Head and Neck Medicine by Alexandros G.Sfakianakis: 06/14/17

Τετάρτη 14 Ιουνίου 2017

Clinical efficacy of utilizing Ultrapulse CO2 combined with fractional CO2 laser for the treatment of hypertrophic scars in Asians—A prospective clinical evaluation

Summary

Background and Objective

Hypertrophic scarring is seen regularly. Tissue penetration of laser energy into hypertrophic scars using computer defaults from some lasers may be insufficient and penetration not enough. We have developed a treatment with an interrupted laser "drilling" by the Ultrapulse CO₂ (Manual Fractional Technology, MFT) and, a second pass, with fractional CO₂. The MFT with fractional CO₂ lasers to treat hypertrophic scars is evaluated.

Study Design/Materials and Methods

A total of 158 patients with hypertrophic scars had three sessions of MFT with fractional CO₂ laser at 3-month intervals. Evaluations made before and 6 months after the 3rd treatment: (1) the Vancouver Scar Scale (VSS), (2) the University of North Carolina (UNC) Scar Scale, and (3) a survey of patient satisfaction.

Results

All data were analyzed using a t-test before and after treatment. The VSS score decreased from 9.35 to 3.12 (P<.0001), and the UNC Scar Scale score decreased from 8.03 to 1.62 (P<.0001). The overall satisfaction rate was 92%. No long-term complications occurred in the clinical trial.

Conclusion

The interrupted laser drilling by MFT and a fractional CO2 laser had profound effects on the hypertrophic scars treated. It works by increasing the penetration depth of the CO₂ laser in the scar tissue, exerting more precise effects on the hypertrophic scars. MFT combined with fractional CO₂ laser has the potential to be a major advance in the treatment of hypertrophic scars.

http://ift.tt/2rjByw0

Issue Information - TOC

http://ift.tt/2t4UDDF

BJD Snippet

http://ift.tt/2sv2Dk3

JCD Editorial – June, 2017

http://ift.tt/2t4uSDr

Effect of gels containing chlorhexidine or epigallocatechin-3-gallate on the protein composition of the acquired enamel pellicle

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Cíntia Maria de Souza-e-Silva, Talita Mendes da Silva Ventura, Luiza de Pau, la Silva Cassiano, Aline de Lima Leite, Marília Afonso Rabelo Buzalaf
ObjectiveThis study evaluated changes in protein profile of the acquired enamel pellicle (AEP) formed in vivo, after application of gels containing chlorhexidine or EGCG and further challenge with citric acid.DesignAEP was formed in 9 volunteers for 2h and then treated with one of the following gels: placebo, 400μM EGCG or 0.012% chlorhexidine. A thin layer of gel was applied and after 1min the excess was removed. One hour after gel application, the AEP was collected from the buccal surface (upper and lower jaw) of one of the sides with filter paper dipped in 3% citric acid. On the other side, erosive challenge was performed through gentle application of 1% citric acid (pH 2.5) for 20s (using a pipette) followed by washing with deionized water. The AEP was collected as mentioned before. Proteomic analysis was performed through liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI–MS/MS). The MS/MS spectra obtained were compared with human protein databases (SWISS-PROT). Label-free quantitation was done using the PLGS software.ResultsIn total, 223 proteins were identified. After treatment with EGCG and CHX gels, proteins with potential functions to protect against caries and erosion such as PRPs, calcium-bind proteins and Statherin were increased. When EGCG and CHX-treated AEPs were challenged with citric acid, there was increase in cystatins and Profilin-1.ConclusionCHX- and EGCG-treated AEPs, submitted to challenge with citric acid or not, had remarkable changes in their proteomic profiles.

http://ift.tt/2rjzvrQ

Effect of gels containing chlorhexidine or epigallocatechin-3-gallate on the protein composition of the acquired enamel pellicle

Histologic features of chronic cutaneous lupus erythematosus of the scalp using horizontal sectioning: Emphasis on follicular findings

Chronic cutaneous lupus erythematosus (CCLE) often affects the scalp resulting in scarring alopecia. While histopathologic findings of CCLE have been well described, there is little written on the morphologic changes to the hair follicles in this condition.

http://ift.tt/2toNzAX

Skin-infiltrating, interleukin-22–producing T cells differentiate pediatric psoriasis from adult psoriasis

Evidence from adult psoriasis studies implicates an imbalance between regulatory and effector T cells, particularly TH-17–producing T cells, in the pathogenesis of psoriasis. Little is known about the immunopathology of psoriasis in children.

http://ift.tt/2sraxdw

Erratum to: Early gastric adenocarcinoma arising within foveolar-type dysplasia in a patient with Muir-Torre variant Lynch syndrome

http://ift.tt/2srkmIh

Quality of Life and Dysphagia Following Palliative Stenting in Esophageal Cancer

Condition: Esophageal Cancer
Intervention:
Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)
Recruiting - verified June 2017

http://ift.tt/2sqYv3X

Anesthetic Management of Reversible Cerebral Vasoconstriction Syndrome: A Case Report

Publication date: Available online 14 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hiroshi Hoshijima, Naoki Itoh, Yoshinori Iwase, Hiroshi Nagasaka
PurposeReversible cerebral vasoconstriction syndrome (RCVS) is a group of disorders characterized by prolonged reversible cerebral vasoconstriction, associated with acute-onset severe episodic "thunderclap" headaches with or without other neurologic clinical features. Here, we describe the first reported case, to our knowledge, of a patient with RCVS who was managed under general anesthesia in the field of oral and maxillofacial surgery.Materials and MethodsA 67-year-old woman with a diagnosis of RCVS made 2 months earlier was scheduled for surgical extraction of the mandibular right third molar. Standard monitoring included noninvasive blood pressure measurement, pulse oximetry, and electrocardiography; a bispectral index monitor (BIS) sensor was placed on her forehead. General anesthesia was induced by target-controlled infusion of propofol to an effect site concentration of 5.0 μg·mL^-1, with remifentanil 0.50 μg·kg^-1·min^-1 and rocuronium 40 mg. After tracheal intubation, anesthesia was maintained uneventfully with remifentanil 0.15-0.2 μg·kg^-1·min^-1 and propofol 2.0-3.0 μg·mL^-1 in oxygen and air. End-tidal CO2 concentration was maintained at 38-42 mmHg. The BIS reading was 40-60. Fentanyl 0.1 mg and acetaminophen 750 mg were administered before the end of surgery for postoperative analgesia.ResultsThe postoperative course was uneventful, with no headache or hypertensive complications.ConclusionWe successfully achieved anesthetic management with no appreciable clinical signs of cerebral ischemia or recurrence in a patient with RCVS. We used propofol as the anesthetic agent with BIS monitoring to detect cerebral ischemia. However, there is no definitive evidence of the utility of these measures for prevention or diagnosis of RCVS and further study is needed.

http://ift.tt/2t4kEmm

Pre-emptive effect of dexamethasone and diclofenac sodium associated with codeine on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind controlled clinical trial

Publication date: Available online 14 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Thiago César Lima, Elizabete Bagordakis, Saulo Gabriel Moreira Falci, Cássio Roberto Rocha dos Santos, Marcos Luciano Pimenta Pinheiro
PurposeTo compare the effect of dexamethasone 8 mg and diclofenac sodium 50 mg associated with codeine 50 mg on the control of pain, swelling, and trismus following the extraction of impacted third molars.MethodsFifteen healthy patients with a mean age of 22.8 (standard deviation 12.62) years received a single oral dose of either drug 1 h prior to each surgical procedure (left and right teeth). At 24, 48, and 72 h following surgery, swelling was determined using linear measurements on the face and trismus was determined by maximal mouth opening. Postoperative pain was self-recorded by the patients using a numerical rating scale at 24-h intervals for a period of 72 h. Data analysis involved descriptive statistics, and Shapiro-Wilk, Wilcoxon, and paired t tests (p < 0.05).ResultsDexamethasone controlled pain (p = 0.016) and edema (p = 0.08) better than diclofenac sodium associated with codeine, within 48 hours. No statistically significant differences were found between drugs in regard to trismus and consumption of rescue analgesics (acetaminophen).ConclusionThe results of this study suggest that pre-emptive administration of dexamethasone 8 mg showed better control of pain and swelling in bilateral extractions third impacted mandibular molars.

http://ift.tt/2suIOJx

Salivary calculi removal by minimally invasive techniques: A decision-tree based on the diameter of the calculi, and their position in the excretory duct.

Publication date: Available online 14 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jean Marc Foletti, Nicolas Graillon, Simon Avignon, Laurent Guyot, C. Chossegros
IntroductionThe authors of this article suggest a decision tree for the choice of the best minimally invasive technique for treating submandibular and parotid calculi, according to the diameter of the calculi, and their position in the excretory duct.Materials and MethodsSubmandibular and parotid ducts can be both divided into three thirds, delineated by easily recognizable landmarks. The diameter of calculi is schematically classified into 1 of these 3 categories: floating, slightly impacted or largely impacted.ResultsUsing three criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a GTD 3-stage classification of calculi is established. Then, the best indication of each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra or extracorporeal stone fragmentation) is discussed for each stage of calculi.DiscussionMinimally invasive treatment options mentioned here are numerous and have replaced invasive resection surgeries (submandibulectomy and parotidectomy) in the management of salivary calculi, improving significantly the prognosis of these diseases. The authors emphasize the need for flexibility in surgical indications, and challenge the dogma of an "all endoscopic" management of salivary calculi.

http://ift.tt/2t4doH0

Is there association between the presence of lower third molar and mandibular angle fractures: a meta-analysis?

Publication date: Available online 13 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Wagner de Sousa Ruela, Vinícius Lima de Almeida, Luciana Monti Lima-Rivera, Pâmela Letícia dos Santos, André Luís Porporatti, Paulo Henrique Luiz de Freitas, Luiz Renato Paranhos
PurposeThe current literature suggests that the presence of lower third molars predisposes to a higher risk of mandibular angle fracture. Thus, this review aims to answer the following question: "Is there an association between the presence of lower third molar and mandibular angle fractures in adults?", as well as to assess the influence of third molar position according to Pell and Gregory.Material and methodsthe present study is a systematic review and meta-analysis on analytical observational studies. The study population was composed of all publication on the relationship between mandibular angle fracture and the lower third molar. There was no restriction of year, language, and publication status. The review protocol was registered at the PROSPERO database (CRD42016047057). Electronic searches unrestricted for publication period and language were performed in the PubMed, Scopus, SciELO, LILACS databases. Google Scholar and Open Grey databases were used to search the "grey literature", avoiding selection and publication biases. The entire search was performed by two eligibility reviewers. Association and proportion meta-analyses were planned for the studies with sufficient data. The primary predictor variable was the relationship between the presence of lower third molar and the development of mandibular angle fractures. The secondary outcome variables were the vertical and horizontal positions of the lower third molar, according to the classification by Pell and Gregory and their relation to the susceptibility to developing mandibular angle fracture.Resultsthe search strategies resulted in a set of 411 studies, from which 16 were selected for qualitative and quantitative review. Association meta-analysis included all the selected studies and showed that patients with lower third molars are 3.16 times more likely to develop mandibular angle fractures. Proportion meta-analysis included five studies and showed that the overall rate of mandibular angle fractures was 51.58% and that positions III and C are more likely to cause fracture, with rate of 59.84 and 63.67%, respectively.Conclusionsthis study showed that the presence of impacted third molars increases by 3.16 times the risk of mandibular angle fractures in adults, with the highest risk present when third molars are classified as IIIC according to Pell and Gregory. The available evidence is not sufficiently robust to determine third molar presence or level of impaction as the main causative factors for mandibular angle fractures.

http://ift.tt/2suGEcV

Management of surgical third lower molar extraction and post-operative progress in patients with factor VII deficiency: a clinical protocol and a focus on this rare pathology

Publication date: Available online 14 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Pier Carmine Passarelli, Guido Pasquantonio, Antonio D'Addona
PurposeThe purpose of this study was to analyze the management of surgical third molar extraction and postoperative progress in patients with a diagnosis of factor VII deficiency. Close collaboration between the oral-maxillofacial surgeon and hematologist allows the team to categorize the risk and to operate safely, thereby minimizing intraoperative and postoperative complications.Materials and methodsThis retrospective study includes 7 patients with factor VII deficiency who underwent third lower molar surgery. Their factor VII deficiency was in the range of 10.5–21.0%.Recombinant activated factor VII (rFVIIa) (NovoSeven) was transfused intravenously in a single dose of 25 μg/kg body weight, 30 min before surgical extractions. After the surgery, betamethasone, an analgesic, and an ice pack were administered.ResultsPretreatment with recombinant activated factor VII resulted in excellent hemostasis. No hemorrhagic complications and no postoperative major bleeding were observed.ConclusionThe extraction of the third lower molar appears to be a safe procedure in patients with factor VII deficiency when appropriate prophylaxis with rFVIIa is used.

http://ift.tt/2t4u6Go

Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

Squamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area.

http://ift.tt/2sC3kaW

Undifferentiated sarcoma of the sphenoid sinus

Paranasal sinuses sarcomas are rare and no treatments have been established. We report a young-adult case of sphenoid sinus sarcoma treated by carbon-ion radiotherapy. The patient presented with progressive left-sided visual impairment. A tumor was then identified and partial resection by transnasal approach was performed. The resected mass showed typical morphology of mesenchymal tumor, and morphological and molecular analyses ruled out a predominant-differentiation phenotype. The pathological diagnosis was undifferentiated sarcoma.

http://ift.tt/2rjkshW

A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job.

http://ift.tt/2sBINn6

Inspiring a career in oral and maxillofacial surgery: a first-degree medical student’s perspective

When a person is considering a career in oral and maxillofacial surgery (OMFS) the need for both medical and dental qualifications can be discouraging. The long training is daunting, and may not seem worthwhile to students who have not experienced the specialty first hand. In 2015, 76% of medical students reported no exposure to OMFS, and 82% of those who had, attributed it to extra-curricular activities.1 These figures starkly outline the need to expose students to OMFS and highlight its absence from the undergraduate curriculum.

http://ift.tt/2sqVaBI

Three-dimensional scanning electron microscopy of maxillofacial biomaterials

Recent studies have used conventional scanning electron microscopy (SEM), micro-computed tomography (μCT), and synchrotron-based X-ray tomographic microscopy (SRXTM) to visualise and characterise maxillofacial biomaterials.1,2 We report a method of 3-dimensional scanning electron microscopy (3D-SEM) to visualise maxillofacial biomaterials.

http://ift.tt/2toRjT8

Simultaneous, congenital, mucocoele of the Blandin-Nühn glands and teratoma of the tongue: early management and follow up at one year

Mucocoele of the Blandin-Nühn glands and teratomas of the tongue are rare in newborn babies. We present what is to our knowledge the first documented case of both at the same time, and describe management and follow up over 12 months after the birth. Prenatal diagnosis defined the treatment plan during delivery to establish an airway for the baby promptly. A normal delivery is possible if the cyst is anterior, and can be punctured during delivery. Delayed excision reduces the possibility of oedema and obstruction of the airway, ensures complete resection, avoids recurrence, and confirms the diagnosis.

http://ift.tt/2toFVGB

Efficacy of an eccentric osteopathic manipulation treatment in somatic tinnitus

Manu Goyal, Sorabh Sharma, Nitish Baisakhiya, Kanu Goyal

Indian Journal of Otology 2017 23(2):125-127

Tinnitus is the ringing in the ears heard by the patients in the absence of external sounds. The potential causes for the tinnitus could be the vascular, temporal bone dysfunction, inflammation in the ear, idiopathic, muscular spasms of the middle ear and palatal muscles, functional impairment of the eustachian tube, functional disorders of the jaw, and cervical spine. The author reported a 30-year-old female case who presented with the complaint of buzzing and hissing in the right ear accompanied by the stiffness in the head and neck. Patient had no past medical and surgical history of any ear problem. On otoscopic examination of the tympanic membrane by otolaryngologist no abnormality was detected. In the present case, the diagnosis was made as somatic tinnitus accompanied by reduced cranial sacral motion. The craniosacral osteopathic manipulation was performed which remains the only choice in such cases. In follow-up of 1 month, patient was doing well and is asymptomatic.

http://ift.tt/2toEBna

To study the anatomy of tympanomastoid segment of facial nerve and its variations in human cadaveric temporal bone

Nitika Gupta, Rohan Gupta, IP Singh, Sunil Kotwal, Anil Suri, Sunanda Raina

Indian Journal of Otology 2017 23(2):108-112

Introduction: The facial nerve is one of the most significant and vulnerable structures in the temporal bone. Its dysfunction affects both voluntary and voluntary motion leading to noticeable disfigurement and emotional distress to those suffering from it. Iatrogenic facial paralysis is known to be a feared complication of ear surgery, and its incidence is reported to be 0.6–3.6% in all otologic surgical procedures, which increases to 4–10% in revision cases. Objective: The aim of this study is to study the anatomical aspects of tympanomastoid segment of the facial nerve. Materials and Methods: Thirty wet human cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of ENT, Government Medical College, Jammu. The length of the tympanomastoid segment of the facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variation in its course were studied. Observations and Results: The mean length of the tympanic segment of the facial nerve was 10.44±1.428 mm while that of the mastoid segment was 13.33±2.202 mm. The angle formed between the tympanic and mastoid segments of the facial nerve varied between 95°and 120°with the mean angle being 104.66°±7.760°.

http://ift.tt/2sr3t0h

Screening of auditory acuity in patients with type 2 diabetes mellitus

Netra A Pathak, Vidya V Rokade, Kiran J Shinde

Indian Journal of Otology 2017 23(2):67-70

Diabetes mellitus (DM) is a multifunctional metabolic disorder affecting almost all the systems of the body. There is a strong relation between DM and hearing. The three main theories of pathogenesis of hearing impairment in patients with diabetes are microangiopathy, neuropathy, and combination of both. Even though studies have proved the occurrence of sensorineural hearing loss in DM, disagreement still exists among some about their relation. Material and Methods: This study was a prospective design. Aim: The present study aimed (1) to focus on and evaluate the interrelation between Type 2 DM and hearing loss; (2) to screen the degree of auditory acuity in patients with Type 2 DM using pure tone audiometry; and (3) to analyze the effect of age, glycemic status (fasting blood sugar and postprandial blood sugar), glycemic control (glycosylated hemoglobin), and duration of Type 2 diabetes on auditory acuity. Results: In the present study, it was found that the patients with Type 2 diabetes had a higher hearing threshold than the healthy controls. The patients with diabetes showed significant high-frequency, bilateral, mild-to-moderate SNHL. Conclusion: The glycemic status had significant correlation with hearing loss may be explained by diabetic microangiopathy of the inner ear, and the hearing was affected in both sexes equally.

http://ift.tt/2toPzt4

Investigating a patient of vertigo: Where do we stand today?

Chetana Naik

Indian Journal of Otology 2017 23(2):63-66

http://ift.tt/2sqK0Nm

Effect of postauricular sulcus incision for myringoplasty on auricle protrusion: 5 years' experience

Mohammad Waheed El-Anwar, Ahmed Shaker ElAassar

Indian Journal of Otology 2017 23(2):71-73

Objective: The objective of this study was to investigate the effect of postauricular incision (sulcus incision) during myringoplasty using conchal perichondrial graft with or without conchal cartilage on the ear protrusion. Patients and Methods: A prospective study was conducted on 243 patients who underwent myringoplasty using small postauricular sulcus incision. The distances from postauricular area to the lateral aspects of helical rim and ear lobule at three different levels and the maximum ear protrusion were measured pre- and post-operatively. Results: There were no statistically significant differences between the measures of the auricle position preoperatively and 2 weeks, 1 month, and 3 months postoperatively. Conclusion: There was no effect of the short postauricular sulcus incisions for myringoplasty on the ear position. It does not affect or annoy the glasses wearers with highly satisfactory cosmetic results without reported persistent complications.

http://ift.tt/2toD3ts

Evaluation of the myringosclerotic tympanic membrane with wideband tympanometry

Suat Terzi, Abdulkadir Özgür, Zerrin Özergin Coşkun, Özlem Çelebi Erdivanlı, Metin Çeliker, Münir Demirci, Engin Dursun

Indian Journal of Otology 2017 23(2):117-120

Objective: The purpose of this study is to evaluate the effects of myringosclerosis (MS) localized to the tympanic membrane (TM) on the mechano-acoustics of hearing using wideband tympanometry (WBT). Materials and Methods: In this prospective case-controlled study, 86 ears of 54 patients who were found to have MS localized to the TM were compared to 40 healthy eardrums in 20 patients. Thirty-seven ears which had a MS ratio to the whole TM of <25% were classified as Group 1, 33 ears with a ratio of 25–50% were classified as Group 2, and 16 ears with a ratio of >50% were classified as Group 3. Peak acoustic compliance, resonant frequency (RF), and frequency-specific absorbance results of WBT were compared among the MS groups and the control group. Results: When the amplitudes of peak acoustic compliance of the MS groups and control group were compared, the MS groups were found to have lower amplitudes, and the difference was statistically significant (P < 0.05). There was no difference in frequency-specific absorbance values (250, 500, 1000, 2000, 4000, 8000, and 375–2000 Hz averaged absorbance) among the groups (P > 0.05). The RF of Groups 1, 2, and 3 were 1062, 1154, and 1166 Hz, respectively, and the RF of the control group was 1077 Hz. There was no significant difference among the groups with regard to resonant frequencies. Conclusion: This study showed that although MS localized to the TM decreased the amplitude of peak acoustic compliance of the tympanogram, it did not affect the RF or the wideband acoustic absorbance.

http://ift.tt/2sqLFCE

Vestibular dysfunction in children with sensorineural hearing loss: A cross-sectional study

Poonam Raj, Atul Gupta

Indian Journal of Otology 2017 23(2):74-77

Introduction: The cochlea and vestibule are anatomically and functionally related to each other and any dysfunction in each or both of them may result in vestibular functional derangement and subsequent deficit in the function of balance. This is especially true in children where the two systems are still evolving. Vestibular dysfunction has been reported in approximately 20-70 % of children with hearing loss of different causes. This study was aimed to detect and evaluate the prevalence of vestibular dysfunction in children with SNHL. Methods and Materials: Vestibular function assessment was done with monothermal warm air caloric test on 50 children less than 12 years of age with bilateral severe to profound SNHL. Recordings were made using a head band camera on SYNAPSYS Ulmer VNG software. "Monothermal Caloric Asymmetry" (MCA) was depicted in the recording software as unilateral weakness. MCA of >15 % was taken as evidence of canal paresis. Results: The mean age of the children was 5.48 years. Of the 48 children who successfully completed the test, 09 children had vestibular dysfunction indicative of canal paresis. Prevalence was 18.75 % with 95% CI (7.3, 30.2). Correlation between compensated vestibular function results with age and severity of SNHL was not significant. Conclusions: Children with SNHL should be evaluated for occult compensated vestibular dysfunction. It may also be relevant in the context of any further vestibular pathology the child may develop and should be kept in mind when surgical procedures like cochlear implantation are being contemplated.

http://ift.tt/2toM3Ps

Enterococcus brain abscess with lateral sinus thrombophlebitis as a complication of chronic otitis media

Manu Malhotra, Shubhankur Gupta, Saurabh Varshney, Poonam Joshi, Rashmi Malhotra

Indian Journal of Otology 2017 23(2):121-124

With widespread use of antibiotics, the occurrence of brain abscess and lateral sinus thrombosis together is rare these days, especially with enterococcus as the causative organism. We here present a case of pediatric case of brain abscess and lateral sinus thrombosis which developed an additional complication of postoperative cerebrospinal fluid leakage. The case was successfully treated by excision of the abscess, canal wall down mastoidectomy with partial obliteration of cavity, and Type III tympanoplasty with umbrella graft.

http://ift.tt/2sqV1hH

Glomus tympanicum: A radiological dilemma

A Karunagaran, VJ Niranjana Bharathi, Anand Karthikeyan

Indian Journal of Otology 2017 23(2):131-133

Glomus tumors are non chromaffin paraganglionomas, a vascular tumor arising in the middle ear, presents with tinnitus and aural block with radiological supportive findings. Diagnosis is made easy by the radiological investigations. Even in this modern era, the role played by clinical examination is vital and as we present in this case report, played an important role in management of the disease.

http://ift.tt/2sqQqft

Nitinol piston versus conventional teflon piston in the management of otosclerosis: A comparative study

Poonam Raj, Atul Gupta, Ruchika Mittal

Indian Journal of Otology 2017 23(2):78-82

Introduction: Otosclerosis is a primary metabolic localized disease characterized by conductive deafness. The mainstay of treatment of this condition remains surgical. Several techniques and approaches are commonly used with largely excellent results. A newly developed piston made of Nitinol has the property of crimping by heat activation rather than manually. This study, carried out at a tertiary care centre of the armed forces, proposed to evaluate the efficacy and complications of the Nitinol Smart piston in comparison to the conventional pistons currently being used. Methods and Materials: 50 patients of otosclerosis were evaluated with Pure tone audiometry and randomized into test and control groups of 25 each. The control group underwent stapedotomy by the conventional Teflon piston and in the test group Nitinol smart pistons were used. Pure tone Audiometry for hearing thresholds and AB gap was performed at 06 weeks after surgery and repeated at 06 months, 01 year and 02 years after surgery. Results: Results show an almost identical outcome in terms of improvement of hearing thresholds with the two kinds of prosthesis used with the 'Smart' piston showing marginally better results. There was no significant difference in the postoperative ABG (P < .23) or ABG closure (P < .09). Conclusion: The nitinol piston prosthesis represents the latest advancement in stapes prosthesis design in that incorporates heat-sensitive crimping to preclude the technically difficult step of manual crimping. It is at least as effective as a standard prosthesis in closing the ABG in patients with otosclerosis.

http://ift.tt/2toD1lk

Effect of mastoid pneumatization on myringoplasty success: A radiological study

Hazem Saeed Amer, Mohammad Waheed El-Anwar, Mohammad Abdelhady, Ghada Abdulmonaem, Khaled Mohammad Elgerby

Indian Journal of Otology 2017 23(2):104-107

Objectives: The objective of the study was to evaluate the effect of mastoid pneumatization on myringoplasty success. Patients and Methods: Forty-two adult patients with dry central tympanic membrane perforation scheduled for myringoplasty were included in the study. Computed tomography (CT) scans of the temporal bone coronal and axial cuts were done 1–2 days before surgery. The patients were evaluated on the basis of postoperative graft taking. Results: Success rate was 85.7% while failure rate was 14.3%. The mean longitudinal diameter of the mastoid was found to be 2.35 cm in succeeded cases and 1.43 cm in failed cases with near significant difference (P = 0.0636). The mean transverse diameter was 1.44 cm in succeeded cases and 0.83 cm in failed cases with a significant difference (P = 0.0476). The mean depth of the mastoid was 0.4 in both succeeded and failed cases. The mean total mastoid volume was 2.832 ml in succeeded cases and 1.13 ml in failed cases with nonsignificant difference (P = 0.1218). The mean mastoid surface area was 516.9 cm2 in succeeded cases and 448.5 cm2 in failed cases with a significant difference (P = 0.0087). Conclusions: Success rate of myringoplasty is higher in patients with chronic suppurative otitis media (CSOM) having large mastoid system than those having small one. Preoperative CT scans in patients with CSOM undergoing myringoplasty are advisable.

http://ift.tt/2sqKoLQ

Effect of inter-stimulus interval on the acoustic change complex elicited with tone-complex and speech stimuli

Mohan Kumar Kalaiah, Anjali Jude, Vinaya Palora Malayil

Indian Journal of Otology 2017 23(2):83-88

Background: Acoustic change complex (ACC) is an auditory-evoked cortical potential elicited for a change in the physical properties of the sound. It can be elicited for a change in frequency, amplitude, or periodicity in the ongoing speech and nonspeech stimuli. Earlier investigations have established a significant effect of stimulus-related factors on the cortical auditory-evoked potentials. However, investigations to understand the effects of stimulus factors on the ACC are rare. Purpose: This study aimed to investigate the effect of inter-stimulus interval (ISI) between the stimuli on the ACC elicited for speech and tone-complex stimuli. Research Design: This is a cross-sectional study. Method: A total of 12 young adults aged between 18 and 22 years with normal hearing in both ears participated in the study. The ACC was elicited using a consonant-vowel syllable/sa/and frequency-changing tone-complex. Tone-complex had an onset frequency of 1000 Hz and changed its frequency to 2000 Hz at 120 ms after the onset. Both stimuli had a total duration of 350 ms and changed their characteristics at 120 ms after the onset. The stimulus was presented monaurally with ISIs of 500, 1000, 1500, and 2000 ms, and the ACC was recorded from Cz to Fz. Results: The present study showed a significant effect of ISI on peak latencies and peak-to-peak amplitudes. Shorter ISI was found to elicit peaks with smaller amplitude and slightly longer latency, whereas longer ISI elicited peaks with larger amplitude and shorter latency. Further, the amplitude of response for tone-complex was larger than response for syllable/sa/. Conclusions: ISI is one of the stimulus-related factors which significantly affects the ACC. Longer ISIs (≥1500 ms) should be used to elicit the ACC.

http://ift.tt/2toCY98

Effect of duration of diabetes mellitus on hearing threshold among type 2 diabetics

Stephen Semen Yikawe, Kufre Robert Iseh, Anas Ahmad Sabir, Joseph Hassan Solomon, Caleb Manya, Nasiru Aliyu

Indian Journal of Otology 2017 23(2):113-116

Background: Diabetes mellitus (DM) is a syndrome of chronic hyperglycemia due to relative insulin deficiency or resistance. The risk of complications of diabetes has been observed to increase as a function of the duration of hyperglycemia. Objective: The objective of this study is to determine the effect of duration of DM on hearing thresholds among type 2 diabetics. Methodology: This was a cross-sectional descriptive study conducted between October 2015 and May 2016 in Usmanu Danfodiyo University Teaching Hospital Sokoto among type 2 diabetic patients attending the Endocrine Clinic of the hospital. Patients had their blood sugar and hearing thresholds measured. Results: A total of 170 type 2 diabetics were recruited into the study, out of which 98 (57.6%) were females and 72 (42.4%) were males. The mean age was 46.49±10.02 years. One hundred and twenty-two (71.8%) had elevated hearing thresholds. The mean duration of diabetes among participants was 7.81±5.34 years, with durations ranging from <1 year to 30 years. The mean pure tone average increased with increase in duration of diabetes (P < 0.001). Simple linear regression showed that increase in duration of diabetes was positively related with hearing threshold (P < 0.0001). For every year increase in duration of type 2 DM, a 1.036 dB HL increase in pure tone average is to be expected. Conclusion: This study demonstrated a relationship between duration of diabetes and hearing threshold. It has shown that as the duration of hyperglycemia increased, the hearing threshold among participants also increased.

http://ift.tt/2sr1WYo

Test-retest reliability of contralateral suppression of acoustic middle ear muscle reflex

Sandeep Maruthy, G Nike Gnanateja, M Shamantha, M Nayana

Indian Journal of Otology 2017 23(2):89-93

Background and Objective: The role of efferent system in auditory perception is very important. To assess this, a reliable measure of efferent functioning is necessary. The efferent suppression of otoacoustic emission lacks good test-retest reliability, and there is a need to look for the reliability of other measures of efferent auditory functioning. The current study evaluated the test-retest reliability of contralateral suppression of acoustically evoked middle ear muscle reflexes (MEMR). Method: Nineteen normal hearing adults in the age range of 18–24 years participated in the study. A Repeated measures design was used to establish the reliability of the contralateral suppression of MEMR. Measurements were spaced 1 h and 1 day apart. Results: The results showed acceptable test-retest reliability of contralateral suppression of acoustically evoked MEMR in terms of its Cronbach's alpha. However, inspection of the individual data did not support the impression to call it a reliable tool to assess efferent auditory functioning. The findings of the study are discussed in light of its clinical utility. Conclusion: Contralateral suppression of acoustically evoked MEMR has questionable reliability to be used as a clinical tool.

http://ift.tt/2toMXvd

Effects of ethnicity and gender on the middle ear function in Asian adults

Aw Cheu Lih, Mohd Normani Zakaria, Ridwan Afif Mohamad, Mohd Fadzil Nor Rashid

Indian Journal of Otology 2017 23(2):94-97

Introduction: Tympanometry is a standard clinical test to measure the middle ear function objectively. Ethnicity and gender may affect tympanometric results, and specific normative data are required for diagnosing middle ear disorders accurately. Aim: This study aimed to determine the effects of ethnicity (Malay vs. Chinese) and gender on tympanometric results among Asian adults. Materials and Methods: A total of 72 young adults aged 20–25 years participated in this comparative study. They comprised two ethnic groups: Malay (n = 31 [14 males and 17 females]) and Chinese (n = 41 [20 males and 21 females]) participants. All participants fulfilled the inclusion criteria (no history of ear and hearing difficulties and normal findings in routine audiological assessments) and underwent a standard 226 Hz tympanometric testing. Tympanometric parameters including static admittance (SA), ear canal volume (ECV), tympanometric peak pressure (TPP), and tympanometric width (TW) were recorded from each participant. Results: No significant differences in all tympanometric parameters were found between Chinese and Malay participants (P > 0.05). However, statistically higher SA and ECV values were noted in males than in females (P < 0.05). No gender effect was observed in TPP and TW (P > 0.05). Conclusions: For a more accurate middle ear evaluation in Malay and Chinese young adults, gender-specific tympanometric normative data derived from this study are recommended.

http://ift.tt/2toM5qy

Migrated guidewire: An unusual cause for recurrent aural polyps

Kong Yew Liew, Aun Wee Chong

Indian Journal of Otology 2017 23(2):128-130

Aural polyps are secondary to multiple ear pathologies, most commonly inflammatory or cholesteatoma related. Here, we present a rare case of recurrent aural polyps caused by guidewire migration into the middle ear with serious systemic complications and our attempts at removal.

http://ift.tt/2sqvsgH

Comparison of performance across transcranial contralateral routing of signal, trimmer digital and digital bone-anchored hearing implant (with headbands) in children with unilateral hearing loss

N Devi, Suma Chatni, K. J. S. Ramadevi, D Baba Fakruddin

Indian Journal of Otology 2017 23(2):98-103

Background: Children with unilateral hearing loss (UHL) of severe profound degree find it challenging to locate a sound source and to comprehend speech in the presence of noise, like in classrooms. The objectives of the present study were to compare the available rehabilitative options for children with UHL and arrive at a probably appropriate option. Methods: Fifteen children with unilateral severe sensorineural or profound hearing loss participated in the study. The sound field thresholds, speech perception in the presence of noise and in quiet were assessed with the digitally programmable bone-anchored hearing implant (BAHI), the trimmer digital BAHI and the transcranial contralateral routing of signal (T-CROS). Results: BAHI and T-CROS both provide significant benefit for the children with UHL. However, the children performed better with the BAHIs than the T-CROS both in quiet and noise in most of the measures. It was also noted that the digitally programmable and the trimmer digital BAHI both gave similar performance. Conclusions: BAHI was a better option in both quiet and noise than the T-CROS as a rehabilitation option for children with UHL. The current study helps in prioritizing the rehabilitation options while considering trial and also helps in narrowing down at the appropriate rehabilitative option for the children with UHL.

http://ift.tt/2toMTLZ

Erratum: Influence of channel and channelfree™ processing technology on the vocal parameters in hearing-impaired individuals

Indian Journal of Otology 2017 23(2):134-134

http://ift.tt/2sr1B7N

Structural Basis for CD4+ T Cell Epitope Dominance in Arbo-Flavivirus Envelope Proteins: A Meta-Analysis

Viral Immunology , Vol. 0, No. 0.

http://ift.tt/2rtsAk4

Endoscope-assisted Neurectomy and Inferior Alveolar Nerve Avulsion in Treating Trigeminal Neuralgia

To explore endoscope-assisted surgical treatment for idiopathic trigeminal neuralgia (TN), with neurectomy and avulsion of the inferior alveolar nerve (IAN), when patients are not willing to undergo intracranial procedures.

http://ift.tt/2sci1yR

Imiquimod-induced cutaneous lupus erythematosus with antinuclear antibodies showing a homogenous pattern

http://ift.tt/2tognd1

Lichen striatus following yellow fever vaccination in an adult woman

http://ift.tt/2sqAqdg

Vocal palsy increases the risk of lower respiratory tract infection in low-risk low-morbidity patients undergoing thyroidectomy for benign disease: a big data analysis

Abstract

Objectives

Thyroidectomy is the commonest and most rapidly-growing operation which places normally-functioning laryngeal nerves at risk of injury. Laryngeal palsy is a major risk-factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure.

Design

An N=near-all analysis of the English administrative dataset using a previously-validated informatics algorithm to identify young and otherwise low-risk patients undergoing thyroidectomy for benign disease. Information about age, sex, morbidities, social deprivation, and postoperative and late complications were derived.

Main Outcome Measures

Between 2004 and 2012, 43,515 patients between the ages of 20 and 69 who had no history of cancer, neurological, or respiratory disease underwent first-time elective total or hemithyroidectomy without concomitant or late neck dissection, parathyroidectomy, or laryngotracheal surgery for benign thyroid disease. Information about age, sex, morbidities, and in-hospital and late complications was recorded.

Results

Mean age at surgery was 46±12. There was a strong female preponderance (85%) and most patients (89%) had no recorded Charlson morbidities. Most patients (65%) underwent hemithyroidectomy. Late vocal palsy was recorded in 449 (1.03%) patients and its occurrence was an independent risk factor for emergency hospital readmission (n=7113; Hazard Ratio 1.52; 95% Confidence interval 1.21-1.91), hospitalisation for lower respiratory tract infection (n=944; HR 2.04; 95% CI 1.07-3.75), dysphagia (n=564; HR 3.47; 95% CI 1.57-7.65) and gastrostomy/tracheostomy placement (n=80; HR 20.8; 95% CI 2.5-171.2). Independent risk-factors for late vocal palsy were age, burden of morbidities, total thyroidectomy, and postoperative bleeding. Female sex and annual surgeon volume >30 were independently protective.

Conclusions

There is a significant association between post-thyroidectomy vocal palsy and long-term risks of hospital readmission, dysphagia, pneumonia, and gastrostomy/tracheostomy tube placement. This adds weight to the need, from a thyroid surgical perspective, to undertake universal post-thyroidectomy laryngeal surveillance with a focus on postoperative dysphagia and aspiration, and from a medical/respiratory perspective, to initiate investigations to identify occult vocal palsy in patients who present with pneumonia, who have a history of thyroid surgery.

http://ift.tt/2rtma4g

Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Davide Giordano, Andrea Frasoldati, Enrico Gabrielli, Carmine Pernice, Michele Zini, Andrea Castellucci, Simonetta Piana, Alessia Ciarrocchi, Silvio Cavuto, Verter Barbieri
Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study.MethodsClinical records of patients (n=610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n=205); Group B, total thyroidectomy and elective ipsilateral CND (n=281); Group C, total thyroidectomy and bilateral CND (n=124).ResultsOf a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p=0.890) or distant metastasis (p=0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p=0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B.ConclusionCND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.

http://ift.tt/2sugVl2

Neck dissection for unknown cancer of the head and neck in the era of chemoradiation

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Mark J. Amsbaugh, Mehran Yusuf, Jeremy Gaskins, Craig Silverman, Kevin Potts, Jeffrey Bumpous, Rebecca Redman, Cesar Perez, Neal Dunlap
PurposeTo report outcomes for patients with cervical lymph node metastases from an unknown primary site of the head and neck treated with either non-operative therapy or neck dissection followed by adjuvant therapy.Materials and MethodsAll patients with squamous cell carcinoma of an unknown primary site of the head or neck seen between 2003 and 2013 were reviewed. The Kaplan-Meier method was used to estimate overall survival, local recurrence free survival, loco-regional recurrence free survival, and progression free survival. The log-rank test and proportional hazards regression were used to analyze factors influencing outcomes.ResultsOf 2258 patients with a new diagnosis of head and neck cancer, no primary site was identified in 66 patients. Twenty-nine patients were treated with definitive non-operative therapy (15 with chemoradiation and 14 with radiation alone). Thirty-seven patients received an upfront neck dissection followed by adjuvant radiation or chemoradiation. Three-year loco-regional recurrence free survival, progression free survival, and overall survival were 55.9%, 55.4%, and 69.4% respectively. Patients treated with preoperative neck dissection had improved local recurrence free survival (96.7% vs 54.1%, p=0.003) and loco-regional recurrence free survival (82.2% vs 46.4%, p=0.068) compared to patients treated with definitive chemoradiation with no difference in overall survival (p=0.641).ConclusionsNeck dissection improved local and regional control but not overall survival in patients with unknown primary squamous cell carcinoma of the head and neck over non-operative therapy alone.

http://ift.tt/2t3LPxJ

Temporal bone computed tomography findings associated with feasibility of endoscopic ear surgery

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Dunia Abdul-Aziz, Elliott D. Kozin, Brian M. Lin, Kevin Wong, Parth V. Shah, Aaron K. Remenschneider, Lukas D. Landegger, Amy F. Juliano, Michael S. Cohen, Daniel J. Lee
PurposeThere are no formal radiologic criteria to stratify patients for transcanal (TEES) or transmastoid endoscopic ear surgery for resection of cholesteatoma. We aim to determine 1) whether standard preoperative computed tomography (CT) findings are associated with the need for conversion to a transmastoid approach and 2) the amount of time added for conversion from TEES to transmastoid techniques.Materials and methodsRetrospective chart review of consecutive pediatric and adult cases of TEES for primary cholesteatoma from 2013 through 2015 (n=52). TEES cases were defined as endoscope-only procedures that did not require a transmastoid approach (n=33). Conversion cases were defined as procedures that began as TEES however, required conversion to a transmastoid approach due to the inability to complete cholesteatoma removal (n=19). Preoperative CT findings and total operating room (OR) times of TEES and conversion cases were compared.ResultsPreoperative CT scan characteristics that were associated with conversion included tegmen erosion (p=0.026), malleus erosion (p<0.001), incus erosion (p=0.009), mastoid opacification (p=0.009), soft tissue opacification extending into the aditus ad antrum (p=0.009) and into antrum (p=0.006). Total OR time for TEES cases was significantly shorter than conversion cases (median 143min versus 217min, p<0.001).ConclusionsPreoperative CT findings, notably extension of soft tissue in the aditus ad antrum, antrum and mastoid, are associated with need for conversion to transmastoid technique to achieve removal of cholesteatoma. Endoscope-only cases were significantly faster than cases that required conversion to a transmastoid approach.

http://ift.tt/2su7h1I

The effects of fibroblast growth factor-2 delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic eardrum perforations lying close to the malleus

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Zhong-hai Jin, Yi-Han Dong, Zi-Han Lou
ObjectiveWe evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus.Study designA prospective, randomized, controlled clinical study.SettingA university-affiliated teaching hospital.Subjects and methodsWe prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only.ResultsWe analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group.ConclusionsFGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.

http://ift.tt/2t3JpiJ