OtoRhinoLaryngology by Alexandros G.Sfakianakis: Σεπτεμβρίου 2017

Σάββατο 30 Σεπτεμβρίου 2017

Plasticity of white matter connectivity in phonetics experts.

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Plasticity of white matter connectivity in phonetics experts.

Brain Struct Funct. 2016 Sep;221(7):3825-33

Authors: Vandermosten M, Price CJ, Golestani N

Abstract
Phonetics experts are highly trained to analyze and transcribe speech, both with respect to faster changing, phonetic features, and to more slowly changing, prosodic features. Previously we reported that, compared to non-phoneticians, phoneticians had greater local brain volume in bilateral auditory cortices and the left pars opercularis of Broca's area, with training-related differences in the grey-matter volume of the left pars opercularis in the phoneticians group (Golestani et al. 2011). In the present study, we used diffusion MRI to examine white matter microstructure, indexed by fractional anisotropy, in (1) the long segment of arcuate fasciculus (AF_long), which is a well-known language tract that connects Broca's area, including left pars opercularis, to the temporal cortex, and in (2) the fibers arising from the auditory cortices. Most of these auditory fibers belong to three validated language tracts, namely to the AF_long, the posterior segment of the arcuate fasciculus and the middle longitudinal fasciculus. We found training-related differences in phoneticians in left AF_long, as well as group differences relative to non-experts in the auditory fibers (including the auditory fibers belonging to the left AF_long). Taken together, the results of both studies suggest that grey matter structural plasticity arising from phonetic transcription training in Broca's area is accompanied by changes to the white matter fibers connecting this very region to the temporal cortex. Our findings suggest expertise-related changes in white matter fibers connecting fronto-temporal functional hubs that are important for phonetic processing. Further studies can pursue this hypothesis by examining the dynamics of these expertise related grey and white matter changes as they arise during phonetic training.

PMID: 26386692 [PubMed - indexed for MEDLINE]

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Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography data.

Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography data.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jul 25;:

Authors: Yeo BR, Han JJ, Jung S, Park HJ, Oh HK, Kook MS

Abstract
OBJECTIVES: To evaluate horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography (3-D CT).
STUDY DESIGN: This study included 66 patients who underwent bilateral sagittal split ramus osteotomy for correction of mandibular prognathism. With the use of 3-D CT data obtained preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3), horizontal changes of the proximal mandibular segment, including the intercondylar width, the intergonial width, and the frontal-ramal inclination were evaluated.
RESULTS: The value of the right frontal-ramal inclination was 11.43 ± 1.36° at T1, 11.91 ± 1.96° at T2, and 10.7 ± 1.5° at T3. The values of the left frontal-ramal inclination were 6.10 ± 1.03° at T1, 8.17 ± 1.66° at T2, and 7.66 ± 1.65° at T3. The values of the intergonial width were 99.67 ± 1.67 mm at T1, 98.24 ± 1.72 mm at T2, and 97.08 ± 1.71 mm at T3. The intergonial width was significantly decreased at T3 compared with T1 (P < .001). The values of the intercondylar width were 123.51 ± 1.66 mm at T1, 123.9 ± 1.66 mm at T2, and 122.88 ± 1.58 mm at T3.
CONCLUSIONS: Lower facial width at mandibular angle region decreased immediately after mandibular setback surgery and showed further decreases during the postoperative period.

PMID: 28958899 [PubMed - as supplied by publisher]

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Brazilian scientific production in Oral Medicine and Oral Pathology.

Brazilian scientific production in Oral Medicine and Oral Pathology.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 24;:

Authors: de Andrade RS, Martelli DRB, de Almeida OP, Lopes MA, Swerts MSO, Pires FR, de Abreu Alves F, Filho MRM, Machado RA, Martelli-Júnior H

PMID: 28958594 [PubMed - as supplied by publisher]

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Παρασκευή 29 Σεπτεμβρίου 2017

Word-initial tap-trill clusters: Hungarian.

Word-initial tap-trill clusters: Hungarian.

Clin Linguist Phon. 2017 Sep 28;:1-19

Authors: Tar É

Abstract
This study investigates the developmental patterns of acquisition of word-initial (WI) /r/-clusters in children speaking Hungarian, typically developing (TD) or with protracted phonological development (PPD). Comparison data were also analysed for WI singleton /r/ and /l/. Participants were 191 children (aged 3;0-5;11) divided into three age groups (3, 4, 5 years), and further subdivided into TD and PPD subgroups on the basis of Whole Word Match scores (WWM). Acoustic analyses of perceptually accurate clusters were conducted to investigate epenthesis. Findings revealed that (1) both stop-/r/ clusters and singleton /r/ were mastered at age 5 by TD children, but not by children with PPD; (2) /l/ was mastered earlier than /r/; (3) mismatch types for clusters varied by age, with more C2 Deletion than C2 substitution at younger ages, and (4) schwa epenthesis durations were longer than, or equal to, those documented for adults.

PMID: 28956666 [PubMed - as supplied by publisher]

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Word-initial trill clusters in children with typical versus protracted phonological development: Bulgarian.

Word-initial trill clusters in children with typical versus protracted phonological development: Bulgarian.

Clin Linguist Phon. 2017 Sep 28;:1-17

Authors: Ignatova D, Bernhardt BM, Marinova-Todd S, Stemberger JP

Abstract
The current paper describes acquisition of word-initial (WI) trilled /r/ in clusters and as a singleton in 60 Bulgarian 3-5-year-olds with typically developing (TD) versus protracted phonological development (PPD). A native speaker audio-recorded and transcribed single-word responses to a picture-naming task (110 words) that included eight words with WI rhotic clusters and two with WI singleton /r/. Accuracy was significantly higher in the TD groups and for the PPD groups, by age. Mismatch patterns varied: the PPD cohort had the most varied patterns although the younger children with PPD showed more /r/ deletion in clusters, and the TD groups and 5-year-olds with PPD more substitutions for /r/. Substitutions for rhotics included taps (most frequent; possibly an acceptable variant), voiced uvular and palatal fricatives, laterals, glides, other rhotics, stops and nasals. These results add to the growing database on Bulgarian phonological acquisition concerning accuracy and mismatches by group and age.

PMID: 28956661 [PubMed - as supplied by publisher]

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Word-initial /r/-clusters in Icelandic-speaking children with protracted versus typical phonological development.

Word-initial /r/-clusters in Icelandic-speaking children with protracted versus typical phonological development.

Clin Linguist Phon. 2017 Sep 28;:1-22

Authors: Másdóttir T

Abstract
Rhotics are generally acquired late across languages (Jiménez, 1987; Tar, 2006; Blumenthal and Lundeborg, 2014). Prior research suggests some possible differences in acquisition across languages, however (Másdóttir and Stokes, 2016). The current study set out to examine acquisition of /r/ in Icelandic, focusing primarily on match (accuracy) and mismatch data for word-initial (WI) /r/-clusters, but also comparing /r/-clusters with WI singleton /r/ and /l/ plus /l/-clusters. Single-word data were collected for 27 Icelandic-speaking preschoolers with protracted phonological development (PPD) and compared with data from age- and gender-matched typically developing peers. Results showed lower match levels for clusters versus singletons, /r/ versus /l/ and the children with PPD. Most frequent substitutions were approximant [ð̞] and [l]. Younger children with PPD showed more deletion in clusters and a greater variety of substitutions for both consonants. The data support general cross-linguistic trends in rhotic acquisition with the [ð̞] substitution being one difference.

PMID: 28956659 [PubMed - as supplied by publisher]

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Word-initial /r/-clusters in Swedish speaking children with typical versus protracted phonological development.

Word-initial /r/-clusters in Swedish speaking children with typical versus protracted phonological development.

Clin Linguist Phon. 2017 Sep 28;:1-13

Authors: Lundeborg Hammarström I

Abstract
The present study investigated word-initial (WI) /r/-clusters in Central Swedish-speaking children with and without protracted phonological development (PPD). Data for WI singleton /r/ and singleton and cluster /l/ served as comparisons. Participants were twelve 4-year-olds with PPD and twelve age- and gender-matched typically developing (TD) controls. Native speakers audio-recorded and transcribed 109 target single words using a Swedish phonology test with 12 WI C+/r/-clusters and three WI CC+/r/-clusters. The results showed significantly higher match scores for the TD children, a lower match proportion for the /r/ targets and for singletons compared with clusters, and differences in mismatch patterns between the groups. There were no matches for /r/-cluster targets in the PPD group, with all children except two in that group showing deletions for both /r/-cluster types. The differences in mismatch proportions and types between the PPD group and controls suggests new directions for future clinical practice.

PMID: 28956657 [PubMed - as supplied by publisher]

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Tap and trill clusters in typical and protracted phonological development: Conclusion.

Tap and trill clusters in typical and protracted phonological development: Conclusion.

Clin Linguist Phon. 2017 Sep 28;:1-13

Authors: Bernhardt BM, Stemberger JP

Abstract
The current issue examined acquisition of challenging segments in complex contexts: Taps/trills in word-initial clusters, plus related targets (/l/-clusters and singleton rhotics and /l/). Data were from preschool children with typical versus protracted phonological development (PPD) in Iceland, Sweden (Germanic), Portugal, Spain/Chile (Romance), Bulgaria, Slovenia (Slavic), and Hungary (Finno-Ugric). Results showed developmental group and age effects. Clusters generally had lower accuracy than singletons, although not uniformly, and were more accurate in stressed syllables. The rhotics were less advanced than alveolar /l/ except in European Portuguese, where the lateral is velarized. In early development, the rhotic is often deleted, but in later, development substitutions for rhotics were more common, primarily non-nasal coronal sonorants, which match some of the place and manner features of the rhotic. Vowel epenthesis sometimes appeared in rhotic clusters. Children with PPD showed more varied mismatch patterns, including more than one mismatch pattern within a cluster. Implications for research and clinical practice are suggested.

PMID: 28956654 [PubMed - as supplied by publisher]

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Word-initial rhotic clusters in Spanish-speaking preschoolers in Chile and Granada, Spain.

Word-initial rhotic clusters in Spanish-speaking preschoolers in Chile and Granada, Spain.

Clin Linguist Phon. 2017 Sep 28;:1-25

Authors: Perez D, Vivar P, Bernhardt BM, Mendoza E, Ávila C, Carballo G, Fresneda D, Muñoz J, Vergara P

Abstract
The current paper describes Spanish acquisition of rhotic onset clusters. Data are also provided on related singleton taps/trills and /l/ as a singleton and in clusters. Participants included 9 typically developing (TD) toddlers and 30 TD preschoolers in Chile, and 30 TD preschoolers and 29 with protracted phonological development (PPD) in Granada, Spain. Results showed age and developmental group effects. Preservation of cluster timing units preceded segmental accuracy, especially in stressed syllables. Tap clusters versus singleton trills were variable in order of mastery, some children mastering clusters first, and others, the trill. Rhotics were acquired later than /l/. In early development, mismatches (errors) involved primarily deletion of taps; where substitutions occurred, [j] frequently replaced tap. In later development, [l] more frequently replaced tap; where taps did occur, vowel epenthesis sometimes occurred. The data serve as a criterion reference database for onset cluster acquisition in Chilean and Granada Spanish.

PMID: 28956653 [PubMed - as supplied by publisher]

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Tap and trill clusters in typical and protracted phonological development: Challenging segments in complex phonological environments. Introduction to the special issue.

Tap and trill clusters in typical and protracted phonological development: Challenging segments in complex phonological environments. Introduction to the special issue.

Clin Linguist Phon. 2017 Sep 28;:1-13

Authors: Stemberger JP, Bernhardt BM

Abstract
The papers in this crosslinguistic issue address children's acquisition of word-initial rhotic clusters in languages with taps/trills, that is, the acquisition of challenging segments in complex environments. Several papers also include comparisons with singleton rhotics and/or /l/ as a singleton or in clusters. The studies are part of a larger investigation that uses similar methodologies across languages in order to enhance crosslinguistic comparability (Bernhardt and Stemberger, 2012, 2015). Participants for the current studies were monolingual preschoolers with typical or protracted phonological development who speak one of the following languages: Germanic (Icelandic/Swedish); Romance (Portuguese/Spanish); Slavic (Bulgarian/Slovenian) and Finno-Ugric (Hungarian). This introductory paper describes characteristics of taps/trills and general methodology across the studies, concluding with predicted patterns of acquisition. The seven papers that follow are in a sense the 'results' for this introduction. A concluding paper discusses major findings and their implications for theory, research and clinical practice.

PMID: 28956649 [PubMed - as supplied by publisher]

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Πέμπτη 28 Σεπτεμβρίου 2017

The Canadian Otolaryngology-Head and Neck Surgery Workforce in the Urban-Rural Continuum: Longitudinal Data from 2002 to 2013.

The Canadian Otolaryngology-Head and Neck Surgery Workforce in the Urban-Rural Continuum: Longitudinal Data from 2002 to 2013.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817733688

Authors: Crowson MG, Lin V

Abstract
Objectives To evaluate the proportion of otolaryngology-head and neck surgery (OHNS) providers who are rural versus urban based from 2002 to 2013. Secondary objective was to present perspectives of rural primary care providers on unmet needs for OHNS services. Study Design Mixed methods database analysis and prospective survey. Setting National administrative database. Subjects and Methods The Canadian Medical Association OHNS provider Masterfile and the Statistics Canada postal code file were used to determine provincial, urban, rural, and Aboriginal group care coverage. The Society of Rural Physicians of Canada was surveyed to explore care delivery and unmet needs for OHNS and audiology. Descriptive statistics and linear regression were used to describe results. Results Ontario and Quebec had the largest annual OHNS physician growth (6.38 providers/year; r(2) = 0.94) versus stagnant growth in the territories. The clear majority of OHNS providers are in urban centers, and rural OHNS coverage is decreasing annually (-0.33 providers/year, r(2) = 0.28). There are no OHNS providers in 485 population centers where Aboriginal groups are located. A survey of 40 rural primary care providers reported that OHNS care is most commonly delivered through seasonal visits to a local facility, with otology (hearing loss, chronic ear disease) and rhinology (nonmalignant nasal or sinus conditions) as the most frequently reported unmet needs. Conclusion From 2002 to 2013, OHNS coverage showed a trend for urban consolidation. Most Aboriginal groups may have decreased access to care, as there are no OHNS providers in 485 population centers where reserves are located. There is an unmet need for specialized OHNS services reported by rural primary care physicians, especially otology and rhinology.

PMID: 28949835 [PubMed - as supplied by publisher]

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Accuracy of the ETDQ-7 for Identifying Persons with Eustachian Tube Dysfunction.

Accuracy of the ETDQ-7 for Identifying Persons with Eustachian Tube Dysfunction.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731729

Authors: Teixeira MS, Swarts JD, Alper CM

Abstract
Objective To compare the accuracy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) in identifying people with eustachian tube (ET) dysfunction based on symptoms and an objective ET function test. Study Design Cross-sectional study. ObjSettingective Tertiary referral center. Subjects and Methods Fifty-five subjects with and without symptoms suggestive of ET dysfunction completed the ETDQ-7 and had their ET function evaluated by the percentage of middle ear pressure equilibrated after 5 swallows (PEq5) either during a pressure chamber test (intact tympanic membranes) or by the inflation-deflation test (nonintact tympanic membranes). ETDQ-7 score ≥14.5 and PEq5 <60% were used to define ET dysfunction, and sensitivity, specificity, and receiver operating characteristic curves were used to assess the level of association between ETDQ-7 scores and PEq5. Results Twenty-five asymptomatic subjects (group 1 = 15 females, 15 white; mean ± SD age, 32 ± 12.8 years) and 30 subjects with ET dysfunction symptoms (group 2 = 17 females, 25 white; age, 27 ± 16.3 years) were included in the analysis. ETDQ-7 sensitivity and specificity regarding correct group assignment were 70% and 100%, respectively, and with respect to predicting PEq5<60%, 54% and 78%. An area under the curve (AUC) of 0.68 (95% CI, 0.53-0.83) at the participant level and 0.64 (95% CI, 0.50-0.77) at the ear level indicated a moderate level of association that was lower, though not statistically significant, for nonintact tympanic membranes (AUC = 0.63 at the participant level and AUC = 0.49 at the ear level). Conclusion The ETDQ-7 score had a higher correlation with the ET dysfunction symptoms than with an objective measure of ET function.

PMID: 28949806 [PubMed - as supplied by publisher]

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Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817733735

Authors: Lee HS, Yoon HY, Jin HJ, Hwang SH

Abstract
Objectives Dexmedetomidine has sympatholytic, sedative, anesthetic, and analgesic effects, as well as vasoconstrictive effects, which may help prevent hypotension under general anesthesia. This meta-analysis aimed to perform a systematic review of the literature and investigate the effect of dexmedetomidine on perioperative morbidity following nasal surgery and its adverse effects. Data Sources MEDLINE, SCOPUS, and the Cochrane database. Review Methods Two authors independently searched the databases from their inception to March 2017. Studies were selected that compared perioperative dexmedetomidine administration (dexmedetomidine groups) with a placebo or remifentanil (control groups) with regard to intraoperative morbidity, including surgical time, bleeding amount, hypotension, and bradycardia during operation, and postoperative morbidity, such as emergence agitation, nausea and vomiting, and sedation after operation. Results Surgical time, intraoperative blood loss, dose of inhaled anesthetic gas, dose of fentanyl, postoperative pain, and incidence of emergence agitation were significantly lower in the dexmedetomidine group versus the placebo group. In contrast, there were no significant differences in intraoperative hemodynamic stability and postoperative residual sedation and nausea and vomiting between groups. Additionally, compared with remifentanil (a currently widely used agent), dexmedetomidine was superior in view of postoperative pain and intraoperative blood pressure control. Conclusion This meta-analysis shows that the systemic administration of dexmedetomidine can decrease surgical time, intraoperative blood loss, and doses of intraoperative inhaled anesthetic gas and fentanyl as compared with placebo. It can also decrease postoperative pain and incidence of the emergence agitation. Due to the small number of studies, further clinical trials are needed to confirm these results.

PMID: 28949804 [PubMed - as supplied by publisher]

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An Algorithm to Evaluate Suspected Lung Metastases in Patients with HPV-Associated Oropharyngeal Cancer.

An Algorithm to Evaluate Suspected Lung Metastases in Patients with HPV-Associated Oropharyngeal Cancer.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817733677

Authors: VanKoevering KK, Marchiano E, Walline HM, Carey TE, McHugh JB, Brenner JC, Goudsmit CM, Belille E, Spector ME, Shuman AG, University of Michigan Head and Neck SPORE Team

Abstract
Distinguishing between distantly metastatic and metachronous lung primary carcinoma is challenging for patients with a history of head and neck cancer. There are implications for registry data, prognosis and related counseling, and management options, including eligibility for precision oncology trials. Patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma who were treated under a uniform clinical protocol and achieved a complete response were identified in a single-institution prospective head and neck cancer epidemiology database (n = 205). Fifteen patients presented with pulmonary nodule(s) after completion of therapy. We describe our algorithm for the evaluation of these patients, including histopathology, p16 immunohistochemistry, and HPV in situ hybridization.

PMID: 28949800 [PubMed - as supplied by publisher]

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Comparison between Awake Endoscopy and Computed Tomography to Define Lingual Tonsil Hypertrophy.

Comparison between Awake Endoscopy and Computed Tomography to Define Lingual Tonsil Hypertrophy.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731731

Authors: Tang JA, Gorelick G, Friedman M

Abstract
Objectives To analyze correlations between endoscopic lingual tonsil grade (LTG) by the Friedman Lingual Tonsil Hypertrophy grading system and computed tomography (CT) measurements of lingual tonsil thickness (LTT). Study Design Retrospective chart review. Setting Single-center database, September 2016 to April 2017. Subjects and Methods Patients who received CT covering base of tongue and endoscopic LTG were included. LTT was measured on axial and sagittal CT. LTT measurements were compared against endoscopic LTG. One-way analysis of variance with Tukey's post hoc adjustment for multiple comparisons was performed. Results Seventy-five charts were included for a total of 150 LTT measurements. Axial CT measurements of LTG 1 and LTG 2 were each significantly different from LTG 3 ( P < .001 for both), and LTG 1 and LTG 2 also differed significantly ( P = .010). Mean sagittal CT measurements were significantly different between LTG 1 and LTG 3 ( P < .001) and between LTG 2 and LTG 3 ( P = .002) but not between LTG 1 and LTG 2 ( P = .186). Those without lingual tonsil hypertrophy had a mean axial CT thickness of 6.45 ± 1.39 mm and mean sagittal CT thickness of 6.58 ± 1.53 mm, which was significantly different from both the mean axial CT thickness of 8.48 ± 1.52 mm and the mean sagittal CT thickness of 8.07 ± 1.16 mm in the LTG 3 group ( P < .001 for both). Threshold analysis showed a potential cutoff of approximately 7.5 mm on axial and sagittal CT for defining clinically significant lingual tonsil hypertrophy. Conclusion Awake endoscopy grading of lingual tonsil hypertrophy is a subjective measurement that seems to correlate with objective CT measurements. LTT measurements of LTG 1 and LTG 2 on awake endoscopy differed significantly from LTG 3.

PMID: 28949799 [PubMed - as supplied by publisher]

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Unplanned 30-Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis.

Unplanned 30-Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817721154

Authors: Ferrandino R, Roof S, Ma Y, Chan L, Poojary P, Saha A, Chauhan K, Coca SG, Nadkarni GN, Teng MS

Abstract
Objective To examine rates of readmission after parathyroidectomy in patients with chronic kidney disease and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in patients with chronic kidney disease between January 2013 and November 2013. Patient-, admission-, and hospital-level characteristics were compared for patients with and without at least 1 unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the 30 days after discharge, but readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5 to 6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% confidence interval [CI], 1.55-7.05; P = .002) and 1.87 (95% CI, 1.10-3.19; P = .02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR, 2.53; 95% CI, 1.07-5.95; P = .03) were associated with higher risk of readmission. Conclusion Postparathyroidectomy readmission rates for patients with chronic kidney disease are nearly 5 times that of the general population. Careful consideration of postoperative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.

PMID: 28949797 [PubMed - as supplied by publisher]

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Endoscopically Assisted Drilling, Exposure of the Fundus through a Presigmoid Retrolabyrinthine Approach: A Cadaveric Feasibility Study.

Endoscopically Assisted Drilling, Exposure of the Fundus through a Presigmoid Retrolabyrinthine Approach: A Cadaveric Feasibility Study.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817733665

Authors: Muelleman T, Shew M, Alvi S, Shah K, Staecker H, Chamoun R, Lin J

Abstract
The presigmoid retrolabyrinthine approach to the cerebellopontine angle is traditionally described to not provide access to the internal auditory canal (IAC). We aimed to evaluate the extent of the IAC that could be exposed with endoscopically assisted drilling and to measure the percentage of the IAC that could be visualized with the microscope and various endoscopes after drilling had been completed. Presigmoid retrolabyrinthine approaches were performed bilaterally on 4 fresh cadaveric heads. We performed endoscopically assisted drilling to expose the fundus of the IAC, which resulted in exposure of the entire IAC in 8 of 8 temporal bone specimens. The microscope afforded a mean view of 83% (n = 8) of the IAC. The 0°, 30°, 45°, and 70° endoscope each afforded a view of 100% of the IAC in 8 of 8 temporal bone specimens. In conclusion, endoscopic drilling of the IAC of can provide an extradural means of exposing the entire length of the IAC while preserving the labyrinth.

PMID: 28948858 [PubMed - as supplied by publisher]

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Τρίτη 26 Σεπτεμβρίου 2017

Real-time Simultaneous DKG and 2D DKG Using High-speed Digital Camera.

http:--linkinghub.elsevier.com-ihub-imag

Real-time Simultaneous DKG and 2D DKG Using High-speed Digital Camera.

J Voice. 2017 Mar;31(2):247.e1-247.e7

Authors: Kang DH, Wang SG, Park HJ, Lee JC, Jeon GR, Choi IS, Kim SJ, Shin BJ

Abstract
INTRODUCTION: For the evaluation of voice disorders, direct observation of vocal cord vibration is important. Among the various methods, laryngeal videostroboscopy (LVS) is widely used, but it was not a true image because it collects images from different cycles. In contrast, high-speed videoendoscopy and videokymography have much higher frame rates and can assess functional and mobility disorders.
OBJECTIVE: The purpose of the study is to describe real-time, simultaneous digital kymography (DKG), two-dimensional scanning (2D) DKG, and multi-frame (MF) LVS system using a high-speed digital camera, and identify the efficacy of this system in evaluating vibratory patterns of pathologic voice.
METHODS: The pattern of vocal fold vibration was evaluated in a vocally healthy subject and in subjects with vocal polyp, vocal nodules, vocal cord scar, and vocal cord paralysis. We used both quantitative (left-right phase symmetry, amplitude symmetry index) and qualitative (anterior-posterior phase symmetry) parameters for assessment of vocal fold vibration.
RESULTS: Our system could record videos within seconds and required relatively little memory. The speed of replay in the DKG, 2D DKG, MF LVS, and high-speed videoendoscopy was controllable. The number of frame per cycle with MF LVS was almost the same as the fundamental frequency.
CONCLUSION: Our system can provide images of various modalities simultaneously in real time and analyze morphological and functional vibratory patterns. It can be possible to provide a greater level of information for the diagnosis and treatment of vibratory disorders.

PMID: 27839706 [PubMed - indexed for MEDLINE]

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Δευτέρα 25 Σεπτεμβρίου 2017

P-AzeFlu provides rapid and effective allergic rhinitis control: results of a non-interventional study in Romania.

P-AzeFlu provides rapid and effective allergic rhinitis control: results of a non-interventional study in Romania.

Rhinology. 2017 Sep 24;:

Authors: Agache I, Doros IC, Leru PM, Bucur I, Poenaru M, Sarafoleanu C

Abstract
BACKGROUND: Allergic Rhinitis and its Impact on Asthma (ARIA) and the European Union (EU) recommend a shift to guide allergic rhinitis (AR) treatment decisions from symptom severity to disease control, using a simple visual analogue scale (VAS). Using this VAS we assessed, in a real-life study in Romania, the effectiveness of MP-AzeFlu nasal spray.
METHODOLOGY: In this multi-centre, prospective, non-interventional study, 253 patients (over 11 years old) with moderate-to-severe AR were prescribed MP-AzeFlu and assessed their symptoms on a VAS (0 (not at all bothersome) to 100 mm (very bothersome)) on Days 0, 1, 3, 7 and 14. The proportion of patients who achieved a defined VAS score cut-off for well-controlled (38 mm) AR were also calculated. Patients perception of disease control was assessed on Day 3.
RESULTS: MP-AzeFlu use was associated with a mean (standard deviation) VAS score reduction from 78.4 (15.1) mm at baseline to 14.7 (15.1) mm on the last day. Effectiveness was consistent irrespective of disease severity, phenotype or patient age. 83.4% of patients achieved the smaller than 39 mm well-controlled VAS score cut-off by last day and 95.2% considered their symptoms to be well- or partly controlled at Day 3.
CONCLUSIONS: MP-AzeFlu provided rapid, effective and sustained AR symptom control in a real-life setting in Romania, irrespective of severity, phenotype or patient age, aligning with ARIA and EU recommendations and supporting the position of MP-AzeFlu as the drug of choice for the treatment of moderate-to-severe AR.

PMID: 28942457 [PubMed - as supplied by publisher]

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DNA methylation polymerase chain reaction (PCR) array of apoptosis-related genes in pleomorphic adenomas of the salivary glands.

DNA methylation polymerase chain reaction (PCR) array of apoptosis-related genes in pleomorphic adenomas of the salivary glands.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 31;:

Authors: Pereira NB, do Carmo ACM, Campos K, Costa SFDS, Diniz MG, Gomez RS, Gomes CC

Abstract
OBJECTIVE: The aim of this study was to evaluate the DNA methylation profile in 22 apoptosis-related genes in pleomorphic adenomas (PAs) of the salivary glands, in comparison with normal salivary glands (NSGs), and to address the differences in methylation patterns between smaller and larger tumors. Additionally, we investigated if the hypermethylation of differentially methylated genes between NSGs and PAs impacted the messenger RNA (mRNA) transcription.
DESIGN: Twenty-three fresh PA samples and 12 NSG samples were included. The PA samples were divided into 2 groups: PAs with clinical size larger than 2 cm (n = 12) and PAs with clinical size 2 cm or smaller (n = 11). DNA methylation at the promoter region of a panel of 22 genes involved in apoptosis was profiled by using a human apoptosis DNA methylation polymerase chain reaction array, and the transcriptional levels of genes showing differential methylation profiles between PAs and NSGs were assessed.
RESULTS: TNFRSF25 and BCL2 L11 were highly methylated in PAs, in comparison with NSGs, irrespective of tumor size. However, no difference could be observed in the mRNA transcription between PAs and NSGs.
CONCLUSIONS: Hypermethylation of the proapoptotic genes BCL2 L11 and TNFRSF25 is observed in PA. However, this phenomenon did not impact mRNA transcription.

PMID: 28941993 [PubMed - as supplied by publisher]

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Κυριακή 24 Σεπτεμβρίου 2017

Clinicopathologic significance of in vivo antinuclear autoantibodies in oral mucosal biopsies.

Clinicopathologic significance of in vivo antinuclear autoantibodies in oral mucosal biopsies.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 24;:

Authors: Alshagroud R, Neiders M, Kramer JM, Suresh L

Abstract
OBJECTIVE: Although antinuclear autoantibody (ANA) staining of oral biopsy specimens is indicative of chronic ulcerative stomatitis, it is not known whether this staining is characteristic of other autoimmune diseases. Our study was undertaken to characterize the various in vivo ANA patterns detected in the oral mucosa by direct immunofluorescence to describe the associated hematoxylin and eosin findings, and determine whether patients with these findings had a coexisting systemic connective tissue disease.
STUDY DESIGN: This was a retrospective analysis of oral biopsy specimens submitted from 2013 to 2016.
RESULTS: In vivo ANA staining was present in 72 of the 2019 cases examined. Immunoglobulin G was the most common immunoreactant (71 of 72 cases), and speckled nuclear staining was the most frequent in vivo ANA pattern (52 of 72). In most cases, hematoxylin and eosin staining of biopsy specimens showed mucositis (24 of 34). Detailed clinical information was available for 10 patients, and all of them had an autoimmune disease.
CONCLUSIONS: We found similar prevalence of ANA staining with direct immunofluorescence in oral epithelial biopsy specimens as reported for those of skin. In vivo ANA in the oral epithelium may indicate the presence of an immune-mediated disease. Patients who show ANA deposits in oral mucosal biopsy specimens should be investigated for systemic connective tissue disease as well as for chronic ulcerative stomatitis.

PMID: 28939244 [PubMed - as supplied by publisher]

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Παρασκευή 22 Σεπτεμβρίου 2017

Sequential processing deficit as a shared persisting biomarker in dyslexia and childhood apraxia of speech.

Sequential processing deficit as a shared persisting biomarker in dyslexia and childhood apraxia of speech.

Clin Linguist Phon. 2017 Sep 21;:1-31

Authors: Peter B, Lancaster H, Vose C, Middleton K, Stoel-Gammon C

Abstract
The purpose of this study was to investigate the hypothesis that individuals with dyslexia and individuals with childhood apraxia of speech share an underlying persisting deficit in processing sequential information. Levels of impairment (sensory encoding, memory, retrieval, and motor planning/programming) were also investigated. Participants were 22 adults with dyslexia, 10 adults with a probable history of childhood apraxia of speech (phCAS), and 22 typical controls. All participants completed nonword repetition, multisyllabic real word repetition, and nonword decoding tasks. Using phonological process analysis, errors were classified as sequence or substitution errors. Adults with dyslexia and adults with phCAS showed evidence of persisting nonword repetition deficits. In all three tasks, the adults in the two disorder groups produced more errors of both classes than the controls, but disproportionally more sequencing than substitution errors during the nonword repetition task. During the real word repetition task, the phCAS produced the most sequencing errors, whereas during the nonword decoding task, the dyslexia group produced the most sequencing errors. Performance during multisyllabic motor speech tasks, relative to monosyllabic conditions, was correlated with the sequencing error component during nonword repetition. The results provide evidence for a shared persisting sequential processing deficit in the dyslexia and phCAS groups during linguistic and motor speech tasks. Evidence for impairments in sensory encoding, short-term memory, and motor planning/programming was found in both disorder groups. Future studies should investigate clinical applications regarding preventative and targeted interventions towards cross-modal treatment effects.

PMID: 28933620 [PubMed - as supplied by publisher]

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The role of short-term memory impairment in nonword repetition, real word repetition, and nonword decoding: A case study.

The role of short-term memory impairment in nonword repetition, real word repetition, and nonword decoding: A case study.

Clin Linguist Phon. 2017 Sep 21;:1-6

Authors: Peter B

Abstract
In a companion study, adults with dyslexia and adults with a probable history of childhood apraxia of speech showed evidence of difficulty with processing sequential information during nonword repetition, multisyllabic real word repetition and nonword decoding. Results suggested that some errors arose in visual encoding during nonword reading, all levels of processing but especially short-term memory storage/retrieval during nonword repetition, and motor planning and programming during complex real word repetition. To further investigate the role of short-term memory, a participant with short-term memory impairment (MI) was recruited. MI was confirmed with poor performance during a sentence repetition and three nonword repetition tasks, all of which have a high short-term memory load, whereas typical performance was observed during tests of reading, spelling, and static verbal knowledge, all with low short-term memory loads. Experimental results show error-free performance during multisyllabic real word repetition but high counts of sequence errors, especially migrations and assimilations, during nonword repetition, supporting short-term memory as a locus of sequential processing deficit during nonword repetition. Results are also consistent with the hypothesis that during complex real word repetition, short-term memory is bypassed as the word is recognized and retrieved from long-term memory prior to producing the word.

PMID: 28933571 [PubMed - as supplied by publisher]

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Πέμπτη 21 Σεπτεμβρίου 2017

A Case of Prethoracic Pain Radiating Upward and Initiating Nervus Intermedius Neuralgia and Migraine Headache: Could Epicrania Fugax Pain Start in the Upper Body?

A Case of Prethoracic Pain Radiating Upward and Initiating Nervus Intermedius Neuralgia and Migraine Headache: Could Epicrania Fugax Pain Start in the Upper Body?

J Oral Facial Pain Headache. 2017 Sep 20;:

Authors: Wang Y, Kan PL, Tao YF, Li XY, Yang XJ, Liang GL

Abstract
Epicrania fugax (EF) was recently classified as a primary headache in the Appendix of the International Classification of Headache Disorders, third edition (ICHD-III). It is characterized by a paroxysmal pain rapidly radiating forward or backward along a linear or zigzag trajectory on the surface of the head. This article reports a 76-year-old woman who newly developed a paroxysmal EF-type pain distributed not only in the territories of the trigeminal and occipital nerves, but also in the territories of the cervical and thoracic nerves. This EF-type pain started in a point on the prethoracic area, radiated along the ipsilateral neck, face, auditory canal, and head surface in a linear trajectory, and finally initiated attacks of nervus intermedius neuralgia (NIN) and migraine without aura (MWA). Treatment with a low dose of carbamazepine was associated with decreased intensity of EF-type pain and fewer NIN and MWA attacks, while a higher dose of carbamazepine was associated with complete termination of EF-type pain and NIN and MWA attacks. This case report expands the clinical spectrum of EF and may also be helpful in understanding its pathophysiology.

PMID: 28931106 [PubMed - as supplied by publisher]

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Neurofibromatosis Type 1 Accompanied by Craniofacial Pain: Literature Review and Descriptive Case.

Neurofibromatosis Type 1 Accompanied by Craniofacial Pain: Literature Review and Descriptive Case.

J Oral Facial Pain Headache. 2017 Sep 20;:

Authors: Son C, Park JW

Abstract
Neurofibromatosis type 1 (NF-1) is a genetic disease with characteristic neurofibromas and bony dysplasia that manifest throughout the body, including the craniofacial region. NF-1 patients are known to frequently report chronic pain in areas below the head; however, the matter of pain in the craniofacial region in this patient group has not been handled intensively so far, and studies have mainly focused on headaches. This article comprehensively reviews the related literature and reports a case of an NF-1 patient whose chief complaint was headache and pain in the temporomandibular joint area. Craniofacial pain is probably not an exceptional problem in NF-1, but the current inadequacy of related data is worrisome, considering the impact of pain on NF-1 prognosis and patient quality of life. The presence of craniofacial pain in NF-1 patients should be actively sought out in the diagnostic process and appropriate guidelines for its diagnosis and treatment should be established.

PMID: 28931105 [PubMed - as supplied by publisher]

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Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report.

Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 24;:

Authors: Gvetadze SR, Xiong P, Li J, Lv M, Li J, Yang X, Ilkaev KD, Sun J

Abstract
In oral and oropharyngeal cancer, the presence of regional neck metastasis strongly influences treatment planning and survival prognosis. A number of imaging techniques can be utilized in the clinic for diagnosis and staging. A patient with oropharyngeal cancer was staged T2 cN1 after clinical examination, computed tomography, and (18)F-fluorodeoxyglucose positron emission tomography with computed tomography. Contrast-enhanced microbubble imaging was applied for diagnosis of a lymph node suspected of harboring a metastasis. The result of the microbubble procedure showed the suspicious node to be tumor negative, and this was later confirmed by frozen section and serial step section of the harvested node. Contrast-enhanced ultrasonography with introduction of intravenous microbubble contrast may be of benefit in staging oropharyngeal cancer in patients with enlarged neck lymph nodes.

PMID: 28927729 [PubMed - as supplied by publisher]

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Τετάρτη 20 Σεπτεμβρίου 2017

The precursors of double dissociation between reading and spelling in a transparent orthography.

The precursors of double dissociation between reading and spelling in a transparent orthography.

Ann Dyslexia. 2017 Apr;67(1):42-62

Authors: Torppa M, Georgiou GK, Niemi P, Lerkkanen MK, Poikkeus AM

Abstract
Research and clinical practitioners have mixed views whether reading and spelling difficulties should be combined or seen as separate. This study examined the following: (a) if double dissociation between reading and spelling can be identified in a transparent orthography (Finnish) and (b) the cognitive and noncognitive precursors of this phenomenon. Finnish-speaking children (n = 1963) were assessed on reading fluency and spelling in grades 1, 2, 3, and 4. Dissociation groups in reading and spelling were formed based on stable difficulties in grades 1-4. The groups were compared in kindergarten phonological awareness, rapid automatized naming, letter knowledge, home literacy environment, and task-avoidant behavior. The results indicated that the double dissociation groups could be identified even in the context of a highly transparent orthography: 41 children were unexpected poor spellers (SD), 36 were unexpected poor readers (RD), and 59 were poor in both reading and spelling (RSD). The RSD group performed poorest on all cognitive skills and showed the most task-avoidant behavior, the RD group performed poorly particularly on rapid automatized naming and letter knowledge, and the SD group had difficulties on phonological awareness and letter knowledge. Fathers' shared book reading was less frequent in the RD and RSD groups than in the other groups. The findings suggest that there are discernible double dissociation groups with distinct cognitive profiles. This further suggests that the identification of difficulties in Finnish and the planning of teaching and remediation practices should include both reading and spelling assessments.

PMID: 27286963 [PubMed - indexed for MEDLINE]

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Vocal function exercises for normal voice: The effects of varying dosage.

Vocal function exercises for normal voice: The effects of varying dosage.

Int J Speech Lang Pathol. 2017 Sep 19;:1-9

Authors: Bane M, Angadi V, Dressler E, Andreatta R, Stemple J

Abstract
PURPOSE: This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity.
METHOD: Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture.
RESULT: No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups.
CONCLUSION: High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.

PMID: 28925286 [PubMed - as supplied by publisher]

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Malignant transformation of oral leukoplakia in a patient with dyskeratosis congenita.

Malignant transformation of oral leukoplakia in a patient with dyskeratosis congenita.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 12;:

Authors: Bongiorno M, Rivard S, Hammer D, Kentosh J

Abstract
Dyskeratosis congenita (DC) is a rare, inherited, bone marrow failure syndrome caused by premature telomere shortening. The classic mucocutaneous triad of clinical features comprises reticulated skin pigmentation, nail dysplasia, and oral leukoplakia. Multiple somatic features, including bone marrow failure, pulmonary fibrosis, and liver disease, are also common. DC significantly increases the risk for malignant transformation, including myelodysplastic syndrome, acute myeloid leukemia, head and neck squamous cell carcinoma, and anogenital cancer. This case report describes a 23-year-old female with malignant transformation of oral leukoplakia to squamous cell carcinoma, demonstrated in a series of biopsies of the same site. Increased surveillance, proper biopsy technique, and a multidisciplinary approach are critical for patients with DC to ensure rapid diagnosis and treatment.

PMID: 28923296 [PubMed - as supplied by publisher]

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Corrigendum.

Corrigendum.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731774

Authors:

Abstract
Brunner JP, Jawad BA, McCoul ED. Polypoid change of the middle turbinate and paranasal sinus polyposis are distinct entities. Otolaryngol Head Neck Surg. 2017;157:519-523. (Original doi: 10.1177/0194599817711887) The Results section of this article and its abstract contained several errors in describing data that appears in Tables 1 and 2. The tables contain the correct information, the corrected abstract and article text appears below. Abstract: Results. Of 593 patients, 23 (3.9%) had PCMT and 44 (7.4%) had PSP. The PSP group was predominantly male (75% vs 52%, P < .001) with an older mean age (53.4 vs 35.4 years, P < .0001). PCMT was more often associated with allergic rhinitis (83% vs 34%, P < .001), whereas PCMT was rarely associated with chronic rhinosinusitis (10% vs 100%, P < .0001). Mean eosinophil count (7.1 vs 3.1, P = .08) was not significantly different between groups, whereas mean Lund-Mackay score was higher in PSP (14.9 vs 2.4, P < .0008). Mean NOSE score was greater in PSP (65.3 vs 44.3, P = .008), whereas SNOT-22 score was comparable between groups (40.6 vs 32.6, P = .14). Text: A total of 593 patients were prospectively screened with nasal endoscopy during the study period (Table 1). Of these, 23 (3.9%) were identified with PCMT and 44 (7.4%) were identified with PSP. When comparing the demographics between both groups, PSP patients were predominantly male (75% vs 52%, P < .001) with an older mean age (53.4 vs 35.4 years, P < .0001). Inhalant allergy was confirmed by either cutaneous or serologic testing in 19 patients in the PCMT group and 15 patients in the PSP group. A greater association was noted between PCMT and AR (83% vs 34%, P < .001), whereas PCMT was rarely associated with CRS (9% vs 100%, P < .0001). Among all sensitized patients, the most common aeroallergens were dust mites (47.5%), grasses (45.0%), trees (27.5%), and weeds (25.0%). No difference in the incidence of asthma was noted between study groups (34% vs 22%, P = .21). AERD was present in 14% of PSP patients but was not seen in the PCMT group ( P = .024). No significant difference was found in the incidence of smoking between groups (9% vs 9%, P = .64). Data on patient-reported QOL, imaging, and laboratory values are shown in Table 2. The mean NOSE score was greater in PSP (65.3 vs 44.3, P = .008), signifying a higher degree of nasal obstruction. SNOT-22 score was comparable between groups (40.6 vs 32.6, P = .14), with mean scores exceeding the minimum that would predict improvement from surgical management.(11) The Lund-Mackay score was significantly higher in the PSP group compared with the PCMT group (14.9 vs 2.4, P < .0008), although CT was infrequently indicated and therefore not often performed in the PCMT group. The mean percentage of eosinophils in peripheral blood was not significantly different between groups (PSP 7.1 vs PCMT 3.1, P = .08). No difference was observed in mean total serum IgE, although because this information was obtained for only 21 of the 67 patients, that result may be difficult to interpret.

PMID: 28926718 [PubMed - as supplied by publisher]

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Evidence-Based Medicine in Otolaryngology, Part 6: Patient-Reported Outcomes in Clinical Practice.

Evidence-Based Medicine in Otolaryngology, Part 6: Patient-Reported Outcomes in Clinical Practice.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731759

Authors: Carroll TL, Lee SE, Lindsay R, Locandro D, Randolph GW, Shin JJ

Abstract
The assessment of patient-reported outcome measures (PROMs) in the outpatient setting is gaining momentum in clinical and research venues. Implementing this data capture into one's practice, however, is not a one-size-fits-all venture, and it is critical to determine when, how, and where to include these patient-centered assessments. This installment of the "Evidence-Based Medicine in Otolaryngology" series provides insight into the implementation process and experiences with successful incorporation of PROMs into clinical practice. Specifically, 4 differing clinical scenarios and collection techniques are described, including data acquisition protocols, formats for clinician data usage, and applications of PROM results in clinical and research scenarios.

PMID: 28926299 [PubMed - as supplied by publisher]

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Preoperative Positron Emission Tomography for Node-Positive Head and Neck Cutaneous Squamous Cell Carcinoma.

Preoperative Positron Emission Tomography for Node-Positive Head and Neck Cutaneous Squamous Cell Carcinoma.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731735

Authors: Hirshoren N, Olayos E, Herschtal A, Ravi Kumar AS, Gyorki DE

Abstract
Objectives Surgery is the primary treatment modality for node-positive cutaneous squamous cell carcinoma of the head and neck with no distant disease (HNcSCC-M0). The role of preoperative positron emission tomography/computed tomography (PET/CT) scan for these patients is unclear. We compared preoperative PET/CT with final histopathology among patients undergoing lymphadenectomy and/or parotidectomy for HNcSCC-M0. Study Design Case series with chart review. Setting Single Australian center. Subjects and Methods Investigation included disease parameters and preoperative CT and PET/CT findings of 64 patients with node-positive HNcSCC without distant metastatic disease. Fisher's exact test was used to test for a difference in the proportion of patients with chronic lymphocytic leukemia between the false- and true-negative PET/CT subgroups. Results Of 64 patients who underwent PET/CT prior to surgery for node-positive HNcSCC-M0, 56 underwent a neck dissection and 30, a parotidectomy. Of these, 13 neck dissections and 2 parotidectomies were performed in the absence of FDG-avid (18F-fludeoxyglucose) nodes in these nodal fields. The PET/CT positive predictive value of the neck was 91.1%. The negative predictive values in the neck and parotid regions were 60%. Of the false-negative subgroup, 66.7% had chronic lymphocytic leukemia, compared with 11.1% of the true-negative subgroup ( P = .09). Based on PET/CT findings, surgical plans according to preoperative CT were changed for 6.25% of patients. Conclusion Use of PET/CT for surgical candidates with node-positive HNcSCC-M0 has high specificity and positive predictive value with relatively low sensitivity and negative predictive value. A statistical trend toward a higher rate of chronic lymphocytic leukemia among patients with false-negative results is suggested.

PMID: 28925330 [PubMed - as supplied by publisher]

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Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731740

Authors: Error M, Ashby S, Orlandi RR, Alt JA

Abstract
Objective To determine if the introduction of a systematic preoperative sinus computed tomography (CT) checklist improves identification of critical anatomic variations in sinus anatomy among patients undergoing endoscopic sinus surgery. Study Design Single-blinded prospective cohort study. Setting Tertiary care hospital. Subjects and Methods Otolaryngology residents were asked to identify critical surgical sinus anatomy on preoperative CT scans before and after introduction of a systematic approach to reviewing sinus CT scans. The percentage of correctly identified structures was documented and compared with a 2-sample t test. Results A total of 57 scans were reviewed: 28 preimplementation and 29 postimplementation. Implementation of the sinus CT checklist improved identification of critical sinus anatomy from 24% to 84% correct ( P < .001). All residents, junior and senior, demonstrated significant improvement in identification of sinus anatomic variants, including those not directly included in the systematic review implemented. Conclusion The implementation of a preoperative endoscopic sinus surgery radiographic checklist improves identification of critical anatomic sinus variations in a training population.

PMID: 28925320 [PubMed - as supplied by publisher]

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Corrigendum.

Corrigendum.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817731766

Authors:

Abstract
Lin J, Hafrén L, Kerschner J, et al. Panel 3: genetics and precision medicine of otitis media. Otolaryngol Head Neck Surg. 2017;156(4S):S41-S50. (Original doi: 10.1177/0194599816685559) In this article the second author's first name was misspelled in the online and print versions. It should have appeared as Lena Hafrén. This has been corrected in the full text online article.

PMID: 28925319 [PubMed - as supplied by publisher]

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Objective Assessment of Technical Skills in Otorhinolaryngology-Head and Neck Surgery Residents: A Systematic Review.

Objective Assessment of Technical Skills in Otorhinolaryngology-Head and Neck Surgery Residents: A Systematic Review.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817729826

Authors: Mercier É, Chagnon-Monarque S, Lavigne F, Ayad T

Abstract
Objectives The primary goal is the indexation of validated methods used to assess surgical competency in otorhinolaryngology-head and neck surgery (ORL-HNS) residents. Secondary goals include assessment of the reliability and validity of these tools, as well as the documentation of specific procedures in ORL-HNS involved. Data Sources MEDBASE, OVID, Medline, CINAHL, and EBM, as well as the printed references, available through the Université de Montréal library. Review Methods The PRISMA method was used to review digital and printed databases. Publications were reviewed by 2 independent reviewers, and selected articles were fully analyzed to classify evaluation methods and categorize them by procedure and subspecialty of ORL-HNS involved. Reliability and validity were assessed and scored for each assessment tool. Results Through the review of 30 studies, 5 evaluation methods were described and validated to assess the surgical competency of ORL-HNS residents. The evaluation method most often described was the combined Global Rating Scale and Task-Specific Checklist tool. Reliability and validity for this tool were overall high; however, considerable data were unavailable. Eleven distinctive surgical procedures were studied, encompassing many subspecialties of ORL-HNS: facial plastics, general ear-nose-throat, laryngology, otology, pediatrics, and rhinology. Conclusions Although assessment tools have been developed for an array of surgical procedures, involving most ORL-HNS subspecialties, the use of combined checklists has been repeatedly validated in the literature and shown to be easily applicable in practice. It has been applied to many ORL-HNS procedures but not in oncologic surgery to date.

PMID: 28925316 [PubMed - as supplied by publisher]

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Τρίτη 19 Σεπτεμβρίου 2017

Axitinib-related osteonecrosis of the jaw.

Axitinib-related osteonecrosis of the jaw.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 18;:

Authors: Patel V, Sproat C, Kwok J, Tanna N

Abstract
Tyrosine kinase inhibitors (TKIs) are oral chemotherapy drugs used primarily to treat leukemias, renal cell carcinomas, gastrointestinal stromal tumors, and neuroendocrine tumors. Within this group, a number of drugs have already been implicated in jaw necrosis. Axitinib (Inlyta) is a novel TKI currently licensed for the treatment of renal cell carcinoma. We report the first case, to our knowledge, of jaw necrosis solely related to this medication and review the literature surrounding TKIs and their implication in osteonecrosis of the jaw.

PMID: 28918879 [PubMed - as supplied by publisher]

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Erratum to "Extramammary Paget's disease of the oral mucosa and perioral skin" [Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124 (2):e157-e163.].

Erratum to "Extramammary Paget's disease of the oral mucosa and perioral skin" [Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124 (2):e157-e163.].

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep 11;:

Authors: Wang X, Wu L, Shi X, He X, Li W, Zhou H

PMID: 28918854 [PubMed - as supplied by publisher]

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Σάββατο 16 Σεπτεμβρίου 2017

Mouse Model of IL-17-Dominant Rhinitis Using Polyinosinic-Polycytidylic Acid.

Mouse Model of IL-17-Dominant Rhinitis Using Polyinosinic-Polycytidylic Acid.

Allergy Asthma Immunol Res. 2017 Nov;9(6):540-549

Authors: Bae JS, Kim EH, Kim JH, Mo JH

Abstract
Interleukin (IL)-17 plays an important role in rhinitis and the level thereof correlates with the severity of disease. However, no mouse model for IL-17-dominant rhinitis has yet been developed. Our objective was to establish a mouse model of IL-17-dominant rhinitis via intranasal application of polyinosinic-polycytidylic acid (abbreviated as Poly(I:C)). Mice were divided into 6 groups (n=8 for each group); 1) 1 negative control group, 2) 1 positive control group (OVA/alum model), 3) 2 Poly(I:C) groups (10 or 100 μg), and 4) 2 OVA/Poly(I:C) groups (10 or 100 μg). The positive control group was treated with the conventional OVA/alum protocol. In the Poly(I:C) and OVA/Poly(I:C) groups, phosphate-buffered saline or an OVA solution plus Poly(I:C) were administered. The OVA/Poly(I:C) groups exhibited significantly greater neutrophil infiltration and increased IL-17/interferon γ expression compared with the other groups. However, the levels of total immunoglobulin E (IgE), OVA-specific IgE, eosinophil infiltration, IL-4, IL-5, IL-6, and IL-10 were significantly lower in the OVA/Poly(I:C) groups than in mice subjected to conventional Th2-dominant OVA/alum treatment (the positive control group). IL-17 and neutrophil measurement, chemokine (C-X-C motif) ligand 1 immunohistochemistry, and confocal microscopy revealed increased numbers of IL-17-secreting cells in the nasal mucosa of the OVA/Poly(I:C) groups, which included natural killer cells, CD4 T cells, and neutrophils. In conclusion, we developed a mouse model of IL-17-dominant rhinitis using OVA together with Poly(I:C). This model will be useful in research on neutrophil- or IL-17-dominant rhinitis.

PMID: 28913994 [PubMed]

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A Retrospective Study of Korean Adults With Food Allergy: Differences in Phenotypes and Causes.

A Retrospective Study of Korean Adults With Food Allergy: Differences in Phenotypes and Causes.

Allergy Asthma Immunol Res. 2017 Nov;9(6):534-539

Authors: Lee SH, Ban GY, Jeong K, Shin YS, Park HS, Lee S, Ye YM

Abstract
PURPOSE: Increasing in prevalence, food allergy (FA) is becoming an important public health concern. In Korean adults, however, clinical phenotypes and causes of FA have not been studied. We aimed to study common causative allergens and clinical manifestations of FA in Korean adults.
METHODS: This study was conducted as a retrospective review of medical records for 95 patients (≥19 years old) diagnosed with FA from September 2014 to August 2015 at a single university hospital.
RESULTS: In the 95 patients, 181 FA events were recorded. The mean age of first onset of FA symptoms was 34.7±15.8 years. The most frequent causative food was seafood (34.8%); shrimp and crab allergies ranked highest, regardless of age and sex. Among all FA events, there were 47 (26.0%) cases of anaphylaxis and 26 (14.4%) cases of oral allergy syndrome (OAS). Seafood (51.1%) was the most frequent cause of anaphylaxis, followed by grains (14.9%). Most OAS cases were associated with fruits (95.7%). The frequency of fruit-induced FA was significantly higher in males than in females (23.0% vs 8.4%, P=0.011). While no cases of vegetables-induced FA were noted in younger individuals (19 to 30 years), vegetables accounted for 20.5% of FA symptoms in older subjects (≥51 years, P<0.001). Allergic rhinitis (44.2%) and drug allergy (20.0%) were major comorbidities associated with FA. Overall, 29 FA events had cofactors, of which 10 were combined with exercise.
CONCLUSIONS: The major causes of FA in Korean adults were crustacean, fruits, and grains. Interestingly, the clinical manifestations of FA and demographics varied according to type of food allergen.

PMID: 28913993 [PubMed]

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Effects of Immunoglobulin Replacement on Asthma Exacerbation in Adult Asthmatics with IgG Subclass Deficiency.

Effects of Immunoglobulin Replacement on Asthma Exacerbation in Adult Asthmatics with IgG Subclass Deficiency.

Allergy Asthma Immunol Res. 2017 Nov;9(6):526-533

Authors: Kim JH, Ye YM, Ban GY, Shin YS, Lee HY, Nam YH, Lee SK, Cho YS, Jang SH, Jung KS, Park HS

Abstract
PURPOSE: Recurrent respiratory tract infection is a common manifestation of primary immunodeficiency disease, and respiratory viruses or bacteria are important triggers of asthma exacerbations. Asthma often coexists with humoral immunodeficiency in adults, and some asthmatics with immunoglobulin (Ig) G subclass deficiency (IgGSCD) suffer from recurrent exacerbations. Although some studies suggest a benefit from Ig replacement, others have failed to support its use. This study aimed to assess the effect of Ig replacement on asthma exacerbation caused by respiratory infection as well as the asthma control status of adult asthmatics with IgGSCD.
METHODS: This is a multi-center, open-label study of adult asthmatics with IgGSCD. All patients received monthly intravenous immunoglobulin (IVIG) for 6 months and were evaluated regarding asthma exacerbation related to infection, asthma control status, quality of life, and lung function before and after IVIG infusion.
RESULTS: A total of 30 patients were enrolled, and 24 completed the study. Most of the patients had a moderate degree of asthma severity with partly (52%) or uncontrolled (41%) status at baseline. IVIG significantly reduced the proportion of patients with asthma exacerbations, lowered the number of respiratory infections, and improved asthma control status, compared to the baseline values (P<0.001). The mean asthma-specific quality of life and asthma control test scores were improved significantly (P=0.009 and P=0.053, respectively); however, there were no significant changes in lung function.
CONCLUSIONS: IVIG reduced the frequency of asthma exacerbations and improved asthma control status in adult asthmatics with IgGSCD, suggesting that IVIG could be an effective treatment option in this population.

PMID: 28913992 [PubMed]

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Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups.

Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups.

Allergy Asthma Immunol Res. 2017 Nov;9(6):517-525

Authors: Lee SW, Lee S, Sheen YH, Ha EK, Choi SH, Yang MS, Hwang S, Kim SS, Choi JH, Han MY

Abstract
PURPOSE: Seasonal variations in asthma exacerbation (AE) are associated with respiratory virus outbreaks and the return of children to school after vacation. This study aims to elucidate the period, phase, and amplitude of seasonal cycles of AE in 5 different age groups with regard to rhino- and influenza virus epidemics in Korea.
METHODS: The number of daily emergency department (ED) visits for AE in all age groups of Korea and the nationwide weekly incidence of rhino- and influenza virus, were obtained for 2008-2012. Fourier regression was used to model rhythmicity, and the Cosinor method was used to determine the amplitude and phase of the cycles in each age group. The cross-correlation function (CCF) between AE and the rhino- and influenza virus epidemics was also calculated.
RESULTS: There were 157,559 events of AE (0.62 events/1,000 individuals/year) during the study period. There were spring and fall peaks of AE in children and adults, but only 1 winter peak in the elderly. The amplitude of the AE peak in infants was higher in spring than in fall (9.16 vs 3.04, P<0.010), and the fall peak was approximately 1 month later in infants than in school children (October 11 vs November 13, P<0.010). The association between AE and rhinovirus was greatest in school children (rho=0.331), and the association between AE and influenza virus was greatest in those aged ≥60 years (rho=0.682).
CONCLUSIONS: The rhythmicity, amplitude, and phase of the annual cycle of AE differed among different age groups. The patterns of AE were related to the annual rhino- and influenza virus epidemics.

PMID: 28913991 [PubMed]

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Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma.

Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma.

Allergy Asthma Immunol Res. 2017 Nov;9(6):509-516

Authors: Byeon JH, Ri S, Amarsaikhan O, Kim E, Ahn SH, Choi IS, Kim HJ, Seo S, Yoon W, Yoo Y

Abstract
PURPOSE: Recent data indicate that sensitization to mold contributes to the severity and persistence of asthma. In this study, we investigated the relationships between sensitization to mold and lung function parameters in children with asthma.
METHODS: We retrospectively reviewed clinical data from 551 asthmatic subjects. We selected subjects who met clinical diagnostic criteria of asthma. Their spirometry, methacholine challenge tests, and measurements of blood eosinophils, serum IgE, eosinophil cationic protein (ECP) and fractional exhaled nitric oxide (FeNO) results were included. Skin prick testing (SPT) results with 13 common aeroallergens in Korea including house dust mites, animal dander, pollen, cockroach and mold were reviewed. Subjects were divided into 3 groups according to their SPT results. Subjects who showed no positive result to any aeroallergen were designated as group 1 (non-sensitized). Group 2 represented subjects who were sensitized to aeroallergens other than mold (other allergen-sensitized) and group 3 included subjects who were sensitized to mold allergens (mold-sensitized).
RESULTS: Among the 551 asthmatic subjects, 67 (12.2%) were sensitized to mold and 366 (66.4%) were sensitized to other aeroallergens. The log mean IgE levels were higher in groups 2 (5.96±1.14 IU/mL) and 3 (5.81±0.97 IU/mL) compared to group 1 (3.88±1.68 IU/mL). Blood eosinophils, ECP and FeNO concentrations were significantly higher in groups 2 and 3, but no significant difference was found between the 2 groups. The mean FEV1 value was significantly lower in group 3 (86.9±12.1%pred) than in groups 2 (92.0±14.8%pred) and 1 (93.4±15.4%pred). The log mean methacholine PC20 was significantly lower in group 3 (0.08±1.91 mg/mL) than in groups 2 (1.31±1.69 mg/mL) and 1 (2.29±1.66 mg/mL).
CONCLUSIONS: We observed a differential association between mold and other aeroallergen sensitization, and severity of asthma. Sensitization to mold is associated with lower lung function and increased airway hyper-responsiveness in children with asthma. Mold sensitization could be an important factor determining asthma severity particularly airflow limitation in children.

PMID: 28913990 [PubMed]

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Patterns of Inhalant Allergen Sensitization and Geographical Variation in Korean Adults: A Multicenter Retrospective Study.

Patterns of Inhalant Allergen Sensitization and Geographical Variation in Korean Adults: A Multicenter Retrospective Study.

Allergy Asthma Immunol Res. 2017 Nov;9(6):499-508

Authors: Kang MG, Kim MY, Song WJ, Kim S, Jo EJ, Lee SE, Kwon JW, Lee SM, Park CS, Park HK, Park HW, Chang YS, Lee J, Lee YM, Jee YK, Lee JM, Choi IS, Cho SH

Abstract
PURPOSE: Inhalant allergen sensitization is one of the major factors involved in the pathogenesis of allergic respiratory diseases. However, the sensitization is determined by interactions between genetic and environmental factors. Thus, testing panels of inhalant allergens may differ among geographical areas. Here we aimed to determine 10 common inhalant allergens in Korean adult patients with suspected respiratory allergies and to examine the variation between different geographical locations.
METHODS: A total of 28,954 patient records were retrieved for retrospective analysis, from 12 referral allergy clinics located in 9 different areas. Inclusion criteria were Korean adults (≥18 years old) who underwent the inhalant allergen skin prick test for suspected history of respiratory allergy. The primary outcome was inhalant allergen skin prick response. Demographic and clinical information were also collected. Positive skin prick responses to allergens were defined as allergen-to-histamine wheal ratio ≥1. Based on skin test results, the most prevalent aeroallergens were determined.
RESULTS: The overall prevalence of allergic sensitization was 45.3%. Dermatophagoides farinae and Dermatophagoides pteronyssinus were the most commonly sensitized allergens. Other common inhalant allergens were cat epithelium (8.1%), birch (7.7%), mugwort (6.9%), alder (6.7%), hazel (6.7%), beech (6.7%), oak (6.6%), and Tyrophagus putres (6.2%), in decreasing order frequency. These 10 inhalant allergens explained 90% of inhalant allergen sensitization in the study participants. However, distinct patterns of the 10 inhalant sensitization were observed in patients living in Chungnam and Jeju. American cockroach, Gernam cockroach, and Trichophyton metagrophytes were unique in Chungnam. Orchard, Japanese cedar, and Velvet were unique in Jeju.
CONCLUSIONS: The present analysis suggests a panel of 10 most common inhalant allergens in Korean adult patients with suspected respiratory allergies, which explained 90% of inhalant allergen sensitization. This panel can be utilized as a practical and convenient tool for primary practice and epidemiological surveys of respiratory allergic diseases.

PMID: 28913989 [PubMed]

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Prevalence of Respiratory Viral Infections in Korean Adult Asthmatics With Acute Exacerbations: Comparison With Those With Stable State.

Prevalence of Respiratory Viral Infections in Korean Adult Asthmatics With Acute Exacerbations: Comparison With Those With Stable State.

Allergy Asthma Immunol Res. 2017 Nov;9(6):491-498

Authors: Seo KH, Bae DJ, Kim JN, Lee HS, Kim YH, Park JS, Kim MS, Chang HS, Son JH, Baek DG, Lee JS, Park CS

Abstract
PURPOSE: Viral infections are involved in ~50% of exacerbations among Caucasian adult asthmatics. However, there have been few reports on the causative virus of exacerbations in Korean adult asthmatics. Thus, we compared frequencies and types of viruses between lower respiratory tract illnesses (LRTIs) with exacerbations (exacerbated LRTIs) and those without exacerbations (stable LRTIs) to evaluate contribution of respiratory viruses to exacerbations.
METHODS: Viral RNA was extracted from sputum using the Viral Gene-spin™ Kit. Reverse transcription-polymerase chain reaction (RT-PCR) was performed to detect adenovirus (ADV), metapneumovirus (MPV), parainfluenza virus (PIV) 1/2/3, influenza virus (IFV) A, IFV B, respiratory syncytial virus (RSV) A/B, and rhinovirus (RV) A.
RESULTS: Among the 259 patients, 210 underwent a single sputum examination, and the remaining 49 underwent 2 to 4 sputum examinations. Virus was detected in 68 of the 259 exacerbated episodes and in 11 of the 64 stable episodes. Among the exacerbated episodes, RV was the most frequently detected virus, followed by influenza A, parainfluenza, RSV A/B, and ADV. Among the 11 stable episodes, RV was most frequently detected. Detection rates of these viruses did not differ between the 2 groups (P>0.05). Thirty-five patients underwent the virus examination at 2 episodes of exacerbation, while 14 patients underwent at each time of exacerbated and stable episodes. Virus detection rate at the second examination was significantly higher in cases with 2 exacerbation episodes than in those with initial exacerbation and sequential stable episodes (P=0.003). A seasonal pattern was noted in the detection rates of RV (September to December), IFV (January to April), PIV (May to September), and RSV A/B (September to April).
CONCLUSIONS: Respiratory viruses were identified in approximately 20% of LRTI irrespective of the presence of asthma exacerbation. RV and IFV A/B were most frequently detected. A group of patients experienced frequent viral infections followed by asthma exacerbations.

PMID: 28913988 [PubMed]

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Clinical Characteristics of Exacerbation-Prone Adult Asthmatics Identified by Cluster Analysis.

Clinical Characteristics of Exacerbation-Prone Adult Asthmatics Identified by Cluster Analysis.

Allergy Asthma Immunol Res. 2017 Nov;9(6):483-490

Authors: Kim MA, Shin SW, Park JS, Uh ST, Chang HS, Bae DJ, Cho YS, Park HS, Yoon HJ, Choi BW, Kim YH, Park CS

Abstract
PURPOSE: Asthma is a heterogeneous disease characterized by various types of airway inflammation and obstruction. Therefore, it is classified into several subphenotypes, such as early-onset atopic, obese non-eosinophilic, benign, and eosinophilic asthma, using cluster analysis. A number of asthmatics frequently experience exacerbation over a long-term follow-up period, but the exacerbation-prone subphenotype has rarely been evaluated by cluster analysis. This prompted us to identify clusters reflecting asthma exacerbation.
METHODS: A uniform cluster analysis method was applied to 259 adult asthmatics who were regularly followed-up for over 1 year using 12 variables, selected on the basis of their contribution to asthma phenotypes. After clustering, clinical profiles and exacerbation rates during follow-up were compared among the clusters.
RESULTS: Four subphenotypes were identified: cluster 1 was comprised of patients with early-onset atopic asthma with preserved lung function, cluster 2 late-onset non-atopic asthma with impaired lung function, cluster 3 early-onset atopic asthma with severely impaired lung function, and cluster 4 late-onset non-atopic asthma with well-preserved lung function. The patients in clusters 2 and 3 were identified as exacerbation-prone asthmatics, showing a higher risk of asthma exacerbation.
CONCLUSIONS: Two different phenotypes of exacerbation-prone asthma were identified among Korean asthmatics using cluster analysis; both were characterized by impaired lung function, but the age at asthma onset and atopic status were different between the two.

PMID: 28913987 [PubMed]

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Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations.

Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations.

Allergy Asthma Immunol Res. 2017 Nov;9(6):477-482

Authors: Kaplan AP

Abstract
The treatment of chronic spontaneous urticaria begins with antihistamines; however, the dose required typically exceeds that recommended for allergic rhinitis. Second-generation, relatively non-sedating H₁-receptor blockers are typically employed up to 4 times a day. First-generation antihistamines, such as hydroxyzine or diphenhydramine (Atarax or Benadryl), were employed similarly in the past. Should high-dose antihistamines fail to control symptoms (at least 50%), omalizumab at 300 mg/month is the next step. This is effective in 70% of antihistamine-refractory patients. H₂-receptor blockers and leukotriene antagonists are no longer recommended; they add little and the literature does not support significant efficacy. For those patients who are unresponsive to both antihistamines and omalizumab, cyclosporine is recommended next. This is similarly effective in 65%-70% of patients; however, care is needed regarding possible side-effects on blood pressure and renal function. Corticosteroids should not be employed chronically due to cumulative toxicity that is dose and time dependent. Brief courses of steroid e.g., 3-10 days can be employed for severe exacerbations, but should be an infrequent occurrence. Finally, other agents, such as dapsone or sulfasalazine, can be tried for those patients unresponsive to antihistamines, omalizumab, and cyclosporine.

PMID: 28913986 [PubMed]

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Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic?

Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic?

Allergy Asthma Immunol Res. 2017 Nov;9(6):466-476

Authors: Agache I, Rogozea L

Abstract
Measurement of biomarkers has been incorporated within clinical research of asthma to characterize the population and to associate the disease with environmental and therapeutic effects. Regrettably, at present, there are no specific biomarkers, none is validated or qualified, and endotype-driven choices overlap. Biomarkers have not yet reached clinical practice and are not included in current asthma guidelines. Last but not least, the choice of the outcome upholding the value of the biomarkers is extremely difficult, since it has to reflect the mechanistic intervention while being relevant to both the disease and the particular person. On the verge of a new age of asthma healthcare standard, we must embrace and adapt to the key drivers of change. Disease endotypes, biomarkers, and precision medicine represent an emerging model of patient care building on large-scale biologic databases, omics and diverse cellular assays, health information technology, and computational tools for analyzing sizable sets of data. A profound transformation of clinical and research pattern from population to individual risk and from investigator-imposed subjective disease clustering (hypothesis driven) to unbiased, data-driven models is facilitated by the endotype/biomarker-driven approach.

PMID: 28913985 [PubMed]

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Effective Strategies for Managing Asthma Exacerbations for Precision Medicine.

Effective Strategies for Managing Asthma Exacerbations for Precision Medicine.

Allergy Asthma Immunol Res. 2017 Nov;9(6):463-465

Authors: Cho YS

PMID: 28913984 [PubMed]

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Rare Giant Upper Lip Epidermal Cyst in a Patient Wearing a Denture.

Rare Giant Upper Lip Epidermal Cyst in a Patient Wearing a Denture.

Arch Craniofac Surg. 2016 Dec;17(4):222-224

Authors: Kim JC, Hong IP

Abstract
Epidermal cysts are intradermal or subcutaneous cystic tumors that frequently occur in the face, scalp, neck, and body trunk. Acquired cases of epidermal cyst commonly occur as a result of various surgical operations, chronic irritation, or trauma, all of which may trigger the occurrence of the invagination of squamous epithelium. A 57-year-old man presented with a palpable mass 7 cm×2 cm in size in the upper lip. The patient had a 3-year history of wearing a denture to restore missing bilateral maxillary central and lateral incisors, accompanied by inflammatory findings on the buccal mucosa due to chronic lip irritation. The resected oval-shaped cyst had a size of 5.5 cm×3.0 cm×2.5 cm, and it was an encapsulated mass with a well-defined margin. The histopathology was typical of epidermal cyst. This case of a rare giant upper lip epidermal cyst in a patient wearing a denture may be of interest to clinicians.

PMID: 28913288 [PubMed]

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"Gan To Kagaku Ryoho"[jour]; +20 new citations

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Complications and parent satisfaction in pediatric osseointegrated bone-conduction hearing implants.

http:--media.wiley.com-assets-7315-19-Wi

Complications and parent satisfaction in pediatric osseointegrated bone-conduction hearing implants.

Laryngoscope. 2017 Sep;127(9):2165-2170

Authors: Chan KH, Gao D, Jensen EL, Allen GC, Cass SP

Abstract
OBJECTIVE: To assess long-term complication rate and parental satisfaction of osseointegrated bone conduction hearing implants (OBCHIs).
STUDY DESIGN: Retrospective chart review of children undergoing OBCHIs.
METHODS: A retrospective chart review of children undergoing OBCHIs for the treatment of conductive, mixed, and single-sided sensorineural hearing loss in children.
RESULTS: Forty-five subjects were identified with 0.3 to 10.4 years of follow-up. The mean/median age and age range at implant were 9.0/7.8 and 1.7 to 19.1 years. The underlying hearing loss for the cohort included conductive (N = 30), sensorineural (N = 7), and mixed (N = 8) hearing loss. Conductive hearing loss, caused by aural atresia (62.9), was the most common indication for implantation. Fifty-eight complications occurred in 29 subjects, most related to skin infection or overgrowth. Seventeen events required revision surgery, and 18 required oral antibiotics and/or office-based cauterization. Children under the age of 5 years were more likely to have failure of osseointegration or require revision surgery. Parents of 33 subjects underwent a phone interview; 76% rated the overall satisfaction as satisfied or very satisfied.
CONCLUSION: A large percentage of children undergoing OBCHI develop postoperative complications, and up to 44% require revision surgery-a figure higher than generally reported and higher than in adults. No factors were found to adequately explain the higher complication rates in children compared to adults. Despite the occurrence of complications, parents viewed this device as satisfactory from many perspectives.
LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2165-2170, 2017.

PMID: 28092097 [PubMed - indexed for MEDLINE]

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Is hippocampal neurogenesis modulated by the sensation of self-motion encoded by the vestibular system?

Is hippocampal neurogenesis modulated by the sensation of self-motion encoded by the vestibular system?

Neurosci Biobehav Rev. 2017 Sep 11;:

Authors: Smith PF

Abstract
It is now well accepted that physical exercise stimulates hippocampal neurogenesis and may promote cognitive ability. Less clear are the mechanisms by which this process occurs. One potential contributing influence, that is usually neglected, is the vestibular system, which by its very nature must be activated during physical exercise and which essentially cannot be turned off without complete bilateral vestibular lesions. This paper reviews a small literature that demonstrates that bilateral vestibular loss (BVL) in rats modulates cell proliferation in the dentate gyrus (DG) and that artificial electrical activation of the vestibular system, using galvanic vestibular stimulation, does also. Although there are only a few piecemeal studies of this subject, because of the way that they were controlled, it is likely that the vestibular system has a regulatory role in cell proliferation in the DG and therefore possibly in neurogenesis, which needs to be taken into account in the interpretation of neurogenesis studies.

PMID: 28912091 [PubMed - as supplied by publisher]

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Overview of Sinonasal and Ventral Skull Base Malignancy Management.

Overview of Sinonasal and Ventral Skull Base Malignancy Management.

Otolaryngol Clin North Am. 2017 Apr;50(2):205-219

Authors: Svider PF, Setzen M, Baredes S, Liu JK, Eloy JA

Abstract
Significant technological advances have fostered a movement toward minimally invasive surgical interventions for the management of ventral skull base malignancies. The care of patients with these lesions ideally involves an interdisciplinary skull base team that includes otolaryngologists, neurologic surgeons, radiation oncologists, and medical oncologists. This article describes considerations essential for diagnosis, prognosis, and preoperative evaluation. Furthermore, surgical nuances, strategies for skull base reconstruction, and nonsurgical options are briefly discussed. This overview may be useful as an up-to-date description of the challenging clinical scenarios associated with these lesions.

PMID: 28160998 [PubMed - indexed for MEDLINE]

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Hydroxyapatite cement cranioplasty following translabyrinthine approach: Long-term study of 369 cases.

Hydroxyapatite cement cranioplasty following translabyrinthine approach: Long-term study of 369 cases.

Laryngoscope. 2017 Sep;127(9):2120-2125

Authors: Volsky PG, Hillman TA, Stromberg KJ, Buchinsky FJ, Chen DA, Jackson NM, Arriaga MA

Abstract
OBJECTIVE: To report the authors' experience with hydroxyapatite cement (HAC) cranioplasty and analyze the material's long-term safety and efficacy in repairing translabyrinthine skull-base defects by examining adverse events, specifically cerebrospinal fluid (CSF) leaks and surgical site infections.
STUDY DESIGN: Retrospective case-control study (primary study arm); prospective cross-sectional study of patients not examined within the last 5 years (secondary arm).
SETTING: tertiary-care neurotology private practice and academic practice (two centers).
METHODS: Hydroxyapatite cement implanted following translabyrinthine approach, with or without fat graft, was included. Combined approaches were excluded. Implant-associated adverse events were defined as 1) CSF leaks requiring reoperation or spinal drainage, and (2) infections requiring reoperation. Patients not examined within 5 years were interviewed by telephone to update their condition. Incidence of adverse events was compared to published data for translabyrinthine cranioplasty using fat graft alone. Implant survival analysis was performed.
RESULTS: The study cohort included 369 HAC implants in the same number of patients. There were seven CSF leaks and seven infections. Combined (n = 14) incidence of adverse events was 3.8% (2.09%, 6.28%). Compared to fat graft alone, the adverse events associated with HAC were fewer (P < 0.001). Up to 15 years (5,475 days), HAC cement maintained 95% adverse event-free survival. There were no cases of meningitis.
CONCLUSION: Cranioplasty using HAC with autologous fat following translabyrinthine skull-base surgery is safer and more effective than fat graft alone, up to 15 years after surgery.
LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2120-2125, 2017.

PMID: 28059442 [PubMed - indexed for MEDLINE]

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