Acknowledgement to referees 2017

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Multiple bilateral adnexal tumours of the ear: Dermoscopic clues

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Onychoscopy of trachyonychia: An analysis of 30 patients and comparison with onychomycosis

The diagnosis of trachyonychia is often challenging, and misdiagnoses, particularly as onychomycosis, are common.^1-3 The correct diagnosis of trachyonychia is crucial because treatment options for trachyonychia include observation/active non-intervention, topical and systemic steroids, or immunomodulating agents, while onychomycosis should be treated with antifungal agents^{1, 2}. Onychoscopy (nail dermoscopy) is a useful tool for various nail disorders.^4-8 However, a detailed morphologic analysis of trachyonychia has not been performed. Here, we aim to describe the characteristic dermoscopic features of trachyonychia and to explore whether these features are significantly different from those in onychomycosis.

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The use of specific immunoglobulin E in nasal secretions for the diagnosis of allergic rhinitis

Objective

Although local specific immunoglobulin (sIgE) has been employed as a diagnostic criterion for allergic rhinitis (AR), the use of local sIgE has not been fully evaluated in the diagnosis of allergic rhinitis. The aim of this study was to evaluate the use of nasal secretion sIgE in the diagnosis of allergic rhinitis.

Methods

A total of 51 patients (27 males and 24 females, mean age = 33.3 years) with rhinitis symptoms were enrolled consecutively from the allergy-rhinology clinic of Beijing TongRen Hospital (Beijing, People's Republic of China). Questionnaires were completed by each participant at recruitment to record demographic data, nasal symptom severity, and physician-diagnosed comorbid asthma. The severity of nasal obstruction, rhinorrhea, sneezing, and nasal/eye itching was recorded according to a visual analogue scale (VAS) of 10 cm. Sensitization to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mugwort, Candida albicans, Penicillium notatum, Alternaria, Cladosporium, and Aspergillus were assessed according to presence of sIgE antibodies to these allergens in serum and nasal secretions.

Results

VAS scores of the participants ranged from 11 to 25 (mean = 17), and 14 (27.5%) patients had comorbid asthma. Based on serum sIgE, 31 (60.8%) patients were allergic to mugwort, 14 (27.5%) to Dermatophagoides, and three (5.9%) to fungal allergens. Based on nasal secretion sIgE, 32 (62.7%) patients were allergic to mugwort, 12 (23.5%) to Dermatophagoides, and three (5.9%) to fungal allergens. The local mugwort sIgE level and serum mugwort sIgE level were positively correlated with each other and with VAS scores.

Conclusion

sIgE level in nasal secretions of subjects with rhinitis is a reliable noninvasive alternative to serum sIgE for diagnosis of allergic rhinitis.

Level of Evidence

4. Laryngoscope, 2018

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Patient and surgeon factors explain variation in the frequency of frontal sinus surgery

Objectives/Hypothesis

Ethmoidectomy may be sufficient to address frontal sinus disease, but some surgeons may perform frontal recess dissection initially. Our objectives were to describe patient-associated factors with frequency of frontal sinus surgery and analyze the association with provider volume.

Study Design

Retrospective cohort analysis.

Methods

The 2013 State Ambulatory Surgery Databases of New Jersey, Florida, and Kentucky were queried to identify adults who underwent anterior ethmoidectomy or total ethmoidectomy using standard Current Procedural Terminology codes. Univariate and multivariate logistic regression was performed to determine the odds of undergoing concurrent frontal sinus exploration along with ethmoidectomy, adjusting for age, gender, race, insurance type, median income, and the metropolitan designation by zip code. We also examined provider and center volume, use of image guidance, and total charges.

Results

There were 10,564 ethmoidectomies, of which 4,726 had concurrent frontal sinus surgery. Women were less likely to have frontal sinus surgery (P = .0011), as were patients with Medicare (P = .007). Hispanics were more likely to have frontal sinus surgery (P = .0003). Surgeons with higher surgical volumes were more likely to perform frontal sinus surgery; it was also more likely to be performed in centers where more sinus procedures occurred (P < .0001, both).

Conclusions

Variation in the utilization of frontal sinus surgery is associated with patient sex, ethnicity, insurance status, geography, as well as provider and hospital volumes. These data support the idea that nonclinical factors may influence the treatment of frontal sinus disease.

Level of Evidence

4. Laryngoscope, 2018

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Office-based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis

Objective

To review experience, safety, and cost of office-based esophageal dilation in patients with history of head and neck cancer (HNCA).

Methods

The medical records of patients undergoing esophageal dilation in the office were retrospectively reviewed between August 2015 and May 2017. Patients were given nasal topical anesthesia. Next, a transnasal esophagoscopy (TNE) was performed. If the patient tolerated TNE, we proceeded with esophageal dilation using Seldinger technique with the CRE™ Boston Scientific (Boston Scientific Corp., Marlborough, MA) balloon system. Patients were discharged directly from the outpatient clinic.

Results

Forty-seven dilations were performed in 22 patients with an average of 2.1 dilations/patient (range 1–10, standard deviation [SD] ± 2.2). Seventeen patients (77%) were male. The average age was 67 years (range 35–78 years, SD ± 8.5). The most common primary site of cancer was oral cavity/oropharynx (n = 10), followed by larynx (n = 6). All patients (100%) had history of radiation treatment. Four patients were postlaryngectomy. The indication for esophageal dilation was esophageal stricture and progressive dysphagia. All dilations occurred in the proximal esophagus. There were no major complications. Three focal, superficial lacerations occurred. Two patients experienced mild, self-limited epistaxis. One dilation was poorly tolerated due to discomfort. One patient required pain medication postprocedure. Office-based esophageal dilation generated $15,000 less in health system charges compared to traditional operating room dilation on average per episode of care.

Conclusion

In patients with history of HNCA and radiation, office-based TNE with esophageal dilation appears safe, well-tolerated, and cost-effective. In a small cohort, the technique has low complication rate and is feasible in an otolaryngology outpatient office setting.

Level of Evidence

4. Laryngoscope, 2018

http://ift.tt/2nSepAp

Olfactory and middle meatal cytokine levels correlate with olfactory function in chronic rhinosinusitis

Objectives/Hypothesis

The etiology of chronic rhinosinusitis (CRS)-associated olfactory loss is unclear, but may result from inflammatory changes in the olfactory epithelium that result in signaling dysfunction or loss of olfactory neurons. Several proinflammatory cytokines have been associated with CRS, but their expression within the olfactory cleft microenvironment and association with olfactory function is unknown.

Study Design

Prospective case-control study.

Methods

Mucus was collected from the olfactory cleft and middle meatus of 31 CRS without nasal polyps subjects, 36 CRS with nasal polyps (CRSwNP) subjects, and 12 healthy controls. Olfactory function was assessed using the validated Smell Identification Test (SIT). Site-specific levels of 14 cytokines/chemokines (interleukin [IL]-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17A, tumor necrosis factor-α, Eotaxin, RANTES [regulated on activation, normal T cell expressed and secreted]) were assessed using a multiplex flow cytometric bead assay and correlated with SIT scores.

Results

Mucus cytokine levels in the olfactory cleft were strongly or moderately correlated with levels in the middle meatus for all but one measured inflammatory mediators. SIT scores were inversely correlated with levels of IL-2 (P = .006), IL-5 (P < .0001), IL-6 (P = .0009), IL-10 (P < .0001), and IL-13 (P < .0001), with significance largely driven by CRSwNP patients.

Conclusions

The inflammatory microenvironment within the olfactory cleft mirrors that within the middle meatus. Elevated levels of IL-2, IL-5, IL-6, IL-10, and IL-13 in olfactory cleft mucus are associated with reduced olfactory identification scores in CRS patients. Altered levels of select olfactory mucus cytokines could potentially have deleterious effects on olfactory neuron function and turnover.

Level of Evidence

NA. Laryngoscope, 2018

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