Intranasal immunization with phosphorylcholine suppresses allergic rhinitis in mice

Objectives/Hypothesis

Intranasal immunization with phosphorylcholine (PC) is known to reduce immunoglobulin (Ig)E production. However, its effects on the occurrence of allergic rhinitis (AR) are unknown. This study was performed to evaluate the effects of PC-keyhole limpet hemocyanin (PC-KLH) and to examine the effects on the occurrence of AR in a murine model of AR.

Study Design

In vivo study using an animal model.

Methods

Forty-five female BALB/c mice were divided into three groups; those pretreated with intranasal administration of PC-KLH followed by intraperitoneal sensitization and nasal challenge with ovalbumin (OVA) (group A), those untreated with PC-KLH followed by sensitization and nasal challenge with OVA (group B), and those untreated with PC-KLH or OVA as controls (group C). Nasal symptoms, allergic inflammation in the nasal mucosa, OVA specific IgE production, and cytokine profile were compared among those three groups. Dendritic cells (DCs) were isolated from splenic cells and PC-KLH–stimulated interleukin (IL)-12p40 production was measured.

Results

The mice pretreated with PC-KLH showed lower allergic nasal symptoms and inflammation compared to untreated mice. The levels of total IgE and OVA-specific IgE in serum, and IL-4 production by nasal and splenic CD4⁺ T cells were significantly reduced by PC-KLH pretreatment. Furthermore, IL-12p40 production by DCs was induced by PC-KLH in a dose-dependent manner.

Conclusions

Intranasal administration of PC-KLH suppressed allergic inflammation in nasal mucosa and antigen-specific IgE production by downregulating Th2-type immune response. Intranasal immunization with PC might be useful to prevent AR and upper airway bacterial infection.

Level of Evidence

NA Laryngoscope, 2017

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Treatment of tracheoesophageal fistula after laryngectomy by a customized tracheal prosthesis

http://ift.tt/2Bz06qj

Tinnitus and its risk factors in african americans: The Jackson Heart Study

Objectives/Hypothesis

To describe the prevalence of reported tinnitus and tinnitus handicap in the all–African American Jackson Heart Study (JHS) cohort, with assessment of the relationship to cardiometabolic risk and depression.

Study Design

Prospective cohort study.

Methods

Audiologic data were obtained from a sample of 1,314 participants of the JHS. Reported tinnitus was assessed dichotomously (yes/no) by interview and with the Tinnitus Handicap Inventory (THI). The statistical relationship of reported tinnitus and tinnitus handicap to various cardiometabolic risks (i.e., hypertension and waist circumference) and Center for Epidemiologic Studies Depression scale (CES-D) was assessed with logistic and gamma regression procedures.

Results

Tinnitus was found to be a highly prevalent condition (29.5%), with an additionally high rate of individuals who report at least slight tinnitus handicap (35%). Hypertension (β = 1.344, 95% confidence interval [CI]: 1.015-1.780, P = .039) and waist circumference (β = 1.009, 95% CI: 1.001-1.018, P = .021) were found to have a statistically significant relationship with THI score, depending on the level of covariate adjustment. Depression, as measured by the CES-D, was found to have a statistically significant relationship with both reported tinnitus (odds ratio [OR]: 1.051, 95% CI: 1.030-1.072, P < .001) and THI score (β = 1.029, 95% CI: 1.013-1.047, P = .001), which persisted for all levels of covariate adjustment in statistical models.

Conclusions

Tinnitus was found to be highly prevalent in the JHS, and certain measures of cardiometabolic risk are weakly related to both reported tinnitus and level of tinnitus handicap. A consistent relationship between depression and tinnitus/level of tinnitus handicap was observed.

Level of Evidence

2b Laryngoscope, 2017

http://ift.tt/2kaQVIj

Cytologic findings of spindle epithelial tumor with thymus-like elements

Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare and morphologically unique biphasic pediatric thyroid tumor of low malignant potential. There are less than 50 cases reported in the literature and few reported metastases. Despite the common usage of needle aspiration for thyroid and lymph node evaluation, cytologic descriptions of SETTLE are rare and tend to focus on a hypercellular biphasic appearance. We report aspirate findings of early cystic lymph node metastases in a 14-year-old girl, showing abundant matrix and low cellularity. We propose that the lack of recognition of this abundant matrix and cystic ultrasound appearance (as well as rarity of this tumor) may account for the low number of cytologic descriptions in the literature. Improved recognition may lead to increased usefulness of aspiration in the diagnosis and follow-up of SETTLE. Laryngoscope, 2017

http://ift.tt/2BwDSFg

Correlations between cystic fibrosis genotype and sinus disease severity in chronic rhinosinusitis

Objective

Cystic fibrosis (CF) patients commonly develop chronic rhinosinusitis (CRS). The impact of the most common cystic fibrosis transmembrane conductance regulator (CFTR) mutation, F508del, on the severity of sinonasal disease remains inconclusive. The objective of this study is to evaluate the impact of CFTR genotype functional classification on sinonasal disease severity in patients with CRS.

Methods

Retrospective chart review of patients with CF who underwent endoscopic sinus surgery for chronic rhinosinusitis from 1998 to 2015. Patients were divided into high- or low-risk genotypes based on standardized CFTR gene functional classification. The primary outcome was the 22-item Sino-Nasal Outcome Test (SNOT-22) score. Secondary outcomes included endoscopic scores, extent of surgery performed, presence of polyposis, number of revision surgeries, and Lund-MacKay computed tomography scores.

Results

Thirty-eight patients harbored a high-risk CFTR genotype, and 11 had a low-risk genotype. On bivariate analysis, there was no association between CFTR genotype risk stratification and measures of preoperative disease severity or postoperative outcomes. There were no associations between genotype risk stratification and outcome variables on multivariate linear regression, adjusted for age and gender. There were significant improvements in several SNOT-22 subdomains before and after endoscopic sinus surgery (P < 0.05), but the magnitude of improvement was not significantly different on the basis of CFTR genotype risk stratification.

Conclusion

High-risk CFTR genotypes are not associated with worse sinonasal disease severity or postoperative symptom control than low-risk CFTR genotypes after adjusting for confounding factors.

Level of Evidence

Level IV. Laryngoscope, 2017

http://ift.tt/2k9q9jC

The role of elective neck dissection in the treatment of maxillary sinus squamous cell carcinoma

Objective

This study is designed to analyze the survival benefits of elective neck dissection (END) in the treatment of squamous cell carcinoma of the maxillary sinus (MS-SCC) with clinically negative neck lymph nodes (N0) and no metastasis (M0).

Study Design

The aim of this study was to evaluate whether END improves survival in patients with MS-SCC.

Methods

This study is a population-based, concurrent retrospective database analysis of patients diagnosed with N0M0 MS-SCC from 2004 to 2013. Data were acquired from the Surveillance, Epidemiology, and End Results database. Frequency functions, Kaplan-Meier and Cox regression models were queried to analyze demographics, treatment status, and survival outcomes.

Results

There were a total of 927 MS-SCC cases in the database between 2004 and 2013. This analysis revealed that for the overall cohort, END significantly and independently reduces the 5-year hazard of death in MS-SCC (hazard ratio [HR] = 0.646, 95% confidence interval [CI] = 0.419–0.873, P = 0.047). For early tumor (T)1/T2 tumors and T4 tumors, END did not independently improve 5-year survival. However, for T3 disease, END significantly reduced the 5-year hazard of death in MS-SCC (HR = 0.471, 95% CI = 0.261–0.680, P = 0.001), regardless of other covariates, including adjuvant radiation. There has been an increase in the percentage of MS-SCC surgeries that have been accompanied by END since SEER started collecting this data, although this did not demonstrate significance (R² = 0.622).

Conclusion

END improves disease-specific survival in patients with MS-SCC size > 4 cm and advanced T-stage (American Joint Committee on Cancer AJCC TIII). Therefore, surgeons performing maxillectomies should consider conducting an END concurrent with maxillectomy for those with size > 4 cm advanced stage cancer.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2Bwe6kH

Prevalence of adult unilateral hearing loss and hearing aid use in the United States

Objective

The prevalence of unilateral hearing loss (UHL) in adults has not been well characterized. The objectives of this study are to determine the prevalence of UHL in U.S. adults and its treatment with hearing aids using a nationally representative study.

Study Design

Cross-sectional national epidemiologic study (n = 6,242).

Methods

Subjects ≥ 18 years old with audiometric testing in the 2005 to 2006, 2009 to 2010, and 2011 to 2012 cycles of the National Health and Nutrition Examination Study were included. UHL was defined as normal hearing (≤25 decibels hearing level [dB HL] pure tone average [PTA]) in one ear and at least mild hearing loss (>25 dB HL PTA) in the other ear. Hearing aid usage was defined by at least 5 hours per week (2005–2006) or at least seldom (2009–2012) use. Sampling weights were utilized to ensure generalizability to the U.S. population.

Results

The overall prevalence of UHL in adult Americans was 7.2% (95% confidence interval 6.1%–8.6%), with 5.7% (4.8%–6.7%) having mild and 1.5% (0.1%–2.1%) with moderate-or-worse UHL; nearly one-third of the latter reported trouble hearing. The prevalence of hearing aid usage in those with UHL was 2.0% (0.6%–6.7%). Of those with mild UHL, 1.4% (0.2%–8.0%) used hearing aids. Of those with moderate UHL, 4.2% (0.1%–22%) used hearing aids. Among those with UHL and also at least moderate subjective difficulty hearing, only 11% wore hearing aids.

Conclusion

UHL is common among U.S. adults. Hearing aid usage is very low, even when there is perceived handicap. Public health education is needed to increase awareness of and auditory rehabilitation for UHL.

Level of Evidence

2. Laryngoscope, 2017

http://ift.tt/2kcxrDv