Referred or secondary otalgia is the complaint of ear pain arising from pathology of non-otologic locations with which the ear shares common neural pathways. The pain can present in various degrees of intensity and characteristics while severity is not proportional to the seriousness of the underlying cause1,2.
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The authors describe the use of superiorly curved scalp Incision for Implantation of Magnetic Transcutaneous Bone Conduction Devices
They describe a new technical aspect to minimise numbness issues in a series of 60 patients from two tertiary referral centres.
An inferiorly-based flap design will help to preserve branches of the great auricular and lesser occipital nerves, which normally sacrificed with the original technique.
Superiorly curved scalp Incision will be suitable for subsequent retroauricular incision that is used in auricular reconstruction in microtia patients.
These easily reproducible technical modification comfortable be used safely for Implantation of Magnetic Transcutaneous Bone Conduction Devices, especially patients with auricular dysplasia where auricular reconstruction is planned
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In the Picardie region of northern France, the prevalence of intracranial suppurative complications (particularly empyema) of ear, nose and throat infections seems to have increased over the last 10 to 15 years.
Three possible reasons for the increased incidence in this region are the inappropriate use of antibiotics, low socioeconomic status, and poor access to high-quality healthcare.
Intracranial complications affect both sexes and all ages.
If a patient suffering from sinusitis or (especially) otitis media complains of headache, the possible presence of an intracranial suppurative complication must be always be considered and should prompt immediate medical imaging (a cranial CT scan and MRI) for confirmation of the diagnosis.
Early diagnosis and multidisciplinary pharmacological and surgical management (focused on the intracranial complication) should enable complete recovery in more than three quarters of these cases
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A peritonsillar abscess (PTA) is a collection of pus between the pharyngeal musculature and palatine tonsil capsule. It is the most common deep space infection of the head and neck region and the most common indication for acute ORL hospital admission 1. Causative microorganisms include Gram negative rods, Gram positive cocci and anaerobes 2. Usual treatment is aspiration +/- incision and drainage of PTA, but there is practice variation based on geographical location 3.
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A systematic review and meta-analysis was conducted to evaluate the association between periodontitis (PD) and chronic kidney disease (CKD) and to explore the potential influence of periodontal treatment in CKD patients. Databases (PubMed, Web of Science, Science direct, Cochrane Database) were screened for relevant articles, focusing on the periodontal status of patients with CKD, published until December 2017. Five-hundred fifty-three articles were identified and 37 fulfilled the inclusion criteria and were considered in this systematic review. Seventeen articles were included in the meta-analysis and 7 in the review focusing on the impact of periodontal treatment. Most of the identified studies indicated an increased incidence of PD in CKD patients. Meta-analysis showed an association between CKD and PD and strength of this association was increased when severe PD was considered (OR=2.39 (1.70 – 3.36)). The association could be observed even after adjustment for major CKD risk factors or use of precise diagnosis criteria (OR=2.26 for severe PD (1.69 – 3.01)). Analysis of cohort studies indicated an incident rate ratio (IRR) of 1.73. Periodontitis is associated with CKD after multivariable adjustment. Further studies are necessary to determine whether prevention or treatment of PD can reduce the incidence and/or severity of CKD.
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Circular RNA (circRNA), a class of non-coding RNAs, is a new group of RNAs that are related to tumorigenesis. The role of circRNAs in various diseases has been already highlighted. However, the expression levels and functions of circRNAs related to the melanocytes in the skin are poorly understood. RNA sequence was performed to analyze the expression profiles of circRNAs in black fur skin and white fur skin during different differentiation stages and investigate the relevant metabolism mechanisms. Differentially expressed circRNAs were detected using empirical Bayes sequencing (EBSeq) and then verified through the quantitative real-time PCR method. The EQSeq analysis of circRNAs identified 11 downregulated and 32 upregulated circRNAs in the embryo of black fur skin and white fur skin, as well as 21 downregulated and 17 upregulated circRNA in the postnatal stage. A circRNA–microRNA (miRNA)– messenger RNA (mRNA) network was established to predict the circRNA targets. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were applied to enrich the mRNA data further. Results showed that the specific mRNAs mainly involved in the transcription- related GOs, especially GO:0042802, GO:0005080 and GO:0032403, demonstrate their specific actions in transcriptional regulation. In the circRNA–miRNA–mRNA network, the most enriched GO terms of the mRNAs were pigmentation, protein autophosphorylation, and protein complex. Therefore, the circRNA–miRNA–mRNA pathway may reveal novel mechanisms for pigmentation, and circRNAs may serve as candidates in pigmentation.
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The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty ...
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Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults and Colocalization in Biofilm of Tonsillar Crypts.
JAMA Otolaryngol Head Neck Surg. 2018 Jan 25;:
Authors: Rieth KKS, Gill SR, Lott-Limbach AA, Merkley MA, Botero N, Allen PD, Miller MC
Abstract
Importance: The pathogenesis of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma is currently an important topic of elucidation. The presence of latent HPV infection in tonsil tissue of healthy adults may provide an explanation for a component of this process and contribute to the understanding of HPV-associated squamous cell carcinoma oncogenesis of the oropharynx.
Objective: To determine the prevalence of oropharyngeal HPV and to determine the spatial relationship between the virus and crypt biofilm in tonsil tissue.
Design, Setting, and Participants: A retrospective, cross-sectional study was carried out using samples obtained from tonsils that were archived at a university hospital following elective nononcologic tonsillectomy from 2012 to 2015. Samples consisted of formalin-fixed paraffin embedded samples of tumor-free tonsil tissue from 102 adults between the ages of 20 and 39 years.
Exposures: Human papillomavirus status was assessed by polymerase chain reaction, and high-risk subtypes 16 and 18 were assessed with quantitative polymerase chain reaction assay. Samples that demonstrated presence of HPV were then analyzed by in situ hybridization to localize the viral capsid protein. These samples were then stained with concanavalin A to establish biofilm presence and morphology. These samples were also stained with diamidino-phenylindole (DAPI) to visualize location of the virus in relation to cell nuclei. These data were then assembled for aggregate analysis to colocalize HPV in the biofilm of the tonsillar crypts.
Main Outcomes and Measures: Outcome measurements were determined prior to data collection and include prevalence of high-risk HPV types 16 and 18 in tonsil tissue of otherwise healthy adults, as well as demonstration with immunohistochemistry of HPV in tonsillar crypt biofilm.
Results: In 102 otherwise healthy adults (55 [53.9%] female; age range, 20-39 years), the overall prevalence of HPV in tonsils was 4.9% (n = 5); and high-risk type 16 or 18, 3.9% (n = 4). In this sample population, in situ hybridization colocalized HPV virus to the biofilm of the tonsillar crypts.
Conclusions and Relevance: Biofilm is present in the tonsillar crypts in a considerable proportion of tonsil tissues and may be reproducibly identified. Human papillomavirus is demonstrated to colocalize to the crypt biofilm. This has important implications with respect to the determination of HPV prevalence rates in the oropharynx. It may also play a role in the pathogenesis of HPV-related oropharyngeal carcinoma.
PMID: 29372248 [PubMed - as supplied by publisher]
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Hearing Loss Among Older Adults With Heart Failure in the United States: Data From the National Health and Nutrition Examination Survey.
JAMA Otolaryngol Head Neck Surg. 2018 Jan 25;:
Authors: Sterling MR, Lin FR, Jannat-Khah DP, Goman AM, Echeverria SE, Safford MM
PMID: 29372239 [PubMed - as supplied by publisher]
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Otolaryngologic Manifestations of Klippel-Feil Syndrome in Children.
JAMA Otolaryngol Head Neck Surg. 2018 Jan 25;:
Authors: Kenna MA, Irace AL, Strychowsky JE, Kawai K, Barrett D, Manganella J, Cunningham MJ
Abstract
Importance: Children with Klippel-Feil syndrome (KFS), characterized principally by abnormal fusion of 2 or more cervical vertebrae, may have many additional congenital anomalies. The overall prevalence of otolaryngologic manifestations among patients with KFS has not been previously characterized.
Objective: To define the otolaryngologic diagnoses made and procedures performed in 95 patients with KFS, which, to our knowledge, is the largest series of this challenging patient population published to date.
Design, Setting, and Participants: For this retrospective review, all patients with KFS who underwent otolaryngology consultation at our institution over a 26-year period (January 1989 to December 2015) were included. Patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and were confirmed through individual medical record review. Relevant otolaryngologic diagnoses and procedures were extracted using ICD-9 and Current Procedural Terminology codes, respectively. Selected demographics included age, sex, number of clinic visits, and number of procedures.
Main Outcomes and Measures: The primary outcomes were the otolaryngologic diagnoses and procedures associated with the KFS patient population; the secondary outcome was Cormack-Lehane classification documented during airway procedures.
Results: Overall, 95 patients with KFS were included in this study (55 males [58%] and 40 females [42%]); mean (range) age at time of presentation to the otorhinolaryngology clinic was 5.8 (birth-23.0) years. Each patient with KFS averaged 8 visits to the otorhinolaryngology office and 5 otolaryngologic diagnoses. The most common diagnosis was conductive hearing loss (n = 49 [52%]), followed by sensorineural hearing loss (n = 38 [40%]), and dysphagia (n = 37 [39%]). Sixty-two (65%) patients underwent otolaryngologic procedures, with 44 (46%) undergoing multiple procedures. The most common procedure was tympanostomy tube placement (n = 36 [38%]), followed by office flexible endoscopy (n = 23 [24%]). Twelve of the 20 patients who underwent direct laryngoscopy had documented Cormack-Lehane classification; 5 of 12 patients (42%) had a compromised view (grade 2, 3, or 4) of the larynx. Three patients required tracheotomies at this institution for airway stabilization purposes; each had severe upper airway obstruction leading to respiratory failure.
Conclusions and Relevance: Patients with KFS require consultation for a variety of otolaryngologic conditions. Among these, hearing loss is the most common, but airway issues related to cervical spine fusion are the most challenging. Formulating an appropriate care plan in advance is paramount, even for routine otolaryngology procedures.
PMID: 29372238 [PubMed - as supplied by publisher]
Ectopic intratracheal thyroid tissue (EITT) is a rare abnormality with only limited cases reported so far. The presenting symptoms can be very similar to those of bronchial asthma. We discuss the case of a 29-year-old man with subglottic ectopic thyroid, with a history of thyroid surgery for goiter, which has been managed with laser-assisted endoscopic approach. We have also included presenting symptoms, pathophysiology, diagnosis, and management of EITT. We aim to include EITT in the differentials of airway obstruction, particularly in those patients who have goiter or previous thyroid surgeries.
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Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution, however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge.
On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice.
Besides an update on indications, contraindications and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 ml per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure.
The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.
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