Otolaryngology–head and neck surgery at Johns Hopkins: The first 100 years (1914–2014)
Howard W. Francis, Ira Papel, Ioan Lina, Wayne Koch, David Tunkel, Paul Fuchs, Sandra Lin, David Kennedy, Robert Ruben, Fred Linthicum, Bernard Marsh, Simon Best, John Carey, Andrew Lane, Patrick Byrne, Paul Flint, David W. Eisele, 2015-08-25 08:44:11 AM
Otolaryngological manifestations of Measles (Rubeola): A case report and brief review
Jay M. Bhatt, Kevin C. Huoh, 2015-08-25 08:44:11 AM
Measles is an acute viral respiratory illness caused by a virus of the Paramyxoviridae family. Despite being eliminated from the United States, small outbreaks across the country continue to occur. The United States experienced a record number of cases in 2014, with 668 cases seen across the country, a record since its elimination in 2000. Here, we present a case of an acute presentation of measles illness and discuss the otolaryngologic manifestation of the disease.
Level of Evidence
NA Laryngoscope, 2015
2014 Ogura Lecture
David Eibling, 2015-08-25 08:44:11 AM
Proliferative laryngitis with airway obstruction in an adult: Consider herpes
Carla V. Valenzuela, Colin P. Newbill, Christine Johnston, Tanya K. Meyer, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Few cases of herpes simplex virus (HSV) affecting the larynx have been reported in the literature. Although HSV laryngitis appears to present with nonspecific symptoms, this is a potentially serious condition that can rapidly progress to unnecessary morbidity and mortality if not identified and treated accordingly. We report a case of HSV laryngitis in an individual with well controlled human immunodeficiency virus infection and perform a comprehensive literature review of HSV laryngitis in adults. From this case report and review of the literature, we advocate early diagnostic biopsy of unusual or poorly responsive laryngeal lesions for pathology, culture, and virology studies. Laryngoscope, 2015
Endoscopic surgery of the orbital apex: Outcomes and emerging techniques
Janalee Stokken, Divya Gumber, Jastin Antisdel, Raj Sindwani, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To review our experience with endoscopic orbital apex surgery.
Study Design
Retrospective review.
Methods
All cases with Current Procedural Terminology codes for endoscopic orbital decompression between 2002 and 2011 at two institutions were reviewed. Patients with a diagnosis of Graves orbitopathy or an orbital complication of sinusitis were excluded. Presenting symptoms, lesion location, pathology, surgical outcomes, and complications were examined.
Results
A total of 27 patients were identified. Seventeen (63%) of the patients were men, and the average age was 56 (range = 14–82) years. Eighteen patients had primary orbital apex lesions, and nine patients had sinonasal lesions that predominantly involved the medial orbital apex. The lesions were found to be on the right in 59% of cases. The etiologies include benign (40.7%), malignant (44%), infectious (7.4%), and metastatic (7.4%) lesions. Obtaining a pathologic diagnosis was successful endoscopically in all but two (7.4%) patients, both with lateral lesions. The two-surgeon, four-handed technique and intraoperative image guidance employing fused computed tomography/magnetic resonance imaging were used in the majority of intraconal cases. Complications occurred in three patients (11%) and included myocardial infarction, deep venous thrombosis, and vision loss. There were no cerebrospinal fluid leaks or postoperative hemorrhages. Notably, vision remained stable or improved in all but one patient (3.7% risk of vision decline). Average follow-up was 4 years (range = 1 month–8 years).
Conclusions
The endoscopic approach to the orbit apex offers significant advantages over traditional external approaches, and should be the preferred approach for all medial and inferior lesions. A two-surgeon multihanded technique can help facilitate difficult cases.
Level of Evidence
4. Laryngoscope, 2015
A multisensor approach to improve manometric analysis of the upper esophageal sphincter
Corinne A. Jones, Michelle R. Ciucci, Michael J. Hammer, Timothy M. McCulloch, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
High-resolution manometry (HRM) improves on previous manometric systems by including a greater number of sensors that are more densely placed. Due to deglutitive movement of the HRM catheter and upper esophageal sphincter (UES), it is unclear which HRM sensors capture pressure in the UES. To address this issue, we present two complementary studies to describe UES pressure patterns using HRM + videofluoroscopy and HRM + electromyography (EMG).
Study Design
Case series involving a new analysis method.
Methods
Study 1: Simultaneous HRM + videofluoroscopy were performed in 11 healthy subjects swallowing five 10-mL thin-liquid boluses. HRM catheter and UES movement were tracked to identify UES pressure patterns over multiple HRM sensors. Study 2: Simultaneous HRM + cricopharyngeal EMGs were performed in six healthy subjects swallowing five 10-mL water boluses. HRM and EMG outputs were correlated over individual and multiple HRM sensors.
Results
HRM sensors move prior to UES movement (P < .001) and to a lesser extent in rostral and ventral directions (P ≤ .01) than the UES. UES closure pressure is captured with two distinct patterns: 1) a rostral UES pattern with short durations and fast rate of pressure release, depicting UES descent along the catheter as it closes; and 2) a caudal UES pattern with tonic pressures at baseline and a deglutitive nadir. The HRM + EMG multisensor correlation (r = 0.88) was significantly stronger than the single-sensor correlation (r = 0.80; P = .02).
Conclusions
During deglutition, the HRM catheter and the UES rise above baseline positions and create a distinctive, multisensor manometric trace. Accurate deglutitive UES pressure evaluation must include multiple manometric sensors.
Level of Evidence
4 Laryngoscope, 2015
Squamous cell carcinoma of the nasal cavity: A population-based analysis
Aykut A. Unsal, Pariket M. Dubal, Tapan D. Patel, Alejandro Vazquez, Soly Baredes, James K. Liu, Jean Anderson Eloy, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Squamous cell carcinoma of the nasal cavity (NCSCC) is an infrequent malignancy that has been historically difficult to characterize. This study provides new insight into NCSCC utilizing a population-based database. We analyze the propensity for cervical and distant metastasis from NCSCC, as well as survival outcomes.
Study Design
Retrospective database analysis.
Methods
The Surveillance, Epidemiology, and End Results (SEER) database (2004–2012) was queried for NCSCC cases. Data were analyzed with respect to various demographic and clinicopathologic factors. The results were further examined for regional and distant metastasis. Survival was analyzed using the Kaplan-Meier model.
Results
A total of 1,180 cases of NCSCC were identified in the SEER database between 2004 and 2012. The mean age at diagnosis was 65.8 years. American Joint Committee on Cancer stage was known in 1,050 cases, of which 53.4% were stage I, 13.3% were stage II, 10.2% were stage III, and 23.0% were stage IV. By tumor (T) stage classification, T1 was the most common (56.6%), followed by T4 (19.3%). Most cases had no nodal (N) involvement at diagnosis (90.8%). Cervical nodal involvement was present in 9.1% of cases, while distant metastasis was seen in 1.9%. Five-year disease-specific survival was 69.5% overall, 39.6% in cases with neck involvement and 0.0% for metastatic cases.
Conclusions
This study represents the only known population-based investigation of NCSCC. Metastasis to cervical nodes or distant sites, especially with T1 tumors, is rare. However, any cervical involvement or distant metastasis discovered on presentation is a poor prognostic indicator.
Level of Evidence
4. Laryngoscope, 2015
Does septoplasty performed at the same time as oropharyngeal surgery increase complication rates?
Francis X. Creighton, Neil Bhattacharyya, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine whether septoplasty when combined with ambulatory oropharyngeal surgery increases postoperative complications.
Study Design
Cross-sectional analysis of multistate ambulatory surgery and hospital databases.
Methods
Ambulatory adult septoplasty and oropharyngeal surgical procedures (tonsillectomy and uvulopalatoplasty [UPPP]) were extracted from the state ambulatory surgery databases for New York, Florida, Iowa, and California for 2010–2011. Cases with concurrent sinus surgery were excluded. Cases were linked to the state emergency department databases and the state inpatient databases to identify revisits within 14 days. The rates of unplanned revisits and postoperative bleeding were determined and compared among groups undergoing solely oropharyngeal surgery versus groups undergoing oropharyngeal surgery combined with septoplasty.
Results
Among 26,280 tonsillectomies alone versus 1,002 tonsillectomies + septoplasty, rates for unplanned revisits and hemorrhage were 13.2% and 12.8% (P = .66) and 4.9% and 7.0% (P = .003), respectively. Among 2,598 UPPPs alone versus 1,343 UPPPs + septoplasty, rates for revisits and hemorrhage were 11.4% versus 10.1% (P = .242) and 3.5% versus 3.8% (P = 0.683), respectively. Among 389 UPPP/tonsillectomies versus 164 UPPP/tonsillectomies + septoplasty, rates for revisits and hemorrhage were 11.8% versus 8.5% (P = .256) and 3.9% versus 6.1% (P = .247), respectively. Among all cases and groups, there were mortalities only in the UPPP alone group.
Conclusions
The addition of septoplasty to oropharyngeal ambulatory surgical procedures does not significantly increase the rate of unplanned revisits or postoperative hemorrhage except in the case of septoplasty added to tonsillectomy, with a small percentage increase in hemorrhage rate. Combining septoplasty with ambulatory oropharyngeal surgery is clinically reasonable in adults.
Level of Evidence
2b Laryngoscope, 2015
Voice disorders in the elderly: A national database study
Nelson Roy, Jaewhan Kim, Mark Courey, Seth M. Cohen, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the type, frequency, and factors associated with voice disorders in the elderly.
Study Design
Retrospective analysis of data from a large national administrative US claims database.
Methods
Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses.
Results
Of the almost 55 million individuals in the database, 60,773 unique patients (mean age = 74.9 years, standard deviation = 6.6 years, range = 65–105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosis. The most frequent diagnoses overall were acute and chronic laryngitis, nonspecific dysphonia, and benign vocal fold lesions. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific dysphonia and laryngeal changes/lesions. In the otolaryngology group, odds of nonspecific dysphonia and vocal fold paralysis/paresis diagnoses increased with advancing age, whereas benign laryngeal pathology, and acute and chronic laryngitis decreased. As compared to men, women had lower odds of paralysis/paresis and laryngeal cancer but higher odds of acute laryngitis and nonspecific dysphonia. Odds of specific LVDs also varied depending upon comorbid conditions and geographic location.
Conclusions
Age, gender, comorbid conditions, geographic location, and physician type were significantly associated with specific LVD diagnoses within the elderly.
Level of Evidence
4 Laryngoscope, 2015
Endonasal identification of the orbital apex
Miguel S. Tepedino, Carlos D. Pinheiro-Neto, Thiago F. P. Bezerra, Paul A. Gardner, Carl H. Snyderman, Richard L. Voegels, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To describe anatomical landmarks for endoscopic endonasal approaches to the orbital apex and to measure the distances between those landmarks.
Methods
In this anatomic study, the nasal fossae of 30 adult fresh cadavers were dissected (n = 60 half-skulls). One double-injected orbit was carefully dissected, mainly focusing on the neurovascular structures. The orbital apex was dissected under endoscopic endonasal visualization in all cases. The distances between the ethmoidal crest and choanal arch to the optic canal (OC) and superior orbital fissure (SOF) were measured and recorded.
Results
The sample was predominantly male (63.3%, 19/30 cadavers). The following correlations between measurements according to side were observed: ethmoidal crest to OC, r = 0.748 (P = 0.0001); ethmoidal crest to SOF, r = 0.785 (P = 0.0001); choanal arch to OC, r = 0.835 (P = 0.0001); choanal arch to SOF, r = 0.820 (P = 0.0001).
Conclusions
In the cadavers studied in this sample, the ethmoidal crest and choanal arch were relevant structures and exhibited consistent measurements. Spearman correlation coefficients were greater than 0.7, which is indicative of good correlation between measurements obtained in the skull halves of each cadaver. Comparison of the measurements obtained in different sides showed similar values, with no statistically significant differences in the distances between any of the proposed anatomic landmarks.
Level of Evidence
N/A. Laryngoscope, 2015
Effect of three different chin-down maneuvers on Swallowing pressure in healthy young adults
Keigo Matsubara, Yoshihiko Kumai, Yuta Kamenosono, Yasuhiro Samejima, Eiji Yumoto, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the effects of three different chin-down maneuvers on swallowing pressure (SP) in healthy young adults using high-resolution manometry (HRM).
Study Design
Repeated measures with subjects serving as their own controls.
Methods
Twenty-six healthy subjects (average age 26.4 [range 21–35] years) swallowed 5 mL of cold water to examine the maximum swallowing pressure (MSP) at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES), and to determine the duration of lowered SP at the UES using HRM. The subjects swallowed in the neutral position as a control and in the following three chin-down positions: 1) head flexion (HF); 2) neck flexion (NF); and 3) combined head and neck flexion (HFNF).
Results
The MSP at the velopharynx and meso-hypopharynx did not significantly differ among the three chin-down positions. Upon swallowing in the NF posture, the MSP was significantly lower (P < 0.0001) at the UES, and the duration of the lowered SP at the UES was significantly prolonged (P = 0.0010) compared to the neutral position. In comparison, the duration of lowered SP at the UES was significantly (P = 0.0001) shorter in the HF position than in the neutral position. Moreover, the HFNF position significantly (P = 0.0276) lowered the MSP at the UES compared to the control position.
Conclusion
In young healthy adults, NF maneuver resulted in significantly lower MSP and longer duration of the lowered swallowing pressure at the UES, which might assist bolus passage through the UES.
Level of Evidence
3b. Laryngoscope, 2015
Volumetric nasal cavity analysis in children with unilateral and bilateral cleft lip and palate
Zainab Farzal, Jonathan Walsh, Gabriella Lopes de Rezende Barbosa, Carlton J. Zdanski, Stephanie D. Davis, Richard Superfine, Luiz A. Pimenta, Julia S. Kimbell, Amelia Fischer Drake, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Children with cleft lip and palate (CLP) often suffer from nasal obstruction that may be related to effects on nasal volume. The objective of this study was to compare side:side volume ratios and nasal volume in patients with unilateral (UCLP) and bilateral (BCLP) clefts with age-matched controls.
Study Design
Retrospective case–control study using three-dimensional (3D) nasal airway reconstructions.
Methods
We analyzed 20 subjects (age range = 7–12 years) with UCLP and BCLP from a regional craniofacial center who underwent cone beam computed tomography (CT) prior to alveolar grafting. Ten multislice CT images from age-matched controls were also analyzed. Mimics software (Materialise, Plymouth, MI) was used to create 3D reconstructions of the main nasal cavity and compute total and side-specific nasal volumes. Subjects imaged during active nasal cycling phases were excluded.
Results
There was no statistically significant difference in affected:unaffected side volume ratios in UCLP (P = .48) or left:right ratios in BCLP (P = .25) when compared to left:right ratios in controls. Mean overall nasal volumes were 9,932 ± 1,807, 7,097 ± 2,596, and 6,715 ± 2,115 mm3 for control, UCLP, and BCLP patients, respectively, with statistically significant volume decreases for both UCLP and BCLP subjects from controls (P < .05).
Conclusions
This is the first study to analyze total nasal volumes in BCLP patients. Overall nasal volume is compromised in UCLP and BCLP by approximately 30%. Additionally, our finding of no major difference in side:side ratios in UCLP and BCLP compared to controls conflicts with pre-existing literature, likely due to exclusion of actively cycling scans and our measurement of the functional nasal cavity.
Level of Evidence
3b. Laryngoscope, 2015
High-frequency sensorineural hearing loss in children
Kaalan Johnson, Meredith Tabangin, Jareen Meinzen-Derr, Aliza P. Cohen, John H. Greinwald, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Determine the prevalence of high-frequency sensorineural hearing loss (HFSNHL) in our hearing loss population and a diagnostic algorithm for these patients.
Study Design
Retrospective case series.
Methods
We identified patients diagnosed with sensorineural hearing loss (SNHL) at our pediatric tertiary care institution from 1981 to 2010. Based on audiometric profiles, these patients were subdivided into those with a flat SNHL configuration and those with HFSNHL. Imaging and genetic testing data and data regarding age at diagnosis, laterality, and risk factors were obtained for both groups. Comparisons were then made between the two groups.
Results
Of 2,867 patients included in the study, 7.6% had HFSNHL. Age at diagnosis was significantly higher in HFSNHL patients (8.3 years vs. 6.1 years; P < .0001). These patients also had a significantly higher proportion of unilateral versus bilateral loss (49.1% vs. 26.1%; P < .0001); unilateral losses were also less severe. Genetic testing showed no significant difference between groups in the proportion of patients tested or in those who tested positive. Similarly, imaging data revealed no difference in the proportion of patients tested in the two groups; however, overall diagnostic yield was significantly higher in flat SNHL patients (29.5% vs.17.3; P = .02).
Conclusions
The positive predictive value of simple genetic testing is similar to that of imaging studies. However, given cost differences between genetic testing and imaging, it is prudent to perform genetic testing as the initial diagnostic test. Determination of whether high-throughput, multigene diagnostic platforms offer an added benefit in the evaluation of children requires further study.
Level of Evidence
4. Laryngoscope, 2015
A low-cost transcervical laryngeal injection trainer
Cristina Cabrera-Muffly, Matthew S. Clary, Mona Abaza, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To develop a low-cost, easy-to-construct model for education in transcervical laryngeal injection techniques. To validate the simulator among both fellowship-trained laryngologists and otolaryngology resident learners.
Study Design
Survey.
Methods
A transcervical laryngeal injection model was constructed. Fourteen otolaryngology residents used the model to practice vocal fold injection techniques. Survey feedback was obtained from all residents.
Results
Most learners agreed or strongly agreed that the simulator was easy to use (93%), was a good method to learn transcervical laryngeal injection technique (79%), improved their confidence with the procedure (78%), and could be applied to patients (72%). One hundred percent of the learners agreed or strongly agreed that they would recommend the simulator to other learners.
Conclusion
Residents can be taught transcervical laryngeal injection techniques with a low-cost, easily constructed simulator prior to treating patients. This allows for a low-stress environment in which the learner can practice injection techniques. Resident feedback about the transcervical laryngeal injection simulator was very positive, including unanimous recommendation for use in other learners.
Level of Evidence
N/A. Laryngoscope, 2015
In response to: A New Theory on the Pathogenesis of Acquired Cholesteatoma: Mucosal Traction
Matteo Alicandri-Ciufelli, Daniele Marchioni, Livio Presutti, 2015-08-25 08:44:11 AM
Improving access and timeliness of care for veterans with head and neck squamous cell carcinoma: A multidisciplinary team's approach
Reena Dhanda Patil, Jareen K. Meinzen-Derr, Brian Hendricks, Yash J. Patil, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
With the prevalence of head and neck squamous cell carcinoma (HNSCC) nearly twice as high in veterans (6%) than general populations (3%), the noted problems of long waits and access to care in United States Veterans Affairs (VA) hospitals across the country are pressing. We examined primary outcome measures of timeliness and access to care for our patients with HNSCC assessing a multidisciplinary team approach at our VA hospital.
Study Design
Retrospective chart review.
Methods
Our patients newly diagnosed with HNSCC were identified from two 24-month periods: diagnosis before (group 1, 2005–2006) and after (group 2, 2008–2009) implementing our multidisciplinary team in 2007. No significant differences in age (P = .13) or disease stage (P = .18) occurred between groups. Primary and secondary outcomes (i.e., treatment modality, imaging, completion of treatment, survival) were compared.
Results
Timeliness to care improved for all measures. Improvement was significant for times from consult placed to seen in clinic (27.5–16.5 days; P < 0.0001) and from positive biopsy reported to date of initiating definitive treatment (35–27 days; P = 0.04). Pretreatment consults to various services represented by the multidisciplinary team increased from one to four (P < 0.0001). Two-year mortality was approximately the same between group 1 (33%) and group 2 (36%) (P = 0.035). Five-year mortality was slightly better in group 2 (50%) versus group 1 (61%), although not statistically significant.
Conclusion
Our veteran population with HNSCC had improved timeliness and access to care with our multidisciplinary approach.
Level of Evidence
4. Laryngoscope, 2015
In response to A New Theory on the Pathogenesis of Acquired Cholesteatoma: Mucosal Traction
Robert K. Jackler, Peter Luke Santa Maria, Kursad Y. Varsak, Nikolas H. Blevins, Anh Nguyen, 2015-08-25 08:44:11 AM
The efficacy of the interferon-γ release assay for diagnosing cervical tuberculous lymphadenitis: A prospective controlled study
Kyung Hee Kim, Rock Bum Kim, Seung Hoon Woo, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The whole-blood interferon (IFN)-γ release assay (IGRA) has been studied mainly for diagnosing latent tuberculosis (TB). We prospectively evaluated its diagnostic usefulness in patients with suspected cervical TB lymphadenitis.
Study Design
Prospective cohort study.
Methods
An IGRA was performed in subjects with suspected TB lymphadenitis. To evaluate the diagnostic performance of the IGRA, we calculated the sensitivity and specificity of culture, radiologic imaging, polymerase chain reaction testing, fine needle aspiration, and excisional biopsy.
Result
Of the 271 adult patients with suspected TB lymphadenitis, 42 were diagnosed with the disease. The overall sensitivity and specificity of the IGRA were 78.8% and 95.5%, respectively. When the cutoff value of IFN-γ was set to 0.26 IU/mL, it met the inclusion criteria for suspicious TB lymphadenitis, with sensitivity and specificity of 83.3% and 95.1%, respectively.
Conclusions
The IGRA is useful in diagnosing TB lymphadenitis, with high sensitivity and specificity.
Level of Evidence
4. Laryngoscope, 2015
Effect of repeated tracheostomy tube reprocessing on biofilm formation
Jennifer Rodney, Carolyn P. Ojano-Dirain, Patrick J. Antonelli, Rodrigo C. Silva, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the effect of repeated reprocessing of pediatric tracheostomy tubes (TTs) on biofilm formation.
Study Design
In vitro microbiological study.
Methods
Pediatric, uncuffed, polyvinyl chloride (PVC) TTs from two different manufacturers (Tracoe Mini and Shiley) were reprocessed mechanically with household detergent and soaked in sodium hypochlorite (bleach). Two TTs of each brand were reprocessed 0 (control), 10, or 20 times. Twenty 2-mm coupons were then obtained from each TT, immersed in human mucus, and cultured with either Staphylococcus aureus or Pseudomonas aeruginosa. Biofilm formation was evaluated with bacterial counts.
Results
Bacterial counts of S. aureus for both brands were significantly higher on the TTs that were reprocessed 20 times compared to those that were not reprocessed (Tracoe: P = .040, Shiley: P < .0001) or those that were reprocessed 10 times (Tracoe: P = .022, Shiley: P = .0002). There was no difference between controls and TTs reprocessed 10 times (Tracoe: P = .76, Shiley: P = .24). P. aeuruginosa counts were not significantly different among the varying numbers of reprocessing cycles for either Tracoe or Shiley TTs (P = .08 and P = .97, respectively).
Conclusions
Repeated reprocessing of PVC TTs with detergent and bleach paradoxically promotes S. aureus biofilm development, possibly due to degradation of the tube surface that facilitates bacterial attachment. Further investigation is needed to determine the optimal technique and limits of reprocessing TTs in clinical practice.
Level of Evidence
NA Laryngoscope, 2015
Novel mouse model for simulating microsurgical tumor excision with facial nerve preservation
Jae H. Lim, Glen M. Boyle, Benedict Panizza, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the feasibility of using a mouse tumor model as a microsurgical training tool for otolaryngology-head and neck surgery (OHNS) trainees.
Study Design
Animal study.
Methods
We injected athymic nude mice with human cutaneous squamous cell carcinoma (A431 cell line) deep to the parotid region overlying the masseter muscle. We sacrificed the animals 1 to 3 weeks postinjection, once a visible tumor growth was confirmed. We then asked 10 OHNS trainees to excise the tumor with preservation of the facial nerves under a high-magnification dissecting microscope. The trainees graded the tasks in several areas of specific measures using a visual analogue scale (VAS) including 1) tumor texture, 2) surgical realism, 3) usefulness, and 4) difficulty of the task.
Results
Noticeable tumor growth occurred within 5 days following A431 cell injection and reached measureable size (0.5–1.5 cm) within 1 to 3 weeks. The tumor displaced the facial nerve laterally and medially, with few demonstrating infiltration of the nerve. VAS scores (± standard deviation) were 8.1 (±1.7), 7.7 (±2.5), 9.0 (±0.9) and 6.6 (±1.9) for tumor texture, surgical realism, usefulness, and the difficulty of the task, respectively.
Conclusions
We demonstrate a novel, reliable and cost-effective mouse model for simulating tumor extirpation microsurgery with preservation of important neural structures. OHNS trainees have found this simulation model to be realistic, useful, and appropriately challenging.
Level of Evidence
NA Laryngoscope, 2015
Endoscope-assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial
Seung Hoon Woo, Jung Je Park, Jong Chul Hong, Soo-Geun Wang, Gi Cheol Park, Young Gyu Eun, Jin Pyeong Kim, Han-Sin Jeong, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Endoscope-assisted transoral removal of a thyroglossal duct cyst (TGDC) has been introduced to clinical practice. However, the technical feasibility, efficacy, and safety of this procedure have not been studied. Herein, we conducted a prospective clinical trial to evaluate endoscope-assisted transoral removal of a TGDC.
Study Design
Prospective cohort study.
Methods
Thirty patients were included. We performed endoscope-assisted transoral removal of TGDCs and evaluated the clinical results and complications over more than 2 years.
Results
Endoscope-assisted transoral resection was successful in all cases. However, transient morbidity was noted in one patient. The mean operation time was 67.33 ± 17.26 minutes. Surgery was not required for recurrence or revision during a follow-up.
Conclusions
Endoscope-assisted transoral resection of a TGDC is a potentially safe and effective procedure leading to excellent functional and cosmetic outcomes. Additionally, considering the embryological development of TGDCs, the transoral approach can open a new access route to these cysts.
Level of Evidence
2b. Laryngoscope, 2015
Adenosquamous carcinoma of the head and neck: Molecular analysis using CRTC-MAML FISH and survival comparison with paired conventional squamous cell carcinoma
Jason I. Kass, Steve C. Lee, Shira Abberbock, Raja R. Seethala, Umamaheswar Duvvuri, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Adenosquamous carcinoma (ASC) is a rare variant of head-and-neck squamous cell carcinoma (HNSCC) generally thought to be uniformly aggressive with poor prognosis. However, it remains unknown how overall survival compare with conventional HNSCC. Here we report for the first time that ASC does not necessarily indicate a worse prognosis than conventional HNSCC.
Study Design
Case-control retrospective study.
Methods
Forty-two primary tumors of the head and neck, treated with curative intent, were identified. Next, 2:1 matching of HNSCC was performed using the following matching criteria: gender, site, pathologic tumor stage, and pathologic node stage. Successful matching was performed for 32 of 42 tumors. Additionally, 20 samples were sent for break-apart FISH testing to evaluate for the presence of the CRTC1-MAML2 translocation.
Results
There was a 1.8:1 male to female ratio, with a mean age of 62 years (range 38–84). The layrnx was the most common site (26%), followed by oropharynx (24%), oral cavity (19%), and sinonasal (17%). Kaplan-Meier analysis of adenosquamous and matched HNSCC showed similar survival curves. Median survival times for ASC and HNSCC were 4 and 6 years, respectively. A random-effects Cox model with Gamma frailty revealed no statistical difference between the two groups (P = 0.25). All cases of ASC were negative for the CRTC1-MAML2 translocation.
Conclusion
This study directly compares primary ASC with HNSCC. No difference in overall survival was detected in contradistinction to the previously thought uniformly poor prognosis. We also highlight the importance of the CRTC1-MAML2 translocation in distinguishing ASC from mucoepidermoid carcinoma.
Level of Evidence
3b. Laryngoscope, 2015
Clinical analysis of drug-induced sleep endoscopy for the OSA patient
Dina Golbin, Brandon Musgrave, Eric Succar, Kathleen Yaremchuk, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine if the use of drug-induced sleep endoscopy (DISE) and transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA) is associated with improved outcomes and acceptable complication rates when compared to uvulopalatopharyngoplasty (UPPP) with or without tonsillectomy (± T).
Methods
A retrospective cohort review was performed comparing 40 patients who had previously undergone UPPP ± T with 64 patients who had DISE, UPPP ± T, and possible TORS base-of-tongue resection and/or partial epiglottectomy. Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), body mass index, sex, hospital length of stay, hospital charges, hospital readmissions, emergency department visits, and major complications were compared for both groups.
Results
The 40 patients who underwent UPPP ± T without DISE showed a significant reduction in AHI of −20.1 (P = 0.001) and a complication rate of 3% (P = 0.001). There was no significant change in ESS (−2.2; P = 0.734). The 64 patients who underwent DISE and subsequent procedures showed a significant reduction in AHI of −21.4 (P = 0.001) and a complication rate of 34.7% (P = 0.001). There was no significant difference in the ESS (+0.1; P = 0.734) or AHI (P = 0.092) between the two groups.
Conclusion
Patients who underwent UPPP ± T without DISE did not show a statistically significant difference in outcomes compared to the patients who underwent DISE with other procedures, including TORS. The TORS patients had increased total costs and length of stay that were statistically significant and had increased complications that were not statistically significant.
Level of Evidence
4. Laryngoscope, 2015
Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options
Karen B. Zur, Linda M. Carroll, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation.
Study Design
Retrospective case-series chart review.
Methods
Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2–16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time.
Results
Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis.
Conclusions
This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP.
Level of Evidence
4 Laryngoscope, 2015
Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A randomized controlled trial
Alice Zon, Yvette E. Smulders, Geerte G. J. Ramakers, Inge Stegeman, Adriana L. Smit, Gijsbert A. Zanten, Robert J. Stokroos, Nadia Hendrice, Rolien H. Free, Bert Maat, Johan H. M. Frijns, Emmanuel A. M. Mylanus, Wendy J. Huinck, Vedat Topsakal, Rinze A. Tange, Wilko Grolman, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.
Study Design
Prospective study.
Methods
Thirty-eight adult patients were included in this prospective study, as part of a multicenter randomized controlled trial investigating the benefits of bilateral cochlear implantation versus unilateral cochlear implantation. Pre- and postoperative tinnitus perception scores were evaluated, before and 1 year after implantation on three tinnitus questionnaires; the Tinnitus Handicap Inventory (THI), the Tinnitus Questionnaire (TQ), and a visual analogue scale for tinnitus burden.
Results
Before implantation, the tinnitus prevalence was 42.1% (16 of 38) in the whole study group. One year after implantation, the tinnitus questionnaire scores had decreased in 71.4% according to the TQ and 80.0% according to the THI. Tinnitus was induced after cochlear implantation in six patients, five in the bilateral and one in the unilateral group.
Conclusions
Our study shows that cochlear implantation is effective in the reduction of tinnitus in patients with bilateral sensorineural hearing loss who suffered from preoperative tinnitus. Conversely, tinnitus may also increase or even be induced by the cochlear implantation itself. Cochlear implant candidates should be well informed about these possible consequences before undergoing surgery.
Level of Evidence
2b Laryngoscope, 2015
Does quality of life depend on speech recognition performance for adult cochlear implant users?
Natalie R. Capretta, Aaron C. Moberly, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Current postoperative clinical outcome measures for adults receiving cochlear implants (CIs) consist of testing speech recognition, primarily under quiet conditions. However, it is strongly suspected that results on these measures may not adequately reflect patients' quality of life (QOL) using their implants. This study aimed to evaluate whether QOL for CI users depends on speech recognition performance.
Study Design
Twenty-three postlingually deafened adults with CIs were assessed.
Methods
Participants were tested for speech recognition (Central Institute for the Deaf word and AzBio sentence recognition in quiet) and completed three QOL measures—the Nijmegen Cochlear Implant Questionnaire; either the Hearing Handicap Inventory for Adults or the Hearing Handicap Inventory for the Elderly; and the Speech, Spatial and Qualities of Hearing Scale questionnaires—to assess a variety of QOL factors. Correlations were sought between speech recognition and QOL scores. Demographics, audiologic history, language, and cognitive skills were also examined as potential predictors of QOL.
Results
Only a few QOL scores significantly correlated with postoperative sentence or word recognition in quiet, and correlations were primarily isolated to speech-related subscales on QOL measures. Poorer pre- and postoperative unaided hearing predicted better QOL. Socioeconomic status, duration of deafness, age at implantation, duration of CI use, reading ability, vocabulary size, and cognitive status did not consistently predict QOL scores.
Conclusion
For adult, postlingually deafened CI users, clinical speech recognition measures in quiet do not correlate broadly with QOL. Results suggest the need for additional outcome measures of the benefits and limitations of cochlear implantation.
Level of Evidence
4. Laryngoscope, 2015
A lean neck mass clinic model: Adding value to care
Brittny N. Tillman, Tiffany A. Glazer, Amrita Ray, J. Chad Brenner, Matthew E. Spector, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To demonstrate that ultrasound-guided fine needle aspiration (USFNA) with on-site cytopathologic analysis eliminates unnecessary diagnostic testing, return visits, and repeat procedures and optimizes quality of care.
Study Design
Retrospective cohort.
Methods
Sixty-one new patients (28 female; 33 male; age range = 19–85 years) were seen in our dedicated neck mass clinic over a 1-year period. All patients underwent USFNA of masses located in neck levels I–VI (n = 40), parotid gland (n = 20), or parapharyngeal space (n = 1). Each patient underwent two USFNA passes followed by on-site cytopathologic analysis with additional passes if required for diagnosis.
Results
Diagnosis was made in 93.4% (n = 57) of patients, allowing for counseling and treatment planning at the first visit. To obtain a diagnosis, more than half (57.4%, n = 35) of our patients required additional passes, which implies that they would have required an additional visit without on-site cytopathologic analysis. Treatment included observation in 42.6% (n = 26) of patients, surgery in 32.8 % (n = 20) of patients, and nonsurgical treatment (chemotherapy, radiation, other) in 24.6% (n = 15) of patients. The average time from check-in to checkout including the clinic visit, biopsy, and treatment counseling was 103 minutes, and the average round trip mileage traveled per patient was 127.6 miles.
Conclusions
The adult neck mass is a commonly encountered scenario in otolaryngology. For the patient, this can be a stressful situation in which timely and accurate diagnosis is critical. A dedicated lean neck mass clinic model with USFNA and on-site cytopathologic analysis can be both an efficient part of one's practice and a valuable addition to patient care.
Level of Evidence
4 Laryngoscope, 2015
What is the role of sentinel lymph node biopsy in early-stage oral cavity carcinoma?
Vikas Mehta, Cherie-Ann Nathan, 2015-08-25 08:44:11 AM
In response to the usefulness of the stay suture technique in tracheostomy
Sang Ha Lee, Kyung Hee Kim, Seung Hoon Woo, 2015-08-25 08:44:11 AM
Upper airway stimulation for obstructive sleep apnea: The surgical learning curve
Alexander W. Murphey, Andrew B. Baker, Ryan J. Soose, Tapan A. Padyha, Shaun A. Nguyen, Christopher C. Xiao, M. Boyd Gillespie, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the effect of surgeon experience with an upper airway stimulation (UAS) system on surgical time and complication rates.
Study Design
Retrospective review.
Methods
Surgical procedure times and complication rates observed in patients implanted at 22 study centers as part of a phase III, multicenter surgical trial of upper airway nerve stimulation therapy for obstructive sleep apnea were reviewed.
Results
The study included 126 subjects who were predominantly male (83%), with a mean age of 54.5 years (range = 31–80 years), and the mean body mass index was 28.4 ± 2.6. There were an average of 5.7 (range = 1–22) surgical implants per site, with an average surgical time of 2.52 ± 0.98 hours (range = 1.08–6.0 hours). The surgical implant time decreased significantly with surgeon experience, from 2.98 ± 1.18 hours for a surgeon's first implant (n = 22) to 2.08 ± 0.55 hours for the fifth implant (n = 10, P = .025). Surgical time was inversely correlated with the site implant number (rho = −0.334, P < .001). Procedure-specific complications were uncommon and self-limited and did not decrease appreciably with increasing experience.
Conclusions
Surgical time for implantation of the UAS system decreased significantly after the first five implants and then stabilized. The rate of surgical complications did not decrease with surgeon experience, although this may be attributable to the low overall rate of serious surgical complications and low number of implants at some centers.
Level of Evidence
4 Laryngoscope, 2015
Rhinology and medical malpractice: An update of the medicolegal landscape of the last ten years
Anthony M. Tolisano, Grant A. Justin, Douglas S. Ruhl, Benjamin B. Cable, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Malpractice claims pertaining to rhinological procedures are a potentially important source of information that could be used to minimize the risk of future litigation and improve patient care.
Study Design
A retrospective review of a publicly available database containing jury verdicts and settlements.
Methods
The LexisNexis Jury Verdicts and Settlements database was reviewed for all lawsuits and out-of-court adjudications related to the practice of rhinology. Data including patient demographics, type of surgery performed, plaintiff allegation, nature of injury, outcomes, and indemnities were collected and analyzed.
Results
Of 85 cases meeting inclusion criteria, 42 were decided by a jury and 43 were adjudicated out of court. Endoscopic sinus surgery was the most commonly litigated surgery. The plaintiff was favored when the eye was injured (P = 0.0196), but the defendant was favored when neuropsychological injuries (P = 0.0137) or recurrent/worsened symptoms (P = 0.0050) were cited. No difference was found when death or skull base injuries occurred. When lack of informed consent was an allegation, the defendant was favored (P = 0.0001). A payout was made in two-thirds of cases overall, but the defendant was favored in two-thirds of cases decided by a jury. Payments were significant for both out-of-court settlements ($1.3 million) and jury verdicts ($2 million).
Conclusions
Endoscopic sinus surgery remains the most commonly litigated rhinology procedure and has the potential to result in large payouts. Meticulous dissection, recognition of complications, and documentation of informed consent remain paramount for providing optimal patient care.
Level of Evidence
N/A. Laryngoscope, 2015
Spontaneous middle cranial fossa cerebrospinal fluid otorrhea in adults
Neela Rao, Miriam Redleaf, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The goals of this study are to: 1) investigate the urgency for repair of middle cranial fossa spontaneous cerebrospinal fluid (CSF) leaks in adults, and 2) review the literature and treatment recommendations for adult spontaneous CSF otorrhea.
Data Sources
1) All patients who were referred to a tertiary center with spontaneous CSF otorrhea, exposed middle cranial fossa dura, or encephalocele from 2004 to 2015; and 2) landmark references on spontaneous CSF leaks
Review Methods
Electronic medical records of patients with a documented spontaneous CSF leak, exposed dura, or encephalocele were reviewed. Subjects were excluded if they had a congenital, traumatic, or iatrogenic CSF leak. Main outcome measure was duration of CSF leak and development of meningitis after clinical presentation.
Results
Twenty-two patients (27 ears) who were at risk for meningitis from spontaneous CSF otorrhea, encephalocele, or a dural breach with or without mastoiditis were evaluated. Duration of CSF leaks in patients who refused repair or who continued to have CSF leak after repair or prior to successful repair ranged from 4 months to 11 years. Duration of encephaloceles and dural exposure in an uninfected mastoid ranged from 24 months to 6 years. Only one patient presented with meningitis. None of these 22 patients developed meningitis during the time periods they were under our care.
Conclusion
Should patients with CSF otorrhea, exposed dura, or encephalocele refuse operation, it may be reasonable to follow them with close observation and education about warning signs for meningitis. Laryngoscope, 2015
Management of hearing loss and the normal ear in cases of unilateral Microtia with aural atresia
Kathleen R. Billings, Hannan Qureshi, Christopher Gouveia, Colleen Ittner, Stephen R. Hoff, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To identify the rate of hearing loss related to middle ear disease and the frequency of tympanostomy tube (TT) insertion in the contralateral ear of patients with unilateral microtia/aural atresia.
Study Design
Retrospective case series of patients less than 3 years of age with unilateral microtia/aural atresia treated at an urban, tertiary care children's hospital from 2008 to 2013.
Methods
Clinical and audiologic data were reviewed. Statistical analysis was performed to determine the relative risk of TT insertion in the normal ear.
Results
A total of 72 patients were included for analysis. The average age of patients at their initial otolaryngology visit was 3.3 months (range 0.08–1.67 years); 38 (52.8%) patients were males. Aural atresia involved the right ear in 43 (59.7%) cases. Five (6.9%) patients were syndromic. Abnormal audiometric testing of the normal ear was noted in 12 (16.7%), and 14 (19.4%) underwent TT during the first 3 years of life. Twelve children (85.7%) who had a TT placed were nonsyndromic. When compared to published norms for TT placement in the general population (6.8% of children < 3 year of age), a greater proportion of children with unilateral microtia/aural atresia had TT placement in the normal ear (z = 4.26, P < 0.0001).
Conclusion
Patients with unilateral microtia/aural atresia have increased rates of hearing loss and middle ear effusion leading to TT in their normal ear at a higher rate versus the general population. This information can help guide more vigilant care and audiologic follow-up in affected children.
Level of Evidence
4. Laryngoscope, 2015
The effects of treadmill running on aging laryngeal muscle structure
Heidi Kletzien, John A. Russell, Nadine P. Connor, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Age-related changes in laryngeal muscle structure and function may contribute to deficits in voice and swallowing observed in elderly people. We hypothesized that treadmill running, an exercise that increases respiratory drive to upper airway muscles, would induce changes in thyroarytenoid muscle myosin heavy chain (MHC) isoforms that are consistent with a fast-to-slow transformation in muscle fiber type.
Study Design
Randomized parallel group controlled trial.
Methods
Fifteen young adult and 14 old Fischer 344/Brown Norway rats received either treadmill running or no exercise (5 days/week/8 weeks). Myosin heavy chain isoform composition in the thyroarytenoid muscle was examined at the end of 8 weeks.
Results
Significant age and treatment effects were found. The young adult group had the greatest proportion of superfast-contracting MHCIIL isoform. The treadmill running group had the lowest proportion of MHCIIL and the greatest proportion of MHCIIx isoforms.
Conclusion
Thyroarytenoid muscle structure was affected both by age and treadmill running in a fast-to-slow transition that is characteristic of exercise manipulations in other skeletal muscles.
Levels of Evidence
NA. Laryngoscope, 2015
The Chronic Obstructive Sialadenitis Symptoms Questionnaire to assess sialendoscopy-assisted surgery
Annick Aubin-Pouliot, Elise A. Delagnes, David W. Eisele, Jolie L. Chang, William R. Ryan, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Introduce the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire to quantify chronic sialadenitis symptoms and assess the impact of sialendoscopic-assisted salivary duct surgery (SASDS).
Study Design
Retrospective outcome symptoms questionnaire study.
Methods
The COSS questionnaire assesses the severity of sialadenitis symptoms from 0 to 100. Patients who underwent SASDS from April 2006 to December 2013 completed the COSS questionnaire and the ShortForm8 Health Survey (SF-8) based on current symptoms, and reported whether they had complete, partial, or no symptomatic response to SASDS.
Results
Sixty-six of the 156 (43%) contacted patients completed the questionnaires who had had symptoms in 26 submandibular ducts and 53 parotid ducts. The mean COSS score was higher for parotid ducts (12.0; interquartile range [IQR] 1.0–20.0) than for submandibular ducts (7.6; IQR 0.5–15.0) but not significantly so (P = 0.20). Thirty-eight (60%) patients reported complete resolution of symptoms, with a mean COSS score of 4.5 (IQR 0–7). Twenty-one (33%) patients reported partial resolution, with a mean COSS score of 18.5 (IQR 11.3–22.8). Five (8%) patients reported no improvement, with a mean COSS score of 25.1 (IQR 15.2–35). Thirty-six (46%) ducts with sialoliths had a significantly lower mean COSS score (5.8; IQR 0−9.5) compared to those without sialoliths (14.2; IQR 4.5−21.5, P = 0.0004). There was no significant difference in SF-8 survey scores between these groups.
Conclusion
The COSS questionnaire is a novel survey instrument to measure obstructive sialadenitis symptom severity that could be helpful in defining outcomes of SASDS. COSS scores under 10 correlate with complete resolution of symptoms, whereas scores between 10 and 25 correlate with partial resolution.
Level of Evidence
4. Laryngoscope, 2015
Comparison of cadaveric and isomorphic three-dimensional printed models in temporal bone education
Jordan B. Hochman, Charlotte Rhodes, Dana Wong, Jay Kraut, Justyn Pisa, Bertram Unger, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Current three-dimensional (3D) printed simulations are complicated by insufficient void spaces and inconsistent density. We describe a novel simulation with focus on internal anatomic fidelity and evaluate against template/identical cadaveric education.
Study Design
Research ethics board-approved prospective cohort study.
Methods
Generation of a 3D printed temporal bone was performed using a proprietary algorithm that deconstructs the digital model into slices prior to printing. This supplemental process facilitates removal of residual material from air-containing spaces and permits requisite infiltrative access to the all regions of the model. Ten otolaryngology trainees dissected a cadaveric temporal bone (CTB) followed by a matched/isomorphic 3D printed bone model (PBM), based on derivative micro-computed tomography data. Participants rated 1) physical characteristics, 2) specific anatomic constructs, 3) usefulness in skill development, and 4) perceived educational value. The survey instrument employed a seven-point Likert scale.
Results
Trainees felt physical characteristics of the PBM were quite similar to CTB, with highly ranked cortical (5.5 ± 1.5) and trabecular (5.2 ± 1.3) bone drill quality. The overall model was considered comparable to CTB (5.9 ± 0.74), with respectable air cell reproduction (6.1 ± 1.1). Internal constructs were rated as satisfactory (range, 4.9–6.2). The simulation was considered a beneficial training tool for all types of mastoidectomy (range, 5.9–6.6), posterior tympanotomy (6.5 ± 0.71), and skull base approaches (range, 6–6.5). Participants believed the model to be an effective training instrument (6.7 ± 0.68), which should be incorporated into the temporal bone lab (7.0 ± 0.0). The PBM was thought to improve confidence (6.7 ± 0.68) and operative performance (6.7 ± 0.48).
Conclusions
Study participants found the PBM to be an effective platform that compared favorably to CTB. The model was considered a valuable adjunctive training tool with both realistic mechanical and visual character.
Level of Evidence
NA Laryngoscope, 2014
Voice and respiratory outcomes after permanent transoral surgery of bilateral vocal fold paralysis
Tadeus Nawka, Christian Sittel, Christoph Arens, Ruth Lang-Roth, Claus Wittekindt, Rudolf Hagen, Andreas H. Mueller, Ahmed I. Nasr, Orlando Guntinas-Lichius, Gerhard Friedrich, Markus Gugatschka, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Bilateral vocal fold paralysis (BVFP) is a rare but life-threatening condition mostly caused by iatrogenic damage to the peripheral recurrent laryngeal nerve. Endoscopic enlargement techniques have been the standard treatment for decades. However, prospective studies using internationally accepted phoniatric and respiratory evaluation guidelines are rare.
Study Design
Prospective observational multicenter study.
Methods
Twelve clinical centers screened 61 patients, of whom 36 were eligible according to the study protocol. Subjects were assessed with specific phoniatric and respiratory tests preoperatively and at 1 and 6 months postoperatively.
Results
Important respiratory parameters improved significantly 6 months postoperatively (peak expiratory and expiratory flow), confirming that a glottal enlargement effectively reduced the obstruction. Objective parameters dealing with voice quality worsened significantly (maximum phonation time, voice range profile, hoarseness), whereas subjective voice assessment (VHI-12) did not change significantly.
Conclusion
Endoscopic glottal enlargement is an effective method for relieving symptoms of dyspnea due to BVFP. Postoperatively, voice quality objectively worsened; however, this was not perceived by the patients themselves. Laryngostroboscopic findings did not correlate strongly with voice and respiratory outcomes.
Level of Evidence
2b. Laryngoscope, 2015
Canal wall reconstruction and conductive hearing preservation for temporal bone paraganglioma
Danielle S. Hoyne, Sarah E. Mowry, Marlan R. Hansen, 2015-08-25 08:44:11 AM
Propranolol and venlafaxine for vestibular migraine prophylaxis: A randomized controlled trial
Mehti Salviz, Turgut Yuce, Hurtan Acar, Abdullah Karatas, R. Murat Acikalin, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
We compared the effectiveness of venlafaxine and propranolol for the prophylaxis of vestibular migraine (VM).
Study Design
Prospective, randomized, controlled clinical trial.
Methods
Sixty-four subjects with definite VM were enrolled. The subjects were randomly assigned to receive propranolol (group P, n = 33) or venlafaxine (group V, n = 31) for VM prophylaxis. Dizziness Handicap Inventory (DHI) scores, the Vertigo Severity Score (VSS), and the number of vertiginous attacks were recorded before and 4 months after treatment. The Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores were also recorded to monitor the resolution of psychiatric symptoms.
Results
At 4 months after treatment, the DHI total score decreased from 55.8 ± 2.7 to 31.3 ± 3.7 and from 50.9 ± 2.5 to 19.9 ± 2.9 (P < .001), the mean number of total vertiginous attacks decreased from 12.6 ± 1.8 to 1.9 ± 0.7 and from 12.2 ± 1.8 to 2.6 ± 1.1 (P < .001), and VSS decreased from 7.3 ± 0.3 to 2.1 ± 0.4 and from 7.9 ± 0.3 to 1.8 ± 0.5 (P < .001) in groups P and V, respectively. However, the treatment effects were similar in both groups (P > .05). BAI scores significantly decreased in both groups, whereas BDI scores decreased only in group V.
Conclusions
This study provided evidence that venlafaxine and propranolol show equal effectiveness as prophylactic drugs for ameliorating vertiginous symptoms in VM patients. However, venlafaxine may be superior to propranolol in ameliorating depressive symptoms.
Level of Evidence
1b. Laryngoscope, 2015
REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies
Rakesh K. Chandra, Robert C. Kern, Jeffrey L. Cutler, Kevin C. Welch, Paul T. Russell, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To provide the final results from the REMODEL (randomized evaluation of maxillary antrostomy versus ostial dilation efficacy through long-term follow-up) full-study cohorts and perform meta-analyses of standalone balloon sinus dilation studies to explore long-term outcomes in a large patient sample.
Study Design
Randomized controlled trial and meta-analysis.
Methods
Final outcomes from the REMODEL randomized trial, including a larger cohort of 135 patients treated with functional endoscopic sinus surgery (FESS) or in-office balloon dilation, were evaluated. One hundred thirty patients had 12-month data, 66 had 18-month data, and 25 had 24-month data. In addition, a meta-analysis evaluated outcomes from six studies including 358 standalone balloon dilation patients with up to 24 months follow-up.
Results
Outcomes out to 2 years from the REMODEL full-study cohort are consistent with 6-month and 12-month outcomes. In the meta-analysis of standalone balloon dilation studies, technical success is 97.5%, and mean 20-item Sino-Nasal Outcomes Test scores are significantly and clinically improved at all time points (P < .0001). There are significant reductions (P < .0001) in work/school days missed, homebound days, physician/nurse visits, acute infections, and antibiotic prescriptions. Mean recovery time is 1.4 days. Comparison of 12-month symptom improvements and revision rates between the REMODEL FESS arm (n = 59), REMODEL balloon dilation arm (n = 71), and pooled single-arm standalone balloon dilation studies (n = 243) demonstrated no statistical difference.
Conclusions
All outcomes are comparable between FESS and balloon dilation at all time points from 6 months to 24 months. Balloon dilation produces faster recovery, less postoperative pain, and fewer debridements than FESS. There is significant, durable benefit in a large series of 358 patients undergoing standalone balloon dilation.
Level of Evidence
1b/2a. Laryngoscope, 2015
Posterior auricular artery fasciocutaneous island flap: lateral temporal soft tissue reconstruction
Benjamin P. Caughlin, Miriam Redleaf, 2015-08-25 08:44:11 AM
Quantitative assessment of the upper airway in infants and children with subglottic stenosis
Carlton Zdanski, Stephanie Davis, Yi Hong, Di Miao, Cory Quammen, Sorin Mitran, Brad Davis, Marc Niethammer, Julia Kimbell, Elizabeth Pitkin, Jason Fine, Lynn Fordham, Bradley Vaughn, Richard Superfine, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Determine whether quantitative geometric measures and a computational fluid dynamic (CFD) model derived from medical imaging of children with subglottic stenosis (SGS) can be effective diagnostic and treatment planning tools.
Study Design
Retrospective chart and imaging review in a tertiary care hospital.
Methods
Computed tomography scans (n = 17) of children with SGS were analyzed by geometric and CFD methods. Polysomnograms (n = 15) were also analyzed. Radiographic data were age/weight flow normalized and were compared to an atlas created from radiographically normal airways. Five geometric, seven CFD, and five polysomnography measures were analyzed. Statistical analysis utilized a two-sample t test with Bonferroni correction and area under the curve analysis.
Results
Two geometric indices (the ratio of the subglottic to midtracheal airway, the percent relative reduction of the subglottic airway) and one CFD measure (the percent relative reduction of the hydraulic diameter of the subglottic airway) were significant for determining which children with SGS received surgical intervention. Optimal cutoffs for these values were determined. Polysomnography, the respiratory effort-related arousals index, was significant only prior to Bonferroni correction for determining which children received surgical intervention.
Conclusions
Geometric and CFD variables were sensitive at determining which patients with SGS received surgical intervention. Discrete quantitative assessment of the pediatric airway was performed, yielding preliminary data regarding possible objective thresholds for surgical versus nonsurgical treatment of disease. This study is limited by its small, retrospective, single-institution nature. Further studies to validate these findings and possibly optimize treatment threshold recommendations are warranted.
Level of Evidence
4 Laryngoscope, 2015
Otolaryngology Needs in a Free Clinic Providing Indigent Care
Amanda Hu, Thomas Sibert, Wei Zhao, Vincent Zarro, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the otolaryngology needs in a free clinic providing care to medically indigent patients, as perceived by the patients and health care providers.
Study Design
Cross-sectional survey.
Methods
A survey was administered to patients and health care providers of a free clinic from September 2014 through January 2015 in an urban, inner-city location.
Results
One hundred and thirty-seven patients (35.8% male, age 50.8 ± 13.0 years) completed the survey. Mean household income was $29,838 ± $10,425; 32.1% spoke English; 54.7% were employed; 10.2% had health insurance; and 37.2% had seen a primary care provider outside of the free clinic. The top three otolaryngology symptoms among patients were sleep apnea/snoring (39.4%), heartburn/reflux (30.7%), and dizziness (29.9%). Eleven health care providers (45% male, age 50.5 ± 15.3 years, 63.6% physician, 36% nurse) completed the survey. Providers perceived the following otolaryngology complaints as the most prevalent, in descending order: cough, nasal congestion, reflux/heartburn, sore throat, and ear infection/otalgia. Providers felt that sleep apnea and hearing loss were the less common otolaryngology complaints, whereas surveyed patients indicated these symptoms with high frequency. The most requested diagnostic tool among patients and providers was chest X-rays.
Conclusion
There are unmet otolaryngology needs in a free clinic. Medically indigent patients have significant barriers to accessing health care. Patient and provider perceptions of top otolaryngology complaints differed, but both identified access to chest X-rays as a major unmet need. Knowledge of patient perceptions may help providers elicit the breadth of otolaryngology complaints.
Level of Evidence
4. Laryngoscope, 2015
Normative data for rotational chair stratified by age
Fung M. Chan, Jessica Galatioto, Michael Amato, Ana H. Kim, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The purpose of this study is to examine the range of vestibulo-ocular reflex (VOR) gain on rotary chair (RC) testing in subjects without ear and vestibular problems stratified by age and gender.
Study Design
Prospective cross-sectional study.
Methods
One hundred subjects ranging in age from 6 to 78 years underwent RC testing. VOR gains at frequencies ranging from 0.01 to 0.64 Hz were recorded. The PROC MIXED procedure in SAS was used to analyze differences in VOR gain between gender and the following age groups: group 1 (6–12 years), group 2 (13–17 years), group 3 (18–30 years), group 4 (31–50 years), and group 5 (>50 years).
Results
Twenty subjects were recruited for each of the five groups. Group 1 showed the highest average VOR gain compared to all other age groups (P < .05). There was an inverse correlation between VOR gain and age (P < .05). The lowest frequency (0.01 Hz) had the highest correlation between VOR gain and age (r = −0.425; P < .0001).
Conclusions
Our study demonstrates VOR gain differences with age, especially in the preadolescent and geriatric groups. The current manufacturer-provided normative data do not serve as an accurate reference, especially for these two age groups. A larger population of all age groups should be compared to the current RC manufacturer normative values to ensure that they accurately reflect the true normative data.
Level of Evidence
2. Laryngoscope, 2015
Cricothyroid joint anatomy as a predicting factor for success of cricoid-thyroid approximation in transwomen
Sarina Tschan, Flurin Honegger, Claudio Storck, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Cricoid-thyroid approximation (CTA) performed to elevate the vocal pitch in transwomen fails in about one-third of the patients. The purpose of this study was to test the feasibility of predicting the likelihood of success of CTA by preoperative determination of the crico-thyroid joint (CTJ) type using three-dimensional (3-D) images derived from high-resolution computer tomography (HRCT).
Study Design
Prospective cohort study of 18 transwomen who underwent CTA at our institution.
Methods
All patients had a preoperative and a postoperative HRCT of the larynx, as well as pre- and postoperative measurements of the fundamental vocal pitch (F0).
Results
Three-dimensional images showed type A CTJs in 11 patients and type B or C CTJs in seven patients (see below for the definition of these types). Cricoid-thyroid approximation raised the F0 on average by 76 Hz in patients with type A CTJs and by 45 Hz in patients with type B/C CTJs. Moreover, CTA produced a vocal fold elongation of 17% in larynges with type A joint but only of 3% in larynges with type B/C joints.
Conclusion
Three-dimensional images allow the differentiation of type A versus type B/C CTJs but not the distinction between type B and type C CTJs. Both vocal pitch elevation and vocal fold elongation following CTA are significantly greater in patients with type A CTJs than in patients with type B/C CTJs. Based on these preliminary results, we recommend identifying the CTJ type on 3-D images and limiting CTA to patients with type A CTJs.
Level of Evidence
4. Laryngoscope, 2015
Retropharyngeal lymph node involvement in human papillomavirus–associated oropharyngeal squamous cell carcinoma
Michael Baxter, Jason Y. K. Chan, Wojciech K. Mydlarz, Salvatore V. Labruzzo, Ana Kiess, Patrick K. Ha, Nafi Aygun, Nishant Agrawal, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The purpose of this study was to retrospectively review patients with human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC) for the presence of retropharyngeal lymph nodes (RPLNs) prior to treatment using positron emission tomography/computed tomography (PET/CT), and to determine if the presence of RPLNs is of utility in predicting outcomes.
Study Design
Retrospective review of patient data from a single institution.
Methods
Two hundred thirty patients with a diagnosis of HPV-associated OPSCC were identified from 2002 to 2013. The presence of RPLNs was determined primarily from findings on PET/CT as reviewed in a standardized fashion by two neuroradiologists.
Results
Of the 230 patients, 165 had pretreatment PET/CT imaging available for review. There were a total of 16 patients (9.70%) with evidence of RPLNs. Among patients positive for RPLNs pretreatment, with an average follow-up of 2 years, there was a 5.2-times greater odds of having recurrence or death (31.3% vs. 8.1%, P = .004). When T and N stage were adjusted for with multiple regression, there was no significant association between RPLN status and recurrence free survival.
Conclusions
This is a unique investigation utilizing PET/CT to classify RPLN status in HPV-associated OPSCC. RPLNs were relatively common in our HPV-associated OPSCC cohort at 9.70%, at the low end of the quoted positivity of 10% to 27% in all OPSCC. A combination of PET/CT is useful in identifying RPLNs. Prospective investigation will be needed to determine the sensitivity and specificity of PET/CT in identifying RPLNs, and the precise impact of RPLNs on HPV-associated OPSCC treatment and outcomes.
Level of Evidence
4. Laryngoscope, 2015
Wound-healing effect of acupuncture for treating phonotraumatic vocal pathologies: A cytokine study
Edwin M. L. Yiu, Karen M. K. Chan, Nicole Y. K. Li, Raymond Tsang, Katherine Verdolini Abbott, Elaine Kwong, Estella P. M. Ma, Fred W. Tse, Zhixiu Lin, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Acupuncture is a less-invasive procedure when compared with surgical treatment for benign vocal pathologies caused by vocal overuse. This study aimed to determine the wound-healing effect of acupuncture in treating phonotraumatic vocal fold lesions.
Study Design
Two-way, mixed-model, between- and within-subjects, prospective randomized, placebo-controlled, blinded group design.
Methods
Seventeen dysphonic individuals with vocal nodules were recruited from a university clinic in Hong Kong. Each participant was randomly assigned to receive one session of either genuine or sham acupuncture. The genuine acupuncture group (n = 9) received needles puncturing nine voice-related acupoints for 30 minutes, whereas the sham acupuncture group (n = 8) received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. Laryngeal secretions were suctioned from the surface of the vocal folds immediately before, immediately after, and 24 hours after the acupuncture. The protein concentration levels of wound-healing–related cytokines (interleukin [IL]-1β and IL-10) in these secretion samples were measured.
Results
Following acupuncture, a significant increase in the anti-inflammatory cytokine IL-10 was found in the genuine acupuncture group (n = 9) but not in the sham acupuncture group (n = 8).
Conclusions
The findings showed that acupuncture of voice-related acupoints facilitated an anti-inflammatory process in phonotraumatic vocal pathologies. This could be considered as supporting evidence to consider acupuncture as a less-invasive alternative option, when compared to surgery, for treating phonotraumatic vocal pathologies.
Level of Evidence
1b Laryngoscope, 2015
Results of pediatric tympanoplasty on short-term surgical missions
Glenn Isaacson, Abebe Melaku, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the safety and effectiveness of pediatric tympanoplasty performed on short-term international medical missions.
Study Design
Prospective observational study.
Methods
Ethiopian children who had dry or nearly dry tympanic perforations and bilateral conductive hearing losses underwent postauricular tympanoplasties with underlain temporalis fascia grafts. Pre- and postoperative air and bone audiometry was performed. Complications, graft success, hearing improvement, and dry ear at 6-month follow-up were evaluated.
Results
Patients were 7 to 25 years old (24 female ears, 20 male ears). The majority had subtotal perforations. Operative findings included ossicular erosions and fixation by hypertrophic mucosa. There were no major medical complications or deaths in this series.
Of 44 ears, 27 had complete pre- and postoperative audiometric data. Twenty-four of 44 surgeries resulted in an intact tympanic membrane. Twelve of 44 markedly reduced the perforation. Eight of 44 grafts failed. The mean improvement in PTA was 14 dB (range = −6–45 dB). Human immunodeficiency virus (HIV)+ patients had a high rate of graft failure (3/4) and comprised 38% (3/8) of complete graft failures (P = .015). Among the 20 ears with residual perforations, 14 were dry at 6-month follow-up. Of the six ears with drainage, three were HIV+ (P = .019).
Conclusions
Pediatric tympanoplasty is a safe procedure in a short-term surgical mission setting when high anesthetic and surgical standards are maintained. Surgical results were similar to those found in developing-world university hospitals, but were worse than in United States or European series. HIV+ children did worse than their HIV−/unknown peers, with a high rate of graft failure and persistent otorrhea.
Level of Evidence
4. Laryngoscope, 2015
Do otolaryngology residency applicants relocate for training?
Grant M. Gebhard, Leah J. Hauser, Miranda J. Dally, David A. Weitzenkamp, Cristina Cabrera-Muffly, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine whether there is an association between the geographic location of an applicant's undergraduate school, medical school, and residency program among matched otolaryngology residency applicants.
Study Design
Observational.
Methods
Otolaryngology residency program applications to our institution from 2009 to 2013 were analyzed. The geographic location of each applicant's undergraduate education and medical education were collected. Online public records were queried to determine the residency program location of matched applicants. Applicants who did not match or who attended medical school outside the United States were excluded. Metro area, state, and region were determined according to US Census Bureau definitions.
Results
From 2009 to 2013, 1,089 (78%) of 1,405 applicants who matched into otolaryngology residency applied to our institution. The number of subjects who attended medical school and residency in the same geographic region was 241 (22%) for metropolitan area, 305 (28%) for state, and 436 (40%) for region. There was no difference in geographic location retention by gender or couples match status of the subject. United States Medical Licensing Exam step 1 scores correlated with an increased likelihood of subjects staying within the same geographic region (P = .03).
Conclusions
Most otolaryngology applicants leave their previous geographic area to attend residency. Based on these data, the authors recommend against giving weight to geography as a factor when inviting applicants to interview.
Level of Evidence
NA Laryngoscope, 2015
Pediatric endoscopic ear surgery in clinical practice: Lessons learned and early outcomes
Michael S. Cohen, Lukas D. Landegger, Elliott D. Kozin, Daniel J. Lee, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Only a few reports describe the outcomes following endoscopic ear surgery (EES) in children for chronic ear disease. We differentiate between transcanal endoscopic ear surgery (TEES), where the case is performed with only endoscopic visualization, from non-TEES, where the endoscope is not used at all or used as an adjunct to the microscope. We hypothesize that EES is an effective approach to manage middle ear pathology using a transcanal approach in most cases, and can be incorporated into a pediatric otology practice with a neutral or positive effect on outcomes. Lessons learned during this process are analyzed and discussed.
Study Design
Single-institution, retrospective chart review of outcomes following TEES and non-TEES in children from January 1, 2013 through July 1, 2014.
Methods
Procedures included tympanoplasty, ossiculoplasty, and cholesteatoma resection. Primary outcome measures included closure rate of tympanic membrane perforations, audiometric outcomes, and complications. Surgical times were reported as secondary measures.
Results
Ninety-four patients underwent 121 middle ear procedures. TEES was performed in 51/121 of cases (42.1%). Comparison of TEES versus non-TEES cases showed no significant difference in rate of tympanoplasty closure (P > .99). The mean pure-tone improvement following TEES tympanoplasty was −7.8 dB versus −1.33 dB for non-TEES cases (P = .03). Surgical times were similar between groups.
Conclusions
EES techniques were readily incorporated into a pediatric otology practice. A standardized EES classification system is useful for analyzing utilization patterns and results across institutions. Tympanic membrane closure rates and hearing outcomes were similar in TEES and non-TEES cases.
Level of Evidence
4. Laryngoscope, 2015
Sinonasal malignancies: A population-based analysis of site-specific incidence and survival
Rahul Dutta, Pariket M. Dubal, Peter F. Svider, James K. Liu, Soly Baredes, Jean Anderson Eloy, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Sinonasal malignancies vary in behavior according to histology and anatomical location. Incidence, survival, and optimal treatment for these lesions are thus uncertain in various cases. Our objective was to utilize a national population-based registry to identify the most common sinonasal histopathologies by anatomical site, and subsequently analyze the data by incidence trends, survival rates, patient demographics, and treatment modalities.
Study Design
Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry.
Methods
The SEER database was examined for patients diagnosed with sinonasal malignancies between 1973 and 2011. Data were stratified according to anatomical site, incidence, survival, histology, staging, and patient demographics. Therapy-based outcomes were analyzed for cases from 1983 to 2011.
Results
A total of 13,295 patients were identified, with an incidence of 0.83 per 100,000 people. Males comprised 58.6% of cases. Whites represented 81.5% of cases, while blacks comprised 8.7%. Squamous cell carcinoma was the most common histology (41.9%) across all sites of the sinonasal tract. The most common anatomical site of malignancy was the nasal cavity (45.7%), and least common was the frontal sinus (1.2%). For single sites, 5-year disease-specific survival (DSS) was highest for nasal cavity tumors (67.1%) and lowest for overlapping sinus malignancies (37.6%). The overall 5-year DSS for all sinonasal malignancies was 53.7%.
Conclusion
Sinonasal malignancies are rare entities with poor overall prognosis. By anatomical site, prognosis is best for nasal cavity cancers and worst for overlapping lesions.
Level of Evidence
4. Laryngoscope, 2015
Clinical relevance of quality of life in laryngomalacia
Prasad John Thottam, Jeffrey P. Simons, Sukgi Choi, Raymond Maguire, Deepak K. Mehta, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To examine aspects of laryngomalacia and correlate findings with quality of life (QOL).
Study Design
Prospective cross-sectional study.
Methods
Seventy-two patients with laryngomalacia were examined; the mean age was 8.8 weeks. Parents answered questions from the Infant and Toddler Quality of Life Questionnaire–47 (ITQOL-SF47). Fiberoptic laryngoscopy and endoscopic examination of swallowing (FEES) were performed. The presence of laryngomalacia-associated characteristics and swallowing status were recorded. Patient age, sex, presence of reflux, clinical severity, anatomical findings, and swallowing results were evaluated through logistic regression. Independent sample ttests were used to compare responses on the ITQOL-SF47. Overall laryngomalacia ITQOL-SF47 scores were compared to the scores of a large healthy sample population.
Results
Forty-three (60%) patients had mild laryngomalacia, and 61 (85%) patients had findings suggesting gastroesophageal reflux disease. The most common abnormality was shortened aryepiglottic folds. Ten patients failed FEES. Patients with moderate laryngomalacia (χ = 7.62; P = .006) or prolapsing cuneiforms (χ = 4.79; P = .029) were more likely to fail FEES. Laryngomalacia severity impacted parental perception of their child's health (P < .05). Parents of children who demonstrated aspiration or penetration reported significant emotional impact (mean = 56.9; t = 2.74; P = .008). The mean ITQOL-SF47 scores of patients were significantly lower in certain sections than the reported general sample population.
Conclusions
Epiglottal prolapse correlated with severity of laryngomalacia and cuneiform prolapse with swallowing dysfunction. Perceptions of worsening health and physical ability were related to severity of disease. Swallowing dysfunction had a significant emotional impact on parental daily life. Infants with laryngomalacia have a lower QOL
Level of Evidence
3 Laryngoscope, 2015
In response to is the OSA-18 predictive of obstructive sleep apnea: Comparison to polysomnography
Stacey L. Ishman, Christina J. Yang, Aliza P. Cohen, James R. Benke, Rebecca M. Anderson, Marie E. Madden, Jareen K. Meinzen-Derr, Meredith E. Tabangin, 2015-08-25 08:44:11 AM
Characterization of retentive capacity of the subpericranial pocket in cochlear implants with and without a pedestal
Blake C. Papsin, Sharon L. Cushing, Bradley J. Hubbard, Daniel D. E. Wong, Karen A. Gordon, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To quantify the retentive capacity (RC) of the subpericranial pocket (SpP) in children undergoing cochlear implantation (CI) and measure improvements in RC with the addition of a pedestal to the device base. Retention of a CI in an SpP relies on the integrity of surrounding tissues to determine device position and resist movement from external forces. We hypothesize that device position can be controlled and resistance to movement can be improved with placement of a small pedestal on the base of the CI receiver stimulator.
Study Design
Analysis of prospectively assembled data.
Methods
Ninety-seven patients (145 devices) underwent CI (48 bilateral, 49 unilateral). Intraoperatively, a force gauge measured the displacement force on a template Nucleus 5 (Cochlear Corporation, Sydney, Australia) implant placed in an SpP prior to routine suture fixation of a standard device. In 47 patients (64 devices), displacement forces were also measured for a custom template Nucleus 5 implant with pedestal.
Results
Average RC of the SpP for the standard device was 5.59 N ± 2.73 standard deviation (SD), which increased to 9.401 N ± 4.6267 SD with a pedestaled device. Resistance to displacement decreased significantly across trials in both groups (P <.0001). Retentive capacity of the SpP increased significantly with the addition of a pedestaled device (P < .0001). The interaction between device and trial was also found to be significant (P = .05).
Conclusions
The RC of the SpP in children and the ability to resist device migration in the absence of fixation may improve with the addition of a pedestal attached to the device.
Level of Evidence
2b. Laryngoscope, 2015
Development of a novel larynx pacemaker multichannel array electrode: In vivo animal analysis
Bernd Faenger, Nikolaus P. Schumann, Dirk Arnold, Roland Grassme, Orlando Guntinas-Lichius, Hans-Christoph Scholle, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Electrical stimulation of posterior cricoarytenoid muscle offers a physiological approach to retain the function of the paralyzed larynx muscle after paralysis. The aim of this study was to develop and evaluate a durable, biocompatible, and atraumatic array electrode for inclusion in a larynx pacemaker. In addition to developing the electrode array, an evaluation methodology using in vivo multichannel electromyography was assessed.
Study Design
In vivo test procedures for material evaluation: an animal model.
Methods
Over the research period, 42 array electrodes representing nine different prototypes were implanted in the triceps brachii muscle of 21 rats. Biocompatibility and atraumatic functions were evaluated via observation. Electrode function and durability were determined by comparison of daily electromyographic measurements of the muscle activity of the front leg (triceps brachii muscle) during locomotion.
Results
The used animal model demonstrated electrode material problems that could not be material evaluation from in vitro tests alone. Through use of this in vivo method, it was found that an array tip that is durable, biocompatible, and atraumatic should consist of many small electrode plates cast in flexible silicone. The connecting wires to the individual electrode plates should be Litz wire, which consists of multiple strands.
Conclusions
The here demonstrated in vivo test method was a suitable animal model for designing and evaluating electrodes to be further developed for inclusion in human implants.
Level of Evidence
N/A. Laryngoscope, 2015
Prefabricated auricular cartilage radial forearm free flap reconstruction for cricoid chondrosarcoma
Ryan S. Jackson, Eliot J. Martin, Eric J. Moore, 2015-08-25 08:44:11 AM
This case describes a subtotal cricoid cartilage defect reconstructed with a prefabricated composite free flap. A 61-year-old man with a chondrosarcoma of the cricoid cartilage required a subtotal cricoidectomy. The resulting defect was successfully reconstructed with a two-stage prefabricated radial forearm free flap utilizing auricular cartilage. Our case further adds to the evidence that prefabricated flaps are reliable in airway reconstruction. Additionally, this provides another option for laryngeal preservation in patients with laryngeal chondrosarcoma.
Level of Evidence
NA Laryngoscope, 2015
The economic impact of vocal attrition in public school teachers in Miami-Dade County
David E. Rosow, Mikhaylo Szczupak, Sandra Saint-Victor, Julia D. Gerhard, Carl DuPont, Kaming Lo, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Teachers are a known at-risk population for voice disorders. The prevalence and risk factors for voice disorders have been well studied in this population, but little is known about the associated economic cost. The purpose of this study is to assess the economic impact of voice dysfunction in teachers and understand the difference between the cost of absenteeism and presenteeism as a direct result of voice dysfunction.
Study Design
Cross-sectional analysis via self-administered online questionnaire.
Methods
A total of 14,256 public school teachers from Miami-Dade County, Florida, were asked to participate. Questions were formatted based on the previously validated Work Productivity and Activity Impairment: Specific Health Problem questionnaire adapted for hoarseness and voice disorders. Additional demographic questions were included in the questionnaire.
Results
A total of 961 questionnaire responses were received. The demographic characteristics of respondents closely matched known statistics for public school teachers in Miami-Dade County. Economic calculations were performed for each questionnaire respondent and summed for all respondents to avoid bias. Per week, absenteeism-related costs were $25,000, whereas presenteeism-related costs were approximately $300,000. These figures were used to extrapolate annual cost. Per year, absenteeism-related costs were $1 million, whereas presenteeism-related costs were approximately $12 million.
Conclusion
The economic impact of voice dysfunction on the teaching profession is enormous. With the above calculations only including lost wages and decreased productivity, the actual figures may in fact be larger (cost of substitute teachers, impact on nonwork activities, etc.). Research investigating preventative measures for voice dysfunction in teachers is necessary to reduce this costly issue.
Level of Evidence
2C. Laryngoscope, 2015
Internal to external jugular vein bypass allowing for simultaneous bilateral radical neck dissection
Moustafa Mourad, Masoud Saman, Yadranko Ducic, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The goal of the study was to determine the role of internal jugular vein (IJV) to external jugular vein (EJV) bypass grafting in the setting of bilateral radical neck dissection with IJV sacrifice.
Study Design
The study group consisted of eight patients who underwent bilateral radical neck dissection with IJV sacrifice. Demographic and oncologic parameters were defined for each patient, including age, gender, and pathology. Patients were monitored and evaluated for potential effects of increased intracranial pressure (ICP). Doppler ultrasonic evaluation was performed to assess patency of the site of anastamoses.
Results
In all, six patients underwent unilateral bypass grafting, whereas two patients underwent bilateral bypass grafts. Average age at time of surgery was 68.2 (range 56–71). Postoperatively, no sequelae of increased ICP were noted. Follow-up ultrasonic evaluation revealed patent vessels in all patients.
Conclusion
We presently report on the use of EJV-to-IJV bypass grafting for all patients undergoing bilateral radical neck dissection for extensive neck disease.
Level of Evidence
4. Laryngoscope, 2015
Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review
Sara Serra-Torres, Carlos Bellot-Arcís, José M. Montiel-Company, Jaime Marco-Algarra, José M. Almerich-Silla, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). The main aim of this review was to assess the effectiveness of different devices in treating OSAHS, based on polysomnographic measurements such as the apnea/hypopnea index (AHI) and oxygen saturation, and on changes in the upper airway and improvements in the most common symptoms: snoring and somnolence. Their adverse effects were also noted.
Study Design
Systematic review.
Methods
Following an exhaustive search in the Medline, Scopus, and Cochrane Library databases, 22 articles published in the past 10 years met the quality and inclusion criteria.
Results
Using mandibular advancement devices during the hours of sleep helps to prevent snoring and excessive daytime sleepiness, reduce the AHI significantly, and bring about beneficial changes in the upper airway. Adjustable and custom-made mandibular advancement devices give better results than fixed and prefabricated appliances. Monobloc devices give rise to more adverse events, although these are generally mild and transient.
Conclusions
Mandibular advancement devices increase the area of the airway. They bring the soft palate, tongue, and hyoid bone forward and activate the masseter and submental muscles, preventing closure. All these effects reduce the AHI, increase the oxygen saturation, and improve the main symptoms of OSAHS.
Level of Evidence
NA Laryngoscope, 2015
Familial risk of pediatric chronic rhinosinusitis
Quinn Orb, Karen Curtin, Gretchen M. Oakley, Jathine Wong, Jeremy Meier, Richard R. Orlandi, Jeremiah A. Alt, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine the risk of chronic rhinosinusitis (CRS) in relatives of children with a diagnosis of CRS.
Study Design
Retrospective observational cohort study with population-based matched controls.
Methods
A unique genealogical database linked to medical records was used to identify subjects ≤12 years old with a diagnosis of CRS from 1996 to 2011. The familial recurrence risks of CRS in first- through fifth-degree relatives of probands were calculated using Cox models and compared to controls randomly selected from the Utah population and matched 10:1 on sex and birth year.
Results
We identified 496 pediatric patients with CRS. Siblings of patients with CRS demonstrated a 57.5-fold increased risk (P < 10−8) of also having pediatric CRS. First cousins had a 9.0-fold increased risk (P < 10−3) and second cousins had a 2.9-fold increased risk (P = .002) of pediatric CRS. First-degree relatives, second-degree relatives, and first cousins of pediatric cases demonstrated a significant increased risk of having adult CRS. Parents of probands demonstrated a 5.6-fold increased risk (P < 10−15). Fifty-five probands had one affected parent versus three probands with two affected parents.
Conclusions
In the largest population study to date of children with CRS, a significant familial risk is confirmed. Parents of probands were also at increased risk, although it was much more likely for one parent to be affected than both, suggesting a genetic component of the disease. Further understanding of the genetic basis of CRS and its interplay with environmental factors could clarify the etiology and lead to more effective targeted treatments.
Level of Evidence
3b Laryngoscope, 2015
A new open access journal
D. Bradley Welling, Michael G. Stewart, 2015-08-25 08:44:11 AM
Historical classics: Editorial
Myles L. Pensak, 2015-08-25 08:44:11 AM
Direct evidence of bacterial biofilms in otitis media
J. Christopher Post, 2015-08-25 08:44:11 AM
The large vestibular aqueduct syndrome
Galdino E. Valvassori, Jack D. Clemis, 2015-08-25 08:44:11 AM
Can technique used for gastrostomy tube placement reduce the risk of gastrostomy-site metastasis in head and neck cancer patients?
Sobia F. Khaja, Nathan M. Schularick, Henry T. Hoffman, 2015-08-25 08:44:11 AM
What is the role of endoscopic sinus surgery in adult patients with cystic fibrosis?
Amy Hughes, Eelam A. Adil, 2015-08-25 08:44:11 AM
Mucosal contact points and paranasal sinus pneumatization: Does radiology predict headache causality?
Islam R. Herzallah, Maged A. Hamed, Salem M. Salem, Maria V. Suurna, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The goal of this study was to evaluate the prevalence of mucosal contact points (MCP), concha bullosa (CB), and variable paranasal sinus (PNS) volumes among patients sent for rhinogenic headache workup as compared with controls.
Study Design
Retrospective study with case and control groups.
Methods
Fifty-three adults with clear PNS computed tomography (CT) scans were included: 28 patients who have originally undergone PNS CT scan as part of sinus (rhinogenic) headache workup, and 25 controls in whom PNS CT scans were obtained for other purposes. All subjects were asked to report their symptoms using a headache scoring system. CT scans of all subjects were analyzed for presence of MCP, CB, as well as for volumes of maxillary, frontal, and sphenoid sinuses.
Results
MCP was found in 40% of controls, and in 50%, 50%, and 40% of mild, moderate, and severe headache groups, respectively. CB was found in 24% of controls, and in 33.3%, 58.3%, and 20%, of mild, moderate, and severe headache groups, respectively. Total volume of the measured PNS ranged from 23.9 to 81.4 cm3 (mean ± standard deviation [SD], 48.3 ± 15.8) in the control group and from 5.31 to 87.4 cm3 (mean ± SD, 43.6 ± 16) in the patient group. No statistically significant difference was found between groups regarding all studied variables.
Conclusions
Radiological identification of MCP, CB, or hyperpneumatized sinuses does not seem to be a predictor of headache causality. Further studies are required to identify clinical scenarios in which these variations may contribute to pain symptoms.
Level of Evidence
3b. Laryngoscope, 125:2021–2026, 2015
Sinonasal organized Hematoma: Clinical features of seventeen cases and a systematic review
Soo Jung Choi, Sung Tae Seo, Ki-Sang Rha, Yong Min Kim, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Organized hematoma (OH) is a rare non-neoplastic disease. We studied the clinical characteristics of 17 patients with sinonasal OH and those of 75 cases in the English literature.
Study Design
Retrospective review of medical records and systematic review of the literature on OH.
Methods
Comprehensive review of the English-language literature on OH was performed. We screened all eligible cases based on initial features, and 75 eligible cases found in 15 publications were analyzed. We also retrospectively analyzed and compared medical records of 17 patients diagnosed with pathologically proven sinonasal OH. Data such as demographics, clinical characteristics, pathologic features, radiologic findings, treatment modalities, and follow-up results were compared to the 75 previously mentioned cases.
Results
Fifteen cases involved the maxillary sinus, one case involved the frontal sinus, and one case involved the sphenoid sinus. There were six patients over 60 years old, and all were taking an antiplatelet agent. The paranasal sinus computed tomography (CT) of seven patients showed bony destruction of the involved sinus. A review of the available literature revealed mostly similar results with our cases, except for the proportion of patients taking aspirin (5.3%) and sex distribution (male:female = 49:25).
Conclusions
We reported 17 cases of OH, including a case of frontal sinus and a case of sphenoid sinus lesion. A large proportion of OH patients had bony destruction of the affected sinus on CT. In these patients, a careful diagnosis should be made to distinguish them from a malignant tumor or other expansile diseases.
Level of Evidence
4. Laryngoscope, 125:2027–2033, 2015
Orbital decompression for the management of thyroid eye disease: An analysis of outcomes and complications
Todd T. Kingdom, Brett W. Davies, Vikram D. Durairaj, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To analyze the clinical outcomes for a large cohort of patients who underwent orbital decompression for thyroid eye disease (TED) utilizing a consistent surgical approach performed by a single surgical team.
Study Design
Retrospective case series.
Methods
Clinical data were gathered for patients who had undergone surgical decompression for TED. Outcomes analysis included reduction in proptosis (millimeters, Hertel measurements), visual acuity change (Snellen chart), diplopia (new or worsening), and complications.
Results
All patients underwent a combined endoscopic transnasal (medial) and transconjunctival (inferior/lateral) approach. A total of 114 surgeries (orbits) were performed on 77 patients during the period 2002 to 2013. Average follow-up was 31.3 months (range, 1–126 months). At last follow up, mean reduction in proptosis across all patients was 3.2 mm (range, 0–9 mm). Postoperatively, no patients reported new diplopia, whereas two patients reported worsening of their existing diplopia (3.8%). Decompression was performed for proptosis in 62 patients (91 orbits), and for compressive optic neuropathy (CON) in 15 patients (23 orbits). When performed for proptosis, mean reduction in proptosis was 3.4 mm. Vision was maintained or improved in all patients, including those presenting with CON.
Conclusions
Analysis of outcomes in this large cohort showed no new cases of diplopia and only two cases of worsening diplopia balanced with a mean reduction in proptosis consistent with previously reported series. In addition, we demonstrate excellent results stratified by clinical indication (proptosis vs. CON). These results validate the combined endoscopic–transconjunctival approach to orbital decompression for patients with symptomatic TED.
Level of Evidence
4. Laryngoscope, 125:2034–2040, 2015
Effect of steroids for nasal polyposis surgery: A placebo-controlled, randomized, double-blind study
Mustafa Cenk Ecevit, Taner Kemal Erdag, Ersoy Dogan, Semih Sutay, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Although medical intervention is the first option for treatment of nasal polyps, surgery is still a therapeutic option for symptomatic cases that do not respond or partially respond to medical intervention. However, there is a need for high-level evidence for the preoperative use of steroids in nasal polyposis surgery. We aimed to assess the perioperative effect of preoperative use of oral prednisolone for advanced-stage diffuse nasal polyposis.
Study Design
Prospective, double-blind, randomized, placebo-controlled study.
Methods
A visual analog scale (VAS) was evaluated for smell, nasal discharge, nasal obstruction, facial pressure, headache, butanol smell threshold, and peak nasal inspiratory flow (PNIF) before and after the use of study drug. Perioperative bleeding volume, visibility of operative field, operative time, hospital stay, and complication rate were also evaluated.
Results
The improvement in the corticosteroid group (CG) in the VAS scores, butanol thresholds, and PNIF values showed statistically significant differences compared to the placebo group (PG) (P < .05). The perioperative bleeding volume, visibility score, operative time, and hospital stay for CG/PG were 141 mL/384 mL, 2.4/3.4, 61 min/71.6 min, and 1.1 day/1.8 day, respectively (P < .05). The difference between the complication rates for the two groups did not show any statistically significant difference (P = .214).
Conclusions
Preoperative administration of systemic corticosteroids improves the perioperative visibility by reducing blood loss and shortens the operation time. We recommend the use of preoperative corticosteroid for the safety of the patients. The optimum dose and duration have not been established and require further studies.
Level of Evidence
1b Laryngoscope, 125:2041–2045, 2015
Contemporary applications of frontal sinus trephination: A systematic review of the literature
Alpen B. Patel, Rachel B. Cain, Devyani Lal, 2015-08-25 08:44:11 AM
Our objective was to perform a systematic review of the literature on contemporary indications and outcomes for frontal sinus trephination and present an illustrative case of an endoscopically assisted repair of a subcutaneous frontal sinus fistula by trephination technique. PubMed and Ovid databases were used as data sources. A systematic review of the English literature was completed to review reports of frontal trephination from 1980 to 2014. Articles meeting inclusion criteria for inflammatory and noninflammatory indications were reviewed. Articles were systematically reviewed and graded by evidence-based medicine level. An illustrative case from our institution is then presented. The systematic review identified 2,621 published studies. Thirty-eight studies were identified for inclusion. The indications, techniques, outcomes, safety, and complications were reviewed for noninflammatory and inflammatory conditions. There were 32 retrospective case series, reports, or cohort studies (level 4), four systematic reviews (level 3), one prospective analysis (level 3), and one meta-analysis (level 2). Due to the heterogeneity of study cases and inclusion criteria, a meta-analysis was not feasible. We also present a novel closure of an anterior skull base defect resulting in a subcutaneous fistula with use of a frontal trephination approach. The frontal sinus trephination should not be regarded as a procedure of the past, as it useful in the armamentarium of the modern sinus and skull base surgeon. This approach provides access for instrumentation for hard-to-reach frontal sinus disease either purely through a trephination approach or as a supplementation to the transnasal endoscopic approach. Evidence supporting frontal sinus trephination is of levels 2, 3, and 4.
Level of Evidence
NA Laryngoscope, 125:2046–2053, 2015
Mini invasive transoral approach to the glenoid fossa: Benign lesion removal using endoscopy
Valentino Valentini, Filippo Giovannetti, Paolo Priore, Ingrid Raponi, Valentina Terenzi, Andrea Cassoni, 2015-08-25 08:44:11 AM
Objective
We describe an endoscopic transoral approach for treating benign lesions of the glenoid fossa with or without infratemporal fossa involvement.
Study Design
Description and validation of surgical technique on living humans.
Methods
Excision of benign lesions arising from the glenoid fossa was achieved in five patients through a transoral endoscopic approach. Using 0- and 45-degree angled 4-mm optics, the entire middle skull base and infratemporal fossa were explored without damaging the nearby neurovascular structures.
Results
Three of the five patients had complete removal of osteochondroma. In the remaining two patients, the lesion removed was diagnosed as osteoma. In one patient, postoperative numbness of the alveolar nerve was observed. No infections were reported. The surgical approach utilized was determined to be valid not only for glenoid fossa exposure but also for management of the middle skull base and infratemporal fossa.
Conclusion
The described approach to the glenoid fossa offers direct and minimally invasive access to benign lesions within this region. Further use of this approach will allow us to determine its potential in treating malignancies.
Level of Evidence
4. Laryngoscope, 125:2054–2057, 2015
Long-term in vivo electromechanical reshaping for auricular reconstruction in the New Zealand white rabbit model
Karam W. Badran, Cyrus T. Manuel, Anthony Chin Loy, Christian Conderman, Yuk Yee Yau, Jennifer Lin, Tjoson Tjoa, Erica Su, Dmitriy Protsenko, Brian J. F. Wong, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To demonstrate the dosimetry effect of electromechanical reshaping (EMR) on cartilage shape change, structural integrity, cellular viability, and remodeling of grafts in an in vivo long-term animal model.
Study Design
Animal study.
Methods
A subperichondrial cartilaginous defect was created within the base of the pinna of 31 New Zealand white rabbits. Autologous costal cartilage grafts were electromechanically reshaped to resemble the rabbit auricular base framework and mechanically secured into the pinna base defect. Forty-nine costal cartilage specimens (four control and 45 experimental) successfully underwent EMR using a paired set of voltage-time combinations and survived for 6 or 12 weeks. Shape change was measured, and specimens were analyzed using digital imaging, tissue histology, and confocal microscopy with LIVE-DEAD viability assays.
Results
Shape change was proportional to charge transfer in all experimental specimens (P < .01) and increased with voltage. All experimental specimens contoured to the auricular base. Focal cartilage degeneration and fibrosis was observed where needle electrodes were inserted, ranging from 2.2 to 3.9 mm. The response to injury increased with increasing charge transfer and survival duration.
Conclusions
EMR results in appropriate shape change in cartilage grafts with chondrocyte injury highly localized. These studies suggest that elements of auricular reconstruction may be feasible using EMR. Extended survival periods and further optimization of voltage-time pairs are necessary to evaluate the long-term effects and shape-change potential of EMR.
Levels of Evidence
NA Laryngoscope, 125:2058–2066, 2015
Laser-assisted cartilage reshaping for protruding ears: A review of the clinical applications
Franck Marie Leclère, Peter M. Vogt, Vincent Casoli, Spiros Vlachos, Serge Mordon, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
In 2006, our institute reported the first clinical use of laser-assisted cartilage reshaping (LACR) for protruding ears. Since then, the technique has been developed and refined. This article reviews the literature on the clinical application of LACR.
Study Design
Literature review.
Methods
A MEDLINE literature search was performed on LACR combined with cross-referencing. The period of search was 1993 to 2014. Search terms used were: laser, cartilage reshaping, protruding ears, LACR.
Results
Only seven clinical studies using three different wavelengths were found in the literature: 1,064 nm (Nd:YAG), 10,600 nm (CO2), and 1540 nm (Er:Glass). Clinical outcomes, laser wavelength and parameters, and patient satisfaction are discussed in each case.
Conclusions
The success rate for ear reshaping achieved with LACR appears promising. The use of this noninvasive technique will increase in the near future.
Level of Evidence
Laryngoscope, 125:2067–2071, 2015
Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database
Sayaka Suzuki, Hideo Yasunaga, Hiroki Matsui, Kiyohide Fushimi, Tatsuya Yamasoba, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The aim of the study was to evaluate the factors associated with the development of severe epiglottitis in adults to provide information for physicians to make early decisions on airway management.
Study Design
Retrospective cohort study.
Methods
Adult patients admitted to acute care hospitals with a diagnosis of acute epiglottitis between January 2011 and December 2012 were identified in the Diagnosis Procedure Combination database of Japan. The main outcome measures were: 1) severe epiglottitis requiring airway intervention or resulting in early death within 2 days after admission and 2) 2-day mortality. Multivariable logistic regression analysis was performed to evaluate the association between patient characteristics and development of severe epiglottitis.
Results
A total of 6,072 epiglottitis patients from 599 hospitals were identified. The proportion of developing severe epiglottitis was 9.4%, and 2-day mortality was 0.4%. Factors significantly associated with severe epiglottitis were older age, male sex (adjusted odds ratio [OR] 1.60; 95% confidence interval [CI], 1.28–2.00; P < .001), body mass index (BMI) >25.0 kg/m2 (OR 1.31; 95% CI, 1.05–1.63; P = .018), diabetes mellitus (OR 1.41; 95% CI, 1.06–1.86; P = .017), epiglottic cyst (OR 2.90; 95% CI, 1.46–5.78; P = .002), pneumonia (OR 2.90; 95% CI, 1.73–4.86; P < .001), and academic hospitals (OR 1.56; 95% CI, 1.21–2.00; P = .001). Epiglottitis-related admission was summer-dominant, but seasonality was not significantly associated with severe epiglottitis.
Conclusion
Development of severe epiglottitis was significantly associated with older age, BMI >25.0 kg/m2, diabetes mellitus, epiglottic cyst, or pneumonia at admission.
Level of Evidence
2b. Laryngoscope, 125:2072–2078, 2015
Epstein-Barr virus in the enlarged salivary tissues of patients with IgG4-related disease
Takatoshi Furukawa, Yoshitaka Shimotai, Nobuo Ohta, Akihiro Ishida, Kazuya Kurakami, Hitoshi Suzuki, Mitsunori Yamakawa, Seiji Hongo, Seiji Kakehata, 2015-08-25 08:44:11 AM
Objective
Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized disease entity characterized by high-serum IgG4 concentration and IgG4-producing plasma cell production with fibrotic or sclerotic changes in affected organs. We aimed to clarify the roles of Epstein-Barr virus (EBV) in patients with IgG4-RDs.
Study Design and Setting
A retrospective clinical study at the Yamagata University School of Medicine, Yamagata, Japan.
Methods
The patient group consisted of four males and four females with an average age of 62 years (range: 48–73). Expression of IgG4, latent member protein 1, EBV nuclear antigens-2, and EBV-encoded RNA in affected salivary glands from patients with IgG4-RD was examined by using immunohistochemistry and in situ hybridization. The copy number of EBV DNA in the salivary glands was also investigated by real-time polymerase chain reaction.
Results
All patients had hard masses in the salivary or lacrimal glands, or both, bilaterally. Serum concentrations of IgG4 were elevated in all cases (mean 589.1, range 129–1750), and IgG4-positive plasmacytes were observed in the involved salivary glands. Four patients developed potentially life-threatening systemic involvement after initial salivary gland swelling. EBV-associated molecules (EBNA and EBER) were overexpressed in the affected salivary glands. The copy number of EBV DNA was significantly higher in patients with potentially life-threatening systemic involvement than in patients without systemic involvement (P < 0.05).
Conclusion
These results suggest that the copy number of EBV DNA could be useful as diagnostic findings in IgG4-RD to predict potentially life-threatening systemic involvement.
Level of Evidence
4. Laryngoscope, 125:2079–2084, 2015
Effects of honey on oral mucositis in patients with head and neck Cancer: A meta-analysis
Hye Kyung Cho, Yeon Min Jeong, Ho Seok Lee, Yeon Ji Lee, Se Hwan Hwang, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The objective of this study was to perform a meta-analysis of the efficacy of honey in the management of oral mucositis during radiotherapy in patients with head and neck cancer.
Study Design
Meta-analysis using MEDLINE, Scopus, and the Cochrane Library as data sources.
Methods
Two authors independently searched the databases for relevant studies from inception to June 2014. Included in the meta-analysis were randomized controlled studies published in English comparing the oral administration of honey (honey group) with placebo or no treatment (control group) in patients with head and neck cancer who were undergoing radiotherapy or chemoradiotherapy. Excluded studies failed to report quantifiable outcome measures regarding oral mucositis. Outcomes of interest included the degree and incidence of mucositis, incidence of microbial colonization, and weight loss.
Results
Nine studies comprising 476 patients were included in the meta-analysis. The incidence of moderate to severe mucositis and the mean mucositis grade during the first 3 weeks of therapy were significantly lower in the honey group than the control group. Additionally, the onset of mucositis was significantly later in the honey group than the control. Although there were no significant differences in the incidences of microbial colonization and pain experienced between the two groups, the incidence of weight loss was significantly lower in the honey group than control group.
Conclusions
Oral administration of honey after radiotherapy could prevent moderate to severe mucositis and associated weight loss. However, because our results were based on an analysis of a small number of trials, further trials are required to confirm these results.
Level of Evidence
NA Laryngoscope, 125:2085–2092, 2015
Differences in survival outcome between stage I and stage II glottic cancer: A SEER-based analysis
Jonathan J. Chen, Alexander Stessin, Paul Christos, A. Gabriella Wernicke, Dattatreyudu Nori, Bhupesh Parashar, 2015-08-25 08:44:11 AM
Objective
The purpose of this study was to investigate and compare the cause-specific survival (CSS) of stage I (tumor [T]1 node [N]0 metastasis [M]0) versus stage II (T2N0M0) glottic cancer in a large population cohort.
Study Design
We analyzed data from the Surveillance, Epidemiology, and End Results 18 database from 1973 to 2009, comprising patients diagnosed with T1N0M0 or T2N0M0 squamous cell glottic cancer. Kaplan-Meier survival analysis, multivariable Cox proportional hazards regression analysis, and competing-risks survival regression were used for statistical analysis.
Results
There were 4,422 patients who met all inclusion criteria. The 36-month CSS was 93.9% for stage I verus 86.5% for stage II, with P < 0.0001. Stage II status conferred a 2.494 hazard ratio for increased risk of cause-specific death compared to stage I.
Conclusions
Stage II glottic cancers have a significantly worse prognosis and may need a different approach to management than stage I tumors.
Level of Evidence
4. Laryngoscope, 125:2093–2098, 2015
Implications of intraglandular lymph node metastases in primary carcinomas of the parotid gland
Lluís Nisa, Cinzia Salmina, Matthias Stephan Dettmer, Andreas Arnold, Daniel Matthias Aebersold, Urs Borner, Roland Giger, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Assess the diagnostic and prognostic relevance of intraglandular lymph node (IGLN) metastases in primary parotid gland carcinomas (PGCs).
Study Design
Retrospective study at a tertiary referral university hospital.
Methods
We reviewed the records of 95 patients with primary PGCs, treated at least surgically, between 1997 and 2010. We assessed the clinicopathological associations of IGLN metastases, their prognostic significance, and predictive value in the diagnosis of occult neck lymph node metastases
Results
Twenty-four (25.26%) patients had IGLN metastases. This feature was significantly more prevalent in patients with advanced pT status (P = .01), pN status (P < .01), and overall stage (P < .001); high-risk carcinomas (P = .01); as well as in patients with treatment failures (P < .01). IGLN involvement was significantly associated with decreased univariate disease-free survival (P < .001). Positive and negative predictive values and accuracy for IGLN involvement in the detection of occult neck lymph node metastases were 63.64%, 90.48%, and 84.91%, respectively. The diagnostic values were generally higher in patients with low-risk subtype of PGCs.
Conclusions
IGLN involvement provides prognostic information and is associated with advanced tumoral stage and higher risk of recurrence. This feature could be used as a potential readout to determine whether a neck dissection in clinically negative neck lymph nodes is needed or not.
Level of Evidence
4. Laryngoscope, 125:2099–2106, 2015
Surgical margins and oncologic results after carcinoma of the external auditory canal
Friedrich Ihler, Mario Koopmann, Bernhard G. Weiss, Leif Hendrik Dröge, Martin Durisin, Hans Christiansen, Daniel Weiß, Martin Canis, Hendrik A. Wolff, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
External auditory canal cancer is rare and carries a poor prognosis. To date, only a few studies provide evidence for clinical decision making in multimodal treatment.
Methods
Retrospective chart review of 36 cases in three tertiary referral centers.
Results
Thirteen patients were treated by surgery alone, 18 by surgery with adjuvant chemoradiotherapy (CRT) and five by primary CRT. Clear surgical margins (R0) were obtained in 19 patients and positive margins (R1) in 12. The 5-year overall survival and local control rates were 59.4% and 74.2% with R0 status versus 56.6% and 26.3% with R1 status. The 5-year overall survival and local control rates were 46.2% and 70.7% with surgery alone, 78.1% and 43.2% with surgery and adjuvant CRT, and 25.0% and 80.0% with primary CRT.
Conclusion
Surgery is integral to the management of external auditory canal cancer, whereas CRT is necessary as an adjuvant or primary treatment, depending on tumor stage.
Level of Evidence
4. Laryngoscope, 125:2107–2112, 2015
Comorbid diseases of IgG4-related sialadenitis in the head and neck region
Xia Hong, Zhi-Peng Sun, Wei Li, Yan Chen, Yan Gao, Jia-Zeng Su, Zhen Wang, Zhi-Gang Cai, Tong-Tong Li, Lei Zhang, Xiao-Jing Liu, Yan-Ying Liu, Jing He, Zhan-Guo Li, Guang-Yan Yu, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To further recognize the comorbid diseases of immunoglobulin G4-related sialadenitis (IgG4-RS) in the head and neck region and to observe the response of these conditions to immunomodulatory therapy.
Study Design
Retrospective review.
Methods
The symptoms of comorbid diseases and medical histories in 51 patients (24 men, 27 women; median age, 55 years) diagnosed with IgG4-RS were analyzed. Thirty-six patients received immunomodulatory therapy and were followed up for 10.4 ± 5.9 months. Computed tomography (CT) examination was performed before and after therapy.
Results
Rhinosinusitis occurred in 58.8% patients, and manifested with the symptoms of nasal obstruction, nasal xerosis, and hyposmia. In addition, 43.1% patients had allergic rhinitis. Lymphadenopathy was identified in 74.5% patients. Lacrimal gland swelling occurred in 78.4% patients. Extraocular muscles, otologic organs, skin and superficial soft tissue, and cranial nerves were also involved. All of the lesions were relieved after immunomodulatory therapy. The Lund-Mackay scores decreased (9.6 ± 5.6 to 1.0 ± 2.2) according to CT analyses (P < .05). Mean CT volumes of the swollen lymph nodes and lacrimal glands decreased from 1.21 ± 0.61 cm3 to 0.59 ± 0.35 cm3 and from 2.25 ± 1.35 cm3 to 0.70 ± 0.32 cm3, respectively (P < .05) after treatment.
Conclusions
IgG4-RS could potentially develop with involvement of ocular adnexa, sinonasal cavities, ears, lymph nodes, skin and superficial soft tissue, and cranial nerves in the head and neck region. Immunomodulatory therapy could be effective in controlling both the comorbid diseases of IgG4-RS and sialadenitis of the major salivary glands.
Level of Evidence
4 Laryngoscope, 125:2113–2118, 2015
Transoral mandibulectomy and double barrel fibular flap reconstruction
Adam S. Jacobson, Erin Alpert, Mark Persky, Devin Okay, Daniel Buchbinder, Cathy Lazarus, 2015-08-25 08:44:11 AM
Acellular dermal matrices and revision parotid surgery
Mazin Merdad, David W. Eisele, 2015-08-25 08:44:11 AM
Facial palsy after neck arteriovenous fistula embolization
Dong Hoon Lee, Joon Kyoo Lee, Tae Mi Yoon, Sang Chul Lim, Tae Sun Kim, 2015-08-25 08:44:11 AM
Facial palsy after embolization of neck arteriovenous fistula is an extremely rare complication. In our case, complete facial palsy occurred after embolization and was successfully treated with superficial parotidectomy, vessel ligation, and plug removal. We report the first case of unusual facial palsy that developed 13 days after neck arteriovenous fistula embolization. As a result of our findings, we recommend, when a patient suffers from acute ipsilateral facial palsy after arteriovenous fistula embolization, the clinician should consider the possibility of complications of embolization, and immediate and appropriate management should be performed. Laryngoscope, 125:2125–2128, 2015
Temporal characteristics of hyolaryngeal structural movements in normal swallowing
Hyung Seok Nam, Byung-Mo Oh, Tai Ryoon Han, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To evaluate the relationship between movements of hyolaryngeal structures and fluid bolus transition in normal swallowing using automatized kinematic analysis of the videofluoroscopic swallowing study (VFSS).
Study Design
A prospective, descriptive study.
Methods
Seventy-five healthy volunteers underwent VFSS with 2 mL of diluted barium. The timing and sequence of structural movements were measured for laryngeal elevation (LE), hyoid excursion (HE), epiglottic rotation (ER), and fluid bolus transition.
Results
The rapid movement of LE (reference time point) was initiated simultaneously with the fluid bolus head passing the mandibular angle (−0.05 s, P = .07), followed by rapid onset of HE with significant temporal difference (P < .001). After the hyoid onset, onset of ER (0.17 s, P < .001), entrance of the bolus through upper esophageal sphincter (0.33 s, P < .001), maximal point of LE (0.52 s, P < .001), HE (0.53 s, P = .344), and maximal point of ER (0.64 s, P < .001) followed sequentially. For subgroup analysis, we classified 50 subjects without premature bolus loss (PBL) or pharyngeal triggering delay (PTD) into the "early group," and 24 subjects with PBL or PTD for <1 s into the "late group." In both groups, the sequence of the structural movements did not change. The early group showed significant correlation between the fluid transition and structural movements; both LE and HE were initiated when the bolus passed the mandibular angle, and the ER was initiated when the bolus reached the vallecula.
Conclusions
We demonstrated a characteristic pattern of hyolaryngeal structural movements in normal swallowing. The results may serve as a basis for classifying and analyzing aspiration patterns in patients with dysphagia.
Level of Evidence
NA Laryngoscope, 125:2129–2133, 2015
Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients
Sapna A. Patel, Emily K. Plowman, Stacey Halum, Albert L. Merati, Maya G. Sardesai, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To determine whether the timing of tracheotomy placement impacts ventilation weaning status and mortality.
Study Design
Multi-institution retrospective cohort study.
Methods
Demographic data, procedural details, and clinical outcomes were recorded for patients undergoing tracheotomy for prolonged mechanical ventilation across eight sites. The study group was divided into two groups: those undergoing tracheotomy within 14 days of initiation of mechanical ventilation and those undergoing tracheotomy at or after 14 days. Groups were compared for primary outcome measures of mortality and ability to wean from mechanical ventilation within the study period.
Results
Of the 539 patients intubated for ventilator dependence with complete data available, 280 (51.9%) underwent tracheotomy within 14 days. Patients who underwent late tracheotomy were 1.72 times more likely to remain ventilator dependent during the follow-up period (95% confidence interval [CI]: 1.12-2.66), and had a 40% increased risk of death (odds ratio: 1.4, 95% CI: 0.96-1.99).
Conclusions
In this multicenter retrospective review of tracheotomy outcomes, late tracheotomy placement (>14 days) was associated with increased mortality and prolonged ventilator dependence. Standardized multidisciplinary management protocols for prolonged mechanical ventilation are recommended, and future work should confirm these results in a prospective manner.
Level of Evidence
4 Laryngoscope, 125:2134–2138, 2015
Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue
Juliana K. Litts, Jackie L. Gartner-Schmidt, Matthew S. Clary, Amanda I. Gillespie, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
This study investigated financial and treatment implications of a speech-language pathologist (SLP) performing a voice evaluation at the initial laryngologic visit.
Study Design
Retrospective chart review.
Methods
Medical records from 75 consecutive adult voice therapy patients during a 3-month period were categorized into two groups: group 1 (n = 37) represented patients who underwent a medical speech evaluation (MSE) at the initial voice assessment with the laryngologist (+SLP), and group 2 (n = 38) represented patients who did not receive an MSE (−SLP). Data collected included age, gender, voice diagnosis, number of therapy sessions attended and cancelled, reason for discharge, and pre– and post–voice therapy Voice Handicap Index-10 (VHI-10) scores.
Results
Patients in the +SLP group had fewer cancellations (P = 0.001), greater change in VHI-10 from pre- to post-therapy (P = .001), and were more likely to be discharged from therapy having met therapeutic goals (P = .007) than patients in the −SLP group. In addition, lost revenue over 3 months due to cancellations/no-shows was $2,260 in the +SLP group compared to $7,030 in the −SLP group (P < .001).
Conclusions
Concurrent voice evaluation by an SLP and laryngologist at initial diagnostic visit affects therapy attendance, voice therapy outcomes, and ultimately SLP and departmental billing revenue. Results may be due to more appropriate therapy referrals from SLP assessment of patients in conjunction with a laryngologist.
Level of Evidence
4 Laryngoscope, 125:2139–2142, 2015
Supracricoid laryngectomy and dysphagia: A systematic literature review
Marieke Lips, Renée Speyer, Anne Zumach, Kenneth W. Kross, Bernd Kremer, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Perform a systematic literature search to provide an overview of today's literature regarding the different aspects that can cause dysphagia after supracricoid laryngectomy.
Study Design
A systematic literature review.
Review Methods
The inclusion criteria were laryngeal cancer, supracricoid laryngectomy, and swallowing. Thirty-one qualifying articles were included and analyzed describing swallowing after supracricoid laryngectomy.
Results
Included studies examined the incidence of dysphagia and discussed various factors that will or will not contribute to dysphagia after supracricoid laryngectomy, type of reconstruction, swallow training, radiation, arytenoid cartilage resection, extended procedures, and age.
Conclusion
A high incidence of dysphagia was reported after supracricoid laryngectomy. However, good recovery rates were observed with low incidence of severe complications. The included studies used different methods and standards to start oral intake, remove the nasogastric feeding tube, and observe swallow function. Homogenous study population and standardized guidelines on how to handle the pre- and postoperative course after supracricoid laryngectomy and how to measure swallow function could improve further research. Laryngoscope, 125:2143–2156, 2015
Technical tip for difficult injection laryngoplasty: The use of a hypodermic needle as a retractor
Sharan Chakkyath Jayaram, Declan Costello, 2015-08-25 08:44:11 AM
Evaluation of an otoscopy simulator to teach otoscopy and normative anatomy to first year medical students
Daniel J. Lee, Terence S. Fu, Brian Carrillo, Paolo Campisi, Vito Forte, Albino Chiodo, 2015-08-25 08:44:11 AM
Objective/Hypothesis
Our study evaluates the effectiveness of the OtoSim as an educational tool for teaching otoscopy and normal middle ear anatomy to first-year medical students.
Study Design
Cross-sectional survey design.
Methods
A large group otoscopy simulator teaching session was held in January 2014 for 29 first-year medical students at the University of Toronto. Following the training session, survey questions were administered to assess the student experience.
Results
A total of 29 students completed the survey. All respondents rated the overall quality of the event as very good or excellent. Ninety-three percent of respondents indicated that the simulator increased their confidence in otoscopy. Students also commented that they were able to learn normal middle ear anatomy without causing discomfort to patients.
Conclusions
The use of otoscopy simulation is a novel addition to traditional learning methods for undergraduate medical students. Students can effectively learn normal external and middle ear anatomy and improve their confidence in performing otoscopy examination.
Level of Evidence
NA Laryngoscope, 125:2159–2162, 2015
Conservative management of vestibular schwannoma: Predictors of growth and hearing
Daniel Jethanamest, Andrew M. Rivera, Hongzhao Ji, Venkatakarthikeyan Chokkalingam, Fred F. Telischi, Simon I. Angeli, 2015-08-25 08:44:11 AM
Objective
To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss.
Study Design
Retrospective review.
Methods
A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed.
Results
A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03–8.50;P = 0.04) for tumor growth.
Conclusion
Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth.
Level of Evidence
4. Laryngoscope, 125:2163–2168, 2015
Variations in the cochlear implant experience in children with enlarged vestibular aqueduct
Cedric Pritchett, Teresa Zwolan, Farhan Huq, Amanda Phillips, Hemant Parmar, Mohannad Ibrahim, Marc Thorne, Steven Telian, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To describe the clinical experience and characterize the outcomes of cochlear implantation (CI) in children with isolated enlarged vestibular aqueduct (IEVA) as compared to children with enlarged vestibular aqueduct (EVA) associated with other bony labyrinth abnormalities.
Study Design
Single, tertiary care, institutional retrospective review over 2 decades.
Methods
The clinical course and outcomes of 55 children with EVA undergoing CI between 1991 and 2013 were reviewed. Test measures included open and closed set speech perception tests, and various speech and language measures.
Results
In 18 children (32.7%), IEVA was the only defect present. In 33 children (60%), EVA occurred concomitantly with incomplete partition type 2 (IP 2) bilaterally, and three children with incomplete partition type 1 bilaterally. Ninety-two percent (51 of 55) occurred bilaterally and had matching bony defects. Mean age of CI was 73.4 months. A statistically significant defect-related and linguistic-status pattern was noted, impacting the timing of implantation: IEVA = 112.8 months, IP 2 = 58.4 months (P < .001), prelingual deafness = 53.8 months, postlingual deafness = 110.8 months (P < .001). Controlling for implant age and hearing loss severity, IEVA children demonstrated superior performance on speech perception tests (8.2 to 20.3 point differences), though statistical significance was inconsistent (P = .01–.40. Performance was also superior in speech and language tests, though statistical significance was never reached (2.9–13.9 point differences; P = .14–.69).
Conclusions
Children with hearing loss secondary to EVA respond meaningfully to cochlear implantation. However, the severity of temporal bone anomalies in these children has clinical relevance.
Level of Evidence
4 Laryngoscope, 125:2169–2174, 2015
Genetic aspects and clinical characteristics of familial meniere's disease in a South Korean population
Jeon Mi Lee, Mi Joo Kim, Jinsei Jung, Hyun Ji Kim, Young Joon Seo, Sung Huhn Kim, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
This study was undertaken to investigate the prevalence, inheritance patterns, and clinical characteristics of familial Meniere's disease (MD) in a South Korean population.
Study Design
Direct interviews, telephone interviews, and reviews of the medical records of definite Meniere's disease patients and their families.
Methods
Direct and telephone interviews were performed for 286 definite MD patients and their family members who were suspected of having MD. The diagnosis of MD in family members was made by obtaining a detailed history, performing basic neurotological examinations and reviewing hearing test results. The clinical characteristics as well as the prevalence and inheritance patterns of familial MD were analyzed.
Results
The prevalence of familial Meniere-like syndrome (at least one family member with definite MD and other members with probable MD) and definite familial MD (two or more family members with definite Meniere's disease) were 9.8% and 6.3%, respectively, and the most common inheritance pattern was autosomal dominant with incomplete penetrance. The significant clinical characteristics of familial cases were an early disease onset and a higher prevalence of migraines.
Conclusions
This is the first report describing the genetic aspects of MD in a single large Asian population. The prevalence of definite familial MD was 6.3% with an incomplete autosomal dominant inheritance pattern in most cases. Early-onset age and a high prevalence of migraines were significant clinical features of familial MD in this South Korean population. These data could provide a basis for the analysis of the genetic mechanism of familial MD in Asian populations.
Level of Evidence
4 Laryngoscope, 125:2175–2180, 2015
Oral pseudoephedrine decreases the rate of transmucosal nitrous oxide exchange for the middle ear
Miriam S. Teixeira, Cuneyt M. Alper, Brian S. Martin, Brendan M. Cullen Doyle, William J. Doyle, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Determine if oral treatment with a vasoconstrictor decreases the blood to middle ear exchange rate of the perfusion-limited gas, nitrous oxide (N2O).
Study Design
Randomized, double-blind, crossover study.
Methods
Ten adult subjects with and 10 without past middle ear disease completed paired experimental sessions, identical except for oral treatment with either pseudoephedrine hydrochloride or lactose placebo. At each session, subjects were fitted with a nonrebreathing mask and breathed room air for 20 minutes (acclimation period), 50% N2O:50% O2 for 20 minutes (experimental period), and 100% O2 for 10 minutes (recovery period). Throughout, heart rate, blood pressure, and O2 saturation were monitored, and bilateral middle ear pressures were recorded by tympanometry every minute. The primary outcome was the slope of the middle ear pressure-time function for the experimental period, which estimates the volume N2O exchange rate. Using repeated measures analysis of variance, the effects of group (disease history), treatment (active vs. placebo), and period (1 vs. 2) on the recorded vital signs, and of group, treatment, and ear (left/right) on the middle ear pressure-time slope were evaluated for statistical significance.
Results
Statistically significant effects of period on O2 saturation (period 2 > period 1) and of treatment on heart rate (active > placebo) were documented. Only treatment was statistically significant for the middle ear pressure-time slope, with a shallower slope characterizing the active treatment session.
Conclusions
The volume exchange rate across the middle ear mucosa of perfusion-limited gases can be modulated pharmacologically. Theoretically, similar drugs can be used to reduce the requisite eustachian tube opening efficiency for adequate middle ear pressure regulation.
Level of Evidence
1b Laryngoscope, 125:2181–2186, 2015
Do the angle and length of the eustachian tube influence the development of chronic otitis media?
Aykut Erdem Dinç, Murat Damar, Mehmet Birol Uğur, Ibrahim Ilker Öz, Sultan Şevik Eliçora, Sultan Bişkin, Hakan Tutar, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM.
Study Design
A retrospective case-control study.
Methods
The study group comprised 125 patients (age range, 8–79 years; 64 males and 61 females) with 124 normal ears and 126 diseased ears, including ears with chronic suppurative otitis media (CSOM) with central perforation, intratympanic tympanosclerosis (ITTS), cholesteatoma, and a tympanic membrane with retraction pockets (TMRP). ET angle and length were measured using computed tomography employing the multiplanar reconstruction technique.
Results
The ETa was significantly more horizontal in diseased versus normal ears of all study groups (P = .030), and there was no group difference in ETl (P = .160). ETl was shorter in CSOM versus ITTS ears and normal ears (P = .007 and P = .003, respectively) and in cholesteatoma versus TMRP ears (P = .014). In the unilateral COM group, there were no significant differences in the ETa or ETl of diseased versus contralateral normal ears (P = .155 and P = .710, respectively). The ETa was significantly more horizontal in childhood-onset diseased versus normal ears (P = .027), and there was no group difference in ETl (P = .732). The ETa (P = .002) and ETl (P < .001) were significantly greater in males than females.
Conclusions
A more horizontal ETa and shorter ETl could be contributory (though not significantly) etiological factors in the development of COM.
Level of Evidence
3b Laryngoscope, 125:2187–2192, 2015
Surgical management of Patulous eustachian tube: A systematic review
Ahmed A. Hussein, Austin S. Adams, Justin H. Turner, 2015-08-25 08:44:11 AM
Objectives
Patulous Eustachian tube (PET) is a challenging clinical problem with limited medical and surgical options. The current study systematically reviews the literature to determine the safety and efficacy of surgical treatments for PET.
Data Sources
Medline, Google Scholar, and Cochrane databases.
Methods
Studies evaluating the surgical management of PET were extracted based on defined inclusion criteria. Data including surgical techniques, outcomes, and complications were extracted and analyzed.
Results
A total of 1,616 studies were retrieved from the initial search. Of these, 14 studies comprising a total of 226 patients (253 sides) met inclusion criteria and were evaluated for surgical techniques, patient outcomes, and complications. As defined by the Oxford Center for Evidence-Based Medicine (Oxford, UK), all studies were classified as level 4 evidence. The most commonly reported techniques were ET plugging (3 studies), PE tube placement (2 studies), and suture ligation (2 studies). Postoperative follow-up ranged from 2 to 60 months (mean, 20.6 months). Outcome measures varied significantly between individual studies, with overall symptom improvement reported between 22% and 100% (mean 72.4%; 95% CI, 62.5%–81.2%). A low incidence of minor complications was reported in nine of 14 studies.
Conclusions
Current literature evaluating the surgical management of PET is limited and comprised entirely of level 4 studies. Comparisons between techniques were not possible due to the small number of studies and variable outcome measures. Future larger studies evaluating defined outcomes and quality-of-life measures are needed to determine the comparative efficacy of surgical treatments for this challenging condition. Laryngoscope, 125:2193–2198, 2015
Endoscopic endonasal surgery for benign fibro-osseous lesions of the pediatric skull base
Amanda L. Stapleton, Elizabeth C. Tyler-Kabara, Paul A. Gardner, Carl H. Snyderman, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To describe the presentation, treatment, and outcomes of benign fibro-osseous tumors involving the skull base in a pediatric population.
Methods
Retrospective chart review from January 2002 to September 2013 of pediatric patients (ages 0–18 years) who underwent endoscopic endonasal surgery (EES) for benign fibro-osseous tumors involving the skull base.
Results
Fourteen patients were identified with an age range of 2.7 to 17.9 years (mean, 12.5 years). Six juvenile ossifying fibromas, five benign fibro-osseous lesions, two osteomas, and one fibrous dysplasia were treated. Ocular symptoms and nasal obstruction were the most common presenting symptoms in nine (64%) and six (43%) of patients, respectively; five (36%) presented with proptosis and four (29%) with diplopia. Two (14%) patients had cranial nerve VI palsy. Transsellar and transclival approaches were used in five (36%) of patients. Orbital and optic nerve decompressions were the most common components of the approaches performed in nine (64%) of the surgeries. Gross total resection (GTR) was achieved with single-stage surgery in 10 (71%) patients; two additional patients underwent staged GTR. Two intraoperative cerebrospinal fluid (CSF) leaks occurred and were repaired endoscopically. There were no postoperative CSF leaks or infectious complications. Two patients had transient diplopia, and two had transient diabetes insipidus, all of which resolved. The mean follow-up was 13.8 months. Two patients had a recurrence, and both required additional EES achieving GTR.
Conclusions
EES for benign fibro-osseous tumors of the skull base is a safe and effective treatment for excision of these lesions in the pediatric population.
Level of Evidence
4. Laryngoscope, 125:2199–2203, 2015
Effect of pH and oxygen on biofilm formation in acute otitis media associated NTHi clinical isolates
Robert Osgood, Frank Salamone, Alexis Diaz, Janet R. Casey, Peter Bajorski, Michael E. Pichichero, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Biofilms occur in animal models of acute otitis media (AOM) and in children with recurrent AOM (rAOM) and chronic otitis media with effusion (OME). We therefore studied the ability of nontypeable Haemophilus influenzae(NTHi) strains from children to form biofilms in vitro under conditions we presumed occurred in the middle ear during AOM, rAOM, and OME.
Study Design
Evaluate NTHi isolates for biofilm formation across a pH range under aerobic, microaerophilic, and anaerobic conditions.
Methods
Using a crystal violet biofilm assay we studied 12 NTHi pediatric clinical isolates to investigate biofilm formation over a pH range of 4.5 to 10 under aerobic, microaerophilic, and anaerobic conditions.
Results
Our findings included: 1) not all clinical NTHi strains form biofilms (75% did); 2) the pH of middle ear fluid collected from AOM (n = 170; age range, 4–36 months), rAOM (n = 54; age range, 7–36 months), and OME (n = 30; age range, 9–60 months) subjects tested immediately after withdrawal was similar (mean = 8.0;range 7.0–9.0); 3) biofilms formed optimally at pH 8.0, a finding that is consistent with previous studies by other investigators; 4) biofilms did not form under aerobic conditions as likely occurs in AOM, whereas under microaerophilic and anaerobic conditions biofilm formation was observed as likely occurs during rAOM and OME.
Conclusions
We concluded that biofilm formation by NTHi does not occur in all strains, occurs best where the pH = 8.0 and in anaerobic conditions as likely occurs in children during rAOM and OME. However, biofilm formation is limited or absent under aerobic conditions as likely occurs during AOM.
Level of Evidence
NA Laryngoscope, 125:2204–2208, 2015
Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss in children
Jae Ho Chung, Seok Hyun Cho, Jin Hyeok Jeong, Chul Won Park, Seung Hwan Lee, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
To evaluate clinical characteristics and possible associated factors of idiopathic sudden sensorineural hearing loss (ISSNHL) in children using univariate and multivariate analyses.
Study Design
A retrospective case series with comparisons.
Methods
From January 2007 to December 2013, medical records of 37 pediatric ISSNHL patients were reviewed to assess hearing recovery rate and examine factors associated with prognosis (gender; side of hearing loss; opposite side hearing loss; treatment onset; presence of vertigo, tinnitus, and ear fullness; initial hearing threshold), using univariate and multivariate analysis, and compare them with 276 adult ISSNHL patients.
Results
Pediatric patients comprised only 6.6% of pediatric/adult cases of ISSNHL, and those below 10 years old were only 0.7%. The overall recovery rates (complete and partial) of the pediatric and adult patients were 57.4% and 47.2%, respectively. The complete recovery rate of the pediatric group (46.6%) was higher than that of the adult group (30.8%, P = .040). According to multivariate analysis, absence of tinnitus, later onset of treatment, and higher hearing threshold at initial presentation were associated with a poor prognosis in pediatric ISSNHL.
Conclusions
The recovery rate of ISSNHL in pediatric patients is higher than in adults, and the presence of tinnitus and earlier treatment onset is associated with favorable outcomes.
Level of Evidence
4 Laryngoscope, 125:2209–2215, 2015
Sedation after airway reconstruction in children: A protocol to reduce withdrawal and length of stay
Karen R. Fauman, Rashed Durgham, Carlos I. Duran, Mark A. Vecchiotti, Andrew R. Scott, 2015-08-25 08:44:11 AM
Level of Evidence
Laryngoscope, 125:2216–2219, 2015
Drug-induced sleep endoscopy versus Müller maneuver in patients with retropalatal obstruction
Yavuz Fuat Yilmaz, Rauf Oguzhan Kum, Muge Ozcan, Volkan Gungor, Adnan Unal, 2015-08-25 08:44:11 AM
Objective/Hypothesis
This study aimed to compare application of the Müller maneuver (MM) and application of drug-induced sleep endoscopy (DISE) prior to surgery, in addition to MM, to further ascertain the location of an obstruction in the upper airway and whether the location would change the surgical treatment plan in patients with retropalatal obstruction.
Study Design
Prospective, clinical trial at a tertiary referral hospital.
Methods
This study included 39 obstructive sleep apnea patients who were recommended for surgical treatment. Patients were randomly divided into two groups: The first group (DISE plus MM) underwent a DISE (19 patients), in addition to the planned procedure according to MM. Meanwhile, the second group (MM only) underwent surgery based only on their MM evaluation (20 patients). Patients with retrolingual-localized obstructions were excluded, whereas patients with ≥ third-degree obstructions at the retropalatal level, according to DISE and/or MM, were included in the study.
Results
There was a significant improvement between pre- and postoperative polysomnography findings in both groups. However, the postoperative improvements between the groups were not statistically different. Because there was a significant change in the planned surgical procedures in the first group, there were significantly more combined surgeries followed by the DISE procedure.
Conclusions
Although the DISE resulted in more changes in the surgical treatment plan and higher rate of combined treatment compared to MM, we determined that this difference did not result in a significant difference in treatment success.
Level of Evidence
4. Laryngoscope, 125:2220–2225, 2015
Lateral neck recurrence from papillary thyroid carcinoma: Predictive factors and prognostic significance
Davide Giordano, Andrea Frasoldati, Jan L. Kasperbauer, Enrico Gabrielli, Carmine Pernice, Michele Zini, Corrado Pedroni, Silvio Cavuto, Verter Barbieri, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
The aim of this study was to identify any possible predictive factors of lateral neck recurrence in patients with papillary thyroid carcinoma with no ultrasonographic and/or cytological evidence of lymph node metastasis at time of diagnosis. The influence of lateral neck recurrence on survival was also investigated.
Study Design
Observational retrospective study.
Methods
Retrospective review of clinical records of 610 patients surgically treated for papillary thyroid carcinoma with clinically negative lymph nodes at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova–IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008.
Results
Lateral neck recurrences were ipsilateral to the primary tumor in all cases and were associated with the occurrence of more aggressive histological variants and central neck metastasis. Lateral neck recurrences were more frequently observed in patients with distant metastases and were associated with a reduced disease-specific survival.
Conclusion
Lateral neck compartment ipsilateral to the tumor was the most common site of recurrence, with about half of cases appearing in the first 28 months of follow-up. In patients with papillary thyroid carcinoma, detection of lateral neck metastases prior to first surgery is crucial to surgical planning. Aggressive histological variants and postsurgical evidence of lymph node metastasis from papillary thyroid carcinoma in central neck compartment are associated with a higher risk of lateral neck recurrence. In these patients, a closer postsurgical ultrasound surveillance of the lateral neck compartments seems worthwhile.
Level of Evidence
4. Laryngoscope, 125:2226–2231, 2015
Does intraoperative nerve monitoring reliably aid in staging of total thyroidectomies?
Tatyana E. Fontenot, Gregory W. Randolph, Tedhar E. Setton, Nuha Alsaleh, Emad Kandil, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Demonstrate whether intraoperative nerve monitoring is an effective tool in staging bilateral thyroid and neck surgeries in cases of intraoperative injury to the recurrent laryngeal nerve on the side of initial dissection. We hypothesized that IONM provides reliable and appropriate feedback on the functional status of the RLN on side of initial dissection during total thyroidectomy and central neck surgery.
Study Design
Case series with planned data collection.
Methods
All patients receiving total thyroidectomies or central neck surgeries were reviewed. The outcomes of patients treated whose procedures were staged based on intraoperative nerve monitoring are described.
Results
Ten (4.9%) of 206 procedures were staged based on unfavorable signal change including six patients with thyroid cancers and four with compressive substernal goiters. The overall signal drop in the 10 patients with unfavorable signal change was 63%. Three patients had complete loss of signal. In the other seven patients, the signal dropped by a mean of 48%. In the eight patients with laryngoscopy-proven vocal fold paresis, the signal dropped by a mean of 68%.
Conclusions
Intraoperative nerve monitoring results accurately indicated postoperative ipsilateral vocal cord dysfunction with high reliability. Intraoperative nerve monitoring is a reliable tool in staging thyroid surgery.
Level of Evidence
4. Laryngoscope, 125:2232–2235, 2015
MYB rearrangement and clinicopathologic characteristics in head and neck adenoid cystic carcinoma
Eleni M. Rettig, Marietta Tan, Shizhang Ling, Raluca Yonescu, Justin A. Bishop, Carole Fakhry, Patrick K. Ha, 2015-08-25 08:44:11 AM
Objectives
Salivary gland adenoid cystic carcinoma (ACC) is rare, aggressive, and challenging to treat. Many ACCs have a t(6;9) chromosomal translocation resulting in a MYB-NFIB fusion gene, but the clinical significance is unclear. The purposes of this study were to describe the clinicopathologic factors impacting survival and to determine the prevalence and clinical significance of MYB-NFIB fusion.
Study Design
Case series.
Methods
Medical records of patients treated for ACC of the head and neck from 1974 to 2011 were reviewed and clinicopathologic data recorded. Fluorescence in situ hybridization (FISH) was used to detect MYB rearrangement in archival tumor tissue as a marker of MYB-NFIB fusion.
Results
One hundred fifty-eight patients were included, with median follow-up 75.1 months. Median overall survival was 171.5 months (95% confidence interval [CI] = 131.9–191.6), and median disease-free survival was 112.0 months (95% CI = 88.7–180.4). Advanced stage was associated with decreased overall survival (adjusted ptrend < 0.001), and positive margins were associated with decreased disease-free survival (adjusted hazard ratio [aHR] = 8.80, 95% CI = 1.25–62.12, P = 0.029). Ninety-one tumors were evaluable using FISH, and 59 (65%) had evidence of a MYB-NFIB fusion. MYB-NFIB positive tumors were more likely than MYB-NFIB negative tumors to originate in minor salivary glands (adjusted prevalence ratios = 1.51, 95% CI = 1.07–2.12, P = 0.019). MYB-NFIB tumor status was not significantly associated with disease-free or overall survival (hazard ratio [HR] = 1.53, 95% CI = 0.77–3.02, P = 0.22 and HR = 0.91, 95% CI = 0.46–1.83, P = 0.80, respectively, for MYB-NFIB positive compared with MYB-NFIB negative tumors).
Conclusion
Stage and margin status were important prognostic factors for ACC. Tumors with evidence of MYB-NFIB fusion were more likely to originate in minor salivary glands, but MYB-NFIB tumor status was not significantly associated with prognosis.
Level of Evidence
4. Laryngoscope, 125:E292–E299, 2015
Triple-positive pathologic findings in oral cavity cancer are related to a dismal prognosis
Yu-Tsai Lin, Chih-Yen Chien, Cheng-Tung Lu, Sheng-Dean Lou, Hui Lu, Chao-Cheng Huang, Fu-Min Fang, Shau-Hsuan Li, Tai-Lin Huang, Hui-Ching Chuang, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Perineural invasion (PNI), lymphovascular invasion (LVI), and extracapsular spread (ECS) of lymph nodes are adverse histopathologic factors among patients with oral cancer. We analyzed the clinical impact of the combination of PNI, LVI, and ECS among patients with oral cancer.
Study Design
Retrospective analysis of patients with oral cancer that was treated primarily with surgery with at least 5 years of follow-up data in a tertiary referral center.
Methods
In total, 554 patients diagnosed with oral cavity squamous cell carcinoma who underwent operations consecutively between 2006 and 2008 in our hospital were enrolled. Clinical characteristics, 5-year survival rates, and local/regional control rates were analyzed.
Results
There were 41 females and 513 males. Patients with PNI, LVI, or ECS presented pathologically had 5-year overall survival rates of 58.4%, 50.4%, and 31.4%, respectively. Patients with both ECS and PNI or both ECS and LVI presented had 5-year overall survival rates of 31.5% and 22.2%, respectively. Patients presenting with triple-positive status (PNI, LVI, and ECS) had only a 20.0% 5-year overall survival rate. The 5-year local/regional control rate for patients with both ECS and PNI or both ECS and LVI was 26% and 44.4%, respectively; for all three factors, it was 26.7%.
Conclusion
Patients with triple-positive status (PNI, LVI, ECS), ECS and PNI, or ECS and LVI experienced very low 5-year local/regional control rates, 5-year overall, and disease-specific survival rates. Novel interventions are necessary to improve these clinical outcomes.
Level of Evidence
4. Laryngoscope, 125:E300–E305, 2015
MicroRNA-34c-5p is related to recurrence in laryngeal squamous cell carcinoma
Massimo Re, Artan Çeka, Corrado Rubini, Luigi Ferrante, Antonio Zizzi, Federico M. Gioacchini, Michele Tulli, Liana Spazzafumo, Stefano Sellari-Franceschini, Antonio D. Procopio, Fabiola Olivieri, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
Altered microRNA expression has been found in many cancer types, including laryngeal squamous cell carcinoma (LSCC). We investigated the association of LSCC-related miR-34c-5p with disease-free survival and overall survival.
Study Design
Retrospective cohort study.
Methods
Expression levels of miR-34c-5p were detected in 90 LSCC formalin-fixed paraffin-embedded tissues by reverse-transcription quantitative polymerase chain reaction. Overall survival and disease-free survival were evaluated using the Kaplan-Meier method, and multivariate analysis was performed using Cox proportional hazard analysis.
Results
A downregulation of miR-34c-5p expression significantly correlated with worse disease-free and overall survival. In the multivariate analysis, low miR-34c-5p expression was associated with an increased risk of recurrence.
Conclusions
A downregulation of miR-34c-5p in LSCC is independently associated with unfavorable disease-free survival, suggesting that miR-34c-5p might be a promising marker for evaluating the risk of recurrences.
Level of Evidence
NA Laryngoscope, 125:E306–E312, 2015
Identification of distinct layers within the stratified squamous epithelium of the adult human true vocal fold
Jayme R. Dowdall, Peter M. Sadow, Christopher Hartnick, Vladimir Vinarsky, Hongmei Mou, Rui Zhao, Phillip C. Song, Ramon A. Franco, Jayaraj Rajagopal, 2015-08-25 08:44:11 AM
Objectives/Hypothesis
A precise molecular schema for classifying the different cell types of the normal human vocal fold epithelium is lacking. We hypothesize that the true vocal fold epithelium has a cellular architecture and organization similar to that of other stratified squamous epithelia including the skin, cornea, oral mucosa, and esophagus. In analogy to disorders of the skin and gastrointestinal tract, a molecular definition of the normal cell types within the human vocal fold epithelium and a description of their geometric relationships should serve as a foundation for characterizing cellular changes associated with metaplasia, dysplasia, and cancer.
Study Design
Qualitative study with adult human larynges.
Methods
Histologic sections of normal human laryngeal tissue were analyzed for morphology (hematoxylin and eosin) and immunohistochemical protein expression profile, including cytokeratins (CK13 and CK14), cornified envelope proteins (involucrin), basal cells (NGFR/p75), and proliferation markers (Ki67).
Results
We demonstrated that three distinct cell strata with unique marker profiles are present within the stratified squamous epithelium of the true vocal fold. We used these definitions to establish that cell proliferation is restricted to certain cell types and layers within the epithelium. These distinct cell types are reproducible across five normal adult larynges.
Conclusion
We have established that three layers of cells are present within the normal adult stratified squamous epithelium of the true vocal fold. Furthermore, replicating cell populations are largely restricted to the parabasal strata within the epithelium. This delineation of distinct cell populations will facilitate future studies of vocal fold regeneration and cancer.
Level of Evidence
N/A. Laryngoscope, 125:E313–E319, 2015
Immunohistochemical localization of OCT2 in the cochlea of various species
Victoria Hellberg, Caroline Gahm, Wei Liu, Hans Ehrsson, Helge Rask-Andersen, Göran Laurell, 2015-08-25 08:44:11 AM
Objective
To locate the organic cation transporter 2 (OCT2) in the cochlea of three different species and to modulate the ototoxicity of cisplatin in the guinea pig by pretreatment with phenformin, having a known affinity for OCT2.
Study Design
Immunohistochemical and in vivo study.
Methods
Sections from the auditory end organs were subjected to immunohistochemical staining in order to identify OCT2 in cochlea from untreated rats, guinea pigs, and a pig. In the in vivo study, guinea pigs were given phenformin intravenously 30 minutes before cisplatin administration. Electrophysiological hearing thresholds were determined, and hair cells loss was assessed 96 hours later. The total amount of platinum in cochlear tissue was determined using mass spectrometry.
Results
Organic cation transporter 2 was found in the supporting cells and in type I spiral ganglion cells in the cochlea of all species studied. Pretreatment with phenformin did not reduce the ototoxic side effect of cisplatin. Furthermore, the concentration of platinum in the cochlea was not affected by phenformin.
Conclusions
The localization of OCT2 in the supporting cells and type I spiral ganglion cells suggests that this transport protein is not primarily involved in cisplatin uptake from the systemic circulation. We hypothesize that OCT2 transport intensifies cisplatin ototoxicity via transport mechanisms in alternate compartments of the cochlea.
Level of Evidence
N/A. Laryngoscope, 125:E320–E325, 2015
In reference to Treatment of epilepsy by stimulation of the vagus nerve from head-and-neck surgical point of view
Giovanni Felisati, Alberto Maria Saibene, Maria Paola Canevini, 2015-08-25 08:44:11 AM
In response to Treatment of epilepsy by stimulation of the vagus nerve from head-and-neck surgical point of view
Michael Vaiman, Gad Lotan, 2015-08-25 08:44:11 AM
Δευτέρα 24 Αυγούστου 2015
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