Inner ear anomalies in children with isolated unilateral congenital aural atresia

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Tyler R. Halle, Bruno P. Soares, N. Wendell Todd
Objectives/HypothesisWe aim to define the frequencies of anomalies of the inner ear, oval window, and round window ipsilateral to isolated non-syndromic unilateral aural atresia.Methods and materialsRetrospective case series. We reviewed high resolution computed tomography scans of the temporal bones of 70 children with isolated non-syndromic unilateral congenital aural atresia. Scans were reviewed according to the Jahrsdoerfer criteria and further evaluated for anomalies of the vestibule, semi-circular canals, cochlea, internal auditory canal and vestibulocochlear nerve.ResultsInner ear dysplasia was seen in two of 70 atretic ears: one with a dysmorphic lateral semicircular canal and another with a large vestibule assimilating the lateral semicircular canal. Abnormalities of the oval window and round window ipsilateral to the atresia were identified in 21% (15) and 7% (5), respectively, of the atretic ears. Oval window and round window abnormalities were associated with disproportionately lower Jahrsdoerfer scores compared to aural atresia patients without these abnormalities (P < 0.001 and P = 0.04, respectively).ConclusionCompared to studies that included syndromic or bilateral atresia cases, we found inner ear and oval window abnormalities less common in children with isolated non-syndromic unilateral aural atresia. However, round window anomalies seem to occur at about the same frequency.



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A national survey of knowledge, attitude and practices among pediatricians towards newborn hearing screening in India

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Rohit Ravi, Dhanshree R. Gunjawate, Krishna Yerraguntla, Leslie E. Lewis, Bellur Rajashekhar
IntroductionPediatricians have a key role in ensuring that infant has undergone hearing screening and required follow-up. Attempts in various countries and centers have been made at exploring their knowledge, attitude and practices towards universal newborn hearing screening. In India, such a program is at its preliminary stage, and hence a need was felt to study this aspect in pediatricians working in India.MethodA cross-sectional online survey was carried out among 112 pediatricians working in India. The questionnaire was framed after reviewing the existing questionnaires. Descriptive statistics was used to summarize the findings.ResultsA response rate of 7.99% (112/1402) was obtained of which only 20.5% reported of availability of screening program in their work set-up. The majority of the pediatricians (95%) were aware of the newborn hearing screening while 98.3% were affirmative about the importance of screening of all infants. Very few pediatricians reported of a screening program in their set-up or in their close locality. Overall the pediatricians were confident about their knowledge on this topic yet expressed a need to know more about several intricacies about hearing screening. The pediatricians also provided an input on the most preferred method of receiving more information.Summary and conclusionThe success of the universal newborn hearing screening program lies in the support and cooperation of health care providers such as pediatricians. The present study draws attention to the positive attitude and practices exhibited by them. It also sheds light on the knowledge gaps that are present and need the due attention of the policy makers. Further, it highlights the need for having more continuing medical education program and awareness drives for ensuring a better implementation of UNHS.



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An analysis of hearing screening test results in 2291 premature infants of Chinese population

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Lili Huang, Fei Xiong, Jinrong Li, Fan Yang
ObjectiveThe aim of this study was to analyze the hearing screening program among preterm infants as well as to identify risk factors associated with failing primary newborn hearing screening.MethodsThe retrospectively selected population included all preterm infants who had primary hearing screening in a neonatal ward from January 1st, 2013 to December 31st, 2015 at West China Second University Hospital, Sichuan University. The newborn hearing screening (NHS) procedure was performed in all preterm infants by automated auditory brainstem response (AABR). Infants who failed the primary hearing screening received a second screening at 42 days after birth. Infants who failed both tests were referred to a tertiary audiology center for diagnostic confirmation and management before 6 months of age. The final diagnosis for referred infants was obtained by telephone follow-up. The risk factors associated with failure to pass the primary hearing screen were evaluated and analyzed for preterm infants.ResultsAmong 2291 preterm infants recruited, 155 infants (6.8%) failed the primary hearing screening with an abnormal AABR. Of these 155 infants, 113 (72.9%) passed the secondary screening. At the end of the follow-up, 1 infant (0.04%) was diagnosed with hearing loss, 3 infants had delayed language development, and 40 infants were lost to follow up. Multivariate regression analysis revealed that gestational age ≤32 weeks (Odds ratio [OR] = 2.093, 95% confidence interval [CI] 1.370–3.196), super hyperbilirubinemia (≥25 mg/dl) (OR = 3.560, 95% CI 1.009–12.560), and respiratory failure (OR = 1.971, 95% CI 1.188–3.265) were associated with failure to pass newborn hearing screening.ConclusionThe prevalence of failure to pass primary hearing screening among preterm infants was 6.8% in our study, and we found a relatively low prevalence of hearing loss (0.04%). Super hyperbilirubinemia, gestational age ≤32weeks, and respiratory failure were risk factors associated with failure of preterm infants to pass the primary hearing screening. Our results suggest that preterm infants with hyperbilirubinemia, gestational age ≤32 weeks, and respiratory failure should be closely followed.



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Assessment of red blood cell distribution width and mean platelet volume in children with epistaxis

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Selin Üstün Bezgin, Taliye Çakabay, Işık Odaman Al
ObjectiveThis study aimed to investigate whether there is a relationship between red blood cell distribution width, mean platelet volume and epistaxis in children.MethodsBetween January 2015 and July 2016, 105 children who were referred to our clinic with epistaxis and 100 sex- and age-matched controls were retrospectively analyzed. Red blood cell distribution width (RDW) and mean platelet volume (MPV) values were determined in both groups.ResultsRDW values were found significantly (P < 0.05) lower in the group with epistaxis than in the control group (11.95 ± 1.31 vs. 12.74 ± 1.21). MPV was 7.49 ± 1.33 in the group with epistaxis and 7.23 ± 1.06 in the control group, and there was no significant difference between the groups (p > 0.05).ConclusionWe found no difference between MPV values of both groups and significantly lower RDW values in children with epistaxis. Decreased RDW values were considered as an accompanying marker rather than a result of epistaxis. In addition, it may be thought that low RDW values may increase the bleeding tendency by disrupting the thrombotic activities. Further studies are needed to validate the relation of these parameters with epistaxis and its mechanisms.



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Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Martín Pinzón, Nelson Oswaldo Lobelo, María Claudia Rodríguez, Perla Villamor, Ana María Otoya
Extracranial internal carotid artery (ICA) pseudoaneurysms are uncommon in the pediatric population and are usually secondary to direct trauma to the vessel. Treatment options include surgery (ligation), anticoagulation therapy and endovascular treatment. Endovascular covered stents have shown good results in adult populations, resulting in occlusion of the aneurysm and preservation of the artery without significant complications. However, there have been only limited reports in the literature reporting endovascular carotid stent placement in the pediatric population. We report a case of a 9-year-old boy patient, who developed a cervical ICA pseudoaneurysm after a parapharyngeal tumor resection. He was successfully treated by primary endovascular covered stent placement. During a follow-up of 6 months the patient has been asymptomatic, without any adverse event. Additionally, a literature review is done.



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Ultrasonographic assessment of tonsillar volume in children

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Panagiotis Asimakopoulos, David J.L. Pennell, Constantinos Mamais, Derek Veitch, Samuel Stafrace, Thomas Engelhardt
ObjectivesAdenotonsillar hypertrophy in children is the most common anatomical abnormality associated with obstructive sleep apnoea. Perioperative complications associated with adenotonsillectomy are more common in children with severe obstructive sleep apnoea. An objective preoperative method to determine the size of tonsils is missing. This study assessed the validity of ultrasound as a tool for measuring tonsillar size in children.MethodsSingle-institution prospective study of twenty-six children aged 2–6 years who underwent elective bilateral tonsillectomy. Trans-cervical ultrasonographic assessment of tonsillar size prior to tonsillectomy operation was performed. We assessed correlation of ultrasonographic and actual tonsillar volume.ResultsA total of 52 tonsils from 26 patients were measured. Actual and ultrasonographic mean tonsillar volume (±SD) was 3.9 (±2.1) ml and 3.6 (±2.5) ml, respectively (P = 0.24). Ultrasonographic and actual measurements correlated well (r = 0.89).ConclusionsThis is the first study to show that ultrasound is a suitable objective method for determining tonsillar volume in paediatric patients. Preoperative ultrasound assessment of tonsillar anatomy and size may be an additional and suitable, objective method in the development of a risk stratification system in children with obstructive sleep apnoea undergoing tonsillar surgery.



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Acoustic absorbance measurements in neonates exposed to smoking during pregnancy

Publication date: Available online 4 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Beatriz Paloma Corrêa Pucci, Nayara Michelle Costa de Freitas Roque, Marcella Scigliano Gamero, Alessandra Spada Durante
ObjectiveTo analyze acoustic absorbance using wideband tympanometry in neonates exposed to passive smoking during pregnancy.Methoda study comprising 54 neonates in the control group (CG – unexposed) and 19 in the study group (SG – exposed) was carried out. Subjects were submitted to the wideband tympanometry test and subsequent analysis of absorbance of 17 frequencies.ResultLow frequencies had a lower level of absorbance compared to high frequencies for both ambient and peak pressures, with no difference between the groups.ConclusionNo effect of passive smoking on acoustic absorbance measurements in neonates was observed.



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The effect of different cleaning methods on the surface and temperature of failed titanium implants: an in vitro study

Abstract

The aims of this in vitro study are to compare the efficacy of different cleaning methods in removing debris of failed implants and to detect thermal changes of the implants treated by various scaling instruments. Twenty-seven failed implants and two unused implants as control were included to this study—group 1: plastic curette (P), group 2: titanium curette (T), group 3: carbon curette (C), group 4: titanium brush (TB), group 5: Er:YAG laser (laser 1 (L1) 100 mJ/pulse at 10 Hz), group 6: Er:YAG laser (laser 2 (L2) 150 mJ/pulse at 10 Hz), group 7: Er:YAG laser (laser 3 (L3) 200 mJ/pulse at 10 Hz), group 8: ultrasonic scaler appropriate for titanium (US), group 9: air abrasive method (AA) + citric acid, and group 10: implantoplasty (I). The changes on the treated/untreated titanium surfaces and remnant debris were observed by scanning electron microscopy (SEM). Temperature of the implants before and after treatment was detected using a thermocouple. The use of air abrasive and citric acid combination and Er:YAG laser groups was found as the best methods for the decontamination of titanium surfaces of failed implant. When the hand instruments were compared, titanium curette was found better than both the plastic and the carbon curettes which leave plastics and carbon remnants on the titanium surface. The temperature was higher after hand instrumentation when compared to other experimental groups (p < 0.05). Within the limitations of the present in vitro model, it can be concluded that the best method for decontamination of the implant surface is the use of air abrasives and Er:YAG laser.

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In this issue

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Marginal and internal fit of posterior three-unit fixed zirconia dental prostheses fabricated with two different CAD/CAM systems and materials

Abstract

Objectives

The purpose of this in vitro study was to compare the precision of fit of frameworks milled from semi-sintered regular zirconia and high-translucent (HT) zirconia blanks, fabricated with two different CAD/CAM systems.

Material and methods

Three-unit, posterior fixed dental prostheses (FDP) frameworks were fabricated for standardized dies (n = 11) with two different laboratory computer-aided design (CAD)/computer-aided manufacturing (CAM) systems (Cercon/Ceramill). The replica technique was used to evaluate the marginal and internal fit under an optical microscope. Evaluation of the data was performed according to prior studies at a level of significance of 5%.

Results

The systems showed a statistically significant influence on the internal fit of the frameworks (p ≤ 0.001) and on the marginal fit (p < 0.001). The type of material showed no influence on the marginal fit for the Cercon system (p = 0.636) and on the marginal fit (p = 0.064) and the internal fit (p = 0.316) for the Ceramill system, while regular zirconia from Cercon showed higher internal values than HT zirconia (p = 0.016).

Conclusions and clinical relevance

Both investigated systems showed clinically acceptable values within the limitations of this in vitro study. However, one showed less internal accuracy when regular zirconia was used.

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Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size

Thyroid , Vol. 0, No. 0.


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Fat volume is critical when performing fat-plug myringoplasty

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Risks for Staphylococcus aureus Colonization in Psoriasis Patients: A Systematic Review and Meta-Analysis

Abstract

Evidence on whether psoriasis patients have a higher risk for staphylococcal colonization than healthy controls remained controversial. To synthesize the current literature, we performed a systematic review on prevalence and relative risk (RR) of S. aureus colonization in psoriasis patients. We modified the QUADAS-2 instrument to assess the reporting quality of individual studies and applied random-effects models in meta-analysis. Overall, we identified 21 eligible studies, of which 15 enrolled one or more comparison groups. The pooled prevalence of staphylococcal colonization in psoriasis patients was 35.3% (95% confidence interval [CI]: 25.0%, 45.6%) on lesional skin and 39.2% (95%CI: 33.7%, 44.8%) in the nares. Psoriasis patients were 4.5-times more likely to be colonized by S. aureus than healthy controls were on the skin (RR: 5.54; 95% CI: 3.21,9.57) and in the nares (RR: 1.60; 95%CI: 1.11, 2.32). Cutaneous and nasal colonization by methicillin-resistant strains (MRSA) also appeared higher in psoriasis patients (pooled prevalence: 8.6%) than in healthy subjects (2.6%) yet the difference was not statistically significant (P: 0.740). In contrast, despite of a similar risk for nasal staphylococcal colonization (RR: 0.67, 95%CI: 0.38, 1.18), psoriasis patients were less likely to carry S. aureus on lesional skin than atopic patients (RR: 0.64; 95%CI: 0.40, 1.02). In summarizing the current literature, we found that psoriasis patients were at an increased risk for staphylococcal colonization as compared to healthy individuals. Prospective studies on how bacterial loads correlate with disease activity can guide the clinical management of bacterial colonization while preventing the emergence of drug-resistant strains.

This article is protected by copyright. All rights reserved.

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Does green tea consumption improve the salivary antioxidant status of smokers?

Publication date: Available online 3 February 2017
Source:Archives of Oral Biology
Author(s): Somayyeh Azimi, Zahra Mansouri, Sedigheh Bakhtiari, Marc Tennant, Estie Kruger, Masoumeh Rajabibazl, Azam Daraei
Objective
Considering the higher rate of oral cancer, and reduction in salivary antioxidants in smokers as indicated in previous studies, antioxidant- containing nutrients such as green tea, seem to be beneficial in counteracting against oxidative stress in this group. This study assessed the salivary total antioxidant alteration in smokers compared to nonsmokers, after short-tem (7 days) and long-term (3 weeks), green tea drinking.DesignIn this experimental study, 20 volunteer moderate-to-heavy male smokers, and 20 matched healthy non-smokers were selected to participate, according to the inclusion criteria. Participants were instructed to drink two cups of green tea per day, by dissolving 2g of green tea in 150ml of hot water for each cup. After saliva collection, antioxidant capacity of saliva was measured at baseline, after 7 days, and after 21 days. Statistical evaluation was done by SPSS 21, using paired sample t tests, one-way ANOVA and Bonferroni tests.Results
 At day zero nonsmokers had a higher antioxidant capacity than smokers (686.6±62.22 Vs. 338.8 ±59.9) mM/50μL, P<0.001). There was also a significant difference between two groups in salivary total antioxidant capacity after one week and three weeks of green tea consumption (P <0.001). However, there was an upward trend in both smokers and non-smokers over the study period (after tea drinking). In addition, a significant difference was found in total antioxidant capacity alteration in smokers compared to non-smokers from baseline to day 21.ConclusionsResults support the effectiveness of green tea consumption in salivary antioxidants enhancement in smokers, in both the short- and long term.



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BiteStrip analysis of the effect of fluoxetine and paroxetine on sleep bruxism

Publication date: Available online 3 February 2017
Source:Archives of Oral Biology
Author(s): M. Isa KARA, Elif Tarım Ertaş, Emrullah Ozen, Meral Atıcı, Selami Aksoy, Muharrem Serif Erdogan, Seyfi Kelebek
ObjectiveThe relationship between sleep bruxism (SB) and selective serotonin reuptake inhibitors (SSRIs) is still under debate because of the lack of well-designed objective studies. The current study investigates possible effects of SSRIs, fluoxetine, and paroxetine on SB in patients with anxiety and depression.Materials and MethodsThirty users of SSRIs for treatment of depression or anxiety were enrolled in the study. After clinical and anamnestic examination, 15 fluoxetine and 15 paroxetine users were included. For an objective evaluation of SB, a single-use disposable home screening device, BiteStrip, was used prior to the first SSRI intake and was repeated on the 7th and 15th days. Patients' self-reported data also were obtained for assessment of patient awareness.ResultsBiteStrip scores were significantly higher on the 7th and 15th days than the first measurement (p <0.01). There was an increase in 26 (86.6%) patients' bruxism scores on the 7th day. There was also an increase in 27 (90%) patients' bruxism scores on the 15th day. But according to patients' self-reports, only 6 patients had an awareness that bruxism symptoms were initiated or exacerbated 15days after starting fluoxetine or paroxetine.ConclusionFluoxetine and paroxetine, SSRIs used for the treatment of anxiety and depression, may initiate or aggravate SB. Clinicians should consider that SSRIs may be the cause of SB when SSRI users are referred to dental clinics for SB symptoms. As there is a shortage of researches on this subject, further studies are necessary to confirm the existence of SSRI-induced SB.



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Airway and Serum Biochemical Correlates of Refractory Neutrophilic Asthma

Publication date: Available online 3 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Rafeul Alam, James Good, Donald Rollins, Mukesh Verma, HongWei Chu, Tuyet-Hang Pham, Richard J. Martin
BackgroundDespite the progress in diagnosis and management of asthma, many patients have poorly controlled or refractory asthma. The mechanism of this refractory asthma is not well understood.ObjectiveExplore the relationship between neutrophils and other biomarkers of refractory asthma.MethodSixty subjects with refractory asthma (RA), 30 with non-refractory asthma (NRA) and 20 healthy subjects were enrolled. We performed a comprehensive characterization of these study subjects, which included laboratory and pulmonary function studies, chest CT, and bronchoscopy with bronchoalveolar lavage. We analyzed BAL and serum for a total of 244 biomolecules by multiplex assay and correlated them with the clinical and other laboratory parameters.ResultsRA was significantly different from NRA with regard to pulmonary function indices, bronchial basement membrane thickness, and BAL neutrophils and lymphocytes but not eosinophils. BAL neutrophils negatively and positively correlated with the forced vital capacity and age, respectively. Of the 244 biomolecules studied, 52 and 14 biomolecules from BAL and serum, respectively, were significantly different among the study groups. Thirteen of these 52 molecules correlated with BAL neutrophils. BAL from 40% of RA patients was positive for a pathogenic microbe. Infection-negative neutrophilic RA was associated with an increase in select biomarkers of inflammation in the serum suggesting the presence of systemic inflammation.ConclusionsRA was associated with increased number of neutrophils and proneutrophilic biomolecules in the airways. Subclinical infection was present in 40% of RA patients, which likely contributed to neutrophilic inflammation. A subgroup of non-infected neutrophilic RA was associated with systemic inflammation.

Teaser

Through a comprehensive analysis of bronchoalveolar lavage and blood this paper identified neutrophils and proneutrophilic biomolecules as strong correlates of refractory asthma.


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Does green tea consumption improve the salivary antioxidant status of smokers?

Publication date: Available online 3 February 2017
Source:Archives of Oral Biology
Author(s): Somayyeh Azimi, Zahra Mansouri, Sedigheh Bakhtiari, Marc Tennant, Estie Kruger, Masoumeh Rajabibazl, Azam Daraei
Objective
Considering the higher rate of oral cancer, and reduction in salivary antioxidants in smokers as indicated in previous studies, antioxidant- containing nutrients such as green tea, seem to be beneficial in counteracting against oxidative stress in this group. This study assessed the salivary total antioxidant alteration in smokers compared to nonsmokers, after short-tem (7 days) and long-term (3 weeks), green tea drinking.DesignIn this experimental study, 20 volunteer moderate-to-heavy male smokers, and 20 matched healthy non-smokers were selected to participate, according to the inclusion criteria. Participants were instructed to drink two cups of green tea per day, by dissolving 2g of green tea in 150ml of hot water for each cup. After saliva collection, antioxidant capacity of saliva was measured at baseline, after 7 days, and after 21 days. Statistical evaluation was done by SPSS 21, using paired sample t tests, one-way ANOVA and Bonferroni tests.Results
 At day zero nonsmokers had a higher antioxidant capacity than smokers (686.6±62.22 Vs. 338.8 ±59.9) mM/50μL, P<0.001). There was also a significant difference between two groups in salivary total antioxidant capacity after one week and three weeks of green tea consumption (P <0.001). However, there was an upward trend in both smokers and non-smokers over the study period (after tea drinking). In addition, a significant difference was found in total antioxidant capacity alteration in smokers compared to non-smokers from baseline to day 21.ConclusionsResults support the effectiveness of green tea consumption in salivary antioxidants enhancement in smokers, in both the short- and long term.



http://ift.tt/2kCIfbV

BiteStrip analysis of the effect of fluoxetine and paroxetine on sleep bruxism

Publication date: Available online 3 February 2017
Source:Archives of Oral Biology
Author(s): M. Isa KARA, Elif Tarım Ertaş, Emrullah Ozen, Meral Atıcı, Selami Aksoy, Muharrem Serif Erdogan, Seyfi Kelebek
ObjectiveThe relationship between sleep bruxism (SB) and selective serotonin reuptake inhibitors (SSRIs) is still under debate because of the lack of well-designed objective studies. The current study investigates possible effects of SSRIs, fluoxetine, and paroxetine on SB in patients with anxiety and depression.Materials and MethodsThirty users of SSRIs for treatment of depression or anxiety were enrolled in the study. After clinical and anamnestic examination, 15 fluoxetine and 15 paroxetine users were included. For an objective evaluation of SB, a single-use disposable home screening device, BiteStrip, was used prior to the first SSRI intake and was repeated on the 7th and 15th days. Patients' self-reported data also were obtained for assessment of patient awareness.ResultsBiteStrip scores were significantly higher on the 7th and 15th days than the first measurement (p <0.01). There was an increase in 26 (86.6%) patients' bruxism scores on the 7th day. There was also an increase in 27 (90%) patients' bruxism scores on the 15th day. But according to patients' self-reports, only 6 patients had an awareness that bruxism symptoms were initiated or exacerbated 15days after starting fluoxetine or paroxetine.ConclusionFluoxetine and paroxetine, SSRIs used for the treatment of anxiety and depression, may initiate or aggravate SB. Clinicians should consider that SSRIs may be the cause of SB when SSRI users are referred to dental clinics for SB symptoms. As there is a shortage of researches on this subject, further studies are necessary to confirm the existence of SSRI-induced SB.



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Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1599196

The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on plastic surgeons and oral and maxillofacial surgeons is heretofore unknown. A cross-sectional survey was performed to assess the practice pattern variations in frontal sinus fracture management across multiple surgical disciplines. A total of 298 surveys were reviewed. 33.5% were facial plastic surgeons with otolaryngology training, 25.8% general otolaryngologists, 25.5% plastic surgeons, and 15.1% oral and maxillofacial surgeons. 74.8% of respondents practiced in an academic setting. 61.7% felt endoscopic sinus surgery changed their management of frontal sinus fractures. 91.8% of respondents favored observation for uncomplicated, nondisplaced frontal sinus outflow tract fractures. 36.4% favored observation and 35.9% favored endoscopic sinus surgery for uncomplicated, displaced frontal sinus outflow tract fractures. For complicated, displaced frontal sinus outflow tract fractures, obliteration was more frequently favored by plastic surgeons and oral and maxillofacial surgeons than those with otolaryngology training. The utility of FESS in managing frontal sinus fractures appears to be recognized across multiple surgical disciplines.
[...]

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Erratum to: Recent Advances in Face Lift to Achieve Facial Balance

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Chimeric Anti-Human Podoplanin Antibody NZ-12 of Lambda Light Chain Exerts Higher Antibody-Dependent Cellular Cytotoxicity and Complement-Dependent Cytotoxicity Compared with NZ-8 of Kappa Light Chain

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


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Odontogenic sinusitis maxillaris: A retrospective study of 121 cases with surgical intervention

Odontogenic maxillary sinusitis - retrospective study of 121 cases with surgical intervention.

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FDA: Chlorhexidine Gluconate May Cause Allergic Reactions

An increase in reports of serious allergic reactions to OTC skin antiseptic products containing chlorhexidine gluconate prompts safety alert from FDA and a request that manufacturers update labels.
News Alerts

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Antihistamine Updosing in Chronic Urticaria

Is updosing of second-generation H1-antihistamines justified in all patients with chronic urticaria who don't respond sufficiently to standard dosages?
The British Journal of Dermatology

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Qualitätsmanagement in der Arztpraxis

Laryngo-Rhino-Otol 2017; 96: 62-62
DOI: 10.1055/s-0042-118919

© Georg Thieme Verlag KG Stuttgart · New York

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Dysphonie als Folge eines laryngealen Pemphigusbefalls

Laryngo-Rhino-Otol 2017; 96: 40-42
DOI: 10.1055/s-0042-119072

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Genetics of Deafness (aus der Serie: Monographs in human genetics)

Laryngo-Rhino-Otol 2017; 96: 61-61
DOI: 10.1055/s-0042-116987

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 63-64
DOI: 10.1055/s-0042-124254

© Georg Thieme Verlag KG Stuttgart · New York

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Schädelbasischirurgie

Laryngo-Rhino-Otol 2017; 96: 65-67
DOI: 10.1055/s-0042-119413

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2017; 96: 1-2
DOI: 10.1055/s-0042-119415

Liebe Leserinnen und Leser,zum neuen Jahr präsentiert sich die LRO in neuer Aufmachung. Ich finde es leichter, griffiger und klarer strukturiert. Ich bin gespannt wie es Ihnen gefällt.„Referiert und diskutiert" geht los damit, dass Organerhalt nach Radiochemotherapie nicht immer Organerhalt bedeutet 1, nämlich dann wenn der Patient auf ein Langzeit-Tracheostoma angewiesen ist. Die Diskutanten sehen hier u. a. die deutschen Ansätze mit primärer chirurgischer Therapie im Vorteil.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Preventing medication errors in the perioperative setting: recommendations on drug syringe labels

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Nd:YAG laser-induced morphology change and photothermal conversion of gold nanorods with potential application in the treatment of port-wine stain

Abstract

Based on the principle of selective photothermolysis, 1064 nm Nd:YAG laser has great potential for the treatment of deeper and larger PWS. However, the clinical effectiveness is limited because of the weak absorption of blood to Nd:YAG laser. The aim of this study is to obtain the optimal irradiation conditions to effectively destroy vascular lesions with the assistance of PEG-modified gold NRs to enhance blood absorption of Nd:YAG laser. In our study, PEG-modified gold NRs were prepared by the seeded growth method. Gold NRs after exposure to Nd:YAG laser were characterized using absorption spectra and transmission electron microscope images. The tissue-like phantom containing a glass capillary with blood was prepared and exposed to Nd:YAG laser to investigate the laser energy density and pulse number required for blood coagulation before and after the addition of gold NRs in blood. The results show that the millisecond Nd:YAG laser irradiation does not result in the shape change of gold NRs. After injection of gold NRs into the bloodstream (4.60 mg/kg), the absorbance of blood at 1064 nm increased 3.9 times. The threshold energy density for the treatment of PWS decreased by 33% (from 30 to 20 J/cm²). Our findings provide an experimental guide for choosing laser parameters and gold NRs concentration for the treatment of deeper and larger PWS with the assistance of PEG-modified gold NRs in vivo in the future.

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A Case of Myoepithelioma of the Nasal Cavity

Abstract

Myoepithelioma is a rare tumour of the salivary glands. Only 3 cases of myoepithelioma in the nasal cavity have been reported. A 29 year old male presented to us with epistaxis and nasal obstruction. There was a fleshy mass occupying the right middle meatus. Biopsy showed evidence of myoepithelioma and an endoscopic excision of the tumour was done. Histopathological examination of the resected tumour was consistent with myoepithelioma. Due to its rarity, the nature of the tumour is not known and regular follow-ups are needed for early detection of recurrence and malignancy.

http://ift.tt/2kazLYX

Diagnostic Test Value of Assessment Adenoid Enlargement with and Without Airway Obstruction Using Lateral Soft Tissues X-ray Compared to Nasoendoscopy

Abstract

Adenoid hypertrophy is one of the most important causes of airway obstruction. Skull lateral soft tissues X ray are reliable diagnostic tools for detection adenoid enlargement with or without airway obstruction. Compared to nasoendoscopy that invasive and not available in all hospital. The aim of this study is to evaluate the diagnostic value of Skull lateral soft tissues X ray for assessment adenoid enlargement using Kurien, Cohen and Konak, Fujioka and McNamara methods compared with nasoendoscopy. Analytic observational with cross sectional study. 24 patients suspected adenoid enlargement was performed Skull lateral soft tissues X ray and measured the enlargement with Kurien, Cohen and Konak, Fujioka and McNamara methods. After performed X-ray these patients was been nasoendoscopy. Diagnostic value of Skull lateral soft tissues X ray Kurien methods show sensitivity was 73.6%, specificity 100%, positive predictive value 100%, negative predictive value 50% and accuracy 79.1%. Diagnostic value of Skull lateral soft tissues X ray Cohen and Konak methods show sensitivity was 94.7%, specificity 100%, positive predictive value 100%, negative predictive value 83.3% and accuracy 95.8%. Diagnostic value of Skull lateral soft tissues X ray Fujioka methods show sensitivity was 10.5%, specificity 100%, positive predictive value 100%, negative predictive value 22.7% and accuracy 29.1%. Diagnostic value of Skull lateral soft tissues X ray McNamara methods show sensitivity was 68.4%, specificity 100%, positive predictive value 100%, negative predictive value 45.4% and accuracy 75%. Adenoid enlargement can be measure with Skull lateral soft tissues X ray using Cohen and Konak method that has the highest sensitivity, specificity, and accuration compare another methods and using McNamara methods can predict the airway obstruction.

http://ift.tt/2kq8794

Manifestations of Tuberculosis in Otorhinolaryngology Practice: A Retrospective Study Conducted in a Coastal City of South India

Abstract

Tuberculosis (TB) of the head and neck has proved to be a diagnostic challenge for otorhinolarynologists around the world and is often misdiagnosed as cancer. To contribute to a better understanding of TB in the head and neck region by assessing its various manifestations, presentations, diagnostic techniques, risk factors, coexisting illnesses and treatment modalities. This was a retrospective study conducted over a 3 year period (2012–2014) in 2 hospitals in South India, among patients diagnosed to have TB of the head and neck. A semi structured proforma was used to capture information from the medical records pertaining to the various objectives of the study. Data was analysed using SPSS version 16.0 and results obtained were depicted as percentages. Chi-square test was used to find association between the variables and p < 0.05 was considered statistically significant. Among 104 patients with TB of the head and neck, the most common manifestation was found to be Tubercular Lymphadenitis (86.53%), followed by laryngeal TB, submandibular gland TB, deep neck space abscess and adenotonsillar TB. FNAC was found to be the gold standard for the diagnosis of TB lymphadenitis. 26% of the patients had coexisting HIV infection and 16.3% of the patients had associated pulmonary TB. More than 20% of the patients were smokers. Most patients were treated using ATT. Tuberculosis of head and neck is no longer uncommon. Pulmonary TB need not be associated nor is smoking a risk factor according to our study.

http://ift.tt/2kay8e3

Individualized Treatment of Laryngeal Cancer.

Individualized Treatment of Laryngeal Cancer.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 02;:

Authors: Johnson JT

PMID: 28152132 [PubMed - as supplied by publisher]

http://ift.tt/2l53UYh

Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion.

Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 02;:

Authors: Manzi B, Sykes KJ, Wei JL

Abstract
Importance: Chronic nasal congestion often persists in children despite empirical treatment using intranasal corticosteroids, systemic antihistamines, and/or leukotriene receptor antagonists. Symptoms are often reported even with negative results of skin or blood allergy testing. Inferior turbinoplasty has been effective in adults and children, but outfracture of inferior turbinates in children is rarely reported, as is use of validated quality-of-life measures to quantify improvements after intervention. Effective use of these 2 procedures for treating chronic nasal congestion may reduce the need for medication and improve sinonasal quality of life.
Objective: To quantify changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion.
Design, Setting, and Participants: A case series with planned data collection was conducted in an ambulatory pediatric otolaryngology clinic among 43 patients with chronic nasal congestion who underwent surgical intervention between January 1, 2014, and May 31, 2015.
Exposures: Microdebrider submucous inferior turbinoplasty (without bony resection) and outfracture of inferior turbinates.
Main Outcomes and Measures: Demographics and medication use before and after the procedure were reviewed. Scores on the Sinus and Nasal Quality of Life Survey (SN-5) and quality-of-life scores were collected at baseline, 4 to 6 weeks after the procedure, and more than 6 months after the procedure.
Results: Among the 43 patients (14 girls and 29 boys; mean age, 11.2 years [range, 4.8-17.6 years]), every domain showed significant improvements in scores on the Sinus and Nasal Quality of Life Survey and quality-of-life scores 1 to 2 months after the proecdure: sinus infection (-2.55; 95% CI, 1.85-3.26), nasal obstruction (-3.51; 95% CI, 2.88-4.14), allergy symptoms (-2.14; 95% CI, 1.43-2.86), emotional distress (-2.37; 95% CI, 1.68-3.06), activity limitation (-1.70; 95% CI, 1.14-2.25), and overall quality of life (3.72; 95% CI, 2.95-4.48). At long-term follow-up, improvement was maintained in all categories. Significant improvements in SN-5 and quality-of-life scores correlated with proportional decreased reporting of snoring after the procedure (33 [77%] vs 1 [2%]; absolute reduction, 75%; 95% CI, 62%-88%), as well as nasal congestion (41 [95%] vs 1 [2%]; absolute reduction, 93% ; 95% CI, 85%-100%), and rhinorrhea (44 [41%] vs 1 [2%]; absolute reduction, 42%; 95% CI, 27%-57%). The proportion reporting use of intranasal corticosteroids (25 [58%] vs 2 [5%]; absolute reduction, 50%; 95% CI, 39%-71%), antihistamines (27 [63%] vs 1 [2%]; absolute reduction, 61%; 95% CI, 46%-75%), and leukotriene receptor antagonists (13 [30%] vs 0; absolute reduction, 30%; 95% CI, 16%-44%) also decreased.
Conclusions and Relevance: Concomitant outfracture and submucous microdebrider inferior turbinoplasty improves quality of life in children with chronic nasal congestion and can reduce use of daily medication.

PMID: 28152126 [PubMed - as supplied by publisher]

http://ift.tt/2l1ogVi

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer.

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 02;:

Authors: Wolf GT, Bellile E, Eisbruch A, Urba S, Bradford CR, Peterson L, Prince ME, Teknos TN, Chepeha DB, Hogikyan ND, McLean SA, Moyer J, Taylor JM, Worden FP

Abstract
Importance: Use of chemoradiotherapy for advanced laryngeal cancer led to a major shift in treatment as an alternative to laryngectomy. Despite widespread adoption of chemoradiotherapy, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed.
Objective: To determine whether improved survival could be achieved by incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiotherapy.
Design, Setting, and Participants: An unselected cohort of 247 patients with laryngeal cancer in an academic institution between 2002 and 2012 was evaluated. Patients with limited disease (stages I and II) underwent endoscopic resection, radiotherapy, or chemoradiotherapy for deeply invasive T2 lesions. For patients with advanced disease (stages III and IV), neoadjuvant chemotherapy, concurrent chemoradiotherapy, or primary surgery was recommended. Overall survival (OS) and disease-specific survival (DSS) were analyzed. Median follow-up was 48 months. The study was conducted from January 1, 2002, to December 31, 2012; data analysis was completed December 1, 2015.
Interventions: Endoscopic resection, radiotherapy, chemoradiotherapy, neoadjuvant chemotherapy, concurrent chemoradiotherapy, and primary surgery.
Main Outcomes and Measures: Overall survival and DSS.
Results: Of the 247 patients, 191 (77.3%) were male; mean (SD) age was 59.6 (10.4) years. Of 94 patients with limited disease, 33 (35.1%) underwent endoscopic resection; 50 (53.2%), radiotherapy alone; and 11 (11.7%), chemoradiotherapy for deeply invasive T2 lesions. Of 153 patients with advanced disease, 71 (46.4%) received neoadjuvant chemotherapy; 50 (32.7%), concurrent chemoradiotherapy; and 32 (20.9%), surgery. Five-year OS and DSS was 75% (95% CI, 68%-81%) and 83% (95% CI, 77%-88%), respectively, for the entire cohort. The DSS was 92% (95% CI, 83%-97%) for patients with stage I or II and 78% (95% CI, 69%-84%) for patients with stage III or IV disease. For patients with advanced disease, 5-year OS and DSS ranged from 78% (95% CI, 55%-90%) and 91% (95% CI, 67%-98%), respectively, for surgery; to 76% (95% CI, 63%-85%) and 79% (95% CI, 67%-88%), respectively, for neoadjuvant bioselection; and to 61% (95% CI, 44%-75%) and 66% (95% CI, 48%-79%), respectively, for primary chemoradiotherapy. Propensity-adjusted, multivariable controlling for known prognostic factors DSS was significantly improved in the neoadjuvant group compared with the chemoradiotherapy group (hazard ratio [HR], 0.48; 95% CI, 0.29-0.80).
Conclusions and Relevance: Superior survival rates were achieved with a bioselective treatment approach using a single cycle of neoadjuvant chemotherapy. Good survival rates were also achieved in patients selected for primary surgery, and both neoadjuvant chemotherapy and primary surgery were better than survival rates with concurrent chemoradiotherapy, suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.

PMID: 28152117 [PubMed - as supplied by publisher]

http://ift.tt/2l5fvGL

Improving the Evidence for Inferior Turbinate Surgery in Children.

Improving the Evidence for Inferior Turbinate Surgery in Children.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 02;:

Authors: Lam D

PMID: 28152116 [PubMed - as supplied by publisher]

http://ift.tt/2l1oo7d

Left-Sided Facial Pain, Fullness, and Trismus.

Left-Sided Facial Pain, Fullness, and Trismus.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 02;:

Authors: Woodhouse AG, Jardine DA, Mitchell AO

PMID: 28152114 [PubMed - as supplied by publisher]

http://ift.tt/2l5fxhR

A Case of Myoepithelioma of the Nasal Cavity

Abstract

Myoepithelioma is a rare tumour of the salivary glands. Only 3 cases of myoepithelioma in the nasal cavity have been reported. A 29 year old male presented to us with epistaxis and nasal obstruction. There was a fleshy mass occupying the right middle meatus. Biopsy showed evidence of myoepithelioma and an endoscopic excision of the tumour was done. Histopathological examination of the resected tumour was consistent with myoepithelioma. Due to its rarity, the nature of the tumour is not known and regular follow-ups are needed for early detection of recurrence and malignancy.

http://ift.tt/2kazLYX

Diagnostic Test Value of Assessment Adenoid Enlargement with and Without Airway Obstruction Using Lateral Soft Tissues X-ray Compared to Nasoendoscopy

Abstract

Adenoid hypertrophy is one of the most important causes of airway obstruction. Skull lateral soft tissues X ray are reliable diagnostic tools for detection adenoid enlargement with or without airway obstruction. Compared to nasoendoscopy that invasive and not available in all hospital. The aim of this study is to evaluate the diagnostic value of Skull lateral soft tissues X ray for assessment adenoid enlargement using Kurien, Cohen and Konak, Fujioka and McNamara methods compared with nasoendoscopy. Analytic observational with cross sectional study. 24 patients suspected adenoid enlargement was performed Skull lateral soft tissues X ray and measured the enlargement with Kurien, Cohen and Konak, Fujioka and McNamara methods. After performed X-ray these patients was been nasoendoscopy. Diagnostic value of Skull lateral soft tissues X ray Kurien methods show sensitivity was 73.6%, specificity 100%, positive predictive value 100%, negative predictive value 50% and accuracy 79.1%. Diagnostic value of Skull lateral soft tissues X ray Cohen and Konak methods show sensitivity was 94.7%, specificity 100%, positive predictive value 100%, negative predictive value 83.3% and accuracy 95.8%. Diagnostic value of Skull lateral soft tissues X ray Fujioka methods show sensitivity was 10.5%, specificity 100%, positive predictive value 100%, negative predictive value 22.7% and accuracy 29.1%. Diagnostic value of Skull lateral soft tissues X ray McNamara methods show sensitivity was 68.4%, specificity 100%, positive predictive value 100%, negative predictive value 45.4% and accuracy 75%. Adenoid enlargement can be measure with Skull lateral soft tissues X ray using Cohen and Konak method that has the highest sensitivity, specificity, and accuration compare another methods and using McNamara methods can predict the airway obstruction.

http://ift.tt/2kq8794

Dual Ectopic Thyroid Gland in an Elderly Male: Double Trouble?

Abstract

Double ectopic thyroid tissue is a rare phenomenon. We report a case of a 75-year-old man who was referred with two painless swellings in the anterior midline of neck with a tracheostomy tube in situ with the suspicion of malignancy. Such patients should be investigated completely prior to definitive treatment.

http://ift.tt/2kodxRF

Nasal Endoscopy as an Effective Alternative for CT-Scan in Diagnosing Chronic Rhinosinusitis: A Clinical Study and Review of Literature

Abstract

Chronic rhinosinusitis a very common disease characterized by inflammation of the mucosa of the paranasal sinuses. Nasal endoscopy and computed tomography (CT) scans are successfully used as diagnostic modalities of nose and paranasal sinus diseases. CT scan has been traditionally considered as the gold standard for diagnosing Chronic rhinosinusitis. But high cost, radiation exposure and high rates of false positivity are important drawbacks. However, nasal endoscopy as an OPD tool helps in early categorization of patients for further evaluation by imaging. This is a cost cutting as well as time saving option.

1. To compare nasal endoscopy and CT scan with respect to prediction of intrasinus involvement.

2. To evaluate the role of nasal endoscopy as an effective alternative to CT-scan in diagnosing chronic rhinosinusitis.

82 clinically diagnosed cases of chronic rhinosinusitis underwent CT scan and were advised to undergo diagnostic endoscopy. Both the modalities were compared for the diagnosis of chronic rhinosinusitis with focus on anatomic variations and the pathological findings in the nose and paranasal sinuses, and their correlation, specificity, sensitivity, positive predictive value and negative predictive values were calculated. The association between diagnostic endoscopy and CT was calculated using χ ² test. Pearson χ ² value: 8.173, P value = 0.004 (<0.05) i.e. significant. The sensitivity and specificity of nasal endoscopy was calculated with respect to diagnosing chronic rhinosinusitis in comparison to CT-scan. The results were: sensitivity was 78.08% (95% CI 66.57–86.58%), specificity was 66.67% (95% CI 30.91–90.95%) while the positive predictive value: 95% and the negative predictive value was 27.27%. CT scan is considered to be the gold standard for sinonasal imaging. Endoscopy can predict the intrasinus involvement in rhinosinusitis thereby reducing overdone CT-scans.

http://ift.tt/2l30zJi

Universal Hearing Screening in Newborns Using Otoacoustic Emissions and Brainstem Evoked Response in Eastern Uttar Pradesh

Abstract

The objectives were to determine the incidence of hearing impairment in a standardized population of neonates and to determine the significance of association of epidemiological and risk factors with neonatal hearing loss. A cohort of 600 newborns was selected for study and divided into two groups—525 in 'No Risk' group and remaining 75 in 'At Risk' group. The study protocol was carried out in three steps: (a) Screening of Hearing Loss with TOAE, done from 36 h after birth to 28 days of life, (b) Re-screening of hearing loss in newborns (of 4–12 weeks of age), who were tested positive for hearing loss in the first screening, done with DPOAE, (c) Confirmation of hearing loss with BERA, in those who were tested positive in both the first and second screening. In the study the incidence of hearing impairment in 600 infants screened was 6.67 per 1000 screened; 3.81 per 1000 screened in the Not at Risk group and 26.67 per 1000 screened in At Risk group. In At Risk group, admitted to the NICU, severe birth asphyxia and hyperbilirubinemia were found to be major risk factors. Loss to follow up was more in Not at Risk group and False Positive cases with TEOAE were more than DPOAE. BERA was found to be must for confirmation of hearing loss. Neonatal Hearing Screening of only At Risk population is likely to miss some hearing loss. Universal Hearing Screening should be the preferred strategy. Good follow up in the 'At Risk' group suggests that initial interventions in NICU had sensitized the parents for the possibility of hearing loss. This study recommends the introduction of two stage neonatal screening–rescreening protocol, using OAE and BERA, in the country in phased manner.

http://ift.tt/2jEy732

The Role of Balloon Sinuplasty in the Treatment of Vacuum Rhinogenic Headache

Abstract

In this study we tried to demonstrate how balloon sinuplasty could be an option in the treatment of the Rhinogenic Headache due to a probably disventilation of frontal sinus recess. 107 patients were included in the study with diagnosis of Rhinogenic Headache. The surgical group underwent bilateral balloon sinuplasty of the frontal sinus. The medical group underwent pharmacological treatment. Headaches characteristics were evaluated by a clinical personal diary. The severity was recorded by Visual Analog Scale 4 and 8 months after treatment. 98 out of 107 patients completed the protocol. In surgical group and in medical one the mean headache score improved at four and eight months follow up. The headache frequency attacks per month decrease from a preoperative frequency of 18 (±4 SD) in surgical group and 17 (±3 SD) in medical group to 3 (±1 SD) and 6 (±3 SD) respectively at 4 months control but increased slightly to 5 (±2 SD) and 12 (±4 SD) after 8 months. We concluded that the balloon sinuplasty should be considered as an effective alternative option after an accurate selection of surgical candidates. However, it is important a 6–8 month follow-up to evaluate the efficacy and stability of the treatment used.

http://ift.tt/2jFvgH9

Manifestations of Tuberculosis in Otorhinolaryngology Practice: A Retrospective Study Conducted in a Coastal City of South India

Abstract

Tuberculosis (TB) of the head and neck has proved to be a diagnostic challenge for otorhinolarynologists around the world and is often misdiagnosed as cancer. To contribute to a better understanding of TB in the head and neck region by assessing its various manifestations, presentations, diagnostic techniques, risk factors, coexisting illnesses and treatment modalities. This was a retrospective study conducted over a 3 year period (2012–2014) in 2 hospitals in South India, among patients diagnosed to have TB of the head and neck. A semi structured proforma was used to capture information from the medical records pertaining to the various objectives of the study. Data was analysed using SPSS version 16.0 and results obtained were depicted as percentages. Chi-square test was used to find association between the variables and p < 0.05 was considered statistically significant. Among 104 patients with TB of the head and neck, the most common manifestation was found to be Tubercular Lymphadenitis (86.53%), followed by laryngeal TB, submandibular gland TB, deep neck space abscess and adenotonsillar TB. FNAC was found to be the gold standard for the diagnosis of TB lymphadenitis. 26% of the patients had coexisting HIV infection and 16.3% of the patients had associated pulmonary TB. More than 20% of the patients were smokers. Most patients were treated using ATT. Tuberculosis of head and neck is no longer uncommon. Pulmonary TB need not be associated nor is smoking a risk factor according to our study.

http://ift.tt/2kay8e3

Preoperative β-blockade and hypertension in the first hour of functional endoscopic sinus surgery

Objectives/Hypothesis

Local anesthetic with epinephrine is commonly injected into the nasal mucosa during functional endoscopic sinus surgery (FESS). Systemic absorption of epinephrine following local injection may occur, resulting in a mild sympathetic response. This study seeks to determine whether an exaggerated sympathetic response to epinephrine is demonstrated in patients undergoing FESS treated preoperatively with established pharmacologic beta (β) adrenoceptor blockade.

Study Design

A retrospective analysis of adult patients undergoing FESS at a tertiary care university hospital.

Methods

The primary outcome was the occurrence of an exaggerated hypertensive response within the first hour of surgical time defined by a relative increase (>20%) in the first measured intraoperative systolic blood pressure (SBP) prior to induction of anesthesia, or a single SBP value above 200 mm Hg. A mixed effects logistic regression model was developed to identify independent predictors of an exaggerated hypertensive response and describe the variance in the outcome attributable to the surgeon and anesthesiologist.

Results

There were 2,051 patients identified. Independent predictors of an exaggerated intraoperative hypertensive event included: preoperative β-blocker use (adjusted odds ratio [AOR]: 3.33), female gender (AOR: 1.92), body mass index (AOR: 1.03), lower baseline SBP (AOR: 0.93), and advanced age (AOR: 1.03). The C statistic for the model was 0.8881.

Conclusions

Preoperative β-blocker use is an independent predictor of an exaggerated hypertensive response within the first hour of operative time. An exaggerated hypertensive effect should be anticipated in patients presenting for FESS with established pharmacologic β-blockade, and caution should be applied to use of epinephrine-containing solutions.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2l49gTo

Kondylome bei HIV-Infizierten

Zusammenfassung

Kondylome sind bei HIV-infizierten Patienten wesentlich häufiger als bei HIV-negativen Personen. Kondylome HIV-Positiver unterscheiden sich von denen HIV-Negativer in der Ausdehnung, im Auftreten an ungewöhnlicheren Lokalisationen, im HPV (humane Papillomviren)-Typenspektrum, in der Rezidivneigung sowie im Entartungsrisiko. Etwa 18–56 % der Kondylome HIV-positiver Patienten enthalten hochgradige Dysplasien. Aus diesem Grund sollten Kondylome bei HIV-Infizierten vorzugsweise ablativ entfernt und histopathologisch evaluiert werden. Durch die geschlechtsneutrale prophylaktische HPV-Impfung von HPV-naiven Jungen und Mädchen könnte zukünftig eine deutliche Reduktion von Kondylomen auch in dieser Patientengruppe erreicht werden.

http://ift.tt/2jGLvE8

Prenatal sonographic diagnosis of meconium peritonitis from duodenal atresia

Description

A primigravid woman aged 29 years presented for the first time to our antenatal clinic for routine check-up at 34 weeks of pregnancy. She denied any symptoms. Medical, surgical, social and family histories were reviewed and were unremarkable. Prior scans and prenatal workup from 7 to 15, and 24 weeks were reviewed and were normal. Physical examination revealed a fundal height consistent with 34 weeks of pregnancy. Abdominal ultrasound scan detected 25.3 mm bowel dilation consistent with duodenal atresia, and ascites (figures 1 and 2). The fetus was diagnosed to have grade II meconium peritonitis secondary to duodenal atresia. Biophysical profile was performed on admission was 3. The decision for emergency caesarean section was made.

Figure 1

Double bubble sign signifying the bowel dilation of duodenal atresia (orange arrow). Ascites is also visible (yellow arrow).

Figure 2

Bowel dilation (orange arrow)...

http://ift.tt/2k489lH

Corrigendum to “Combined medial canthopexy and lateral tarsal strip for floppy eyelid syndrome” [Am J Otolaryngol 37 (2016) 240–244]

Publication date: Available online 2 February 2017
Source:American Journal of Otolaryngology
Author(s): Christopher J. Compton, Andrew T. Melson, Jeremy D. Clark, Taha Z. Shipchandler, William R. Nunery, H.B. Harold Lee




http://ift.tt/2l3RcZz

Cardiomyopathy – an approach to the autoimmune background

Publication date: Available online 2 February 2017
Source:Autoimmunity Reviews
Author(s): Niels-Peter Becker, Johannes Müller, Gerd Wallukat, Ingolf Schimke
Autoimmunity is increasingly accepted as the origin or amplifier of various diseases. In contrast to classic autoantibodies (AABs), which induce immune responses resulting in the destruction of the affected tissue, an additional class of AABs is directed against G-protein-coupled receptors (GPCRs; GPCR-AABs). GPCR-AABs functionally affect their related GPCRs for activation of receptor mediated signal cascades. Diseases which are characterized by the presence of GPCR-AABs with evidence for disease-specific pathogenic activity could be named "functional autoantibody disease".We briefly summarize here the historical view on autoimmunity in cardiomyopathy, followed by an approach to the mechanistic autoimmunity background. Furthermore, autoantibodies with outstanding importance for cardiomyopathies as a functional autoantibody disease, such as GPCR-AABs, and mainly those directed against the beta1-adrenergic and muscarinic 2 receptor autoantibodies, were introduced. Anti-cardiac myosin and anti-cardiac troponin autoantibodies, as further potential players in autoimmune cardiomyopathy, were additionally taken into account. The basic view on the autoantibodies, their related receptor interactions and pathogenic consequences were presented.Focused specifically on GPCR-AABs, "pros and cons" of assays such as indirect assays (functional changes of cells preparations were monitored after GPCR-AAB receptor binding) and direct assays based on the ELISA technologies (GPCR epitope mimics for GPCR-AAB binding) were critically discussed.Last but not least, treatment strategies for "functional autoantibody disease", such as for GPCR-AAB removal (therapeutic plasma exchange, immunoadsorption) and in vivo GPCR-AAB attack such as intravenous IgG treatment (IVIG), B-cell depletion and GPCR-AAB binding and neutralization, are critically reflected with respect to their patient benefits.



http://ift.tt/2k42FaG

Nasal Endoscopy as an Effective Alternative for CT-Scan in Diagnosing Chronic Rhinosinusitis: A Clinical Study and Review of Literature

Abstract

Chronic rhinosinusitis a very common disease characterized by inflammation of the mucosa of the paranasal sinuses. Nasal endoscopy and computed tomography (CT) scans are successfully used as diagnostic modalities of nose and paranasal sinus diseases. CT scan has been traditionally considered as the gold standard for diagnosing Chronic rhinosinusitis. But high cost, radiation exposure and high rates of false positivity are important drawbacks. However, nasal endoscopy as an OPD tool helps in early categorization of patients for further evaluation by imaging. This is a cost cutting as well as time saving option.

1. To compare nasal endoscopy and CT scan with respect to prediction of intrasinus involvement.

2. To evaluate the role of nasal endoscopy as an effective alternative to CT-scan in diagnosing chronic rhinosinusitis.

82 clinically diagnosed cases of chronic rhinosinusitis underwent CT scan and were advised to undergo diagnostic endoscopy. Both the modalities were compared for the diagnosis of chronic rhinosinusitis with focus on anatomic variations and the pathological findings in the nose and paranasal sinuses, and their correlation, specificity, sensitivity, positive predictive value and negative predictive values were calculated. The association between diagnostic endoscopy and CT was calculated using χ ² test. Pearson χ ² value: 8.173, P value = 0.004 (<0.05) i.e. significant. The sensitivity and specificity of nasal endoscopy was calculated with respect to diagnosing chronic rhinosinusitis in comparison to CT-scan. The results were: sensitivity was 78.08% (95% CI 66.57–86.58%), specificity was 66.67% (95% CI 30.91–90.95%) while the positive predictive value: 95% and the negative predictive value was 27.27%. CT scan is considered to be the gold standard for sinonasal imaging. Endoscopy can predict the intrasinus involvement in rhinosinusitis thereby reducing overdone CT-scans.

http://ift.tt/2l30zJi

The Role of Balloon Sinuplasty in the Treatment of Vacuum Rhinogenic Headache

Abstract

In this study we tried to demonstrate how balloon sinuplasty could be an option in the treatment of the Rhinogenic Headache due to a probably disventilation of frontal sinus recess. 107 patients were included in the study with diagnosis of Rhinogenic Headache. The surgical group underwent bilateral balloon sinuplasty of the frontal sinus. The medical group underwent pharmacological treatment. Headaches characteristics were evaluated by a clinical personal diary. The severity was recorded by Visual Analog Scale 4 and 8 months after treatment. 98 out of 107 patients completed the protocol. In surgical group and in medical one the mean headache score improved at four and eight months follow up. The headache frequency attacks per month decrease from a preoperative frequency of 18 (±4 SD) in surgical group and 17 (±3 SD) in medical group to 3 (±1 SD) and 6 (±3 SD) respectively at 4 months control but increased slightly to 5 (±2 SD) and 12 (±4 SD) after 8 months. We concluded that the balloon sinuplasty should be considered as an effective alternative option after an accurate selection of surgical candidates. However, it is important a 6–8 month follow-up to evaluate the efficacy and stability of the treatment used.

http://ift.tt/2jFvgH9

The Role Of Sentinel Lymph Node Biopsy In The Management Of Laryngeal Carcinoma

Abstract

Laryngeal carcinoma is considered as the most common head and neck neoplasm and the incidence of lymph node metastasis depends on the tumor stage.

Sentinel Lymph Node Biopsy (SLNB) is an investigational tool in treatment of the clinical N0.

The aim of the study is to determine the accuracy of sentinel lymph node biopsy (SLNB) in Laryngeal carcinoma and whether it can be used in the diagnostic and therapeutic approach to the clinical N0 neck.

47 patients were with Laryngeal carcinoma were divide into N0 group (20 patient) and N+ positive group (27 patients). In the clinical N0 neck there was a high degree of accuracy in staging the neck with a sensitivity of 100% and NPV of 100% when using a combination of lympho-scintigraphy, gamma probe and blue dye to identify the sentinel nodes while SLNB is not accurate in the clinical N+ neck and cannot be relied upon in the therapeutic approach

This article is protected by copyright. All rights reserved.

http://ift.tt/2kAZL0q

Patient-reported control of chronic rhinosinusitis symptoms is positively associated with general health-related quality of life

Abstract

Objective

In chronic rhinosinusitis (CRS), although patient-reported severity of sinonasal symptoms is significantly associated with diminishment of patients' general health-related quality of life (QOL), it remains unclear whether patient-perceived control of CRS symptomatology is associated with patients' QOL. In this study, we sought to determine the association between patient-perceived control of CRS symptomatology and QOL.

Design

Prospective cross-sectional study.

Setting

Academic, tertiary care center.

Participants

A cohort of 166 adults with CRS who were asked to categorize their level of CRS symptom control as "Not at all", "A little", "Somewhat", "Very" and "Completely".

Main outcome measure

General health-related QOL, as reflected by the 5-dimensional EuroQol quality of life survey-derived visual analog scale (EQ5D-VAS) and health utility values (EQ5D-HUV).

Results

We found that higher EQ5D-VAS scores were associated with CRS patients who classified their symptom control as "Very" (adjusted β = 15.74, 95%CI: 5.44 – 26.04, p=0.003) and "Completely" (adjusted β= 14.24, 95%CI: 2.98 – 25.52, p=0.014) compared to patients who classified their symptom control as "Not at all". This was also true for higher EQ5D-HUV which was associated with patient-reported CRS symptom control of "A little" (adjusted β = 0.10, 95%CI: 0.01 – 0.18, p=0.024), "Somewhat" (adjusted β = 0.08, 95%CI: 0.00 – 0.17, p=0.049), "Very" (adjusted β = 0.13, 95%CI: 0.05 – 0.21, p=0.002) and "Completely" (adjusted β=0.18, 95%CI: 0.09 – 0.27, p<0.001).

Conclusions

Higher levels of patient-reported CRS symptom control are therefore associated with better QOL. These findings suggest that CRS symptom control should be targeted for improving patients' QOL.

This article is protected by copyright. All rights reserved.

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Assessment of skin pigmentation by confocal microscopy: Influence of solar exposure and protection habits on cutaneous hyperchromias

Summary

Background

Cutaneous hyperchromias are disorders of skin pigmentation involving an increase of melanin production and its irregular accumulation in skin cells. It is known that the use of sunscreens helps to prevent changes in the skin pigmentation pattern, but the structural and morphological alterations that occur in the different types of hyperpigmentations need better elucidation.

Objective

To assess the influence of solar exposure and protection habits on the pattern of skin pigmentation using reflectance confocal microscopy (RCM).

Methods

Forty volunteers aged 18-39 years with skin hyperpigmentation participated in the study. Skin characterization was performed by imaging techniques and by assessing the habits of solar exposure and protection by applying questionnaires to the volunteers. RCM was used to record sequences of confocal sections at areas of interest and to examine cell shape and brightness in the basal cell layer of the lesion and in normal perilesional skin. Furthermore, high-resolution images were obtained for analysis of the spots.

Results

Sunlight influences the number and location of spots as the face of volunteers with higher solar exposure was covered with spots, whereas volunteers with less exposure had fewer spots located in the nose and cheeks region due to greater exposure of these areas to the sun.

Conclusion

The data showed the importance of sun protection for preventing changes in the pattern of skin pigmentation, and RCM proved to be an important tool for skin characterization.

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Hair loss at injection sites of mesotherapy for alopecia

Summary

Background

The side effects of mesotherapy for treatment of various forms of alopecia are often underreported, while scientific data for its efficacy are severely lacking.

Objective

To demonstrate the late onset side effects of mesotherapy for alopecia.

Methods

Three patients with androgenetic alopecia showed hair loss after previously uneventful mesotherapy sessions up to 1 year.

Results

Clinical, dermoscopic, and histopathological findings suggested an inflammatory scaring process at sites of mesotherapy injections.

Conclusion

Mesotherapy for androgenetic alopecia may paradoxically induce hair loss and scarring. Proper regulation and monitoring of the use of mesotherapy products for treating hair loss in women, needs to be addressed.

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Unusual presentation of a severely ill patient having severe fever with thrombocytopenia syndrome: a case report

Severe fever with thrombocytopenia syndrome is an emerging infectious disease caused by a novel phlebovirus belonging to the family Bunyaviridate. Emergence of encephalitis/encephalopathy during severe fever w...

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Positive selection of type II collagen-reactive CD80high marginal zone B cells in DBA/1 mice

Publication date: Available online 2 February 2017
Source:Clinical Immunology
Author(s): Chanho Park, In Seong Kho, Jeong In Yang, Min-Jung Kim, Sunhoo Park, Hoon-Suk Cha, Jaejoon Lee, Tae Jin Kim
To investigate whether dysregulated selection of autoreactive marginal zone (MZ) B cells is involved in autoimmune diseases, we examined MZ B cell profile in multiple strains of mice, and found that type II collagen (CII)-reactive autoreactive CD80^high MZ B cells spontaneously developed in the DBA/1, but not in C57BL/6 mice. CD80^high MZ B cells that were characteristically found in DBA/1 mice expressed higher levels of TACI, SLAM3, and SLAM6 than the usual CD80^low MZ B cells. Notably, the CD80^high MZ B cells were more sensitive to ibrutinib, a Bruton's tyrosine kinase inhibitor, than CD80^low MZ or follicular B cells and their transient depletion via intravenous injection of ibrutinib significantly delayed the induction of collagen-induced arthritis (CIA). In summary, we suggest that the positive selection of CII-reactive CD80^high MZ B cells is a critical homeostatic process predisposing the DBA/1 mice to the CIA induction.



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Does Receiving a Blood Transfusion Predict for Length of Stay in Children Undergoing Cranial Vault Remodeling for Craniosynostosis? Outcomes using the NSQIP Peds Dataset

Publication date: Available online 3 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Michael R. Markiewicz, Tord Alden, Mohmed Vasim Momin, Alexis B. Olsson, Ray J. Jurado, Fizan Abdullah, Michael Miloro
PurposeRecent interventions have aimed at reducing the need for blood transfusion in the perioperative period in patients with craniosynostosis undergoing cranial vault remodeling. However, little is known regarding if the receipt of a blood transfusion influences the length of hospital stay. The purpose of this study is to assess if the receipt of blood transfusion in patients undergoing cranial vault remodeling is associated with an increased length of stay.Materials and MethodsTo address the research purposes, the investigators designed a retrospective cohort study using the the 2014 Pediatric National Surgical Quality Improvement Program (NSQIP Peds) dataset. The primary predictor variable was whether patients received a blood transfusion during cranial vault remodeling. The primary outcome variable was length of hospital stay after the operation. The association between the receipt of blood transfusion and length of stay was assessed using a students T-test. The association between other co-variates and the outcomes variable was assessed using linear regression, Analysis of Variance, and Tukey Test used for post-hoc pairwise comparisons.ResultsThe sample was composed of 756 patients who underwent cranial vault remodeling—503 who received blood transfusion, and 253 who did not. The primary predictor variable of blood transfusion was associated with an increased length of stay (4.1 vs 3.0 days, p = 0.03). Other co-variates associated with an increased length of stay included; race, American Society of Anesthesiologists status, premature birth, presence of a congential malformation, and number of sutures involved in craniosynostosis.ConclusionsThe receipt of a blood transfusion in the perioperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with an increased length of stay.



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Trans-arterial embolization in maxillofacial intractable potentially life- threatening hemorrhage

Publication date: Available online 3 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dani Noy, Adi Rachmiel, Omri Emodi, Yaakov Amsalem, Yair Israel, Rafael M. Nagler
PurposeAlthough trans-arterial embolization (TAE) of vascular lesions through angiographic catheters, with embolizing agents, has been used for more than 45 years, reports for life-threatening maxillofacial bleeding is relatively rare and not updated. We review treatment modalities, present our experience of the past 21 years and suggest a comprehensive algorithm and guidelines for the use of TAE in the treatment of intractable life-threatening maxillofacial hemorrhage.MethodsWe describe 28 patients treated with TAE in our hospital due to severe bleeding, who did not respond to conservative therapies. Of these, 13 had uncontrolled epistaxis, 9 were oncology patients, 4 post-surgical and 2 trauma patients.ResultsDetails of patients' medical history, the failed conservative therapy administered prior to TAE, imaging results and blood vessels involved are presented, as well as TAE procedures and materials used, outcome and complications. All these are discussed in respect to the available updated literature. All 9 oncological patients (100%) had been treated with chemotherapy prior to the uncontrolled bleeding, 7 of the 9 also had radiotherapy administered to the maxillofacial region. Continuous anticoagulant therapy also seems to predict such bleeding episodes. TAE resolved the bleeding in all 28 cases, rapidly in 90% of cases. Only in 3 oncological cases did continued bleeding require 3- 4 consecutive TAE sessions and the use of various combinations of embolizing agents.ConclusionsOur reported high rate of success may be the result of careful techniques, appropriate preoperative imaging, highly professional personnel, as well as intraoperative and perioperative treatments.



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The Burden of Facial Cellulitis Leading to Inpatient Hospitalization

Publication date: Available online 3 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shelly Abramowicz, Sankeerth Rampa, Veerasathpurush Allareddy, Min Kyeong Lee
PurposeThe purpose of the present study is to present nationally representative estimates of hospitalizations primarily attributed to facial cellulitis and to conduct an exploratory analysis on identifying factors associated with outcomes such as hospital charges, length of stay, disposition status, and occurrence of infectious complications.Materials and MethodsThe present study is a retrospective analysis of the Nationwide Inpatient Sample (NIS) for the years 2012 and 2013. ICD-9- CM diagnosis code of "682.0" in the primary diagnosis field of NIS (reason for hospitalization) was used to identify cases with facial cellulitis. All patients 18 years old and above who were hospitalized due to facial cellulitis were included. Outcome variables examined in the present study were hospital charges, length of stay (LOS), disposition status, and occurrence of infectious complications. Descriptive statistics and multivariable linear regression model were used to examine association between independent variables and patient disposition and infectious complications.ResultsIn years 2012 and 2013, 74,480 hospitalizations involved face cellulitis among adults 18 years and older in the United States. Most were female with a mean age of 47.5 years. Most of the patients were routinely discharged to home. Age was associated with an increase in odds of discharge to another facility. Variables associated with decreased odds of bacterial infections were age and black or Hispanic race. Females with at least one comorbidity had higher odds of mycoses. Statistically significant predictors of longer than average LOS were age, race, insurance, presence of sepsis, and location.Conclusionsthis study presented nationally representative estimates of hospitalizations attributed primarily due to facial cellulitis among the adult population in the United States in 2012 and 2013. The presence of comorbid condition predicted worse outcomes. Public health efforts should focus on targeting high risk patients and providing monitoring or early treatment of face cellulitis.



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Impact of Epinephrine Contained in Local Anesthetic Solution on Serum Lactate Level during Orthognathic Surgery

Publication date: Available online 3 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hidetaka Kuroda, Gaku Kawamura, Manabu Soya, Takayuki Kitamura, Tatsuya Ichinohe, Yoshitsugu Yamada
PurposeThere have been many discussions of a relationship between endogenous and/or exogenous epinephrine and hyperlactatemia. This study aimed to identify the impact of epinephrine contained in a local anesthetic solution on serum lactate levels in patients who underwent orthognathic surgery.MethodsThis study was a retrospective record review of cases of maxillary and/or mandibular osteotomy at the Tokyo University Hospital between January 2006 and December 2014. A total of 193 patients were enrolled in this study.ResultsThe maximum intraoperative serum lactate level was 22.3 ± 14.7 mg/dL. Out of 193 patients, 91 showed an intraoperative serum lactate level that was higher than the normal maximum of 19.8 mg/dL (2.2 mmol/L), and 16 of these had a level that was 40 mg/dL (4.49 mmol/L) or higher. A multiple logistic regression analysis revealed two factors that could possibly affect elevation of the serum lactate level: the amount of epinephrine contained in the local anesthetic solution injected into the oral cavity (p = 0.0001; odds ratio [OR], 1.014; 95% confidence interval [CI], 1.006-1.022) and the absence of intraoperative treatment with propranolol (p = 0.0013; OR, 0.105; 95% CI, 0.019-0.434). Patients with severe serum lactate concentrations (i.e., 40 mg/dL [4.49 mmol/L] or higher) had slight metabolic acidosis. All patients survived 90 days. The number of postoperative hospitalization days for patients with severe serum lactate concentrations was 12.8 ± 2.6 days, and that for patients without severe serum lactate concentration was 16.0 ± 8.6 days.ConclusionIncreases in intraoperative serum lactate levels during orthognathic surgery are associated, at least in part, with increased aerobic glycolysis due to β2-adrenergic signaling. Lactate elevation caused by epinephrine contained in a local anesthetic solution does not result in a poor postoperative outcome.



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Histopathological and scanning electron microscopy findings of retrieved porous polyethylene implants

Publication date: Available online 3 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S.-Y. Choi, H.-I. Shin, T.-Y. Kwon, T.-G. Kwon
Porous polyethylene (PPE) implants are biocompatible alloplastic materials commonly used for facial augmentation. However, the effect of sub-periosteal PPE application on the surrounding tissues has not been analyzed clearly. This report documents the case of a 22-year-old woman who underwent peri-alar augmentation with PPE to improve midface retrusion. Although no infection or inflammation occurred at the surgical site, the patient requested removal of the PPE implant for aesthetic reasons alone at 1 year after the surgery. The removed implant was subjected to histological and morphological evaluation using conventional histological staining and scanning electron microscopy (SEM). Histopathological staining revealed bone ingrowth into the pores of the implant near the boundary with the host bone. Little evidence of a foreign body reaction was observed. SEM revealed densely arranged collagen fibres and osteoblastic cells in the pores. Moreover, the outer surface of the PPE implant in contact with the periosteum showed fibrous tissue ingrowth, leading to tissue adhesion. These findings confirm bone ingrowth into the PPE pore structure in humans.



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Supplementary Postoperative Parenteral Nutrition for Head and Neck Cancer Patients

Condition:   Head and Neck Neoplasm
Intervention:   Other: Parenteral Nutrition
Sponsor:   University of Copenhagen
Recruiting - verified February 2017

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Black hairy tongue

Publication date: Available online 2 February 2017
Source:Acta Otorrinolaringológica Española
Author(s): Kenta Watanabe




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Surgical treatment of nasal septal perforations: SIR (Italian Society of Rhinology) experts opinion

Publication date: Available online 2 February 2017
Source:Acta Otorrinolaringológica Española
Author(s): Desiderio Passali, Maria Carla Spinosi, Lorenzo Salerni, Michele Cassano, Hugo Rodriguez, Francesco Maria Passali, Luisa Maria Bellussi
Background and aimThe aim of our study has been to investigate the perception of aspects related to nasal perforation among experts in Rhinology and ENT surgeons. Our aim was reporting the situations in different Countries to improve the knowledge of colleagues interested in this topic.MethodsA panel of experts prepared a 20-question questionnaire regarding nasal perforations and their surgical repair, that were emailed to all the members of SIR (Società Italiana di Rnologia – Italian Society of Rhinology).ResultsData obtained from their answers showed that Cottle technique (64%) is the most common technique to perform septoplasty worldwide. 37% of the sample reported an occurrence of nasal septal perforation in less than 1% of patients and 75% attributed this occurrence to the skill of the surgeon, to infections, to drug use and to septal deformity. Trauma, pressure and Wegener's granulomatosis were also mentioned. The most common closure technique is the mucosal flap (75%), followed by the cartilage grafts (11%). Much less common were oral flaps, septal buttons and others. The majority agreed not to suggest septal perforation surgery in minimal (less than 3–4mm) perforations (73.5%), or limiting it to symptomatic patients (43.5%). The contraindications to repair surgery were reported to be: Wegener's granulomatosis, drug abuse, non-symptomatic perforation, its dimension and age of the patient. Septal deviation, atrophic rhinitis, smoke epistaxis and systemic diseases were also claimed. Failure in repair surgery has been observed to occur in less than 30% of cases.Discussion and conclusionsGiven the great difficulty to make random studies about controversial topics and obtain statistically significant data related to that, expert opinion shall be of great value (expert opinion, level of evidence 5)



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Balloon Eustachian tuboplasty under local anesthesia: Is it feasible?

Objective

To study whether balloon Eustachian tuboplasty (BET) is a feasible and safe procedure under local anesthesia.

Study Design

Prospective multicenter case-control study.

Methods

Patients undergoing either BET (n = 13) or endoscopic sinus surgery (ESS) (n = 12) under local anesthesia, with the possibility of sedation and analgesia, were monitored during the procedure and recovery period for possible adverse effects. After the procedure, the patients responded to a questionnaire assessing their experience.

Results

No adverse effects were detected in the BET group. Patients in the BET group reported similar Visual Analog Scale scores for pain during the operation as the ESS group (5.0 ± 0.7 vs. 3.2 ± 0.7, mean ± standard error of the mean). However, patients in the BET group experienced more discomfort (4.2 ± 0.6 vs. 2.5 ± 0.3, respectively, P = 0.049). Seventy-seven and 92% of the patients in the BET and ESS groups, respectively, considered the anesthesia and pain relief to be sufficient. Patients from both the BET and ESS groups were almost devoid of pain 1 to 2 hours postoperatively (0.8 ± 0.2 and 1.4 ± 0.3, respectively). In total, 12 of 13 patients in the BET group, and all 12 patients in the ESS group, would choose local anesthesia with sedation and analgesia if they needed to undergo the same procedure again.

Conclusion

BET is a safe and feasible procedure under monitored anesthesia care, including local anesthesia along with sedation and analgesia. There is need for further methodological improvement to reduce pain and discomfort during the operation.

Level of Evidence

4. Laryngoscope, 2017

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Serum angiopoietin-2 level as a potential biomarker in psoriasis vulgaris

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Cytokine profiling analysis following a non-ablative fractional laser on rat skin

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Issue Information - PI

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Issue Information - JEB

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Case of a penile atypical Spitz tumor with an agminated appearance

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Ulcerated giant pilomatricoma with appearance of cutaneous malignancy on positron emission tomography/computed tomography

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Idiopathic segmental anhidrosis associated with varicella

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Case of cutaneous polyarteritis nodosa with clinical and histopathological features similar to those of livedo vasculopathy

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Rare cause of recurrent urticaria in childhood and its unusual presentation: Solitary mastocytoma on vulva

http://ift.tt/1TMxTNE

Tympanomastoid cholesterol granulomas: Immunohistochemical evaluation of angiogenesis

Objectives/Hypothesis

This study investigates the immunohistochemical expression of vascular endothelial growth factor (VEGF) and CD34 in patients treated for middle ear and mastoid cholesterol granulomas to evaluate the angiogenesis and vascularization of this type of lesion. A correlation between the immunohistochemical data and the radiological and intraoperative evidence of temporal bone marrow invasion and blood source connection was performed to validate this hypothesis.

Study Design

Retrospective study.

Methods

Immunohistochemical expression of VEGF and CD34 in a group of 16 patients surgically treated for cholesterol granuloma was examined. Middle ear cholesteatomas with normal middle ear mucosa and external auditory canal skin were used as the control groups. The radiological and intraoperative features of cholesterol granulomas were also examined.

Results

In endothelial cells, there was an increased expression of angiogenetic growth factor receptors in all the cholesterol granulomas in this study. The quantitative analysis of VEGF showed a mean value of 37.5, whereas the CD34 quantitative analysis gave a mean value of 6.8. Seven patients presented radiological or intraoperative evidence of bone marrow invasion, hematopoietic potentialities, or blood source connections that might support the bleeding theory. In all of these cases there was computed tomography or intraoperative evidence of bone erosion of the middle ear and/or temporal bone structures. The mean values of VEGF and CD34 were 41.1 and 7.7, respectively.

Conclusions

High values of VEGF and CD34 are present in patients with cholesterol granulomas. Upregulation of VEGF and CD34 is indicative of a remarkable angiogenesis and a widespread vascular concentration in cholesterol granulomas.

Level of Evidence

3b. Laryngoscope, 2017

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EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Editorial Board

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Announcements

Dear Colleagues,

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Dual Ectopic Thyroid Gland in an Elderly Male: Double Trouble?

Abstract

Double ectopic thyroid tissue is a rare phenomenon. We report a case of a 75-year-old man who was referred with two painless swellings in the anterior midline of neck with a tracheostomy tube in situ with the suspicion of malignancy. Such patients should be investigated completely prior to definitive treatment.

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Universal Hearing Screening in Newborns Using Otoacoustic Emissions and Brainstem Evoked Response in Eastern Uttar Pradesh

Abstract

The objectives were to determine the incidence of hearing impairment in a standardized population of neonates and to determine the significance of association of epidemiological and risk factors with neonatal hearing loss. A cohort of 600 newborns was selected for study and divided into two groups—525 in 'No Risk' group and remaining 75 in 'At Risk' group. The study protocol was carried out in three steps: (a) Screening of Hearing Loss with TOAE, done from 36 h after birth to 28 days of life, (b) Re-screening of hearing loss in newborns (of 4–12 weeks of age), who were tested positive for hearing loss in the first screening, done with DPOAE, (c) Confirmation of hearing loss with BERA, in those who were tested positive in both the first and second screening. In the study the incidence of hearing impairment in 600 infants screened was 6.67 per 1000 screened; 3.81 per 1000 screened in the Not at Risk group and 26.67 per 1000 screened in At Risk group. In At Risk group, admitted to the NICU, severe birth asphyxia and hyperbilirubinemia were found to be major risk factors. Loss to follow up was more in Not at Risk group and False Positive cases with TEOAE were more than DPOAE. BERA was found to be must for confirmation of hearing loss. Neonatal Hearing Screening of only At Risk population is likely to miss some hearing loss. Universal Hearing Screening should be the preferred strategy. Good follow up in the 'At Risk' group suggests that initial interventions in NICU had sensitized the parents for the possibility of hearing loss. This study recommends the introduction of two stage neonatal screening–rescreening protocol, using OAE and BERA, in the country in phased manner.

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Ethics of research for patients in pain.

Purpose of review: This review describes advances in rising and continuing ethical issues in research in patients in pain. Although some of the issues focus directly on pain research, such as research in neonatal pain management, others focus on widespread ethical issues that are relevant to pain research, such as scientific misconduct, deception, placebo use and genomics. Recent findings: Scientific misconduct is more widespread than realized and requires greater awareness of the markers of misconduct like irreproducibility. More education about what qualifies as misconduct, such as consent violations, plagiarism and inappropriate patient recruitment along with data falsification needs to be implemented. Wayward researchers may attend a rehabilitation conference to improve their practices. Studies in neonatal pain management do not require comparing an intervention with the inadequate analgesia of a placebo; comparing with a standard approach is sufficient. Deception of research patients may be acceptable under narrow circumstances. The legitimacy of using broad informed consent for biobanking and genomic studies are being challenged as changes to the Common Rule are being considered. Summary: Increasing complexity and the desire to further medical knowledge complicates research methods and informed consent. The ethical issues surrounding these and offshoot areas will continue to develop. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Nutrition in the critically ill patient.

Purpose of review: To summarize recent relevant studies regarding nutrition during critical illness and provide recommendations for clinical practice. Recent findings: Recently acquired knowledge regarding nutritional status and risk assessment, body composition, gastric residual volume, prokinetics, tube positioning, enteral vs parenteral nutrition, nutritional dose and timing of initiation, pharmaconutrition, dysbiosis and probiotics are discussed. Summary: Body composition especially lean body mass is associated with clinical outcomes. The modified NUTrition Risk in the Critically ill score was validated for nutritional risk assessment and identifies patients that benefit from higher nutritional intake; however, caloric restriction decreases mortality in refeeding syndrome. Gastric residual volume monitoring is debated, as abandoning its application doesn't worsen outcome. There is no consensus regarding benefits of gastric vs postpyloric tube placement. Current prokinetics temporarily reduce feeding intolerance, new prokinetics are developed. Enteral remains preferable over parenteral nutrition, although no inferiority of parenteral nutrition is reported in recent studies. Studies imply no harm of hypocaloric feeding when protein requirements are met. Optimal protein provision may be more important than caloric adequacy. Pharmaconutrition confers no superior outcomes and may even confer harm. Dysbiosis is frequently encountered and associated with worse outcomes. Probiotics reduce infectious complications, but not mortality, and may contribute to earlier recovery of gut function. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Haemotherapy algorithm for the management of trauma-induced coagulopathy: an Australian perspective.

Purpose of review: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre. Recent findings: Few topics in trauma resuscitation incite as much debate and controversy as to what constitutes the 'ideal' MHP. There is a widespread geographical and institutional variation in clinical practice. Three strategies are commonly utilized; fixed ratio major haemorrhage protocol (FRMHP), viscoelastic haemostatic assay (VHA)-guided MHP and hybrid MHP. The majority of trauma centres utilize an FRMHP and there is high-level evidence to support the use of high blood product ratios. It can be argued that the FRMHP is too simplistic to be applied to all trauma patients and that the use of VHA-guided MHP with predominant factor concentrate transfusion can allow rapid individualized interventions. In between these two strategies is a hybrid MHP, combining early FRMHP with subsequent VHA-guided transfusion. Summary: There are advantages and disadvantages to each of the various MHP strategies and the evidence base to support one above another with any certainty is lacking at this time. One strategy cannot be considered superior to the other and the choice of MHP is dependent on interpretation of the current literature and local institutional logistical considerations. A number of exciting studies are currently underway that will certainly increase the evidence base and help inform clinical practice. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Continuous electroencephalographic-monitoring in the ICU: an overview of current strengths and future challenges.

Purpose of review: In ICUs, numerous physiological parameters are continuously monitored and displayed. Yet, functional monitoring of the organ of primary concern, the brain, is not routinely performed. Despite the benefits of ICU use of continuous electroencephalographic (EEG)-monitoring (cEEG) is increasingly recognized, several issues nevertheless seem to hamper its widespread clinical implementation. Recent findings: Utilization of ICU cEEG has significantly improved detection and characterization of cerebral pathology, prognostication and clinical management in specific patient groups. Potential solutions to several remaining challenges are currently being established. Descriptive EEG-terminology is evolving, whereas logistical issues are dealt with using telemedicine and quantitative EEG trends, training of nonexpert personnel and development of specialized detection algorithms. These concerted solutions are advancing cEEG-registration towards cEEG-monitoring. Notwithstanding these advances, obstacles such as ambiguous EEG-interpretation and differences in treatment based on EEG-findings need yet to be overcome. Summary: In selected critically ill patient groups, ICU cEEG has clear benefits over (repeated) standard EEG or no functional brain monitoring at all and if available, cEEG should be used. However, several issues preventing optimal ICU cEEG usage persist and should be further explored. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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