Real‐world benefits of allergen immunotherapy for birch pollen‐associated allergic rhinitis and asthma

Allergy, Volume 0, Issue ja, -Not available-.


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Unintended Consequences of White Noise Therapy for Tinnitus-Otolaryngology's Cobra Effect: A Review.

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Unintended Consequences of White Noise Therapy for Tinnitus-Otolaryngology's Cobra Effect: A Review.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 30;:

Authors: Attarha M, Bigelow J, Merzenich MM

Abstract
Importance: Critical to the success of many medical therapeutics is a consideration of the brain's miraculous ability to dynamically rewire itself anatomically and neurochemically on the basis of incoming information. We argue that white noise exposure, a commonly recommended therapy for patients with tinnitus, engages these plastic processes in a way that induces maladaptive changes in the brain that degrade neurological health and compromise cognition.
Observations: The pathophysiologic mechanisms commonly associated with hearing loss and tinnitus reflect cortical dedifferentiation and widespread loss of inhibitory tone throughout the central auditory pathway. Importantly, these same changes are also induced by exposure to unstructured noise, even at nontraumatic levels in the adult nervous system. Not by coincidence, the same changes appear in age-related decline of central auditory function, suggesting that both tinnitus and white noise accelerate the aging of the brain.
Conclusions and Relevance: Noise exposure therapies offer a seductive short-term solution for relief but, in the long term, undermine the functional and structural integrity of the central auditory system and the brain more generally. Sound therapies using unstructured, random ("white") noise should be avoided as a treatment for tinnitus. Alternative therapeutics that drive positive, adaptive plastic changes are discussed.

PMID: 30178067 [PubMed - as supplied by publisher]

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Assessment of a Statistical Algorithm for the Prediction of Benign Paroxysmal Positional Vertigo.

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Assessment of a Statistical Algorithm for the Prediction of Benign Paroxysmal Positional Vertigo.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 30;:

Authors: Britt CJ, Ward BK, Owusu Y, Friedland D, Russell JO, Weinreich HM

Abstract
Importance: Benign paroxysmal positional vertigo (BPPV) is an otologic pathologic condition defined as a sensation of spinning triggered by changes in head position relative to gravity and caused by an entrapment of fragmented endolymph debris most commonly in the posterior semicircular canal. Confirmation of diagnosis requires experience with procedures that are poorly known by those other than practitioners with advanced otologic training. The complexity in the diagnosis of BPPV inspired the design of a questionnaire-based algorithm that would be useful for determining a vestibular diagnosis and treatment options.
Objective: To assess a statistical algorithm for the diagnosis of BPPV in a busy tertiary care setting, with the long-term goal of implementing a clinical pathway to efficiently diagnose and treat patients with dizziness.
Design, Setting, and Participants: In this retrospective case series, 200 patients who visited the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins University School of Medicine for their initial vertigo symptoms from September 1, 2016, to December 31, 2016, were assessed.
Interventions: Use of a validated patient questionnaire as a tool to differentiate patients with dizziness in an electronic medical record review.
Main Outcomes and Measures: Linear predictor (LP) value based on the questionnaire for the diagnosis of BPPV.
Results: Of the 200 patient visits reviewed (132 [66%] female), 106 (53.0%; 68 [64%] female) had the information necessary to calculate the LP value and had a confirmed final diagnosis. On the basis of an LP value of 0.2 or greater, the sensitivity for a diagnosis of BPPV was 0.75 and the specificity was 1.0. The positive predictive value was 1.0, whereas the negative predictive value was 0.96. Patients with BPPV had a statistically significantly different LP value (odds ratio, 5.92; 95% CI, 2.73-12.83) than did patients without BPPV.
Conclusions and Relevance: The findings of this study suggest that the algorithm is efficient for the diagnosis of BPPV in a clinical care setting.

PMID: 30178063 [PubMed - as supplied by publisher]

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Professional and Patient Engagement, Visual Abstracts, and Applications to Otolaryngology-Social Media's Siren Call.

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Professional and Patient Engagement, Visual Abstracts, and Applications to Otolaryngology-Social Media's Siren Call.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 30;:

Authors: Villwock JA, Johns MM

PMID: 30178059 [PubMed - as supplied by publisher]

https://ift.tt/2ClGGd1

Preference Signaling in the National Resident Matching Program.

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Preference Signaling in the National Resident Matching Program.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 30;:

Authors: Chen JX, Deng F, Gray ST

PMID: 30178026 [PubMed - as supplied by publisher]

https://ift.tt/2wKX1mp

Preference Signaling in the National Resident Matching Program-Reply.

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Preference Signaling in the National Resident Matching Program-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 30;:

Authors: Salehi PP, Salehi P, Michaelides E

PMID: 30178008 [PubMed - as supplied by publisher]

https://ift.tt/2CiKCeo

Active Surveillance in Thyroid Microcarcinoma in a Latin-American Cohort.

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Active Surveillance in Thyroid Microcarcinoma in a Latin-American Cohort.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 30;:

Authors: Sanabria A

PMID: 30178005 [PubMed - as supplied by publisher]

https://ift.tt/2wNsSCK