v 9.6; p < 0.001). The SNOT-23 score also showed a significant improvement post-operatively (53.5 v 40.4; p < 0.001). A significant improvement was not found in the smell/taste question (question 21) of the SNOT-23 questionnaire as well as the visual analogue scale for sense of smell. A difference in olfactory outcome was not found between open versus closed approaches, primary versus revision surgery and traumatic versus non traumatic cases.
Conclusions
The results show a measured significant improvement in olfaction following functional Septorhinoplasty but not a subjective improvement in the patients perception of their sense of smell and hence not a clinically significant difference. The reasons for the measured improvement are not clear and are likely to be multifactorial.
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Chronic Rhinosinusitis: Patient Experiences of Primary and Secondary Care – A Qualitative Study
SE Erskine, MM Verkerk, C Notley, IG Williamson, CM Philpott, 2015-08-19 14:26:22 PM
Abstract
Objectives
To explore the experience of CRS and its management from the perspective of patients with CRS. To our knowledge this is the first qualitative study exploring sinus disease.
Design
Semi-structured qualitative interviews.
Setting
ENT outpatient clinic.
Participants
21 adult patients with CRS: 11 male, 10 female. Patients suffered from a range of types of CRS (including polyps and fungal disease) and differing durations of symptoms (1.5- 47 years). Participants were purposively selected. Thematic analysis was used.
Outcome measures
Patient experience of CRS and its management.
Results
Patients had concerns regarding management of their symptoms by both healthcare professionals and themselves, including delays to referral and repeated medications. They reported reduced quality of life and high financial and psychosocial costs associated with living with CRS.
Conclusions
Despite guidelines for CRS treatment, outcomes remain variable leading to dissatisfaction with treatment. Adherence to existing guidelines may result in fewer repeated consultations in primary care and earlier referrals to secondary care.
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One hundred twelve patients above 75 years old with tracheotomy: discharge delayed by 13 days
Mathieu Bergeron, Nathalie Audet, 2015-08-19 14:26:22 PM
Abstract
Healthcare systems are facing two synergistic realities: constantly increasing expenditures and a population with longer life expectancy. Canadians currently spend more than $49 billion (CAD) for hospital services whereas the United States spend more than and $300 billion (USD) for such services [1]. Most of these costs are incurred by adults aged 65-84, averaging a mean cost per hospital stay of $12,600 (USD).
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Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders
Jenny Montgomery, Jane Hendry, Janet A Wilson, Ian J. Deary, Kenneth MacKenzie, 2015-08-19 14:26:22 PM
Abstract
Objective
To evaluate diagnostic performance of the emotional domain of the VoiSS questionnaire compared with the Hospital Anxiety and Depression Scale (HADS).
Design
Cross sectional questionnaire study.
Setting
Tertiary referral centre voice clinic.
Participants
210 consecutive voice clinic patients.
Main outcome measures
Screening with VoiSS and HADS questionnaires. Paired comparison, correlation, multinomial logistic regression and receiver operating characteristic (ROC) curve analysis.
Results
177 returned complete datasets. 96 patients (54.2%) had functional dysphonia and 81(45.8%) had organic laryngeal disorders. Mean total VoiSS score =39.7/120 (standard deviation (SD) 22.2). Mean emotional VoiSS subscale =7.6/22 (SD 7.5). Mean HAD anxiety =6.5/21 (SD 5.2) and depression mean =7.1/21 (SD 4.8). There were 35 (20%) borderline anxiety and/or depression scores and 30 (17%) scores considered positive for "caseness".
There was strong correlation between emotional VoiSS and HADS anxiety (Spearman's Rho= 0.68, p < .001) and HADS depression (Spearman's Rho= 0.62, p < .001). ROC curve analysis exhibited significant association between emotional VoiSS and HADS "caseness" (area under curve =0.88). In addition functional dysphonia patients had lower mean VoiSS and HADS scores than patients with identifiable laryngeal abnormalities.
Conclusion
The VoiSS emotional subscale strongly correlates with HADS anxiety and depression scores and could be used as a measure of psychological distress. This could allow targeted psychological strategies, without additional psychometric questionnaires. Functional dysphonia has less association with psychological distress than certain organic laryngological disorders.
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Application of ultrasound-guided core biopsy as a novel diagnostic tool for base of tongue cancer: our experiences with ten patients
Chun-Nan Chen, Che-Yi Lin, Jenq-Yuh Ko, Pei-Jen Lou, Cheng-Ping Wang, Tseng-Cheng Chen, Tzu-Yu Hsiao, Tsung-Lin Yang, 2015-08-19 14:26:22 PM
Abstract
Objective
The aim of this study was to evaluate the application of ultrasound-guided core biopsy (USCB) as a novel diagnostic tool of base of tongue (BOT) cancer.
Design
A prospective cohort study.
Setting
University Teaching Hospital.
Main outcome measures
Successful evaluation and tissue sampling of BOT malignancy by ultrasound-guided core biopsy.
Results
Ten patients with suspected BOT malignancy were recruited for USCB. BOT malignancy was diagnosed in nine patients. Chronic inflammation was found in the remaining patient. There were 3 new cases, 5 recurrent cases, and 1 metastatic case of BOT cancer confirmed by USCB. Four patients had previously undergone a failed endoscopic biopsy. There were 2 infirm patients who received USCB only, and 2 patients refused scheduled endoscopic biopsy because of early diagnosis by USCB. All patients tolerated the procedure well without remarkable complications.
Conclusions
USCB is a novel diagnostic tool for diagnosing BOT cancer and is especially useful for patients who were contraindicated or could not be diagnosed by endoscopic approaches.
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Paediatric ENT Standards in London: are we delivering a first class service?: A Repeat Audit
K Varadharajan, A Narula, 2015-08-19 14:26:22 PM
Abstract
The Children's Surgical Forum (CSF) of the Royal College of Surgeons of England (RCS) set out key standards pertaining to paediatric ENT care and in 2011 we conducted a pilot audit of these standards in London and found that there were several key deficiencies.
Two years on we decided to re-audit these standards to assess if there has been any change.
In the 15 hospitals we audited we noted an improvement in compliance in 13 out of 17 standards compared to the first cycle. Standards that improved significantly included surgeons being trained in paediatric life support, surgeons receiving structured paediatric training, presence of a separate recovery area for children and staff receiving child protection training.
The encouraging results of this re-audit suggest that the CSF standards are pragmatic and can be achieved.
Moreover these findings highlight the need for a national audit assessing paediatric ENT standards.
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Nasal bone fractures are successfully managed under local anaesthesia – experience on 483 patients
Suvi Renkonen, Sasu Vehmanen, Antti Mäkitie, Karin Blomgren, 2015-08-19 14:26:22 PM
Abstract
Nasal fractures are common but their management remains controversial. The aim of the present study was to investigate the aetiology, management and outcome of these traumas at a tertiary care teaching hospital.
There were 483 patients with a nasal fracture managed at our institution during one year. Closed reduction was performed for 333 (69%) patients, and the rest were treated conservatively (31%).
The average time to reduction was 5.6 days after the injury. However, delay up to one month for closed reduction had no correspondence to the number of re-operations or corrective surgery.
Almost all (95%) primary nasal fracture reductions in adults were performed under local anaesthesia.
Three quarters (75%) of the closed reductions were performed by a resident, and one quarter (25%) by a senior doctor - with no difference in the long-term outcome.
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The need for an objective measure in septorhinoplasty surgery: Are we any closer to finding an answer?
Peter J Andrews, Natasha Choudhury, Arunjit Takhar, Anne-Lise Poirrier, Thomas Jacques, Premjit S Randhawa, 2015-08-19 14:26:22 PM
Abstract
Objectives
To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease specific quality of life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom specific nasal questionnaires following septorhinoplasty..
Design
To perform a prospective comparative analysis between NIPF and the validated disease specific quality of life questionnaire SNOT 22 and to determine if a correlation exists following septorhinoplasty surgery.
Setting
The Royal National Throat Nose and Ear Hospital, London.
Participants
A total of 122 patients (78 males, 44 females; mean age 33.5 +/- 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery
Main outcome measures
Pre and post-operative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality of life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scores (VAS: 0-10).
Results
The mean pre-operative NIPF was 88.2L/min, and the post-operative value was 101.6L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P<0.0001); the NOSE score from 14.1 to 6.6 (P<0.0001); and the VAS blockage score from 6.9 to 3.2 (P<0.0001). All individual domains assessed showed improvements post-operatively but no correlation was found between the NIPF and SNOT-22 score. Equally, we did not find a correlation between NIPF and the symptom specific NOSE questionnaire and the nasal blockage domain on the VAS scale.
Conclusion
We have demonstrated that NIPF does not correlate with the SNOT 22 disease specific questionnaire, although both outcomes significantly improve post-operatively. At present we are still lacking a clinically accurate objective measure of nasal function for the evaluation of patients undergoing septorhinoplasty surgery.
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Improving post-operative pain control in paediatric tonsillectomy through use of a specialist information leaflet; our experience in 43 patients
Y Pilavakis, TC Biggs, A Burgess, A Cowan, RJ Salib, H Ismail-Koch, 2015-08-19 14:26:22 PM
Abstract
Tonsillectomy is the most common surgical procedure performed within the UK, and is commonly associated with uncomfortable post-operative pain6. The optimum method of dissection is currently the use of cold steel, which has been shown to reduce both the risk of secondary haemorrhage, and to a degree, post-operative pain, mainly through the avoidance of bipolar diathermy6,7. Regular analgesia is the mainstay of treatment in the post-operative period, together with antibiotics in the advent of bleeding or infection.
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Labyrinthine function after semicircular canal surgery on seventeen patients with cholesteatoma
Timo P. Hirvonen, Heikki Aalto, Topi Jutila, 2015-08-19 14:26:22 PM
Abstract
The outcome and success of semicircular canal surgery can be assessed with the quantitative head impulse test.
Resurfacing of semicircular canal fistula retains normal function, whereas canal plugging abolishes motion sensitivity.
Larger disturbance of labyrinthine function is possible complication following semicircular canal surgery leading to unilateral loss of function.
Both resurfacing and plugging are feasible techniques with regard to managing semicircular canal fistulas.
Semicircular canal surgery must be planned individually taking account the advantages and disadvantages of the technique in question, and the pathology to be repaired.
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Evaluation of tubomanometry as a routine diagnostic tool for chronic obstructive Eustachian tube dysfunction
S. Schröder, M. Lehmann, D. Korbmacher, O. Sauzet, H. Sudhoff, J. Ebmeyer, 2015-08-19 14:26:22 PM
Abstract
Objective
The objective of the present study is to demonstrate the reliability of tubomanometry (TMM) described by Estéve in the diagnosis of chronic obstructive Eustachian tube (ET) dysfunction.
Study Design
Combined prospective and retrospective clinical study.
Setting
Tertiary referral center, affiliated to university.
Methods
:215 healthy subjects were examined once, 25 healthy subjects underwent TMM weekly for 6 weeks and 6 healthy subjects were tested 3 times a day on at least 3 different days. The results of tubomanometry in healthy subjects were compared to data obtained from 171 patients with chronic obstructive ET dysfunction.
Results
In healthy subjects there was an immediate opening of the ET at 30-50 mbar with an R-value ≤ 1 in at least 94% of the cases. In patients with chronic ET dysfunction an opening of the ET could be registered in only 42% of patients at 30 mbar and in 58% at 50 mbar. The average of the R-value in these subjects always indicated towards a delayed opening (R > 1). When measurements are repeated in the same subject with a weekly interval the intra-class correlation ICC was 0.49 for TMM with 30 mbar, 0.51 for TMM with 40 mbar and 0.52 for the TMM with 50 mbar in healthy people. For the patients with symptoms of ET dysfunction, the ICC for up to four repeated measures was 0.50 for TMM with 30 mbar, 0.53 for TMM with 40 mbar and 0.54 for the TMM with 50 mbar. A complete agreement of the results in repeated measurements within seconds was present in 86% for 30 and 40 mbar and in 79% for 50 mbar. The ICC was 0.61 for TMM with 50 mbar, 0.62 for TMM with 40 mbar and 0.68 for TMM with 30 mbar.
Conclusions
Tubomanometry can support the diagnosis of ET dysfunction. An R-value ≤ 1 indicates a regular function of the ET, an R-value > 1 a delayed opening of the ET and no definable R-value means no detectable opening of the ET. TMM is a reliable and valid instrument to support the diagnosis of chronic obstructive ET dysfunction.
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Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practise
Mohammed Iqbal Syed, Ophir Ilan, Jihad Nassar, John A Rutka, 2015-08-19 14:26:22 PM
Abstract
Background
Meniere's syndrome or disease (MS/D) is typically characterised by episodic vertigo, aural fullness, tinnitus and fluctuating hearing loss. There are multiple options available for treatment with variation in consensus on the best intervention.
Objective
To evaluate the evidence on the efficacy of intratympanic therapies [steroids, gentamicin, antiviral therapy and other therapies] on the frequency and severity of vertigo and other symptoms of MS/D.
Search strategy
A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders group trials register using various MeSH. The search was restricted to English and human subjects and the last date of search was Dec 2014.
Selection criteria
Randomised controlled trials of intratympanic therapies [steroids, gentamicin and antiviral agents, latanoprost] versus a placebo or another treatment.
Results
We analysed 8 RCT's comparing intratympanic steroids, gentamicin, Ganciclovir (antiviral) and latanoprost versus another form of intratympanic treatment or placebo.
Conclusions
On the basis of 6 RCT's (n=242) there is evidence to support the effectiveness of intratympanic steroids and gentamicin to control symptoms of vertigo in MS/D albeit with a risk of hearing loss in gentamicin. However, there was no consensus found on doses or treatment protocols. There was no evidence for the use of other forms of intratympanic therapy (antivirals and latanoprost) in MS/D.
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Evaluation of Noise-Induced Hearing Loss by Auditory Steady State and Auditory Brain Stem-Evoked Responses
Hanin Karawani, Joseph Attias, Rafi Shemesh, Ben Nageris, 2015-08-19 14:26:22 PM
Abstract
Objectives
Noise Induced Hearing Loss (NIHL) may result from occupational noise exposures and is considered as an "Occupational Disease", therefore, it is compensable. To verify the existence and severity of the work-related hearing loss, there is a need of an objective, reliable auditory measure in cases of arbitration of financial disputes to resolve any medicolegal aspects. The objective of the study was to compare between the ABR and ASSR for predicting the behavioral threshold in subjects with normal-hearing or NIHL.
Design
The study included 82 subjects regularly exposed to high levels of occupational noise, with normal-hearing and NIHL. ABR to clicks and to tone-bursts were recorded followed by multiple frequency-ASSR. Physiological and behavioral thresholds were compared for specific frequencies (1000Hz, 2000Hz) and average of high-frequency range (2000Hz and 4000Hz). In addition, Pearson correlations and the specificity and sensitivity of each measure were also calculated by using receiver operating characteristic (ROC) curves.
Results
In the NIHL group, there was a significantly smaller difference between the behavioral threshold and click-ABR than the ASSR in high-frequency range. Pearson correlations were significantly higher for click-ABR. Analysis of specific frequencies yielded a smaller difference between behavioral and ASSR than tone-burst-ABR thresholds, with a slightly better correlation for ASSR than tone-burst-ABR. Higher sensitivity but lower specificity was suggested for ASSR than ABR.
Conclusions
ASSR is associated with high-frequency specificity, shorter test sessions and good correlations with behavioral thresholds, making it a potentially better measure than ABR for predicting audiograms in subjects with NIHL. These findings have diagnostic implications, especially in cases of workers' compensation when subjects may be uncooperative.
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A protocol for same day discharge following paediatric microlaryngobronchoscopy: evaluation of safety and parental acceptability using a prospective review of 30 procedures
Matthew Cherko, Mahmood F Bhutta, Yogesh Bajaj, 2015-08-19 14:26:22 PM
Summary
The principal risk following paediatric microlaryngobronchoscopy (MLB) is of airway oedema which may cause respiratory distress
When MLB is performed without intervention to the airway, this risk is low
This was an observational study of children selected as suitable for same day discharge following MLB
27 of 30 children were discharged on the same day. There were no serious complications or re-admissions
In general parents reported high satisfaction and low anxiety with day-case MLB
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Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark
Nille Birk Wulff, Claus Andrup Kristensen, Elo Andersen, Birgitte Charabi, Christian Hjort Sørensen, Preben Homøe, 2015-08-19 14:26:22 PM
Abstract
Objectives
To determine the rates of and risk factors for postoperative complications following total laryngectomy in patients treated with radiotherapy or chemoradiation.
Design
Retrospective longitudinal study.
Setting
Tertiary medical centers.
Participants
143 patients undergoing total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx.
Main outcome measures
Overall postoperative complications and fistula formation.
Results
Overall postoperative complications, fistula formation, wound infection, bleeding and wound necrosis within one year after total laryngectomy occurred in 56,6%, 42,3%, 31,0%, 11,3% and 9,2% of patients respectively. Stenosis of the pharynx/oesophagus and stoma shrinkage within five years after surgery were each seen in 18,2% of cases. In 66,7% of cases conservative treatment of the fistulas was chosen. Rehospitalizations within five years occurred for 44,8% with a median of 1,5 (range 1-11). Smoking status (p=0,005 and 0,013) and chronic obstructive pulmonary disease (COPD) (p=0,013 and 0,011) were significant risk factors for both overall postoperative complications and fistula formation in uni- and multivariate analysis. Tumor localization in the hypopharynx was associated with overall postoperative complications (p=0,036). Residual tumor or cancer recurrence was associated with late onset fistulas (p<0,001).
Conclusion
The frequencies of postoperative complications after total laryngectomy were comparable with similar international studies, although fistula formation rate is increasing in Denmark. We suggest optimizing treatment of COPD and to further encourage to smoking cessation. We propose that development of fistulas > 2 months after surgery prompt immediate biopsies. Additionally, we suggest standardised registration of surgical techniques to identify variables affecting the frequency of postoperative complications.
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Mastoid obliteration surgery for cholesteatoma in 183 adult ears – a 5-year prospective cohort study
Aaron Trinidade, Andrew Skingsley, Matthew W Yung, 2015-08-19 14:26:22 PM
Abstract
CWU and CWD surgery for cholesteatoma both have advantages and disadvantages; CWD surgery with primary obliteration aims to deliver to the patient the advantages of both.
Using Kaplan-Meier survival analysis, the probability of residual cholesteatoma after 5 years was 3.5% (95% CI: 1.3%-9.3%), representing four residual cholesteatomas; there were no recurrences detected
At 12 months otorrhea risk was 3.8% and definitive water safety was 83.1%. Re-operation rate at 5 years was only 7.2%, including second stage ossiculoplasty.
CWD surgery with primary obliteration seems to be a safe and reliable one-staged procedure for the treatment of cholesteatoma in adults, which is associated with good clinical, functional and social long-term results based on our data.
In this paper, the use of survival analysis standardised to a 5-year cut-off point allows for the interpretation of outcomes against the background of patient follow-up, a crucial factor in the interpretation of mastoid surgery success rates as in reality many patients are lost to follow-up.
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Direct Measurement of the Round Window Niche dimensions using a 3-dimensional moulding technique – A human cadaveric temporal bone study
M Shakeel, P M Spielmann, S E Jones, S S M Hussain, 2015-08-19 14:26:22 PM
Abstract
Objectives
To directly measure the various dimensions of the RWN focusing on the bony overhang and the vertical height between the free margin of the bony overhang and floor of the niche.
Design
Laboratory based anatomical study using formalin preserved human cadaveric temporal bones.
Setting
Temporal Bone laboratory, Department of Otolaryngology University of Dundee Medical School & Ninewells Hospital, Dundee. UK
Participants
NA
Main outcome measures
Three measurements were carried out: (1) The depth of the round window niche extending from the free margin of the bony overhang to the fundus; (2) vertical height from the free margin of the overhang to the floor of the niche (entrance) and (3) the antero-posterior (AP) dimension of the niche.
Results
Based on mould technique the three dimensions were calculated as follow: mean bony overhang = 2.1 mm (range 1.9-2.4 mm), height of RWN = 2.0 mm (1.8-2.15 mm) and AP length 4.0 mm (3.3-4.95 mm).
Conclusions
Our data demonstrates that the mean dimension of the bony overhang superior to the RWM is 2.1 mm.
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Patient positioning for Direct Laryngoscopy - A national survey of 320 UK ENT Consultant Surgeons
Sridhayan Mahalingam, Imad Amer, Khalid Ghufoor, Natasha Choudhury, 2015-08-19 14:26:22 PM
Abstract
Direct Laryngoscopy is a common ENT procedure and the "sniffing" position is considered to achieve optimal views of the larynx.
A recent survey amongst UK ENT trainees indicated no general consensus in positions used for this procedure.
The data suggests that just over half (54.4%) of ENT Consultant Surgeons surveyed use the sniffing position, however, only one third (33.1%) use the appropriate aids to allow this position to be attained.
When encountering a difficult airway, only 48.4% of ENT Consultant Surgeons carried out additional cervical flexion and/or head elevation in order to achieve / exaggerate the sniffing position.
There is significant variation in patient positions used for Direct Laryngoscopy by UK ENT Surgeons. Suboptimal patient positioning may impact on standards of clinical care and training of future ENT specialists.
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Balloon Eustachian Tuboplasty (BET): our experience of 622 cases
Stefanie Schröder, Martin Lehmann, Jörg Ebmeyer, Tahwinder Upile, Holger Sudhoff, 2015-08-19 14:26:22 PM
Abstract
Background
Eustachian tube dysfunction is regarded as a "black box" term, reflecting a spectrum of dysfunction. The key to its diagnosis and management is in identifying the aetiology and exact pathophysiology of the dysfunction.
Design
We present our retrospective 5 year results for the technique of transnasal endoscopic balloon dilatation of the cartilaginous part of the Eustachian tube, Balloon Eustachian Tuboplasty (BET). The indication for treatment is chronic obstructive Eustachian tube dysfunction. Main outcome measures: Pre-operatively, the Eustachian tube score (ETS) was obtained by a clinico-objective assessment involving tubomanometry (TMM) and reported patient symptom. The measurements were repeated 1, 2, 3, 4 and 5 years post-operatively. Setting: Tertiary referral centre. Participants: A total of 622 patients (1076 ears) were treated with BET.
Results
One year after treatment, the Eustachian tube score improved from 3•13 (± 2•47 SD) to 5•75 (± 2•76 SD). The Eustachian tube score improved significantly in 73% of ears. The average Eustachian tube score 2 years after treatment improved from 2•65 (± 2•89 SD) to 6•26 (±3•07 SD). In 82% of patients, the Eustachian tube score improved significantly at 5 years. The subjective satisfaction of the patients was approximately 80%.
Conclusions
Our long-term results suggest that BET is a safe and feasible treatment for chronic obstructive Eustachian tube dysfunction with a success rate of more than 70%. This study has important implications for other Eustachian tube-related clinical entities, such as glue ear management (adults and children), continued grommet insertion, and tympanomastoid surgery outcomes.
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Patient Tolerance of Transoral versus Percutaneous ThyrohyoidOffice-Based Injection Laryngoplasty: A Case-Controlled Study of 41 Patients
Shekhar K. Gadkaree, Simon R A Best, Christopher Walker, Lee M Akst, Alexander T Hillel, 2015-08-19 14:26:22 PM
Abstract
1.Injection laryngoplasty is a well-tolerated procedure with no significant differences in patient tolerance or anxiety related to the approach.
2.Similarly successful outcomes, with low complication rates, can be attained with both the thyrohyoid or transoral approach.
3.Choice of injection laryngoplasty technique should be dictated by surgeon training and comfort, patient preference, and patient anatomy.
4.This study showed a significantly decreased anesthesia time for the thyrohyoid when compared with the transoral approach.
5.Patient tolerance of awake injection laryngoplasty procedures supports the trend toward shiftinglaryngologyprocedures from the operating room to the office setting.
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The Effect of LKB1 on the PI3K/Akt Pathway Activation in Association with PTEN and PIK3CA in HNC
Seda Ekizoglu, Soydan Dogan, Damla Ulker, Didem Seven, Emine Deniz Gozen, Emin Karaman, Nur Buyru, 2015-08-19 14:26:22 PM
Abstract
Objective
PI3K/Akt signaling pathway is frequently activated in several types of cancer. However, activator molecules have not been analyzed systematically in HNSCC. The aim of this study was to investigate upstream activators and inhibitors of this pathway
Design
Prospective study
Setting
University hospital
Participants
108 patients with HNC who were operated at the Istanbul University, Cerrahpasa Medical Faculty, Department of Otorhinolaryngology.
Methods
Mutations in the coding exons and the flanking intronic sequences of the PIK3CA, PIK3R1 and AKT1 genes were analyzed by direct sequencing. Expression levels in the tumors and non-cancerous tissue samples were analyzed by Quantitative RT-PCR and Western Blotting was performed to determine the phosphorylation levels of the Akt1 protein.
Results
Two synonymous alterations in exon 20 of the PIK3CA gene, a 6 bp duplication in the coding region of the PIK3R1 and two different alterations in the non-coding regions of the AKT1 and PIK3R1 genes were observed. Significant downregulation of LKB1 and PTEN mRNA expression levels were detected in tumor tissues compared to non-cancerous tissues. However, we didn't observe any difference between the PIK3CA and AKT1 mRNA expression levels in the tumors and non-cancerous tissue samples. Akt1 phosphorylation was increased in 53.57% of the patients.
Conclusions
Our results indicate that, the PI3K pathway has an important function in HNSCC progression with the contribution of more than one gene of this pathway. Our data suggest that in a high number of HNSCC tumors PI3K/Akt signaling is activated by different molecules or by the combination of these molecules.
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Clinical Otolaryngology 2014 Impact Factor, 2.113
Terry Jones, 2015-08-19 14:26:22 PM
Acknowledgements to reviewers
2015-08-19 14:26:22 PM
Autumn meeting of the Otorhinolaryngology Research Society Meeting in collaboration with Clinical Otolaryngology
J. O'Hara, 2015-08-19 14:26:22 PM
Tests of Eustachian tube function: a review
M.E. Smith, J.R. Tysome, 2015-08-19 14:26:22 PM
Background
Eustachian tube (ET) dysfunction is a common but poorly understood cause of patient symptoms, and an important aetiological factor in the development of middle ear pathology. Despite this, there are no specific tests of ET function in widespread clinical use and no identified 'gold standard' with which to diagnose the disease.
Objective
This review aims to review the literature to identify currently available tests of ET function and, where possible, report on their accuracy.
Type of review
Narrative systematic review.
Search strategy
MEDLINE, EMBASE, Biosis and the Cochrane library were searched and reference lists reviewed for relevant articles.
Evaluation method
Tests in included studies were required to measure a physiological function of the ET, or play a role in the diagnosis of poor ET function. Significant variation in demographic characteristics, disease presentation and severity, and technological approaches only permitted narrative systematic review.
Results
While many tests of ET function have been developed, with some in routine clinical use, all have significant limitations. Published accuracy data are limited and of differing quality due to the variability incomparative tests, and the spectrum of otological disorders associated with ET dysfunction.
Conclusions
Currently, no single test could be considered a 'gold standard' for the diagnosis of ET dysfunction, but there is some evidence that diagnostic accuracy can be improved by combining the results of different objective tests and patient-reported outcome measures. Further development of ET function tests is required to facilitate the accurate diagnosis of patients and allow outcome reporting for new interventions.
Detection of putative stem cell markers, CD44/CD133, in primary and lymph node metastases in head and neck squamous cell carcinomas. A preliminary immunohistochemical and in vitro study
G. Mannelli, L. Magnelli, A. Deganello, M. Busoni, G. Meccariello, G. Parrinello, O. Gallo, 2015-08-19 14:26:22 PM
Objectives
Investigators hypothesized that cancer stem cells (CSCs) could play a role in determining cancer progression by metastasizing to cervical lymph node (N+) and then influencing prognosis of head and neck squamous cell carcinomas (HNSCCs) patients.
Design
To identify CSCs in HNSCCs and their clonogenic capacity.
Setting
In vitro study.
Participants
Putative CSCs from 29 primary HNSCCs and 19 corresponding node metastases were analyzed.
Main outcome measures
Immunohistochemical (IHC) was performed, and CSCs' clonogenic in vitro capacity was tested; ones epithelial nature of cancer cells forming colonies was confirmed by a second IHC, fluorescence-activated cell sorting (FACS) analysis helped in counting CD44/CD133-CSCs markers percentage expression in HNSCC tumour-derived cultures.
Results
Immunohistochemical showed CD44 (93.1%) and CD133 (10.34%) expression; FACS-analysis showed the enrichment of CD44/CD133 cancer cells, with the highest clonogenic capacity of CD44+-subpopulation; a higher CD44 rates were documented from N+ subcultures than from original tumours (P < 0.05).
Conclusions
A putative cancer stem-like cell population is detectable in HNSCCs, and our findings show their in vitroclonogenic capacity by demonstrating that CD44+-cultured cells are the main population proliferating obtained by N+ HNSCC metastases, emphasizing their possible role in tumour progression.
Comparing the Performance Status Scale and MD Anderson Dysphagia Inventory as swallowing outcome measures in head and neck cancer: a prospective cohort study
M.K. Khan, J. Patterson, S. Owen, S. Rees, L. Gamberini, V. Paleri, , 2015-08-19 14:26:22 PM
Objectives
To examine the relationship between the two disease-specific measures currently in use to assess swallowing outcomes following treatment in patients with head and neck cancer: the Performance Status Scale (PSS) and MD Anderson Dysphagia Inventory (MDADI).
Design
A prospective cohort study.
Setting
Four head and neck cancer multidisciplinary clinics in the North of England Cancer Network.
Participants
114 patients with cancers of the upper aerodigestive tract.
Main outcome measure
Measures of swallowing function administered prospectively across 4 timepoints
Results
Spearman's correlation coefficients were used to measure the relationship between the two scales. There was statistically significant correlation between the two tools at pre-treatment (rs = 0.428, P < 0.000), 3 months post-treatment (rs = 0.454, P < 0.002), 6 months post-treatment (rs = 0.551, P < 0.000) and 12 months post-treatment (rs = 0.680, P < 0.000).
Conclusion
This is the first prospective study comparing the MDADI and PSS questionnaires at multiple time points. Our study shows that these different instruments have a good relationship in measuring swallowing function in patients with head and neck cancer in short and medium term after treatment.
Survival outcome of patients with nasopharyngeal carcinoma: a nationwide analysis of 13 407 patients in Taiwan
W.-Y. Huang, C.-L. Lin, C.-Y. Lin, Y.-M. Jen, C.-H. Lo, F.-C. Sung, C.-H. Kao, 2015-08-19 14:26:22 PM
Objectives
We reported the contemporary survival outcome of patients with nasopharyngeal carcinoma (NPC) and analysed the factors affecting survival.
Design
A retrospective cohort study.
Setting
A nationwide population-based study in Taiwan.
Participants
We identified 13 407 patients with newly diagnosed NPC from 2002 to 2010.
Material and Methods
The multivariate Cox proportional hazards model was performed to measure the mortality-association risk factor in patients with NPC after adjusting for NPC treatment and socio-demographic characteristics.
Results
The 1-, 2-, 5- and 8-year overall survival (OS) rates were 89.6%, 80.4%, 65.2% and 56.5%, respectively. The factors associated with mortality risk were sex (men versus women, HR = 1.45), age (>60 versus ≤ 40 years, HR = 3.61), geographic region of residence (eastern Taiwan versus northern Taiwan HR = 1.39), income (<15 840 versus >25 000, HR = 1.87) and treatment modality (chemotherapy alone versus radiotherapy alone, HR = 2.25).
Conclusion
The contemporary 5-year OS rate was 65.2% in Taiwan. Male patients, old age, residing in eastern Taiwan, low income and receiving chemotherapy alone were independent predictors for poor OS.
Fascin expression in cholesteatoma: correlation with destruction of the ossicular chain and extent of disease
A. Binnetoglu, M. Sari, T. Baglam, I. Erbarut Seven, A.C. Yumusakhuylu, M.F. Topuz, C. Batman, 2015-08-19 14:26:22 PM
Objective
Fascin is an actin-bundling protein found in cell membrane protrusions and increases cell motility. The expression of fascin in epithelial neoplasms has been described only recently. No data are available concerning the role of this protein in invasive cholesteatoma. Thus, we investigated the expression of fascin in cholesteatoma tissue and the relationship between fascin expression and intraoperative evaluation of the destruction of the ossicular chain and extent of disease.
Method
Cholesteatoma specimens of 28 patients and external auditory canal (EAC) skin specimens of the same patients (as the control group) were collected from mastoidectomies. Immunohistochemical technique was used to investigate the fascin expression in all cholesteatoma tissues and EAC skin specimens. Immunohistochemical staining was assessed semiquantitatively based on the thickness of epithelium. SPSS software version 16.0 (SPSS Inc., Chicago, IL, USA) was performed to statistically analyse the relationships between fascin expression and intraoperative evaluation destruction of ossicular chain and extent of the disease.
Results
Immunohistochemically, there was no or very low fascin expression observed in normal epithelial cells of EAC skin, while expressed in cholesteatoma tissue. Also, fascin expression in cholesteatoma tissues was significantly correlated with destruction of ossicular chain and extent of the disease.
Conclusions
Fascin expression is usually found in cholesteatoma epithelium and is correlated with destruction of the ossicular chain and extent of disease. Considering all of the correlations between the clinical and histopathological findings, 'fascin immunoexpression scoring' may be used for histological grading of cholesteatoma.
High-frequency jet ventilation for endolaryngotracheal surgery – chart review and procedure analysis from the surgeon's and the anaesthesiologist's point of view
V. Helmstaedter, R. Tellkamp, O. Majdani, A. Warnecke, T. Lenarz, M. Durisin, 2015-08-19 14:26:22 PM
Objective
High-frequency jet ventilation (HFJV) arose as a ventilation alternative in laryngotracheal surgery as it offers the surgeon a better overview and more space for microsurgical manipulations. On the contrary, anaesthesiologic monitoring is limited and (relative) contraindications exist. The aim of this study was to evaluate the procedure. Contraindications and limitations are discussed from the surgeon's and the anaesthesiologist's point of view, and relevant aspects of oncologic surgery are identified.
Design
Retrospective chart review and analysis of clinical experiences.
Setting
University Teaching hospital.
Patients and main outcome measures
Eighty adult patients (97 cases) treated at our institution between June 2012 and September 2013 were included. HFJV was performed using thin, subglottically placed catheters. The analysis focuses on complications and practical steps.
Results
Indications were benign (63%) and malignant pathologies (37%). The CO2 laser was used in 34 cases (35%). The mean operating time averaged 53 min (3–404 min) and the mean duration of anaesthesia was 81 min (16–438 min). Two thirds of the operated patients had a body mass index higher than 25 kg/m2. Eighty-four per cent were classified as ASA I and II according to the American Society of Anesthesiologists. All pathologies could well be exposed by the surgeon. Two reversible desaturations to 70% were documented. In another case, emergency re-intubation was necessary as the saturation dropped below 50%. In 8 (8%) cases, elective re-intubation to conventional tubes was performed during the course of the operation as HFJV did not establish optimal oxygenation conditions. No severe intra-operative bleeding was observed.
Conclusions
High-frequency jet ventilation represents a safe ventilation approach for laryngotracheal surgery in experienced hands. Due to the better overview, it offers a better orientation on anatomical structures and on the pathology. Special attention has to be laid on obesity, reflux and cardiopulmonary diseases. However, individual decisions can be made under consideration of all co-morbidities. A close pre- and intra-operative interdisciplinary work up is required.
Depression, self-esteem and sexual function in laryngeal cancer patients
M. Yılmaz, M. Yener, U. Yollu, F. Akil, Y. Haciyev, I. Yargic, E. Karaman, H. Cansiz, 2015-08-19 14:26:22 PM
Objective
The purpose of this study was to assess sexual function, affective disorders and self-esteem in patients who were surgically treated for laryngeal cancer.
Design
Retrospective, blind, cross-sectional study.
Setting
Single tertiary cancer centre.
Participants
Seventy four patients who were operated on Istanbul University Cerrahpasa School of Medicine Otorhinolaryngology Department between 2008 and 2012 were classified according to the type of the operation as total laryngectomy (Group 1) and partial laryngectomy (Group 2).
Main outcome measures
Sexual dysfunction, depression and self-esteem were evaluated with The Arizona Sexual Experiences Scale (ASEX), Beck's Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES), respectively.
Results
Average ASEX scores of the Group 1 were (13.98 ± 6.32) and Group 2 were (13.08 ± 4.96) without statistically significant difference (P = 0.537). Mean BDI score of Group 1 was (13.20 ± 10.41) higher than Group 2 (7.76 ± 8.14) and the difference was significant statistically (P = 0.026). Mean RSES scores of Group 1 and Group 2 were 20.68 ± 5.33 and 19.25 ± 4.70, respectively, again without significant difference (P = 0.262). However, when the average scores of each item of Rosenberg Scale were compared, significant difference was found in d4 (2.37 ± 0.78; 1.64 ± 0.99; P = 0.001), d6 (1.22 ± 1.05; 1.84 ± 1.14; P = 0.023), d10 (2.55 ± 2.39; 1.28 ± 1.49;P = 0.018) and d11 (1.35 ± 0.95; 2.00 ± 1.41; P = 0.021). BDI scores were correlated with RSES scores, and ASEX scores were correlated with age.
Conclusion
The patients with total laryngectomy seem to have more psychological problems that must be addressed in the postoperative period.
The correlation between lipoprotein ratios and hearing outcome in idiopathic sudden sensorineural hearing loss patients
H.-C. Lin, C.-H. Wang, Y.-C. Chou, C.-P. Shih, Y.-H. Chu, J.-C. Lee, H.-C. Chen, 2015-08-19 14:26:22 PM
Objective
Recent reports have identified hypercholesterolaemia as a significant risk factor for idiopathic sudden sensorineural hearing loss (ISSNHL). Therefore, we investigated whether lipid profiles and lipoprotein ratios are correlated with the prognosis of hearing recovery in ISSNHL patients.
Design
A retrospective cohort study.
Main outcome measures
Patients with ISSNHL were classified into four groups (complete, partial, slight and no recovery) according to their degree of hearing recovery using Siegel's criteria and the Sudden Deafness Research Group (SDRG) criteria developed by the Japanese Ministry of Welfare. All patients' lipid profiles were analysed, including total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol and triglycerides. We calculated the ratios of TC/HDL-C and LDL-C/HDL-C and used statistical methods to evaluate correlations between lipid profiles and lipoprotein ratios and ISSNHL prognosis.
Results
Hearing recovery was observed in 103 (62.0%) of 166 cases using Siegel's criteria and in 114 (68.7%) of 166 cases using SDRG's criteria. Among the three recovery groups (i.e. excluding the no recovery group), the ratio of LDL-C/HDL-C was found to be associated with recovery outcome by showing the ratio on an upward trend from complete recovery to slight recovery group, and the difference is statistically significant (P = 0.016 by Siegel's criteria, P = 0.041 by SDRG's criteria). Multiple linear regression analysis further revealed a significantly higher LDL-C/HDL-C ratio in slight hearing recovery group compared with complete recovery group (P = 0.007 by Siegel's criteria, P = 0.031 by SDRG's criteria).
Conclusion
We suggested that lipoprotein ratio of LDL-C/HDL-C may be a prognostic factor for hearing recovery in ISSNHL patients. Further studies should be conducted to determine whether hearing outcomes in ISSNHL can be improved by changing patients' lipid profiles via antilipidemic treatment.
Validation of the Greek version of Mini Tinnitus Questionnaire as a Brief Screening Test for Assessment of Tinnitus-related Distress: our experience in 301 adult patients
G. Panagiotopoulos, M. Galanakis, L. Varvogli, G. Chrousos, C. Darviri, 2015-08-19 14:26:22 PM
Objectives
Validation of the Greek version of Mini Tinnitus Questionnaire (Mini-TQ-GR) as a Brief Screening Test for Assessment of Tinnitus-related Distress.
Design
Questionnaire study.
Setting
401 General Military Hospital of Athens/Department of Audiology – Neurootology, Athens, Greece.
Participants
Three hundred and one participants have anonymously completed the Mini-TQ-GR, comparing it to the Perceived Stress Scale (PSS 14) and Multidimensional Health Locus of Control Scale (MΗLoC) from November 2013 until May 2014.
Main outcome measure
Mini-TQ-GR, compared to PSS 14 and MΗLoC.
Results
Factor analysis, has shown that the Mini-TQ-GR includes three main factors (Distress, Health pre-occupation and Depression), which explains the 59.05% of the total variance. The Cronbach alpha index was 0.865 approaching the respective reliability factor of the original validation (0.9). The test–retest correlation (intraclass correlation coefficient) was 0.9 (P < 0.01), close to the results of the original study (0.89). We found a positive correlation between tinnitus and perceived stress (r = 0.349**) and negative correlation between tinnitus and external locus of control (r = −0.124*, r = −0.198**) (chance, others).
Conclusions
This study demonstrated that the Mini-TQ-GR has good internal consistency and reliability becoming a useful, validated measurement tool for tinnitus-induced distress.
Severity of pneumococcal versus non-pneumococcal acute otitis media in children
S. Ovnat Tamir, Y. Roth, A. Goldfarb, I. Grotto, T. Marom, 2015-08-19 14:26:22 PM
Background
Pneumococcal acute otitis media (AOM) has been previously considered as a more severe disease than that caused by other otopathogens, based on clinical and/or otologic scores. We sought to test this hypothesis in the pneumococcal conjugated vaccine (PCV) era.
Methods
Children <6 years who presented with 'severe' AOM episodes with middle ear fluid (MEF) cultures during 2008–2013 were retrospectively identified. 'Severe' AOM episodes were considered if tympanocentesis was required or if spontaneous otorrhea was present. Data were extracted for demographics, clinical and laboratory tests. Children were categorised according to their PCV status as 'unimmunised' or 'PCV7/PCV13 immunised' and according to their MEF culture results into the 'pneumococcal' or the 'non-pneumococcal' group. Leukocytosis was defined as white blood cells (WBC) count >15 000/μL, and elevated C-reactive protein (CRP) level was considered as >50 mg/L.
Results
Of 295 eligible AOM episodes, 106 (36%) were culture positive. Children in the pneumococcal group (65, 61%) had a significantly higher WBC counts and higher CRP levels, were more often <2 years old and were more prone to complicate with acute mastoiditis (AM), compared to children in the non-pneumococcal group, P = 0.03,P = 0.02, P = 0.04 and P = 0.03, respectively. In the pneumococcal group, unimmunised children had higher WBC counts when compared with PCV13-immunised children (P = 0.04), but there were no appreciable differences in CRP levels between unimmunised and PCV7/PCV13-immunised children.
Conclusion
Pneumococcal AOM is associated with higher leukocytosis and CRP levels than non-pneumococcal AOM. Circulating Streptococcus pneumoniae strains causing 'severe' AOM in PCV13-immunised children yielded lower inflammatory responses when compared with unimmunised children.
Patients' views on the availability of vegetarian medication in otorhinolaryngology: Our experience in an eighty patient questionnaire study
F. Haarer, B. Fu, K. Desai, 2015-08-19 14:26:22 PM
Acute hearing loss in the only hearing ear of 21 patients
Y.-J. Chen, C.-C. Tseng, Y.-H. Young, 2015-08-19 14:26:22 PM
Paediatric ventilation tube insertion: our experience of seventy-five children in audiology-led follow-up
J. Powell, S. Powell, M. Lennon, A. Ho, N. Murrant, 2015-08-19 14:26:22 PM
The perforation margin phenotypes and clinical outcome of traumatic tympanic membrane perforation with a Gelfoam patch: Our experience from a retrospective study of seventy-four patients
Z.C. Lou, Y.M. Tang, H.Y. Chen, J. Xiao, 2015-08-19 14:26:22 PM
Primary oropharyngeal herpes simplex virus infection in adults: a profile of thirty-two immunoserologically confirmed cases
H. Nakagawa, T. Kusuyama, K. Ogawa, 2015-08-19 14:26:22 PM
Procedures of limited clinical value in ENT: What effect has there been on operating numbers?
F. Shelton, T.C. Biggs, A. Henderson, N.N. Patel, 2015-08-19 14:26:22 PM
When a process is out of control
D. Caldiroli, E.F. Orena, 2015-08-19 14:26:22 PM
Alternatives to Benzalkonium Chloride containing nasal preparations
A.A. Qureshi, E. Nilssen, 2015-08-19 14:26:22 PM
Sizing a nasal septal button using a methylene blue-marked template
N. Ashraf, M.S. Thevasagayam, 2015-08-19 14:26:22 PM
A simple technique for minor salivary gland and oral biopsy in the clinic: our experience
M.I. Syed, O. Ilan, J.A. Rutka, 2015-08-19 14:26:22 PM
Τετάρτη 19 Αυγούστου 2015
Clinical Otolaryngology
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