Erratum to: Sophono Alpha System and subtotal petrosectomy with external auditory canal blind sac closure
2015-09-01 03:00:00 AM
Can we avoid intracranial complications of chronic otitis media?
2015-09-01 03:00:00 AM
Pharyngolateral ferromagnetic prosthesis (PFP) for treatment of obstructive sleep apnea
2015-09-01 03:00:00 AM
Letters to the Editor
2015-09-01 03:00:00 AM
Assessment of the relationship between neutrophil–lymphocyte ratio and hearing loss of diabetics
2015-09-01 03:00:00 AM
An evaluation on the role of MPV on idiopathic sudden hearing loss etiology
2015-09-01 03:00:00 AM
Surgical results of different palate techniques to treat oropharyngeal collapse
2015-09-01 03:00:00 AM
Abstract
The aim of this study was to assess the surgical success rate of patients undergoing oropharyngeal surgery, selected through drug-induced sleep endoscopy. Secondly, to compare outcomes of the different oropharyngeal surgery techniques applied. The study design was retrospective case series of surgically treated patients from 2006 to 2013. All patients were diagnosed with either moderate or severe obstructive sleep apnea and did not tolerate conventional positive airway pressure. We performed five different surgical techniques to treat oropharyngeal collapse: partial palate resection, uvulopalatopharyngoplasty, Z-palatoplasty, lateral pharyngoplasty and expansion pharyngoplasty. Patients in whom multilevel surgery was performed were excluded. 53 patients were included in our study, 52.8 % were severe obstructive sleep apnea patients, mean age was 43.9 years, mean body mass index 27.5. The surgical success rate according to Sher's criteria was 71.7 %. 47.2 % had a postoperative apnea hypopnea index lower than 10. The highest success rate was measured in patients who underwent expansion pharyngoplasty (90 % according to Sher's criteria, 80 % with a postoperative apnea hypopnea index lower than 10) although it did not reach statistical significance. Our conclusion is that drug-induced sleep endoscopy is a good tool to select surgical candidates in patients with moderate-to-severe obstructive sleep apnea who are not compliant with the optimal therapy. Expansion pharyngoplasty was the surgical technique with the highest success rates.
Pattern of hearing loss following cochlear implantation
2015-09-01 03:00:00 AM
Abstract
Cochlear implantation is associated with deterioration in hearing. Despite the fact that the damage is presumed to be of sensory origin, residual hearing is usually assessed by air-conduction thresholds alone. This study sought to determine if surgery may cause changes in air- and bone-conduction thresholds producing a mixed-type hearing loss. The sample included 18 patients (mean age 37 years) with an air–bone gap of 10 dB over three consecutive frequencies and measurable masked and reliable bone-conduction thresholds of operated and non-operated ears who underwent cochlear implant surgery. All underwent comprehensive audiologic and otologic assessment and imaging before and after surgery. The air–bone gap in the treated ears was 17–41 dB preoperatively and 13–59 dB postoperatively over 250–4,000 Hz. Air-conduction thresholds in the treated ears significantly deteriorated after surgery, by a mean of 10–21 dB. Bone-conduction levels deteriorated nonsignificantly by 0.8–7.5 dB. The findings indicate that the increase in air-conduction threshold after cochlear implantation accounts for most of the postoperative increase in the air–bone gap. Changes in the mechanics of the inner ear may play an important role. Further studies in larger samples including objective measures of inner ear mechanics may add information on the source of the air–bone gap.
Diagnosis and management with botulinum toxin in 11 cases of laryngeal synkinesis
2015-09-01 03:00:00 AM
Abstract
Laryngeal synkinesis is a vocal fold movement disorder produced by a misdirected reinnervation after a recurrent laryngeal nerve injury. Its symptoms differ greatly between patients, requiring diverse therapeutical approaches. We aim to describe our experience in the diagnosis and treatment of different laryngeal synkinesis presentations. 11 patients diagnosed between 2011 and 2014 in a tertiary referral center with laryngeal synkinesis confirmed by laryngeal electromyography were included in our study. All medical records and laryngoscopic and electromyographic data were reviewed retrospectively. Four patients had previous unilateral vocal fold palsy and seven had a bilateral palsy with different degrees of clinical involvement. All of them showed paradoxical movements during inhalation in videofibrolaryngoscopic examination. Laryngeal electromyography confirmed the diagnosis of laryngeal synkinesis. Dyspnea was the main presentation symptom. Three patients with mild symptoms were not treated. Patients with unilateral vocal fold immobility were successfully treated with periodic botulinum toxin injections. Patients with bilateral immobility had a good initial response to botulinum toxin, although in some of them, a posterior cordectomy had to be finally performed. In conclusion, laryngeal synkinesis is a heterogeneous clinic entity that appears in patients with unilateral or bilateral vocal fold paralysis. Videofibrolaryngoscopy and laryngeal electromyography are essential to a correct diagnosis. Botulinum toxin injections are the main treatment for symptomatic cases, even if in bilateral palsy cases more aggressive treatments are often required.
What is the role of 'the letter to the editor'?
2015-09-01 03:00:00 AM
Abstract
The letter to the editor plays a dual role in the literature. It serves a corrective critical function but also has the capacity to spread and share knowledge. We sought to identify the role and theme of letters to the editor published in four leading otorhinolaryngology journals, to elicit how well this form of communication is being utilised. All letters to the editor published in; Clinical Otolaryngology, The Laryngoscope, The European Archives of Otorhinolarygnology and The Journal of Laryngology and Otology, for the year 2012, were examined and the individual journal guidelines for submission of letters were noted. Seventeen different countries produced a total of 92 letters for the year 2012. The majority of letters originated from Otolaryngology/Head and Neck departments (78 %). Clinical Otolaryngology contributed to 58 % of total letters, of which 55 % were unrelated to original journal material (n = 29). The Laryngoscope published letters solely in response to original journal material. The Journal of Laryngology and Otology was the only journal to index letters with their corresponding article. More letters agreeing (49 %) than disagreeing (32 %) were published, with the remaining letters either clarifying or ignoring issues raised. Letters to the editor serve two main purposes; post-publication peer review and sharing experiences with fellow readers. Both are equally important in maintaining journals' high standards. Indexing needs to be improved otherwise valuable comment does not endure while the original manuscript's message lives on.
Effects of sevoflurane and desflurane on otoacoustic emissions in humans
2015-09-01 03:00:00 AM
Abstract
Otoacoustic emissions (OAEs) are non-invasive, easy to apply and objective test methods which are widely used to determine the presence of hearing in audiology clinics. Under certain circumstances, the study should be applied under general anesthesia. The aim of this study was to determine the influence of new short-acting inhalation agents, desflurane and sevoflurane, on OAE in humans. These short-acting agents are widely used in general anesthesia. Thirty-one healthy patients who underwent septoplasty and turbinoplasty surgery were included in this study. Unpremedicated patients were anesthetized and monitored by a standard protocol except the inhalation agents. Desflurane and sevoflurane were added to the inhaled gas mixture at ~1MAC, 5−6 % and 1.5−2 %, respectively. Transient evoked otoacoustic emissions and distortion product otoacoustic emissions measured in both ears of each patient preoperatively in the operating room before induction, 5 min after induction, after the completion of surgical procedure while the anesthetic agents are still given and 1 h after surgery in the ward. Between-group and within-group comparisons and correlations with hemodynamic parameters were performed for statistical analysis. The measurements of 26 ears in desflurane group and 28 ears in sevoflurane group were evaluated. There were no differences in initial measurements between groups (p > 0.05). Both groups presented significant decrease in intraoperative measurements and changes in time were statistically significant (p < 0.05). The changes in OAEs were similar to changes in systemic blood pressures. Correlation between OAEs and systemic blood pressures were significant (p < 0.05). In conclusion, sevoflurane and desflurane decreased OAEs around 2–3 dB; OAEs are still measurable under inhalation agents. This provides some findings about the OAE status of patient, but the evaluations should be done with the impact of anesthetic agents in mind.
'What will I be like' after my diagnosis of head and neck cancer?
2015-09-01 03:00:00 AM
Abstract
Consequences of treating head and neck cancer are reflected in health-related quality of life (HRQOL) patient-reported outcomes. HRQOL is an important outcome alongside survival and recurrence. However, relatively little HRQOL information is in a format that patients and oncology teams can easily interpret as a guide to likely outcomes following curative treatment. The study aim was to collate University of Washington Quality of Life (UW-QOL) questionnaires collected 1995–2012 at the Regional Head and Neck Surgical Unit with a view of summarizing key clinical-demographic influences on HRQOL outcomes at 2 years following diagnosis. Patients completing UW-QOL questionnaires at 9–60 months had their record closest to 2 years selected for cross-sectional analyses, while all questionnaires were analyzed to assess temporal trends. 65 % (1,134) of survivors to 9 months had a UW-QOL record in the cross-sectional analysis (median 23 months). Overall 1,349 completed 5,573 UW-QOL questionnaires. Various associations were seen, notably late overall clinical staging and treatment adversely associated with UW-QOL physical functioning domains. Logistic regression was used to better understand the predictive factors of UW-QOL outcome and determined the final formatting of tables for results. These tables provide important reference data about UW-QOL outcome at 2 years relevant to patients at the outset of their cancer journey. The increasing amount of HRQOL data allows for quite detailed subgroup analysis, which can help give patients and the clinical team a better understanding of likely long-term HRQOL outcomes. How this is best utilized in clinical care needs further evaluation.
High stimulus rate brainstem auditory evoked potential in benign paroxysmal positional vertigo
2015-09-01 03:00:00 AM
Abstract
The objective of this study is to use high (49/s) and low (9/s) stimulation rates of the BAEP to investigate the possible mechanism responsible for BPPV. A total of 81 patients (55 women and 26 men, mean age ± SD = 54.6 ± 15.0) with idiopathic BPPV, as well as 106 control subjects (70 women and 36 men, mean age ± SD = 51.2 ± 16.3) participated in the study. The results of high (49/s) and low (9/s) stimulation rates of the BAEP test were compared and analyzed. The difference in BAEP wave I peak latencies between low and high stimulation rate (DPL I) and BAEP wave I peak latency in high stimulation (HPL I) of affected ears (0.24 ± 0.14 and 1.91 ± 0.21 ms) in BPPV patients were significantly prolonged when compared with the controls (0.10 ± 0.08 and 1.76 ± 0.18 ms) and unaffected ears (0.12 ± 0.10 and 1.82 ± 0.21 ms) (p < 0.001). The abnormal rate of DPL I in the affected ear (52/83, 62.65 %) was significantly higher than that in the unaffected ear (7/79, 8.86 %) and the normal left ear (4/106, 3.77 %). We suggest that ischemia of the inner ear might be one of the causes of BPPV and that DPL I may be used to assess the ischemic degree in subjects over 20 years old.
CO 2 laser cordectomy for T1–T2 glottic cancer: oncological and functional long-term results
2015-09-01 03:00:00 AM
Abstract
The purpose of this study was to assess the validity of CO2 laser cordectomy in the treatment of early glottic cancer and to determine the impact of margin status on disease-free survival and of the operation on voice quality. This is a retrospective review of 169 patients. Quantitative and qualitative variables were statistically compared. The impact on overall and disease-free survivals of different variables was calculated by univariate and multivariate analyses. Ten-year overall and disease free-survivals were 75 % and 60 %, respectively. Age and clinical stage showed a significant negative impact on overall survival, while margin status both on overall and disease-free survivals. The degree of dysphonia was directly related to the extension of the resection. This series confirms the good oncologic and functional outcomes of laser surgery for Tis, T1 and selected T2 glottic tumors. Patients with positive margins should undergo a further treatment or a very close follow-up.
How head and neck consultants manage patients' emotional distress during cancer follow-up consultations: a multilevel study
2015-09-01 03:00:00 AM
Abstract
Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant-reduced space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1–20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.
Thyroglossal duct cysts: 20 years' experience (1992–2011)
2015-09-01 03:00:00 AM
Abstract
The objective of the present study is to report on the clinical course and management of thyroglossal duct cysts. Retrospective review of all patients who underwent surgery for thyroglossal duct cysts between 2000 and 2013 at a tertiary referral center was carried out. The operations were performed using a modification of the Sistrunk operation: transcervical cystectomy, partial dissection of the hyoid bone, and dissection of all tracts identified during surgery. A total of 352 patients (176 men, 176 women) underwent surgery for a cyst (n = 282) or discharging sinus (n = 70). The mean age for the incidence of cysts was 26 years. Four of the patients (1.4 %) had a papillary thyroid carcinoma in the epithelium of the cyst. The follow-up period ranged from 7 months to 10 years. The overall recurrence rate was 4.5 %. Resection is often regarded as an elective surgical procedure in patients with thyroglossal duct cysts, but surgery should always be considered. Papillary thyroid carcinoma in the epithelium of the cyst is a rare but possible differential diagnosis. Dissection of all tracts found is recommended and partial dissection of the hyoid bone is mandatory. Dissection of the foramen cecum is not imperative. The recurrence rates with this approach are comparable to more extensive methods such as those described by Sistrunk.
Facial nerve grading after parotidectomy
2015-09-01 03:00:00 AM
Abstract
Dysfunction of the facial nerve is a common complication of parotidectomy. The functional deficit may be total or partial, and may include all or a single branch of the nerve. Despite a wide variety of the facial nerve grading systems, most of them have a limited utility in patients after parotidectomy. Therefore, existing scales assessing facial nerve function are compared to describe facial nerve outcomes after parotidectomy. The regional House–Brackmann, Sydney, and Yanagihara classification systems were utilized. The post-parotidectomy facial nerve grading system (PPFNGS) was created based on these three grading systems and also used for this study. The facial nerve function was assessed and recorded on the first postoperative day following conservative parotidectomy in 200 patients using all 4 scales by 3 otolaryngologists. The validity of the PPFNGS and existing facial nerve grading systems was examined by assessment of interrater agreement, intraclass correlation coefficient, internal consistency and construct validity. A deficit in the facial nerve function was found in 54 patients (27 %). Although results were consistent in all tested scales, the PPFNGS had a higher interrater agreement than the other three scales. PPFNGS is a new grading system designed for assessing the facial nerve function after parotidectomy in a quantitative and qualitative way and has a higher interrater agreement than other scales used to examine function of the 7th nerve.
Relationship between severity of obstructive sleep apnea and adverse cardiac outcomes in non-diabetic patients presenting with myocardial infarction
2015-09-01 03:00:00 AM
Abstract
Previous studies that have reported an association between obstructive sleep apnea and adverse cardiac events were confounded by a high prevalence of diabetes mellitus. We investigated the relationship between obstructive sleep apnea and the occurrence of major adverse cardiac events in non-diabetic patients who presented with ST-segment elevation myocardial infarction. A total of 41 patients who underwent overnight sleep screening within 5 days after admission for myocardial infarction from January 2007 to December 2008 were identified. Major adverse cardiac events—defined as a composite of cardiac death, non-fatal myocardial infarction, hospitalization for angina and congestive heart failure at 5-year follow-up—were determined. The patients were divided into two groups: those who experienced major adverse cardiac events and those who did not. In the overall cohort, the prevalence of obesity was 4.9 %. A total of 13 (31.7 %) patients had major adverse cardiac events. The mean apnea–hypopnea index was 25.4 ± 20.3. The group that experienced major adverse cardiac events had a higher apnea–hypopnea index than the group that did not (36.1 ± 21.0 vs 20.4 ± 18.2; P = 0.016). After adjusting for the resolution of ST-segment elevation and the use of a glycoprotein IIb/IIIa inhibitor, logistic regression analysis revealed that the apnea–hypopnea index remained an independent predictor of major adverse cardiac events (odds ratio 1.044; 95 % confidence interval 1.003–1.086; P = 0.033). In non-diabetic patients, the severity of obstructive sleep apnea was associated with the occurrence of major adverse cardiac events at 5-year follow-up after ST-segment elevation myocardial infarction.
The bonebridge as a transcutaneous bone conduction hearing system: preliminary surgical and audiological results in children and adolescents
2015-09-01 03:00:00 AM
Abstract
The Bonebridge ® (BB, Med-El) is a newly designed transcutaneous active bone conductive implant with functional outcome similar to percutaneous bone-anchored hearing systems (BAHS). It is currently approved only for patients ≥18 years. Since the BB allows the skin to remain intact and therefore should be able to overcome some of the issues related to percutaneous BAHS including skin reactions, wound infection and implant extrusion, it would be especially attractive for use in children. We present a preliminary series of the first three cases of BB implantation in children/adolescents (10–16 years). Two subjects were affected by conductive hearing loss (CHL) and one subject by single-sided deafness (SSD). The surgical procedure with transmastoid approach was completed in all cases without complications. Both subjects with CHL showed an increase in speech perception thresholds in quiet from preoperative unaided to 6 months postoperatively with BB of 37 dB, respectively, of 12 dB. The adolescent with SSD attained –3.1 dB unaided vs. –5.6 dB with the BB in the "speech and noise from the front" presentation and +0.5 unaided vs. –5.0 dB with the BB in the "speech from the unilateral deaf side/noise from the normal hearing side" presentation using the adaptive Oldenburg Sentence Test. The results show a straightforward surgical procedure and satisfactory functional gain after BB implantation also in children/adolescents. BB implantation in patients ≤18 years is currently an "off-label use" so that detailed information about alternative treatment options, operation risks and the lack of approval for use in children is essential.
Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo
2015-09-01 03:00:00 AM
Abstract
Several studies indicated the association between benign paroxysmal positional vertigo (BPPV) with osteoporosis and vitamin D deficiency implying that abnormal calcium metabolism may underlie BPPV. The aim of the present study is to confirm the correlation between BPPV and both decrease in bone mineral density (BMD) and vitamin D deficiency. The study group included 80 patients with idiopathic BPPV (52 females, 28 males), with age range 31–71 years (47.6 ± 9.1). The patients were divided into two groups; recurrent BPPV group including 36 subjects and non-recurrent group including 44 subjects. The control group included 100 healthy volunteers with age and gender distribution similar to the study group. All the subjects in the study were examined using Dual-energy X-ray absorptiometry to assess BMD, and serum 25-hydroxyvitamin D for vitamin D assessment. The accepted normal levels were T-score > −1, and 25-hydroxyvitamin D > 30 ng/ml. Twenty-six (26 %) subjects showed abnormal T-score in the control group; 26 (59 %) in the non-recurrent BPPV and 22 (61 %) in the recurrent BPPV group. Chi square test showed significant difference between the control group and both BPPV groups. The control group had significantly higher 25-hydroxyvitamin D levels than the BPPV subgroups (p < 0.05). Moreover, the 25-hydroxyvitamin D was significantly lower in the recurrent BPPV than it was in the non-recurrent subgroup (p < 0.05). The results of the current study associate between reduced BMD and development/recurrence of BPPV. Moreover, low levels of vitamin D were related to development of BPPV while very low levels were associated with recurrence of BPPV. The co-occurrence of two morbidities is not by itself supportive of a relationship, but the cumulating studies correlating between BPPV and both vitamin D deficiency and low BMD indicate the investigation and treatment of those disorders in cases with recurrent BPPV.
Τετάρτη 12 Αυγούστου 2015
European Archives of Oto-Rhino-Laryngology
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