Food‐induced fatal anaphylaxis: from epidemiological data to general prevention strategies

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.


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Predictors of Therapeutic Outcome to Nucleotide Reverse Transcriptase Inhibitor in Hepatitis B Patients

Viral Immunology, Ahead of Print.


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Classification of lesions inducing acquired cholesteatomas of the middle ear: a didactic suggestion

Fernando de Andrade Quintanilha Ribeiro
Braz J Otorhinolaryngol.2018;84:529-31

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Bacteriology of peritonsillar abscess: the changing trend and predisposing factors

Yi‐Wen Tsai, Yu‐Hsi Liu, Hsing‐Hao Su
Braz J Otorhinolaryngol.2018;84:532-9

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Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model

Şahin Öğreden, Sedat Rüzgar, Hasan Deniz Tansuker, Ümit Taşkın, Yalçın Alimoğlu, Salih Aydın, Mehmet Faruk Oktay, Uğur İzol
Braz J Otorhinolaryngol.2018;84:540-4

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Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations

Peng Huang, Shujun Zhang, Xinhong Gong, Xuesong Wang, Zi‐Han Lou
Braz J Otorhinolaryngol.2018;84:545-52

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Familial misophonia or selective sound sensitivity syndrome: evidence for autosomal dominant inheritance?

Tanit Ganz Sanchez, Fúlvia Eduarda da Silva
Braz J Otorhinolaryngol.2018;84:553-9

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Is there a best side for cochlear implants in post‐lingual patients?

Maria Stella Arantes do Amaral, Thiago A. Damico, Alina S. Gonçales, Ana C.M.B. Reis, Myriam de Lima Isaac, Eduardo T. Massuda, Miguel Angelo Hyppolito
Braz J Otorhinolaryngol.2018;84:560-5

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Prognostic significance of soft tissue deposits in laryngeal carcinoma

Omer Afsin Ozmen, Melih Alpay, Ozlem Saraydaroglu, Uygar Levent Demir, Fikret Kasapoglu, Hamdi Hakan Coskun, Oguz Ibrahim Basut
Braz J Otorhinolaryngol.2018;84:566-73

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Audiological and electrophysiological alterations in HIV‐infected individuals subjected or not to antiretroviral therapy

Carla Gentile Matas, Alessandra Giannella Samelli, Fernanda Cristina Leite Magliaro, Aluisio Segurado
Braz J Otorhinolaryngol.2018;84:574-82

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Psychoacoustic classification of persistent tinnitus

Flavia Alencar de Barros Suzuki, Fabio Akira Suzuki, Ektor Tsuneo Onishi, Norma Oliveira Penido
Braz J Otorhinolaryngol.2018;84:583-90

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Disease‐specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction

Lucas Resende, Carolina do Carmo, Leão Mocellin, Rogério Pasinato, Marcos Mocellin
Braz J Otorhinolaryngol.2018;84:591-8

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Association of Ugrp2 gene polymorphisms with adenoid hypertrophy in the pediatric population

Mahmut Huntürk Atilla, Sibel Özdaş, Talih Özdaş, Sibel Baştimur, Sami Engin Muz, Işılay Öz, Kenan Kurt, Afife İzbirak, Mehmet Ali Babademez, Nilgün Vatandaş
Braz J Otorhinolaryngol.2018;84:599-607

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Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Sinan Uluyol, Omer Ugur, Ilker Burak Arslan, Ozlem Yagiz, Murat Gumussoy, Ibrahim Cukurova
Braz J Otorhinolaryngol.2018;84:608-13

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Temporomandibular disorder: otologic implications and its relationship to sleep bruxism

Bruno Gama Magalhães, Jaciel Leandro de Melo Freitas, André Cavalcanti da Silva Barbosa, Maria Cecília Scheidegger Neves Gueiros, Simone Guimarães Farias Gomes, Aronita Rosenblatt, Arnaldo de França Caldas Júnior
Braz J Otorhinolaryngol.2018;84:614-9

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Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer

Camila Barbosa Barcelos, Paula Angélica Lorenzon Silveira, Renata Lígia Vieira Guedes, Aline Nogueira Gonçalves, Luciana Dall'Agnol Siqueira Slobodticov, Elisabete Carrara‐de Angelis
Braz J Otorhinolaryngol.2018;84:620-9

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Retro‐ and orthonasal olfactory function in relation to olfactory bulb volume in patients with hypogonadotrophic hypogonadism

Murat Salihoglu, Onuralp Kurt, Seyid Ahmet Ay, Kamil Baskoy, Aytug Altundag, Muzaffer Saglam, Ferhat Deniz, Hakan Tekeli, Arif Yonem, Thomas Hummel
Braz J Otorhinolaryngol.2018;84:630-7

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Diagnostic validity of methods for assessment of swallowing sounds: a systematic review

Karinna Veríssimo Meira Taveira, Rosane Sampaio Santos, Bianca Lopes Cavalcante de Leão, José Stechman Neto, Leandro Pernambuco, Letícia Korb da Silva, Graziela De Luca Canto, André Luís Porporatti
Braz J Otorhinolaryngol.2018;84:638-52

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The use of tDCS as a therapeutic option for tinnitus: a systematic review

Amanda dos Humildes Maia Santos, Afonso Paranhos Silva Santos, Henrique Souza Santos, Adriana Campos da Silva
Braz J Otorhinolaryngol.2018;84:653-9

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Transoral robotic supraglottic partial laryngectomy: report of the first Brazilian case

Claudio Roberto Cernea, Leandro Luongo Matos, Dorival de Carlucci Junior, Fernando Danelon Leonhardt, Leonardo Haddad, Fernando Walder
Braz J Otorhinolaryngol.2018;84:660-4

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Bilateral primary histiocytoid eccrine sweat gland carcinoma of eyelids

Malgorzata Seredyka‐Burduk, Pawel Krzysztof Burduk, Magdalena Bodnar, Grazyna Malukiewicz, Andrzej Kopczynski
Braz J Otorhinolaryngol.2018;84:665-8

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Stafne bone cavity containing ectopic parotid gland

Mesut Kaya, Kadriye Serife Ugur, Elif Dagli, Hanifi Kurtaran, Mehmet Gunduz
Braz J Otorhinolaryngol.2018;84:669-72

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Necrotizing fasciitis as a complication of osteonecrosis of the jaw related to oral bisphosphonate application in a patient with osteoporosis: a case report

Abstract

Background

Necrotizing fasciitis has been reported as a complication secondary to bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a low number of patients. The only report of such a case in an osteoporosis patient found in current literature was related to short-term bisphosphonate but long time corticosteroid and methotrexate treatment.

Case presentation

In this article, we report a case of necrotizing fasciitis secondary to osteonecrosis of the jaw related to long-term oral bisphosphonate treatment in an osteoporosis patient additionally suffering from poorly controlled type 2 diabetes. Diabetes mellitus not only has been reported to be a systemic risk factor regarding BRONJ but also to be the most common comorbidity in patients presenting with necrotizing fasciitis and to increase mortality of this condition. Necrotizing fasciitis and BRONJ in the patient could eventually be resolved by a surgical approach and intravenous antibiotic therapy.

Conclusions

The case presented suggests diabetes mellitus potentially having been an important factor in the particularly unfavorable course of therapy. It emphasizes the importance of an adequate therapy and surveillance of modifiable systemic risk factors like diabetes mellitus in patients being at risk for development of BRONJ. If necrotizing fasciitis is suspected, early diagnosis and aggressive surgical and medical management are essential to minimize morbidity and mortality.

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Necrotizing fasciitis as a complication of osteonecrosis of the jaw related to oral bisphosphonate application in a patient with osteoporosis: a case report

Abstract

Background

Necrotizing fasciitis has been reported as a complication secondary to bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a low number of patients. The only report of such a case in an osteoporosis patient found in current literature was related to short-term bisphosphonate but long time corticosteroid and methotrexate treatment.

Case presentation

In this article, we report a case of necrotizing fasciitis secondary to osteonecrosis of the jaw related to long-term oral bisphosphonate treatment in an osteoporosis patient additionally suffering from poorly controlled type 2 diabetes. Diabetes mellitus not only has been reported to be a systemic risk factor regarding BRONJ but also to be the most common comorbidity in patients presenting with necrotizing fasciitis and to increase mortality of this condition. Necrotizing fasciitis and BRONJ in the patient could eventually be resolved by a surgical approach and intravenous antibiotic therapy.

Conclusions

The case presented suggests diabetes mellitus potentially having been an important factor in the particularly unfavorable course of therapy. It emphasizes the importance of an adequate therapy and surveillance of modifiable systemic risk factors like diabetes mellitus in patients being at risk for development of BRONJ. If necrotizing fasciitis is suspected, early diagnosis and aggressive surgical and medical management are essential to minimize morbidity and mortality.

https://ift.tt/2NofHhl

Thyroid® High-Impact Articles

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Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association^®

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery
Hitomi Oda, Akira Miyauchi, Yasuhiro Ito, Kana Yoshioka, Ayako Nakayama, Hisanori Sasai, Hiroo Masuoka, Tomonori Yabuta, Mitsuhiro Fukushima, Takuya Higashiyama, Minoru Kihara, Kaoru Kobayashi, and Akihiro Miya 

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma
Juan P. Brito, Yasuhiro Ito, Akira Miyauchi, and R. Michael Tuttle 

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis
Spyridoula Maraka, Naykky M. Singh Ospina, Derek T. O'Keeffe, Ana E. Espinosa De Ycaza, Michael R. Gionfriddo, Patricia J. Erwin, Charles C. Coddington III, Marius N. Stan, M. Hassan Murad, and Victor M. Montori 

Preoperative Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Prospective Analysis
Kyle C. Strickland, Marina Vivero, Vickie Y. Jo, Alarice C. Lowe, Monica Hollowell, Xiaohua Qian, Tad J. Wieczorek, Christopher A. French, Lisa A. Teot, Peter M. Sadow, Erik K. Alexander, Edmund S. Cibas, Justine A. Barletta, and Jeffrey F. Krane 

An International Multi-Institutional Validation of Age 55 Years as a Cutoff for Risk Stratification in the AJCC/UICC Staging System for Well-Differentiated Thyroid Cancer
Iain J. Nixon, Laura Y. Wang, Jocelyn C. Migliacci, Antoine Eskander, Michael J. Campbell, Ahmad Aniss, Lilah Morris, Fernanda Vaisman, Rossana Corbo, Denise Momesso, Mario Vaisman, Andre Carvalho, Diana Learoyd, William D. Leslie, Richard W. Nason, Deborah Kuk, Volkert Wreesmann, Luc Morris, Frank L. Palmer, Ian Ganly, Snehal G. Patel, Bhuvanesh Singh, R. Michael Tuttle, Ashok R. Shaha, Mithat Gönen, K. Alok Pathak, Wen T. Shen, Mark Sywak, Luis Kowalski, Jeremy Freeman, Nancy Perrier, and Jatin P. Shah 

Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier
Kristine S. Wong, Trevor E. Angell, Kyle C. Strickland, Erik K. Alexander, Edmund S. Cibas, Jeffrey F. Krane, and Justine A. Barletta 

Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma
Saaduddin Siddiqui, Michael G. White, Tatjana Antic, Raymon H. Grogan, Peter Angelos, Edwin L. Kaplan, and Nicole A. Cipriani 

The 2017 Bethesda System for Reporting Thyroid Cytopathology
Edmund S. Cibas and Syed Z. Ali 

 

The post <i>Thyroid^®</i> High-Impact Articles appeared first on American Thyroid Association.

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Navigation-guided resection of maxillary tumours: can a new volumetric virtual planning method improve outcomes in terms of control of resection margins?

In the present study, our aim was to confirm the role of navigation-guided surgery in reducing the percentage of positive margins in advanced malignant pathologies of the mid-face, by introducing a new volumetric virtual planning method for resection.

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Immunohistochemical analysis of lymphatic vessel density and mast cells in oral tongue squamous cell carcinoma

The aim of this study was to analyze lymphangiogenesis and the presence of mast cells in oral tongue squamous cell carcinoma (OTSCC), correlating the findings with clinicopathological parameters (clinical stage, tumor size, nodal metastasis, histological grade of malignancy, local recurrence, and clinical outcome). Fifty-six cases of primary OTSCC were selected. Lymphatic vessels and mast cells were identified by immunostaining with anti-podoplanin (D2-40) and anti-tryptase antibody, respectively.

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Predicting the Size of a Left Double-Lumen Tube for Asian Women Based on the Combination of the Diameters of the Cricoid Ring and Left Main Bronchus: A Randomized, Prospective, Controlled Trial

BACKGROUND: There are limited data about how to choose the correct size of a double-lumen tube (DLT). It is especially difficult to select an appropriate DLT for Asian women because of their small stature. The primary aim of this study was to compare the overall accuracy of the DLT selected based on the combination of transverse diameter of cricoid ring and the equivalent diameter of the left main bronchus (ED-LMB) with that based on the ED-LMB alone for Asian women. METHODS: In this study, 80 consecutive and blinded female patients were assigned randomly to 2 groups. The overall accuracy of the selection of DLT was compared between the Combined group and LMB group. The accuracy of the selection of tracheal segment and bronchial segment was also compared between the 2 groups. The postoperative hoarseness and sore throat were investigated by blinded assessors. RESULTS: The overall accuracy of selection of the DLTs was higher in the Combined group than that in the LMB group (87.5% vs 60.0%; P = .010). The accuracy of selection of tracheal segment was also higher in the Combined group (92.5% vs 67.5%; P = .010). The accuracy of selection of bronchial segment was similar between the groups (95.0 % vs 86.1%; P = .246). The severity of sore throat was higher in the LMB group at 24 hours after the operation (P = .001). CONCLUSIONS: The correct size of DLT for Asian women should be selected based on the combination of transverse diameter of cricoid ring and the ED-LMB. Accepted for publication August 29, 2018. Funding: None. The authors declare no conflicts of interest. Clinical trial number and registry URL: ChiCTR-INR-17013040, https://ift.tt/2IBXrA2. Reprints will not be available from the authors. Address correspondence to Dong Youjing, PhD, Shengjing Hospital, China Medical University, No. 36 Sanhao St, Heping District, 110004 Shenyang, China. Address e-mail to dongyj@sj-hospital.org. © 2018 International Anesthesia Research Society

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Regional Anesthesia and Readmission Rates After Total Knee Arthroplasty

BACKGROUND: Total knee arthroplasty is a commonly performed procedure and an important contributor to national health care spending. Reducing the incidence of readmission could have important consequences for patient well-being and relevant financial implications. Whether regional anesthesia techniques are associated with decreased readmission rates and costs among privately insured patients remains unknown. METHODS: Using administrative claims data, we identified 138,362 privately insured patients 18–64 years of age who underwent total knee arthroplasty between 2002 and 2013. We then examined whether the use of a nerve block was associated with decreases in readmission rates and related costs during the 90 days after discharge. Our analyses were adjusted for potential confounding variables including medical comorbidities and previous use of opioids and other medications. RESULTS: After adjusting for patient demographics, comorbidities, and preoperative medication use, the adjusted 90-day readmission rate was 1.8% (95% confidence interval [CI], 1.1–2.4) among patients who did not receive a block compared to 1.7% (95% CI, 1.1–2.4) among patients who did (odds ratio, 0.99; 95% CI, 0.91–1.09; P = .85). The adjusted readmission-related postoperative cost for patients who did not receive a block was $561 (95% CI, 502–619) and $574 (95% CI, 508–639) for patients who did (difference, $13; 95% CI, −75 to 102; P = .74). This lack of statistically significant differences held for subgroup and sensitivity analyses. CONCLUSIONS: Nerve blocks were not associated with improved measures of long-term postoperative resource use in this younger, privately insured study population. Accepted for publication August 24, 2018. Funding: E.C.S. was supported by the National Institute on Drug Abuse (K08DA042314). Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). This work was presented at the Medical Student Anesthesia Research Fellowship (MSARF) symposium at the annual American Society of Anesthesiologists meeting, Boston, MA, October 22, 2017. Reprints will not be available from the authors. Address correspondence to Eric C. Sun, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, H3580, Stanford University Medical Center, Stanford, CA 94305. Address e-mail to esun1@stanford.edu. © 2018 International Anesthesia Research Society

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Predosing Chemical Stability of Admixtures of Propofol, Ketamine, Fentanyl, and Remifentanil

Admixtures of propofol–ketamine, propofol–ketamine–fentanyl, and propofol–ketamine–remifentanil were subjected to various clinically relevant conditions to study their chemical stability. A novel high-performance liquid chromatography-mass spectrometry method revealed no degradation of any compound by incubation at 37°C, constant mixing, or table-top storage for 6- and 24-hour time periods, except variable recovery of both propofol and fentanyl in the admixtures of propofol–ketamine–fentanyl suggesting possible degradation. Accepted for publication August 1, 2018. Funding: US Army Medical Research and Materiel Command. The authors declare no conflicts of interest. The views expressed in this article are those of the authors and do not reflect the official policy of the Uniformed Services University, Departments of the Army, Navy, or Air Force, Department of Defense, Department of Veterans Affairs, or the US Government. Reprints will not be available from the authors. Address correspondence to Peter Bedocs, MD, PhD, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, 11300 Rockville Pike, Suite 709, Rockville, MD 20852. Address e-mail to peter.bedocs.ctr@usuhs.edu. © 2018 International Anesthesia Research Society

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Resident Competency and Proficiency in Combined Spinal–Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial

BACKGROUND: Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e-learning tool (computer-enhanced visual learning [CEVL] neuraxial) to enhance trainee proficiency in combined spinal–epidural catheter placement in obstetric patients and performed a randomized controlled 2-center trial to test the hypothesis that use of the tool improved the initial procedure performed by the anesthesiology residents. METHODS: Anesthesiology residents completing their first obstetric anesthesiology rotation were randomized to receive online access to the neuraxial module (CEVL group) or no access (control) 2 weeks before the rotation. On the first day of the rotation, residents completed a neuraxial procedure self-confidence scale and an open-ended medical knowledge test. Blinded raters observed residents performing combined spinal–epidural catheter techniques in laboring parturients using a procedural checklist (0–49 pts); the time required to perform the procedure was recorded. The primary outcome was the duration of the procedure. RESULTS: The CEVL group had significantly shorter mean (±standard deviation) procedure time compared to the control group 22.5 ± 4.9 vs 39.5 ± 7.1 minutes (P

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Red Blood Cell Transfusion in Pediatric Orthotopic Liver Transplantation: What a Difference a Few Decades Make

BACKGROUND: Liver transplantation in children is often associated with coagulopathy and significant blood loss. Available data are limited. In this observational retrospective study, we assessed transfusion practices in pediatric patients undergoing liver transplantation at a single institution over the course of 9 years. METHODS: Data were retrospectively collected from patient medical records at the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. All patients who underwent liver transplantation from January 2008 to June 2017 were included. Primary and secondary outcomes were volume of red blood cells (RBCs) transfused and mortality, respectively. RESULTS: From January 2008 to June 2017, there were 278 liver transplants in 271 patients. The number of primary transplants were 259, second retransplants 15, and third retransplants 4. Average age at transplantation was 6.9 years. Biliary atresia, maple syrup urine disease, urea cycle defect, and liver tumor were the leading indications accounting for 66 (23.7%), 45 (16.2%), 24 (8.6%), and 23 (8.3%) of transplants, respectively. Seventy-six cases (27.3%) did not require RBC transfusions. Among those transfused, 181 (89.6%) of the cases required 12 months of age (0.12 BV). By diagnosis, the group requiring the highest median volume transfusion was patients with total parenteral nutrition–related liver failure (3.41 BV) followed by patients undergoing repeat transplants (0.6 BV). Comparison of primary versus repeat transplants shows a trend toward higher volume transfusions in third transplants (median, 2.71 BV), compared to second transplants (0.43 BV) and primary transplants (0.18 BV). Four of 271 patients (1.5%) died during admission involving liver transplantation. Nine of 271 patients (3.3%) died subsequently. Total mortality was 4.8%. CONCLUSIONS: In contrast to historically reported trends, evaluation of current transfusion practices reveals that most patients undergoing liver transplantation receive

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Real-Time Measurement of Xenon Concentration in a Binary Gas Mixture Using a Modified Ultrasonic Time-of-Flight Anesthesia Gas Flowmeter: A Technical Feasibility Study

BACKGROUND: Xenon (Xe) is an anesthetic gas licensed for use in some countries. Fractional concentrations (%) of gases in a Xe:oxygen (O2) mixture are typically measured using a thermal conductivity meter and fuel cell, respectively. Speed of sound in such a binary gas mixture is related to fractional concentration, temperature, pressure, and molar masses of the component gases. We therefore performed a study to assess the feasibility of developing a novel single sterilizable device that uses ultrasound time-of-flight to measure both real-time flowmetry and fractional gas concentration of Xe in O2. METHODS: For the purposes of the feasibility study, we adapted an ultrasonic time-of-flight flowmeter from a conventional anesthetic machine to additionally measure real-time fractional concentration of Xe in O2. A total of 5095 readings of Xe % were taken in the range 5%–95%, and compared with simultaneous measurements from the gold standard of a commercially available thermal conductivity Xe analyzer. RESULTS: Ultrasonic measurements of Xe (%) showed agreement with thermal conductivity meter measurements, but there was marked discontinuity in the middle of the measurement range. Bland-Altman analysis (95% confidence interval in parentheses) yielded: mean difference (bias) 3.1% (2.9%–3.2%); lower 95% limit of agreement −4.6% (−4.8% to −4.4%); and upper 95% limit of agreement 10.8% (10.5%–11.0%). CONCLUSIONS: The adapted ultrasonic flowmeter estimated Xe (%), but the level of accuracy is insufficient for clinical use. With further work, it may be possible to develop a device to perform both flowmetry and binary gas concentration measurement to a clinically acceptable degree of accuracy. Accepted for publication August 17, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Some preliminary data from the first part of this study were presented as a poster at the European Society of Anaesthesia Annual Conference, Geneva, Switzerland, June 5, 2017. Reprints will not be available from the authors. Address correspondence to David J. Williams, FRCA, Department of Anaesthetics, Morriston Hospital, Swansea SA6 6NL, United Kingdom. Address e-mail to davidjwilliams@doctors.org.uk. © 2018 International Anesthesia Research Society

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Statistical Versus Clinical Significance in Subclavian Vein Cross-Sectional Area: Is a 0.10-cm2 Difference Really Meaningful or Just an Example of False Precision?

No abstract available

https://ift.tt/2pAg7ra

Lupin: An Emerging Food Allergen in the United States

Food allergies are on the rise and becoming a global concern.1 Common food allergens are well recognized and have been studied extensively in the US and Europe. However, there is a gradual emergence of new food allergens such as lupin, which are neither as well characterized nor studied.

https://ift.tt/2CvHds6

Sensitization Profiles to Hazelnut Allergens across the United States of America

Hazelnut is a widely consumed tree nut and among the top five most serious instigators of food allergic reactions.1-4 Hazelnut allergy can manifest symptoms that range from mild oral itching to fatal anaphylaxis.4-7 Population-based surveys have found that the incidence of hazelnut allergy varies greatly from location to location, depending on exposure to cross-reacting pollen allergens.8-10 The prevalence of hazelnut allergy is estimated to be 0.2 % in children and up to 4.5 % in adults in regions with heavy exposure to pollen of birch or related tree species.

https://ift.tt/2BUX6ai

Level of competence of primary and secondary school teachers in the management of anaphylaxis

Anaphylaxis is a severe hypersensitivity reaction, with the highest incidence in early childhood.1 It can lead to respiratory arrest, so early detection and immediate reaction is needed.2 However, this is not always simple, as most of the reactions occur far from hospitals, for example, at school.3 Since children spend much of their time in school, teachers should know how to identify and manage these situations. In Spain, training programmes aimed at teachers for the management of anaphylactic reactions, such as the "School Alert (Alerta Escolar) Program",4 have been developed.

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Use of disposable blade for harvesting epidermal skin graft

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Late growth of infantile hemangiomas in children >3 years of age: A retrospective study

The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported.

https://ift.tt/2PajzE5

Outcome of salvage procedures for recurrent oral and oropharyngeal cancer

Despite advances in the primary treatment of oral and oropharyngeal cancer, many patients develop local or regional recurrence, or both, and when radiotherapy has already been used, operation provides the best chance of salvage for these patients. We have looked at the outcomes of salvage procedures in a single unit, including improved survival, morbidity, and treatment-related quality of life. Patients treated with salvage procedures were identified from a prospectively-completed database. Overall and disease-free survival were analysed using Kaplan–Meier curves and logrank tests.

https://ift.tt/2IDyrbQ

Distribution of metastatic regional lymph nodes in squamous cell carcinoma of the oral commissure and its implications for treatment in the neck

Squamous cell carcinoma (SCC) of the oral commissure comprises 6%–8.5% of all tumours of the lip,1 and despite its lower prevalence, it has the poorest survival among all such subsites.2 Although the pathophysiological basis for the lower survival of patients who have primary lesions of the commissure is not entirely clear, evidence suggests that there is a higher incidence of regional nodal metastases compared with other subsites of SCC in the lip.3 It is critical, therefore, for oral and maxillofacial surgeons, head and neck surgeons, and radiation oncologists to understand the patterns of lymphatic distribution in the neck.

https://ift.tt/2pxahHg

Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs

The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient.

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Transoral vertical ramus osteotomy fixed with Kirschner pins

Transoral vertical ramus osteotomy (VRO) has been condemned because the condyle has the potential to sag, and because it needs lengthy maxillomandibular fixation. We have therefore introduced a simple method of fixation, and examined its effectiveness and complications. After the osteotomy, the proximal and distal segments are trimmed to adapt to each other. Four Kirschner (K) pins 0.9mm in diameter are inserted percutaneously from the proximal to the distal segment while the condyle is positioned in the glenoid fossa.

https://ift.tt/2BYOyzu

Impact of reconstructive microsurgery on patients with cancer of the head and neck: a prospective study of quality of life, particularly in older patients

Treatment of cancer of the head and neck often requires extended resection and major reconstructive surgery, both of which can have great functional and emotional impact. It is fundamental to evaluate the outcome with respect not only to the clinical aspects but also to the quality of life (QoL) perceived by the patients. In the light of the reported increasing incidence of oral cancer in older patients, we decided to see if there was an association between QoL and age. Between June 2015 and December 2016 we submitted the Italian version of the 36-item Short Form Health Survey (SF-36) to 30 patients (mean (range) age 65.5 (23–87) years) who had had resection and microsurgical reconstruction at the Ospedale Maggiore Policlinico of Milan.

https://ift.tt/2CqtItK

Accuracy of a CAD/CAM surgical template for mandibular distraction: a preliminary study

We have assessed the accuracy and clinical validation of virtual planning using a surgical template in 16 patients with hemifacial microsomia being treated by mandibular distraction osteogenesis. Virtual planning and simulation were first done on three-dimensional models. Distraction was simulated on the virtual model and the new morphology of the mandible was previewed. Both the position and direction of the distractor were calculated to achieve the optimal morphology. The templates were designed based on the virtual planning, and manufactured using a 3-dimensional printing technique.

https://ift.tt/2BX18iv

Total virtual workflow in CAD-CAM bony reconstruction with a single step free fibular graft and immediate dental implants

The Surgical reconstruction of defects of the face is challenging. Local and regional flaps have an important part to play, but large defects of bone and soft tissue are a greater problem. Microvascular tissue transfer has become the standard for such patients, and preoperative planning of bony reconstructions is now common. To use these preplanning tools best the implants should be placed in the prosthetically ideal place, and the bone positioned to surround the implants – that is, truly backward planning of the position of the bone.

https://ift.tt/2Crnnym

Distances of root apices to adjacent anatomical structures in the anterior maxilla: an analysis using cone beam computed tomography

Abstract

Objectives

The aim was to assess the anatomical relationship of anterior maxillary teeth to the nasal floor in patients referred for apical surgery.

Materials and methods

Cone beam computed tomographic images (CBCT) of 83 patients were analysed retrospectively to quantify the distances between the root apices of maxillary anterior teeth (canine to canine) to the nasal floor or maxillary sinus (whichever was closer). Secondary outcome variables were the distances of the periapical lesion to the nasal floor, distances of the apices to the labial and palatal bone plates as well as to the neighbouring teeth.

Results

A total of 93 teeth (39 central, 35 lateral incisors and 19 canines) were analysed. The mean shortest distances of the apices to the nasal floor (or maxillary sinus) were 8.54 mm for central incisors, 9.49 mm for lateral incisors and 5.39 mm for the canines. The canines exhibited a significantly shorter distance to the nasal floor/maxillary sinus. In the presence of an osteolysis, the distance to the nasal floor was significantly shorter compared to the teeth without lesions. The lateral and central incisors showed significant proximity to each other at the level of the future surgical resection (3 mm from the apex).

Conclusions

A close proximity between apices and adjacent anatomical structures such as nasal floor, maxillary sinus or adjacent roots could be shown in some cases.

Clinical relevance

CBCT could be a valuable adjunctive imaging tool prior to apical surgery in the anterior maxilla to assess the risk for and decrease the incidence of damage to neighbouring anatomical structures such as the nasal floor, maxillary sinus or adjacent roots.

https://ift.tt/2PcJrPN

Two facets of sweat: A defensive factor in skin tissues and an accelerating factor for allergic skin diseases

Publication date: October 2018

Source: Allergology International, Volume 67, Issue 4

Author(s): Hiroo Yokozeki, Kenji Izuhara

https://ift.tt/2DWf66L

Congenital cytomegalovirus infection inducing non-congenital sensorineural hearing loss during childhood; a systematic review

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Maria Riga, George Korres, Pantelis Chouridis, Stephanos Naxakis, Vasilios Danielides

Abstract

Background

Congenital cytomegalovirus (CMV) infection is one of the most important risk factors for delayed onset and progressive hearing loss in children. However, the relevant literature is limited, heterogeneous and currently insufficient to provide guidance toward the effective monitoring of hearing acuity in these children.

Objectives

The aim of this study was to provide a systematic review focused on types of hearing loss that may escape diagnosis through universal neonatal hearing screening and/or present significant changes during childhood, such as progressive, fluctuating and late-onset hearing loss.

Data sources

A review of the present literature was conducted via the PubMed database of the US National Library of Medicine (www.pubmed.org) and Scopus database (www.scopus.com) with the search terms "late-onset hearing loss cytomegalovirus", "progressive hearing loss cytomegalovirus" and "fluctuating hearing loss cytomegalovirus".

Study eligibility criteria

Prospective or retrospective clinical studies were included if they presented a detailed audiological assessment, for a follow-up period of >2years.

Methods

The prevalence and time of diagnosis of progressive, fluctuating and late-onset hearing loss were considered as primary outcomes. Results were recorded separately for symptomatic and asymptomatic children, when possible.

Results

This analysis refers to a population of 181 children with CMV-induced hearing loss, who were diagnosed among 1089 with congenital CMV infection. The prevalence of CMV-induced hearing loss was significantly higher among symptomatic children (p<0.0001), who were also significantly more likely to develop bilateral hearing loss (p=0.001). There was not sufficient information on the prevalence, laterality, degree and time of diagnosis of progressive, fluctuating and late-onset hearing loss that could constitute the basis toward the report of specific follow-up guidelines.

Conclusions

Further studies are needed in order to understand and quantify the potential effects of congenital CMV infection in the inner ear and hearing acuity. The results presented in the relative studies should be very carefully evaluated and compared to each other, since they correspond to substantially different cohorts, study designs, and result elaboration. Infants with congenital CMV infection should be closely monitored, regarding their hearing acuity at least during their preschool years, although substantial changes in hearing thresholds have been reported as late as the 16^th year of age. Parental counseling is of outmost importance in order to minimize the numbers of children lost to follow-up.

https://ift.tt/2y15pyx

Neurologically Acquired Laryngomalacia in a Pediatric Patient with Moyamoya: A Case Report and Literature Review

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hayley Born, Andre Wineland, Michael J. Rutter

Abstract

Acquired laryngomalacia in the pediatric population is rare, especially from a neurogenic cause. This case report describes a pediatric patient who developed laryngomalacia following a neurologic insult. A proposed physiologic pathway is reviewed. A thorough literature review was performed to identify cases of acquired laryngomalacia ascribed to a neurologic cause and are compared to this case.

https://ift.tt/2P7NcpO

Urine concentrations changes of cysteinyl leukotrienes in non-obese children with obstructive sleep apnea undergoing adenotonsillectomy

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): George Κ. Mousailidis, Vasileios A. Lachanas, Afroditi Vasdeki, Emmanuel I. Alexopoulos, Athanasios G. Kaditis, Petinaki Efthymia, Nick Balatsos, John G. Bizakis, Charalampos E. Skoulakis

Abstract

Objective

The main objective of the study was to compare preoperative to postoperative levels of urine-Cysteinyl leukotrienes (uCysLT) in children undergoing adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in order to investigate whether exaggerated leukotriene activity is the cause or consequence of OSA.

Methods and materials

A prospective study was conducted on non-obese children (4-10 years old) referred for overnight PSG. Children with moderate/severe OSA treated with AT were included. A second PSG study performed 2 months postoperatively to confirm OSA resolution, and those with residual OSA were excluded. Morning urine specimens after both PSG studies were obtained and pre-operative uCysLT levels were compared to postoperative levels.

Results

27 children fulfilled the criteria and underwent a post-operative PSG study with three exclusions for residual OSA (postop-AHI>2), so the study group consisted of 24 children (mean age: 5.7±2.1 years). Mean preoperative and postoperative AHI was 10.96±5.93 and 1.44±0.56 respectively. Mean preop-uCysLT were 21.14±4.65, while after AT they significantly reduced to 12.62±2.67 (P<0.01).

Conclusion

uCysLT levels are significantly reduced after AT in non-obese children with moderate/severe OSA, suggesting that exaggerated leukotriene activity is mainly a consequence of OSA.

https://ift.tt/2y15d2h

Trends in Sociodemographic Disparities of Pediatric Cochlear Implantation over a 15-Year Period

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Alex J.F. Tampio, Ronald J. Schroeder, Dongliang Wang, John Boyle, Brian D. Nicholas

Abstract

Objective

Sociodemographic disparities of cochlear implantation in children have been reported. This study sought to determine if disparities in children receiving cochlear implants have narrowed, widened or remained constant.

Methods

Children 18 years or younger who underwent cochlear implantation from 1997-2012 were selected using the Kids' Inpatient Database. Demographic data included primary insurance payer, income quartile and race. The Cochran-Armitage test was used to determine if trends were significant. Prevalence rates of cochlear implantation by race were generated. A Poisson regression model was used to evaluate the rates of cochlear implantation within each racial group.

Results

The proportion of children receiving cochlear implants with private insurance decreased from 79.3% to 42.6% (p < .0001), whereas children with Medicaid increased from 17.4% to 35.2% (p < .0001). Proportion of implanted children from the lowest two income quartiles increased from 15.5% to 24.4% (p < .0001) and 10.3% to 21.8% (p < .0035), respectively. Rates of implantation among children from income quartile four decreased from 50.9% to 35.3% (p < .0001). White children were implanted twice as often as Black or Hispanic children (p = 0.007 and p = 0.0012 respectively). Asian children were implanted more than twice as often as Black or Hispanic Children (p = .0154 and p = .0098 respectively).

Conclusions

Income and insurance disparities have narrowed within the inpatient pediatric cochlear implantation cohort. Racial disparities still exist. White and Asian children are implanted at higher rates than Black or Hispanic children.

https://ift.tt/2P986ok

Corrigendum to 'Epidemiological characteristics of pediatric epistaxis presenting to the emergency department' International Journal of Pediatric Otorhinolaryngology (2017) 121-124

Publication date: Available online 3 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Sophie Shay, Nina L. Shapiro, Neil Bhattacharyya

https://ift.tt/2y151jz

Stress distribution in mandibular donor site after harvesting bone grafts of various sizes from the ascending ramus of a dentate mandible by finite element analysis

Abstract

Purpose

Harvesting bone from the ascending ramus of the mandible is a common procedure. However, mandibular fracture may occur after grafting bone blocks. This study aimed to investigate the resulting force distribution of stress and strain in the mandibular donor site after harvesting bone grafts of different sizes and various loadings.

Methods

Finite element analysis was performed for virtual harvesting of bone blocks of nine different sizes between 15 × 20 and 25 × 30 mm and three different chewing loads (incisal, ipsilateral and contralateral). von Mises stress and first principal stress distributions were measured.

Results

von Mises stress was distributed between 35.01 (10 × 15 mm graft, incisal load) and 333.25 MPa (30 × 20 mm graft ipsilateral load), whereas first principal stress distributions were between 48.27 (10 × 15 mm graft, incisal load) and 414.69 MPa (30 × 20 mm graft ipsilateral load). In general, the least stress was observed with incisal load followed by ipsilateral load and finally contralateral load. The critical value of 133 MPa was found after removing almost all grafts with a width of 20 or 30 mm.

Conclusions

Incisal loading led to less stress compared with contralateral and ipsilateral loads. Increasing graft size led to increasing weakness of the donor site. Graft width exerted a greater influence on stress development than its height.

Clinical relevance

Ipsilateral chewing and increasing width of the bone graft result in maximum stress in the mandibular donor side, and critical values regarding to the possibility of fractures are already to expect from a graft size of 20 × 15 mm.

https://ift.tt/2IC8VDD

Identification of Baseline Factors Associated With Development of Depression in Head and Neck Cancer

This ad hoc secondary analysis of a randomized clinical trial of patients with new or recurrent stages II through IV head and neck epidermoid carcinoma assesses the factors that may be associated with the development of moderate or severe depression during treatment.

https://ift.tt/2RpPRfQ

The Role of Otolaryngologists in Eradicating Human Papillomavirus

To the Editor We read the thoughtful Viewpoint by Todd et al that examines the current human papillomavirus (HPV) pandemic and questions the role of otolaryngologists in fighting this disease. Specifically, they discuss that despite the increase in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), and its expectation of surpassing cervical cancer numbers by 2020, the public is largely unaware of this trend and HPV vaccine uptake is low despite its availability. These gaps yield an important opportunity for otolaryngologists to play.

https://ift.tt/2IERceT

Cognitive Behavioral Therapy for Tinnitus Unbound

In this issue, Beukes and colleagues provide initial evidence that cognitive behavioral therapy (CBT) delivered via the internet, described as internet-based cognitive behavioral therapy (iCBT), may be a noninferior treatment option for patients with bothersome tinnitus compared with standard face-to-face medical care. Their findings, combined with previous evidence that both CBT and iCBT are helpful in managing tinnitus distress, suggest that CBT is a promising approach for patients who experience bothersome tinnitus.

https://ift.tt/2Rqnxdi

The Role of Otolaryngologists in Eradicating Human Papillomavirus—Reply

In Reply We appreciate the response from Dr Laitman and his colleagues to our Viewpoint. Their survey data demonstrating medical students' limited knowledge of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is concerning given that these future doctors will be integral in educating patients in years to come. Their argument to advocate for the inclusion of education of HPV's role in oropharyngeal squamous cell carcinoma is compelling. If our nation's future physicians are unaware of the association, how can we expect the general public to be?

https://ift.tt/2ICE5uP

Effectiveness of Internet Cognitive Behavioral Therapy vs Face-to-Face Care for Tinnitus Treatment

This randomized noninferiority clinical trial compares the effectiveness of guided internet-based cognitive behavioral therapy vs face-to-face clinical care among patients receiving medical treatment for tinnitus.

https://ift.tt/2Rqn6Qc

The 2018 American Head and Neck Society Presidential Address—Reflections

This Presidential Address presented at the 2018 meeting of American Head and Neck Society (AHNS) highlights the challenges and opportunities of the AHNS ongoing reorganization in the rapidly changing practice of head and neck surgery and details how AHNS members can harness this change to direct the future of their field.

https://ift.tt/2IH3d3G

Interaction of Group B Streptococcus sialylated capsular polysaccharides with host Siglec-like molecules dampens the inflammatory response in tilapia

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Junjian Dong, Yuanzheng Wei, Chengfei Sun, Yuanyuan Tian, Jie Hu, Hongya Shi, Dengfeng Zhang, Maixin Lu, Xing Ye

Abstract

Group B Streptococcus (GBS, S. agalactiae) infection in tilapia (Oreochromis niloticus) causes widespread death of this species and is a significant issue for the aquaculture industry. The major virulence factor for GBS is its sialylated capsular polysaccharides (CPs). These CPs interact with sialic acid-binding immunoglobulin-like lectins (Siglecs) on the host immune cells to regulate the downstream inflammatory response and evade detection. Previously, we cloned multiple Siglec-like molecules from an O. niloticus cDNA library, all of which were shown to interact with the sialylated CPs of GBS. In the present study, we investigated the effects of GBS infection on the expression of pro- and anti-inflammatory cytokines in O. niloticus as well as OnSiglec-like-transfected macrophage cells. Eukaryotic expression vectors containing full-length OnSiglec-1-like, -4b-like, -14-like were constructed and used to transfect RAW264 macrophages in vitro as well as live tilapia in vivo prior to GBS infection. The expression of the anti-inflammatory cytokine interleukin (IL)-10 and the pro-inflammatory cytokines tumor necrosis factor (TNF)-α, IL-6, and interferon (INF)-β were then analyzed by qPCR. Our results indicate that as infection progressed, IL-10 expression was significantly upregulated, while that of TNF-α and IL-6 were significantly downregulated in the OnSiglec-like-transfected cells. INF-β expression was also downregulated in cells transfected with OnSiglec-1-like and -4b-like, but was not significantly effected in OnSiglec-14-like-transfected cells. Notably, the magnitude of these cytokine expression changes was greatly decreased when a ΔneuA GBS mutant was used to infect the OnSiglec-1-like-transfected cells. In GBS-infected tilapia, IL-10 expression was significantly upregulated in all tissues, whereas INF-β expression in the spleen, kidney, and gills was significantly downregulated at 12 hpi. While the expression of TNF-α was slightly upregulated, this change was not significant. In GBS ΔneuA mutant-infected O. niloticus, IL-10 expression in all of the tissues was significantly lower than that observed for the wild-type GBS group, while TNF-α expression was higher in the mutant infected group. There was no significant difference in INF-β expression between the two groups. Taken together, sialylated CPs on GBS appear to interact with host OnSiglec-like molecules to transmit negative regulatory signals via enhanced anti-inflammatory cytokine IL-10 production and reduced pro-inflammatory cytokine production, ultimately leading to dampening of the host immune response. The results of this study further elucidate the molecular mechanism underlying GBS infection in tilapia and also provide candidate drug target molecules.

https://ift.tt/2xXY9n8

Afatinib and Pembrolizumab for Head and Neck Squamous Cell Carcinoma (ALPHA Study)

Condition:   Head and Neck Neoplasms
Interventions:   Drug: Afatinib Oral Tablet;   Drug: Pembrolizumab Injection
Sponsor:   National Taiwan University Hospital
Not yet recruiting

https://ift.tt/2xV1jIk

Stafne bone cavity containing ectopic parotid gland

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Mesut Kaya, Kadriye Serife Ugur, Elif Dagli, Hanifi Kurtaran, Mehmet Gunduz

https://ift.tt/2O4G3d7

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Sinan Uluyol, Omer Ugur, Ilker Burak Arslan, Ozlem Yagiz, Murat Gumussoy, Ibrahim Cukurova

Abstract

Introduction

Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure.

Objective

To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction.

Methods

In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups.

Results

The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively).

Conclusions

Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Resumo

Introdução

A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão.

Objetivo

Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide.

Método

No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Benefit Inventory. A migração epitelial, a prova calórica e o Glasgow Benefit Inventory foram avaliados nos grupos de estudo e controle.

Resultados

A taxa de migração epitelial foi significativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36°/s) foi significativamente menor se comparada ao grupo controle (32,11 ± 9,12°/s) (p = 0,018). O escore global do Glasgow Benefit Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33.93, +35.59, +33.31 e +29.61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram significativamente (0,007, 0,008, 0,018 e 0,181, respectivamente).

Conclusões

A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha.

https://ift.tt/2ydtx0g

Association of Ugrp2 gene polymorphisms with adenoid hypertrophy in the pediatric population

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Mahmut Huntürk Atilla, Sibel Özdaş, Talih Özdaş, Sibel Baştimur, Sami Engin Muz, Işılay Öz, Kenan Kurt, Afife İzbirak, Mehmet Ali Babademez, Nilgün Vatandaş

Abstract

Introduction

Adenoid hypertrophy is a condition that presents itself as the chronic enlargement of adenoid tissues; it is frequently observed in the pediatric population. The Ugrp2 gene, a member of the secretoglobin superfamily, encodes a low-molecular weight protein that functions in the differentiation of upper airway epithelial cells. However, little is known about the association of Ugrp2 genetic variations with adenoid hypertrophy.

Objective

The aim of this study is to investigate the association of single nucleotide polymorphisms in the Ugrp2 gene with adenoid hypertrophy and its related phenotypes.

Methods

A total of 219 children, comprising 114 patients suffering from adenoid hypertrophy and 105 healthy patients without adenoid hypertrophy, were enrolled in this study. Genotypes of the Ugrp2 gene were determined by DNA sequencing.

Results

We identified four single nucleotide polymorphisms (IVS1-189G>A, IVS1-89T>G, c.201delC, and IVS2-15G>A) in the Ugrp2 gene. Our genotype analysis showed that the Ugrp2 (IVS1-89T>G) TG and (c.201delC) CdelC genotypes and their minor alleles were associated with a considerable increase in the risk of adenoid hypertrophy compared with the controls (p = 0.012, p = 0.009, p = 0.013, and p = 0.037, respectively). Furthermore, Ugrp2 (GTdelCG, GTdelCA) haplotypes were significantly associated with adenoid hypertrophy (four single nucleotide polymorphisms ordered from 5′ to 3′; p = 0.0001). Polymorfism–Polymorfism interaction analysis indicated a strong interaction between combined genotypes of the Ugrp2 gene contributing to adenoid hypertrophy, as well as an increased chance of its diagnosis (p < 0.0001). In addition, diplotypes carrying the mutant Ugrp2 (c.201delC) allele were strongly associated with an increased risk of adenoid hypertrophy with asthma and with allergies (p = 0.003 and p = 0.0007, respectively).

Conclusion

Some single nucleotide polymorphisms and their combinations in the Ugrp2 gene are associated with an increased risk of developing adenoid hypertrophy. Therefore, we tried to underline the importance of genetic factors associated with adenoid hypertrophy and its related clinical phenotypes.

Resumo

Introdução

A adenoide ou hipertrofia de tonsila faríngea é uma condição que se apresenta como o aumento crônico de tecidos linfóides na rinofaringe e é frequentemente observada na população pediátrica. O gene Ugrp2, um membro da superfamília da secretoglobina, codifica uma proteína de baixo peso molecular que funciona na diferenciação das células epiteliais das vias aéreas superiores. No entanto, pouco se sabe sobre a associação de variações genéticas do Ugrp2 com hipertrofia de tonsila faríngea.

Objetivo

Investigar a associação de polimorfismos de nucleotídeos únicos no gene Ugrp2 com hipertrofia de tonsila faríngea e seus fenótipos relacionados.

Método

Foram incluídos no estudo 219 crianças, 114 pacientes com hipertrofia de tonsila faríngea e 105 saudáveis. Os genótipos do gene Ugrp2 foram determinados por sequenciamento de DNA.

Resultados

Identificamos quatro polimorfismos de nucleotídeo único (IVS1-189G>A, IVS1-89T>G, c.201delC, e IVS2-15G>A) no gene Ugrp2. Nossa análise genotípica mostrou que os genótipos Ugrp2 (IVS1-89T>G) TG e (c.201delC) CdelC e seus alelos menores foram associados a um aumento considerável no risco de HA em comparação com os controles (p = 0,012, p = 0,009, p = 0,013 e p = 0,037, respectivamente). Além disso, os haplótipos Ugrp2 (GTdelCG, GTdelCA) foram significativamente associados com hipertrofia de tonsila faríngea (quatro polimorfismos de nucleot' ordenados de 5' a 3'; p = 0,0001). A análise de interação polimorfismo-polimorfismo indicou uma forte interação entre genótipos combinados do gene Ugrp2 que contribuiu para hipertrofia de tonsila faríngea, bem como uma chance maior de seu diagnóstico (p < 0,0001). Além disso, os diplótipos que transportam o alelo mutante Ugrp2 (c.201delC) foram fortemente associados a um risco aumentado de hipertrofia de tonsila faríngea com asma e com alergias (p = 0,003 e p = 0,0007, respectivamente).

Conclusão

Alguns polimorfismos de nucleotídeo único e suas combinações no gene Ugrp2 estão associados a um risco aumentado de desenvolver hipertrofia de tonsila faríngea. Portanto, tentamos enfatizar a importância dos fatores genéticos e fenótipos clínicos associados à essa hipertrofia.

https://ift.tt/2O4G14Z

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Lucas Resende, Carolina do Carmo, Leão Mocellin, Rogério Pasinato, Marcos Mocellin

Abstract

Introduction

Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure.

Objective

To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical–epidemiological variables associated with functional outcome.

Methods

Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical–epidemiological variables with the scores obtained.

Results

Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann–Whitney).

Conclusion

Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Resumo

Introdução

Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento.

Objetivo

Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional.

Método

Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos.

Resultados

Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney).

Conclusão

A septoplastia e fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.

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Psychoacoustic classification of persistent tinnitus

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Flavia Alencar de Barros Suzuki, Fabio Akira Suzuki, Ektor Tsuneo Onishi, Norma Oliveira Penido

Abstract

Introduction

Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases.

Objective

to propose a single and measurable classification of persistent tinnitus, through its perception as sounds of nature or of daily life and its comparison with pure tone or noise, of high or low pitch, presented to the patient by audiometer sound.

Methods

A total of 110 adult patients, of both genders, treated at the Tinnitus Outpatient Clinic, were enrolled according to the inclusion and exclusion criteria. Otorhinolaryngologic and Audiological, Pitch Matching and Loudness, Visual Analog Scale, Tinnitus Handicap Inventory and Minimum Masking Level assessments were performed.

Results

In these 110 patients, 181 tinnitus complaints were identified accordingly to type and ear, with 93 (51%) Pure Tone, and 88 (49%) Noise type; 19 at low and 162 at high frequency; with a mean in the Pure Tone of 5.47 in the Visual Analog Scale and 12.31 decibel in the Loudness and a mean in the Noise of 6.66 and 10.51 decibel. For Tinnitus Handicap Inventory and Minimum Masking Level, the 110 patients were separated into three groups with tinnitus, Pure Tone, Noise and multiple. Tinnitus Handicap Inventory higher in the group with multiple tinnitus, of 61.38. Masking noises such as White Noise and Narrow Band were used for the Minimum Masking Level at the frequencies of 500 and 6000 Hz. There was a similarity between the Pure Tone and Multiple groups. In the Noise group, different responses were found when Narrow Band was used at low frequency.

Conclusion

Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients' lives.

Resumo

Introdução

O zumbido é um sintoma de difícil tratamento, com respostas diferentes nos pacientes. É classificado de formas diversas, de acordo com a origem ou doenças associadas.

Objetivo

Propor uma classificação única e mensurável do zumbido persistente, por meio da sua percepção como sons da natureza ou da vida cotidiana e da sua comparação com o tom puro ou o ruído, de pitch alto ou baixo, apresentados ao paciente pelos sons do audiômetro.

Método

Participaram 110 pacientes adultos, de ambos os sexos, atendidos no Ambulatório de Zumbido, tendo sido observados os critérios de inclusão e exclusão. Realizada avaliação otorrinolaringológica, audiológica, Pitch Matching e Loudness, Visual Analog Scale, Tinnitus Handicap Inventory e Minimum Masking Level.

Resultados

Nesses 110 pacientes foram identificadas 181 queixas de zumbido separadas por tipo e orelha, sendo 93 (51%) tipo tom puro e 88 (49%) tipo ruído; 19 de baixa frequência e 162 de alta frequência; com média do Visual Analog Scale no tom puro de 5,47 e ruído de 6,66; média do Loudness do tom puro de 12,31 dBNS e ruído de 10,51 dBNS. Para o Tinnitus Handicap Inventory e o Minimum Masking Level os 110 pacientes foram separados em três grupos com zumbido, tom puro, ruído e múltiplo, com a média do Tinnitus Handicap Inventory maior no grupo com zumbido múltiplo com 61,38. Para o Minimum Masking Level foram usados os ruídos mascaradores tipo White Noise e Narrow Band nas frequências de 500 Hz e 6000 Hz. Houve semelhança entre os grupos com tom puro e múltiplo. No grupo de ruído foram encontradas respostas diferentes quando usado o Narrow Band em frequência baixa.

Conclusão

Classificar o zumbido persistente em tom puro ou ruído, presentes em frequência alta ou baixa e estabelecer suas diferentes características nos permitem conhecer suas particularidades e a repercussão desse sintoma na vida dos pacientes.

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Audiological and electrophysiological alterations in HIV-infected individuals subjected or not to antiretroviral therapy

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Carla Gentile Matas, Alessandra Giannella Samelli, Fernanda Cristina Leite Magliaro, Aluisio Segurado

Abstract

Introduction

The Human Immunodeficiency Virus (HIV) and infections related to it can affect multiple sites in the hearing system. The use of High Activity Anti-Retroviral Therapy (HAART) can cause side effects such as ototoxicity. Thus, no consistent patterns of hearing impairment in adults with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome have been established, and the problems that affect the hearing system of this population warrant further research.

Objectives

This study aimed to compare the audiological and electrophysiological data of Human Immunodeficiency Virus-positive patients with and without Acquired Immune Deficiency Syndrome, who were receiving High Activity Anti-Retroviral Therapy, to healthy individuals.

Methods

It was a cross-sectional study conducted with 71 subjects (30–48 years old), divided into groups: Research Group I: 16 Human Immunodeficiency Virus-positive individuals without Acquired Immunodeficiency Syndrome (not receiving antiretroviral treatment); Research Group II: 25 Human Immunodeficiency Virus-positive individuals with Acquired Immunodeficiency Syndrome (receiving antiretroviral treatment); Control Group: 30 healthy subjects. All individuals were tested by pure-tone air conduction thresholds at 0.25–8 kHz, extended high frequencies at 9–20 kHz, electrophysiological tests (Auditory Brainstem Response, Middle Latency Responses, Cognitive Potential).

Results

Research Group I and Research Group II had higher hearing thresholds in both conventional and high frequency audiometry when compared to the control group, prolonged latency of waves I, III, V and interpeak I–V in Auditory Brainstem Response and prolonged latency of P300 Cognitive Potential. Regarding Middle Latency Responses, there was a decrease in the amplitude of the Pa wave of Research Group II compared to the Research Group I.

Conclusions

Both groups with Human Immunodeficiency Virus had higher hearing thresholds when compared to healthy individuals (group exposed to antiretroviral treatment showed the worst hearing threshold) and seemed to have lower neuroelectric transmission speed along the auditory pathway in the brainstem, subcortical and cortical regions.

Resumo

Introdução

O HIV e as infecções relacionadas a ele podem afetar vários locais do sistema auditivo. O uso de terapia antirretroviral altamente ativa pode causar efeitos colaterais, como ototoxicidade. Assim, não foram estabelecidos padrões consistentes de deficiência auditiva em adultos com HIV/Aids e os problemas que afetam o sistema auditivo dessa população justificam pesquisas futuras.

Objetivos

Este estudo teve como objetivo comparar os dados audiológicos e eletrofisiológicos de pacientes HIV positivos com e sem Aids que recebiam terapia antirretroviral altamente ativa com os de indivíduos saudáveis.

Método

Estudo transversal com 71 indivíduos (30-48 anos), dividido em grupos: Grupo de Pesquisa I: 16 indivíduos HIV-positivos sem Aids (não recebendo tratamento antirretroviral); Grupo de Pesquisa II: 25 indivíduos HIV-positivos com Aids (recebiam tratamento antirretroviral); Grupo Controle: 30 indivíduos saudáveis. Todos os indivíduos foram testados para limiares de condução aérea de tons puros a 0,25-8 kHz, altas frequências de 9-20 kHz, testes eletrofisiológicos (potencial evocado auditivo de tronco encefálico, potencial evocado auditivo de média latência, potencial cognitivo).

Resultados

Os grupos de pesquisa I e II apresentaram limiares auditivos mais elevados em audiometria convencional e nas frequências altas quando comparados com o grupo controle, latência prolongada das ondas I, III, V e interpico I-V em resposta auditiva de tronco encefálico e latência prolongada de P300. Em relação às respostas de latência média, houve uma diminuição na amplitude da onda Pa do Grupo de pesquisa II em comparação com o grupo de pesquisa I.

Conclusões

Ambos os grupos com HIV apresentaram limiares auditivos mais elevados quando comparados aos indivíduos saudáveis (o grupo exposto ao tratamento antirretroviral apresentou o pior limiar auditivo) e parecem ter menor velocidade de transmissão neuroelétrica ao longo da via auditiva nas regiões do tronco encefálico, subcortical e cortical.

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Prognostic significance of soft tissue deposits in laryngeal carcinoma

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Omer Afsin Ozmen, Melih Alpay, Ozlem Saraydaroglu, Uygar Levent Demir, Fikret Kasapoglu, Hamdi Hakan Coskun, Oguz Ibrahim Basut

Abstract

Introduction

Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site.

Objective

To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma.

Methods

Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined.

Results

The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor.

Conclusion

In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Resumo

Introdução

Depósitos de tecido mole são ilhas tumorais diferente dos linfonodos e ocasionalmente diagnosticados em amostras de esvaziamento cervical. Sua importância começou a ser reconhecida, mas seu valor não foi investigado no câncer de laringe como um único local de tumor.

Objetivo

Investigar o valor prognóstico do depósito de tecido mole em pacientes com carcinoma laríngeo.

Método

Os prontuários de 194 pacientes com carcinoma laríngeo tratados principalmente por cirurgia e esvaziamento cervical foram analisados. O significado prognóstico dos depósitos de tecido mole foi avaliado juntamente com outros achados clínicos e histopatológicos. As taxas de recidiva, as taxas de sobrevida geral e específicas da doença foram avaliadas.

Resultados

Observou-se uma incidência de depósitos de tecido mole de 7,2% no carcinoma laríngeo. O estágio N foi mais avançado em pacientes com depósitos de tecido mole. A taxa de recorrência regional foi maior e as taxas de sobrevida geral e específica da doença foram significativamente menores nesses pacientes na análise univariada. No entanto, na análise multivariada, o depósito de tecido mole não foi observado como um fator de risco independente.

Conclusão

No carcinoma laríngeo, o depósito de tecido mole foi diagnosticado em pacientes com doença cervical mais avançada, mas sua significância foi menor do que outros fatores, incluindo a extensão extranodal.

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Is there a best side for cochlear implants in post-lingual patients?

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Maria Stella Arantes do Amaral, Thiago A. Damico, Alina S. Gonçales, Ana C.M.B. Reis, Myriam de Lima Isaac, Eduardo T. Massuda, Miguel Angelo Hyppolito

Abstract

Introduction

Cochlear Implant is a sensory prosthesis capable of restoring hearing in patients with severe or profound bilateral sensorineural hearing loss.

Objective

To evaluate if there is a better side to be implanted in post-lingual patients.

Methods

Retrospective longitudinal study. Participants were 40 subjects, of both sex, mean age of 47 years, with post-lingual hearing loss, users of unilateral cochlear implant for more than 12 months and less than 24 months, with asymmetric auditor reserve between the ears (difference of 10 dBNA, In at least one of the frequencies with a response, between the ears), divided into two groups. Group A was composed of individuals with cochlear implant in the ear with better auditory reserve and Group B with auditory reserve lower in relation to the contralateral side.

Results

There was no statistical difference for the tonal auditory threshold before and after cochlear implant. A better speech perception in pre-cochlear implant tests was present in B (20%), but the final results are similar in both groups.

Conclusion

The cochlear implant in the ear with the worst auditory residue favors a bimodal hearing, which would allow the binaural summation, without compromising the improvement of the audiometric threshold and the speech perception.

Resumo

Introdução

O implante coclear é uma prótese sensorial capaz de restaurar a audição em pacientes com perda auditiva neurossensorial bilateral severa ou profunda.

Objetivo

Avaliar se há um melhor lado para o implante coclear em pacientes pós-linguais.

Método

Estudo longitudinal retrospectivo; incluiu 40 indivíduos, de ambos os sexos, idade média de 47 anos, com perda auditiva pós-lingual, usuários de implante coclear unilateral por mais de 12 meses e menos de 24 meses, com perda auditiva assimétrica entre as orelhas (diferença de 10 dBNA, em pelo menos uma das frequências), divididos em dois grupos. O Grupo A foi composto por indivíduos com implante coclear na orelha com melhor audição residual e Grupo B com menor audição residual em relação ao lado contralateral.

Resultados

Não houve diferença estatística entre o limiar auditivo tonal antes e depois do implante coclear. Uma melhor percepção da fala nos testes pré-implante coclear foi observada no grupo B (20%), mas os resultados finais foram semelhantes em ambos os grupos.

Conclusão

O implante coclear na orelha com pior audição residual favorece uma audição bimodal, o que possibilitaria a somação binaural, sem comprometer a melhora do limiar audiométrico e a percepção da fala.

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Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Tanit Ganz Sanchez, Fúlvia Eduarda da Silva

Abstract

Introduction

Misophonia is a recently described, poorly understood and neglected condition. It is characterized by strong negative reactions of hatred, anger or fear when subjects have to face some selective and low level repetitive sounds. The most common ones that trigger such aversive reactions are those elicited by the mouth (chewing gum or food, popping lips) or the nose (breathing, sniffing, and blowing) or by the fingers (typing, kneading paper, clicking pen, drumming on the table). Previous articles have cited that such individuals usually know at least one close relative with similar symptoms, suggesting a possible hereditary component.

Objective

We found and described a family with 15 members having misophonia, detailing their common characteristics and the pattern of sounds that trigger such strong discomfort.

Methods

All 15 members agreed to give us their epidemiological data, and 12 agreed to answer a specific questionnaire which investigated the symptoms, specific trigger sounds, main feelings evoked and attitudes adopted by each participant.

Results

The 15 members belong to three generations of the family. Their age ranged from 9 to 73 years (mean 38.3 years; median 41 years) and 10 were females. Analysis of the 12 questionnaires showed that 10 subjects (83.3%) developed the first symptoms during childhood or adolescence. The mean annoyance score on the Visual Analog Scale from 0 to 10 was 7.3 (median 7.5). Individuals reported hatred/anger, irritability and anxiety in response to sounds, and faced the situation asking to stop the sound, leaving/avoiding the place and even fighting. The self-reported associated symptoms were anxiety (91.3%), tinnitus (50%), obsessive-compulsive disorder (41.6%), depression (33.3%), and hypersensitivity to sounds (25%).

Conclusion

The high incidence of misophonia in this particular familial distribution suggests that it might be more common than expected and raises the possibility of having a hereditary etiology.

Resumo

Introdução

A misofonia é uma condição recentemente descrita, mal compreendida e negligenciada. É caracterizada por fortes reações negativas de ódio, raiva ou medo quando os indivíduos precisam enfrentar alguns sons repetitivos seletivos e de baixa intensidade. Os mais comuns que desencadeiam tais reações aversivas são aqueles provocados pela boca (mascar goma ou mastigar comida, estalar os lábios) ou nariz (respirando, cheirando e soprando) ou pelos dedos (digitando, amassando papel, clicando a caneta, tamborilando na mesa). Artigos anteriores citam que esses indivíduos geralmente conhecem pelo menos um parente próximo com sintomas semelhantes, sugerindo um possível componente hereditário.

Objetivo

Encontramos e descrevemos uma família com 15 membros com misofonia, detalhando suas características comuns e o padrão de sons que desencadeiam um desconforto tão forte.

Método

Todos os 15 membros concordaram em nos fornecer seus dados epidemiológicos e 12 concordaram em responder a um questionário específico que investigou os sintomas, sons de gatilho específicos, principais sentimentos evocados e atitudes adotadas por cada participante.

Resultados

Os 15 membros pertencem a três gerações da família. A idade variou de 9 a 73 anos (média de 38,3 anos, mediana de 41 anos) e 10 eram mulheres. A análise dos 12 questionários mostrou que 10 indivíduos (83,3%) desenvolveram os primeiros sintomas durante a infância ou a adolescência. A média do escore de irritação na Escala Visual Analógica de 0 a 10 foi de 7,3 (mediana 7,5). Os indivíduos relataram sentimentos de ódio/raiva, irritabilidade e ansiedade em resposta a sons, e enfrentaram a situação pedindo para interromper o som, deixando/evitando o lugar e até mesmo discutindo. Os sintomas associados auto-relatados foram ansiedade (91,3%), zumbido (50%), transtorno obsessivo-compulsivo (41,6%), depressão (33,3%) e hipersensibilidade aos sons (25%).

Conclusão

A alta incidência de misofonia nessa distribuição familiar em particular sugere que possa ser mais comum do que o esperado e suscita a possibilidade de haver uma etiologia hereditária.

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Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Peng Huang, Shujun Zhang, Xinhong Gong, Xuesong Wang, Zi-Han Lou

Abstract

Introduction

In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic.

Objective

This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation.

Methods

In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n = 57) and Gelfoam patch-treated group (n = 57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months.

Results

Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p > 0.05). However, the total average closure time was significantly different between the two groups (26.8 ± 9.1 days in the spontaneous healing group vs. 14.7 ± 9.1 days in the Gelfoam patch-treated group, p < 0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1 ± 1.6 days vs. 12.6 ± 3.9, medium-sized perforations: 13.3 ± 2.2 days vs. 21.8 ± 4.2 days, and large perforations: 21.2 ± 4.7 days vs. 38.4 ± 5.7 days; p < 0.01).

Conclusion

In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.

Resumo

Introdução

Na última década, houve um uso crescente de placas biomateriais na regeneração de perfurações traumáticas da membrana timpânica. As principais vantagens das placas de biomateriais são restaurar provisoriamente a função fisiológica da orelha média, assim melhoram imediatamente os sintomas da orelha e atuam como um suporte para a migração do epitélio. No entanto, não se sabe se há efeitos clínicos adicionais na regeneração do tímpano em relação ao fragmento de material biológico.

Objetivo

Avaliar a resposta de cicatrização para diferentes padrões de reparo em perfurações de membrana timpânica traumáticas humanas por meio de observação endoscópica.

Método

Foram alocados 114 pacientes com perfurações de membrana timpânica traumáticas sequencialmente para dois grupos: o de cicatrização espontânea (n = 57) e o tratado com esponja de Gelfoam (n = 57). A velocidade de fechamento, o tempo de fechamento e a taxa de otorreia foram comparados entre os grupos aos três meses.

Resultados

Foram analisados 107 pacientes nos dois grupos (52 no de cicatrização espontânea e 55 no tratado com esponja de Gelfoam). A velocidade global de fechamento no final do período de seguimento de três meses foi de 90,4% no grupo de cicatrização espontânea e de 94,5% no grupo tratado com esponja de Gelfoam; a diferença não foi estatisticamente significativa (p > 0,05). No entanto, o tempo total médio de fechamento foi significativamente diferente entre os dois grupos (26,8 ± 9,1 dias no de cicatrização espontânea versus 14,7 ± 9,1 dias no tratado com esponja de Gelfoam, p < 0,01). Além disso, a velocidade de fechamento não foi significativamente diferente entre o grupo de cicatrização espontânea e o grupo tratado com esponja de Gelfoam, independentemente do tamanho da perfuração. O tempo de fechamento no grupo tratado com esponjas de Gelfoam foi significativamente menor do que no grupo de cicatrização espontânea, independentemente do tamanho da perfuração (pequenas perfurações: 7,1 ± 1,6 dias vs. 12,6 ± 3,9, perfurações de tamanho médio: 13,3 ± 2,2 dias vs. 21,8 ± 4,2 dias e grandes perfurações: 21,2 ± 4,7 dias vs. 38,4 ± 5,7 dias; p < 0,01).

Conclusão

Na regeneração de PMT traumáticas, a esponja de Gelfoam não só desempenha um papel de estrutura à migração epitelial, mas também promove edema e hiperplasia de tecido de granulação nas bordas da perfuração e acelera a cicatrização do tímpano.

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Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Şahin Öğreden, Sedat Rüzgar, Hasan Deniz Tansuker, Ümit Taşkın, Yalçın Alimoğlu, Salih Aydın, Mehmet Faruk Oktay, Uğur İzol

Abstract

Introduction

Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other.

Objective

The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model.

Methods

Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n = 4), and percutaneous osteotomy (8 bones) in Group 2 (n = 4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively.

Results

In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed.

Conclusion

Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.

Resumo

Introdução

Nas rinoplastias, a osteotomia lateral é realizada principalmente por via endonasal ou percutânea para correção de deformidades nasais. Ambas as técnicas apresentam vantagens e desvantagens.

Objetivo

Comparar os efeitos histopatológicos sobre a cicatrização óssea e estabilidade nasal entre as técnicas de osteotomia endonasal e percutânea em rinoplastia em um modelo animal experimental.

Método

Foram incluídos oito coelhos brancos da Nova Zelândia de um ano de idade. Hidrocloreto de xilazina e cetamina intramuscular foram administrados aos coelhos como agentes anestésicos. Osteotomia endonasal (8 ossos) foi realizada no Grupo 1 (n = 4) e osteotomia percutânea (8 ossos) no Grupo 2 (n = 4). Um mês depois, os coelhos foram sacrificados. A cicatrização óssea dos coelhos foi avaliada de acordo com o escore de cicatrização óssea de Huddleston et al. Em ambos os grupos, a integridade do osso nasal foi avaliada subjetivamente.

Resultados

No grupo da osteotomia percutânea, observou-se cicatrização óssea de grau 1 em duas amostras (25%), cicatrização óssea de grau 2 em duas amostras (25%), e cicatrização óssea de grau 3 em quatro amostras (50%). No grupo da osteotomia endonasal, observou-se cicatrização óssea de grau 1 em 6 amostras (75%) e a cicatrização óssea de grau 2 foi observada em 2 amostras (25%). No grupo percutâneo, o tecido fibroso foi observado em 2 amostras, enquanto tecido predominantemente fibroso e uma menor quantidade de cartilagem foi observada em 2 e uma quantidade igual de tecido fibroso e cartilagem foi observada em 4 amostras. No grupo endonasal, observou-se tecido fibroso em 6 amostras e tecido predominantemente fibroso com uma menor quantidade de cartilagem em 2 amostras. Em ambos os grupos, quando força manual foi aplicada aos ossos nasais, a mesma resistência foi observada subjetivamente.

Conclusão

A técnica de osteotomia lateral percutânea resultou em menor traumatismo ósseo e periosteal e melhor cicatrização óssea em comparação com a técnica de osteotomia endonasal.

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