The effect of poly‐p‐dioxanone plates on the protection and vitality of cartilage: An animal study

Objectives/Hypothesis

In septorhinoplasty, septal, auricular, and costal cartilage are often used as autologous graft. Autologous grafts are preferred in nasal reconstruction. The aim of this study was to histopathologically examine the tissue compatibility and the effect on the stability and cartilage vitality of poly‐p‐dioxanone (PDS) plates.

Study Design

Ten adult New Zealand rabbits were used.

Methods

Ten New Zealand rabbits were used. Septal and auricular cartilage sections were removed; one of the two cartilage grafts was left plain, and the other was sutured to a PDS plate. Grafts were placed into the back of the rabbits. After 12 weeks, the graft material was examined microscopically.

Results

The specimens did not cause any significant foreign body reaction. Within 3 months, a significant degree of color, stability, and stiffness was lost. Microscopically, inflammation, necrosis, and cartilage cell degeneration scores were statistically significantly lower in the grafts using PDS (P < .05), and the vascularization, collagen, and cartilage proliferation scores were found to be statistically significantly higher (P < .05). No statistically significant difference was determined in respect of the bone proliferation scores (P > .05).

Conclusions

The use of PDS plates together with cartilage provided mechanical support to the graft. Therefore, changes that disrupt the integrity of the graft, such as inflammation, necrosis, and cartilage cell degeneration, were reduced, and changes that provide greater stability, such as vascularization, collagen, and cartilage proliferation, were increased.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2zJeD3n

Use of bovine pericardium for the treatment of anterior iatrogenic glottic web

https://ift.tt/2PjeGb9

Vertical head impulse and caloric are complementary but react opposite to Meniere's disease hydrops

Objectives/Hypothesis

Meniere's disease (MD) patients can show normal head impulses despite poor caloric test results. This study aimed to investigate the discrepancy in the vestibulo‐ocular reflex (VOR) in MD patients and whether endolymphatic hydrops (EH) influence the VOR.

Study Design

Prospective, cross‐sectional observational study.

Methods

Ninety MD patients were enrolled. Neuro‐otological testing, including a video head impulse test (vHIT) of all semicircular canals (SCs), and gadolinium‐enhanced inner ear magnetic resonance imaging were performed. The vestibular EH volume was quantitatively evaluated by processing magnetic resonance images.

Results

Abnormal vHIT results in MD patients were found most frequently in the posterior (44.4%) SCs, followed by the horizontal (13.3%) and anterior (10%) SCs. Canal paresis (CP) was assessed using the vHIT and the caloric test, and results were not significant when vHIT responses were assessed as CP only using the horizontal SC. The difference in the vestibular EH between the presence and absence of CP was not significant if assessed using the vHIT (P = .5591), but it was statistically different if assessed using the caloric test (P = .0467).

Conclusions

The contradictory reaction of VOR in MD patients may result from the high specificity but low sensitivity of CP in the horizontal vHIT. EH volume in the vestibule affects the caloric response but does not affect the vHIT response.

Level of Evidence

2b Laryngoscope, 2018

https://ift.tt/2zKCC2f

Imaging predictors for malignant transformation of inverted papilloma

Objectives/Hypothesis

Inverted papillomas (IPs) are benign tumors of the sinonasal tract with a malignant transformation potential. Predicting the transformation propensity of IPs and corresponding risk factors has long been a challenge. In this study, we aimed to use radiographic findings on magnetic resonance imaging (MRI) and computed tomography (CT) to help differentiate IP from IP‐transformed squamous cell carcinomas (IP‐SCC).

Study Design

Retrospective cohort study.

Methods

A retrospective analysis was performed at two institutions comparing IP (n = 76) and IP‐SCC (n = 66) tumors, evaluating preoperative radiographic imaging with corresponding surgical pathology reports. The presence of a convoluted cerebriform pattern (CCP) using postcontrast T1‐weighted and T2‐weighted MRI was evaluated. Using MRI diffusion‐weighted imaging (DWI), we calculated the apparent diffusion coefficient (ADC) value of each tumor. We also determined the tumor origin, attachment sites, and presence of bony erosion using CT imaging.

Results

Benign IPs had a higher prevalence of CCP on MRI compared to IP‐transformed SCC (P = .0001. The mean value ADC of malignant IP‐SCC (ADC_b0,1000 = 1.12 × 10⁻³ mm²/s) was significantly lower than that of benign IPs (ADC_b0,1000 = 1.49 × 10⁻³ mm²/s, P = .002). IP‐SCC tumors were more likely to be have orbital wall attachment (P = .002) and bony erosion (P < .0001) compared to IPs.

Conclusions

Evaluation of CCP and DWI with ADC values on MRI are promising qualitative and quantitative methods to help differentiate benign IP tumors from their transformed malignant counterparts. Malignant IP‐SCCs are associated with a loss of CCP and lower ADC values. Findings of orbital wall involvement and bony erosion on CT may also help determine presence of malignancy.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2PfyCvD

Is acupuncture effective in reducing overall symptomatology in chronic rhinosinusitis?

https://ift.tt/2zEr4gU

Differences in video head impulse test gains from right versus left or outward versus inward head impulses

Objective

To investigate the effect of the right/left and outward/inward head impulses on video head impulse test (vHIT) gains.

Methods

Video head impulse test gains were calculated by recording the right eye movements with an infrared camera in a cohort of 24 healthy subjects (26–39 years old, 30 ± 9 years old). We compared the vHIT gains in four different situations in which the right and left lateral semicircular canals (LSCC) were stimulated through outward or inward head impulses.

Results

The vHIT gains from stimulating the right LSCC were significantly larger than those stimulating the left LSCC, regardless of whether the head impulse was outward or inward (1.06 ± 0.1 by right outward vs. 0.98 ± 0.08 by left outward, P = 0.003; 1.02 ± 0.1 by right inward vs. 0.92 ± 0.07 by left inward, P < 0.0001). The mean difference in vHIT gain between stimulating the right or left LSCC was 0.09. The gains from outward vHITs were significantly larger than those from the inward tests, regardless of the LSCC side stimulated (1.06 ± 0.1 from right outward vs. 1.02 ± 0.1 from right inward, both stimulating the right LSCC, P = 0.013; 0.98 ± 0.08 from left outward vs. 0.92 ± 0.07 from left inward, both stimulating the left LSCC, P = 0.001). The mean difference in the vHIT gains between the outward and inward tests was 0.05.

Conclusion

The right/left vHIT gain difference (0.09) is higher than the outward/inward vHIT gain difference (0.05). These are independently significant differences when using a vHIT system, which records movements in the right eye. An understanding of these differences may be helpful when interpreting vHIT results.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2PkyLOv

When Should Pediatric Septoplasty Be Performed for Nasal Airway Obstruction?

https://ift.tt/2zIseb6