Description of tinnitus and its relation to discomfort level in a group of elderly hearing aid wearers.

Description of tinnitus and its relation to discomfort level in a group of elderly hearing aid wearers.

Int Tinnitus J. 2016;20(1):36-41

Authors: Cribari J, Ribas A, Fonseca VR, Moretti CM, Zeigelboim BS, Martins J, Rosa MR

Abstract
INTRODUCTION: Evaluating quality of life for tinnitus patients has been an interest of several specialties that have seen the negative impact that the disorder has on people.
OBJECTIVE: To assess and qualify tinnitus in a group of elderly hearing aid wearers.
MATERIALS AND METHODS: A descriptive cross-sectional study involving 53 elderly patients with tinnitus without remission after wearing hearing aids. All subjects were submitted to: a medical evaluation, an audiological evaluation, acuphenometry, an investigation of tinnitus annoyance level and quality of life.
RESULTS: There were 20 men and 33 women. The mean age was 72.5 years. The sample was mostly characterized by having sensorineural hearing loss (84%), moderate to moderately severe (86%) and downward sloping (82%). With respect to the description of the tinnitus sound, the most common were a hissing sound (93%) of average pitch (84%). Regarding the subjects' perception of tinnitus, it was found that subjects had varying levels of annoyance: mild (25%), moderate (33%), severe (22%), most severe (20%). Men are more bothered by tinnitus than women. Most of the sample reported being satisfied or very satisfied with their quality of life.
CONCLUSION: It was possible to evaluate and qualify tinnitus in the sample. Although tinnitus is a frequent audiological symptom that interferes in the life of the elderly, in the sample it did not weigh heavily in terms of quality of life.

PMID: 27488992 [PubMed - in process]

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Speech language pathology findings in a Treacher Collins syndrome patient.

Speech language pathology findings in a Treacher Collins syndrome patient.

Int Tinnitus J. 2016;20(1):31-5

Authors: Massi G, França DR, Santos RS, Ribas A, Fonseca VD, Guarinello AC, Ziesemer Nde B

Abstract
BACKGROUND: Treacher Collins syndrome (TCS) is a rare disorder with different levels of severity due to congenital head and face abnormalities which affect language, orofacial musculature, voice and breadth, suction, chewing and swallowing functions.
AIMS: This paper objectifies to report a Treacher Collins syndrome patient, describing phonoaudiological changes that can be found in individuals suffering from this syndrome.
METHODS & PROCEDURES: The study was carried out with a male child at a teaching Speech Language Pathology clinic in Southern Brazil. The patient underwent audiological assessment, as well as orofacial motricity, swallowing, voice and speech assessments.
OUTCOMES & RESULTS: By means of the assessments, it was possible to perceive that the patient presents moderate hearing loss, inadequacy of phonoarticulatory organs, base of the tongue going backwards and epiglottis collapse over the larynx. In spite of evidencing significant difficulty in producing speech sounds, due to musculoskeletal changes, he effectively interacts in communicative situations, besides understanding sentences and narrated stories.
CONCLUSIONS & IMPLICATIONS: The screened case report evidences that an interdisciplinary follow-up is indispensable for this patient suffering from Treacher Collins syndrome, which implies not only speech language therapeutic follow-up, but also in ear, nose and throat and orthodontics areas.

PMID: 27488991 [PubMed - in process]

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Brazilian scale of hearing and language development in children (EDAL-1) with cochlear implant and less than two years of hearing AGE.

Brazilian scale of hearing and language development in children (EDAL-1) with cochlear implant and less than two years of hearing AGE.

Int Tinnitus J. 2016;20(1):7-10

Authors: Ribas A, Kochen AP

Abstract
OBJECTIVE: To present the protocol called the Brazilian Scale of Hearing and Language Development.
MATERIALS AND METHODS: This is a protocol developed in order to assess and record the development of hearing and language skills in young children who have undergone cochlear implantation during the first two years of hearing age. It was applied to the parents of 41 children over a period of 12 months at the cochlear implant clinic in the Pequeno Príncipe Hospital in Curitiba, Brazil. Registered were: the time taken to implement the protocol; ease of understanding the questions; numerical results obtained by the children evaluated.
RESULTS: In general, the questions were considered easy to understand. The minimum time taken for application of the protocol was two minutes and the maximum was 11 minutes. At the end of the evaluation, it was possible to quantify the development in 100% of the cases.
CONCLUSIONS: EDAL proved an agile, quick and easy, instrument to be used in the first two years of hearing age.

PMID: 27488987 [PubMed - in process]

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Role of Binaural Temporal Fine Structure and Envelope Cues in Cocktail-Party Listening.

Role of Binaural Temporal Fine Structure and Envelope Cues in Cocktail-Party Listening.

J Neurosci. 2016 Aug 3;36(31):8250-7

Authors: Swaminathan J, Mason CR, Streeter TM, Best V, Roverud E, Kidd G

Abstract
UNLABELLED: While conversing in a crowded social setting, a listener is often required to follow a target speech signal amid multiple competing speech signals (the so-called "cocktail party" problem). In such situations, separation of the target speech signal in azimuth from the interfering masker signals can lead to an improvement in target intelligibility, an effect known as spatial release from masking (SRM). This study assessed the contributions of two stimulus properties that vary with separation of sound sources, binaural envelope (ENV) and temporal fine structure (TFS), to SRM in normal-hearing (NH) human listeners. Target speech was presented from the front and speech maskers were either colocated with or symmetrically separated from the target in azimuth. The target and maskers were presented either as natural speech or as "noise-vocoded" speech in which the intelligibility was conveyed only by the speech ENVs from several frequency bands; the speech TFS within each band was replaced with noise carriers. The experiments were designed to preserve the spatial cues in the speech ENVs while retaining/eliminating them from the TFS. This was achieved by using the same/different noise carriers in the two ears. A phenomenological auditory-nerve model was used to verify that the interaural correlations in TFS differed across conditions, whereas the ENVs retained a high degree of correlation, as intended. Overall, the results from this study revealed that binaural TFS cues, especially for frequency regions below 1500 Hz, are critical for achieving SRM in NH listeners. Potential implications for studying SRM in hearing-impaired listeners are discussed.
SIGNIFICANCE STATEMENT: Acoustic signals received by the auditory system pass first through an array of physiologically based band-pass filters. Conceptually, at the output of each filter, there are two principal forms of temporal information: slowly varying fluctuations in the envelope (ENV) and rapidly varying fluctuations in the temporal fine structure (TFS). The importance of these two types of information in everyday listening (e.g., conversing in a noisy social situation; the "cocktail-party" problem) has not been established. This study assessed the contributions of binaural ENV and TFS cues for understanding speech in multiple-talker situations. Results suggest that, whereas the ENV cues are important for speech intelligibility, binaural TFS cues are critical for perceptually segregating the different talkers and thus for solving the cocktail party problem.

PMID: 27488643 [PubMed - in process]

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Evolution of speech and evolution of language.

Evolution of speech and evolution of language.

Psychon Bull Rev. 2016 Aug 3;

Authors: de Boer B

Abstract
Speech is the physical signal used to convey spoken language. Because of its physical nature, speech is both easier to compare with other species' behaviors and easier to study in the fossil record than other aspects of language. Here I argue that convergent fossil evidence indicates adaptations for complex vocalizations at least as early as the common ancestor of Neanderthals and modern humans. Furthermore, I argue that it is unlikely that language evolved separately from speech, but rather that gesture, speech, and song coevolved to provide both a multimodal communication system and a musical system. Moreover, coevolution must also have played a role by allowing both cognitive and anatomical adaptations to language and speech to evolve in parallel. Although such a coevolutionary scenario is complex, it is entirely plausible from a biological point of view.

PMID: 27488556 [PubMed - as supplied by publisher]

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Grommets and speech at three and six years in children born with total cleft or cleft palate.

Related Articles

Grommets and speech at three and six years in children born with total cleft or cleft palate.

Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2243-7

Authors: Ezzi OE, Herzog G, Broome M, Trichet-Zbinden C, Hohlfeld J, Cherpillod J, de Buys Roessingh AS

Abstract
OBJECTIVE: Grommets may be considered as the treatment of choice for otitis media with effusion (OME) in children born with a cleft. But the timing and precise indications to use them are not well established. The aim of the study is to compare the results of hearing and speech controls at three and six year-old in children born with total cleft or cleft palate in the presence or not of grommets.
METHODS: This retrospective study concerns non syndromic children born between 1994 and 2006 and operated for a unilateral cleft lip palate (UCLP) or a cleft palate (CP) alone, by one surgeon with the same schedule of operations (Malek procedure). We compared the results of clinical observation, tympanometry, audiometry and nasometry at three and six year-old. The Borel-Maisonny classification was used to evaluate the velar insufficiency. None of the children had preventive grommets. The Fisher Exact Test was used for statistical analysis with p<0.05 considered as significant.
RESULTS: Seventy-seven patients were analyzed in both groups. Abnormal hearing status was statistically more frequent in children with UCLP compared to children with CP, at three and six years (respectively, 80-64%, p<0.03 and 78-60%, p<0.02), with the use of grommets at six years in 43% of cases in both groups. Improvement of hearing status between three and six year-old was present in 5% of children with UCLP and 9% with CP, without the use of grommets.
CONCLUSION: The use of grommets between three and six year-old was not associated to any improvement of hearing status or speech results children with UCLP or with CP, with a low risk of tympanosclerosis. These results favor the use of grommets before the age of three, taking into account the risk of long term tympanosclerosis.

PMID: 26545794 [PubMed - indexed for MEDLINE]

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Surgery for velopharyngeal insufficiency: The outcomes of the University Hospitals Leuven.

Related Articles

Surgery for velopharyngeal insufficiency: The outcomes of the University Hospitals Leuven.

Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2213-20

Authors: Samoy K, Hens G, Verdonck A, Schoenaers J, Dormaar T, Breuls M, Vander Poorten V

Abstract
OBJECTIVES: We reviewed the outcomes of patients who underwent a velopharyngoplasty and subsequent speech therapy for velopharyngeal insufficiency (VPI) to determine possible prognostic variables.
METHODS: During the period 2002-2010, 91 patients with VPI underwent a velopharyngoplasty (either the Honig velopharyngoplasty, the modified Honig velopharyngoplasty or the Hynes pharyngoplasty). Of these, 62 had complete data for long-term evaluation of speech outcome and analysis of variables potentially influencing this outcome. Speech outcome was assessed using five criteria that were evaluated pre- and postoperatively: hypernasality, nasal emission, facial grimacing, retro-articulation and glottal stops. The former two variables were transformed into a semi-objective nasality index (NI), the latter three variables were assembled to form a subjective articulation index (AI). Prognostic variables for outcome that were studied included age at velopharyngoplasty, associated 22q11.2 deletion syndrome, intervention type, primary or secondary surgery and pre-intervention speech therapy.
RESULTS: Before surgery, based on the NI, 15 patients had mild VPI and 44 patients had moderate to severe VPI. Postoperatively at 12 months, 46 patients had a good speech outcome (normal or mild VPI), 13 patients had moderate VPI and no more severe VPI was observed. The overall success rate of 78% after one year increased to 90% in the long-term (median 27 months) with further speech therapy. Patients without the diagnosis of 22q11.2 deletion syndrome had better speech outcomes than patients with the syndrome. No statistically significant effect of the age at velopharyngoplasty on speech outcome was found. No cases of sleep apnea syndrome were reported.
CONCLUSIONS: Our protocol of patient tailored surgical interventions and further postoperative speech therapy results in good speech outcomes, with no or only mild remaining VPI for the majority of patients. The correction of VPI is more difficult for the subgroup of patients with 22q11.2 deletion syndrome.

PMID: 26520910 [PubMed - indexed for MEDLINE]

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The role of working memory and verbal fluency in autobiographical memory in early Alzheimer's disease and matched controls.

Related Articles

The role of working memory and verbal fluency in autobiographical memory in early Alzheimer's disease and matched controls.

Neuropsychologia. 2015 Nov;78:115-21

Authors: Benjamin MJ, Cifelli A, Garrard P, Caine D, Jones FW

Abstract
Retrieval of autobiographical memories (AMs) is important for "sense of self". Previous research and theoretical accounts suggest that working memory (WM) and semantic and phonemic fluency abilities facilitate the hierarchical search for, and reliving of past, personal events in the mind's eye. However, there remains a lack of consensus as to the nature of the relationships between these cognitive functions and the truly episodic aspects of AM. The present study therefore aimed to explore the associations between these variables in a sample with a wide range of cognitive abilities. The study incorporated a between-groups component, and a correlational component with multiple regression. Participants with Alzheimer's disease (n=10) and matched healthy controls (n=10) were assessed on measures of semantic and episodic AM search and retrieval, auditory and spatial WM, and semantic and phonemic fluency. The AD group produced less episodic AM content compared to controls. Semantic fluency predicted episodic AM retrieval independent of age effects but there were no significant relationships between measures of phonemic fluency, WM and episodic AM. The results suggest that the ability to maintain hierarchical search of the semantic knowledge-base is important for truly episodic reliving, and interventions for people with AM impairment might therefore benefit from incorporating structured, individualised external memory-aids to facilitate AM search and retrieval.

PMID: 26443928 [PubMed - indexed for MEDLINE]

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Effects of production training and perception training on lexical tone perception--A behavioral and ERP study.

Related Articles

Effects of production training and perception training on lexical tone perception--A behavioral and ERP study.

Brain Res. 2015 Oct 22;1624:28-44

Authors: Lu S, Wayland R, Kaan E

Abstract
The present study recorded both behavioral data and event-related brain potentials to examine the effectiveness of a perception-only training and a perception-plus-production training procedure on the intentional and unintentional perception of lexical tone by native English listeners. In the behavioral task, both the perception-only and the perception-plus-production groups improved on the tone discrimination abilities after the training session. Moreover, the participants in both groups generalized the improvements gained through the trained stimuli to the untrained stimuli. In the ERP task, the Mismatch Negativity was smaller in the post-training task than in the pre-training task. However, the two training groups did not differ in tone processing at the intentional or unintentional level after training. These results suggest that the employment of the motor system does not specifically benefit the tone perceptual skills. Furthermore, the present study investigated whether some tone pairs are more easily confused than others by native English listeners, and whether the order of tone presentation influences non-native tone discrimination. In the behavioral task, Tone2-Tone1 (rising-level) and Tone2-Tone4 (rising-falling) were the most difficult tone pairs, while Tone1-Tone2 and Tone4-Tone2 were the easiest tone pairs, even though they involved the same tone contrasts respectively. In the ERP task, the native English listeners had good discrimination when Tone2 and Tone4 were embedded in strings of Tone1, while poor discrimination when Tone1 was inserted in the context of Tone2 or Tone4. These asymmetries in tone perception might be attributed to the interference of native intonation system and can be altered by training.

PMID: 26206301 [PubMed - indexed for MEDLINE]

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Mortality in people with intellectual disabilities in England.

Mortality in people with intellectual disabilities in England.

J Intellect Disabil Res. 2016 Aug 2;

Authors: Glover G, Williams R, Heslop P, Oyinola J, Grey J

Abstract
BACKGROUND: People with intellectual disabilities (IDs) die at younger ages than the general population, but nationally representative and internationally comparable mortality data about people with ID, quantifying the extent and pattern of the excess, have not previously been reported for England.
METHOD: We used data from the Clinical Practice Research Datalink database for April 2010 to March 2014 (CPRD GOLD September 2015). This source covered several hundred participating general practices comprising roughly 5% of the population of England in the period studied. General practitioner (GP) records identified people diagnosed by their GP as having ID. Linked national death certification data allowed us to derive corresponding mortality data for people with and without ID, overall and by cause.
RESULTS: Mortality rates for people with ID were significantly higher than for those without. Their all-cause standardised mortality ratio was 3.18. Their life expectancy at birth was 19.7 years lower than for people without ID. Circulatory and respiratory diseases and neoplasms were the three most common causes of death for them. Cerebrovascular disease, thrombophlebitis and pulmonary embolism all had standardised mortality ratios greater than 3 in people with ID. This has not been described before. Other potentially avoidable causes included epilepsy (3.9% of deaths), aspiration pneumonitis (3.6%) and colorectal cancer (2.4%). Avoidable mortality analysis showed a higher proportion of deaths from causes classified as amenable to good medical care but a lower proportion from preventable causes compared with people without ID. International comparison to areas for which data have been published in sufficient detail for calculation of directly standardised rates suggest England may have higher death rates for people with ID than areas in Canada and Finland, and lower death rates than Ireland or the State of Massachusetts in the USA.
CONCLUSIONS: National data about mortality in people with ID provides a basis for public health interventions. Linked data using GP records to identify people with ID could provide comprehensive population-based monitoring in England, unbiased by the circumstances of illnesses or death; to date information governance constraints have prevented this. However, GPs in England currently identify only around 0.5% of the population as having ID, suggesting that individuals with mild, non-syndromic ID are largely missed. Notably common causes of death suggest control of cardiovascular risk factors, epilepsy and dysphagia, management of thrombotic risks and colorectal screening are important areas for health promotion initiatives.

PMID: 27489075 [PubMed - as supplied by publisher]

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Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review.

Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review.

Dysphagia. 2016 Aug 4;

Authors: Alali D, Ballard K, Bogaardt H

Abstract
Dysphagia or swallowing difficulties have been reported to be a concern in adults with multiple sclerosis (MS). This problem can result in several complications including aspiration pneumonia, reduced quality of life and an increase in mortality rate. No previous systematic reviews on treatment effects for dysphagia in MS have been published. The main objective of this study is to summarise and qualitatively analyse published studies on treatment effects for dysphagia in MS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied to conduct a systematic search of seven databases, using relevant key words, and subsequent analysis of the identified studies. The studies were required to meet all three inclusion criteria of including a statement on intention to treat, or measure the effects of treatment for dysphagia in adults with MS and data on treatment outcomes for at least one adult diagnosed with MS. Retained studies were evaluated by two independent reviewers using a critical appraisal tool. This study has not been registered. A total of 563 studies were identified from the database searches. After screening and assessment of full articles for eligibility, five studies were included in the review. Three examined electrical stimulation and two examined the use of botulinum toxin. One study testing electrical stimulation was a randomised controlled trial, two were well-designed case series and two were case series lacking experimental control. All studies reported some positive effects on dysphagia; however, treatments that involved the use of electrical stimulation showed larger effect sizes. There is a paucity of evidence to guide treatment of dysphagia in MS, with only electrical stimulation and botulinum toxin treatment represented in the literature search conducted here. While both treatments show initial promise for reducing the swallowing impairment, they require further research using well-controlled experimental designs to determine their clinical applicability and long-term treatment effects for dysphagia across different types and severity of MS.

PMID: 27488370 [PubMed - as supplied by publisher]

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Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study.

Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study.

Food Nutr Res. 2016;60:30456

Authors: Hede GW, Faxén-Irving G, Olin AÖ, Ebbeskog B, Crisby M

Abstract
BACKGROUND: Oropharyngeal dysphagia is one of the major complications of stroke and a risk factor for malnutrition and prolonged in-hospital stay.
OBJECTIVE: The overall aim was to describe to what extent nutritional assessments (i.e. BMI kg/m(2), eating problem, and weight loss) were performed and documented in the records of older stroke patients treated with enteral nutrition by percutaneous endoscopic gastrostomy (PEG). A secondary aim was to identify documented post-procedural complications after PEG insertion during hospital stay.
DESIGN: The study is retrospective. Data were collected from records of 161 stroke patients ≥65 years, who received PEG, admitted to three stroke units during a 4-year period.
RESULTS: Mean age of the patients was 82.2 (±7) years, and 86% of the patients were ≥75 years old. On admission, body weight was documented in 50% of the patients and at discharge in 38% of the patients. BMI data were not documented at all at discharge in one of the units. Almost 80% of the patients fulfilled the European Network criteria for multimorbidity. Morbidity and multimorbidity correlated to the length of stay (p<0.0005). Complications were reported in 111 (69%) of the patient records. In 53 patients (33%) more than one complication was reported. A total of 116 pressure ulcers were reported and 30 patients had more than one pressure ulcer. The number of complications was related to weight loss (p=0.046) and BMI change (p=0.018).
CONCLUSIONS: Essential information of the patient's nutritional status was poorly recorded which could affect the patient's nutritional treatment during the hospital stay. This study indicates that implementation of guidelines in patients with stroke is needed. The high number of pressure ulcers was an unexpected finding.

PMID: 27487849 [PubMed]

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FOREIGN BODY IN THE NASOPHARYNX; MASQUERADING AS PHARYNGOTONSILLITIS.

FOREIGN BODY IN THE NASOPHARYNX; MASQUERADING AS PHARYNGOTONSILLITIS.

Niger J Med. 2015 Oct-Dec;24(4):380-3

Authors: Enyuma CO, Offiong M, Adekanye A, Akpan U, Ezeanyagu N, Uffiah O

Abstract
Foreign body (FB) in the aerodigestive tracts has been commonly reported but findings of impacted foreign bodies in the nasopharynx following inhalation/ingestion are very rare. Most of the FB gets lodged as a result of forceful vomiting, coughing,and digital manoeuvres for removal of FB in the oropharynx. Several objects have been identified lodged in the nasopharynx. No age group is spared although most victims are children under 10 years of age. Foreign bodies in the nasopharynx can be uneventful or potentially dangerous depending on type, size and location as it may cause sudden airway obstruction, or local pressure necrosis of alimentary or respiratory tract or both. Presentation in children is usually with a history of swallowed FB which may not be witnessed in children, choking, cough, bluish discolouration, breathlessness, drooling of saliva, halitosis, rhinorrhoea, snoring, stridor, dysphagia, vomiting and dysphonia. A foreign body in the nasopharynx is a challenge to patient, parents, the physician and the ENT surgeon, as it may be miss-diagnosed, in the index case, as Pharyngotonsilitis. The index patient, a 14 month child,was presented with a two days history of fever, drooling of saliva, mouth breathing, and digital manipulation. Lateral imaging of the post nasal space following initial treatment with antibiotics, aided the diagnosis of a periwinkle shell in the nasopharyngx that was removed during a nasopharyngoscopy under general anaesthesia without complication and subsequently discharged home. This emphasizes a high index of suspicion for FB in the nasopharynx in children with history of missing foreign body, digital manipulation, drooling of saliva and mouth breathing. Lateral X-ray of the postnasal space, neck, chest and abdomen should be the minimum investigation required.

PMID: 27487618 [PubMed - in process]

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A jackhammer in the gullet: high amplitude oesophageal contractions as a cause of atypical chest pain.

Related Articles

A jackhammer in the gullet: high amplitude oesophageal contractions as a cause of atypical chest pain.

BMJ Case Rep. 2015;2015

Authors: Goel R, Anggiansah A, Wong T, Wilkinson M

Abstract
Chest pain is a common cause for referral to emergency departments. A proportion of these patients have non-cardiac chest pains with normal investigations. Such patients should be considered for oesophageal studies as these may reveal an underlying dysmotility disorder. We report the case of a 51-year-old man who presented with chest pain and underwent oesophageal studies. He was diagnosed with acid reflux and high amplitude oesophageal contractions, otherwise known as a jackhammer oesophagus. Treatment was successful with omeprazole and glyceryl trinitrate relieving his symptoms.

PMID: 26438674 [PubMed - indexed for MEDLINE]

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GeneReviews(®)

GeneReviews(®)

Book. 1993

Authors: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Fong CT, Mefford HC, Smith RJH, Stephens K

Abstract
CLINICAL CHARACTERISTICS: Virtually all individuals with Woodhouse-Sakati syndrome (WSS) have the endocrine findings of hypogonadism (evident at puberty) and progressive childhood-onset hair thinning that often progresses to alopecia totalis in adulthood. More than half of individuals have the neurologic findings of progressive extrapyramidal movements (dystonic spasms with dystonic posturing with dysarthria and dysphagia), moderate bilateral post-lingual sensorineural hearing loss, and mild intellectual disability. To date 32 families (including 23 with a molecularly confirmed diagnosis) with a total of 76 affected individuals have been reported.
DIAGNOSIS/TESTING: The diagnosis is established in a proband with suggestive clinical findings and by identification of biallelic pathogenic variants in DCAF17 (formerly known as C2orf37) on molecular genetic testing.
MANAGEMENT: Treatment of manifestations: Treatment is symptomatic and should be managed by a multidisciplinary team. Hypogonadism requires hormone replacement therapy to induce secondary sex characteristics and promote bone health at the usual age of puberty. Alopecia is treated symptomatically for cosmetic reasons only. Treatment for dystonia is routine; oral medications are tried first and followed in some instances by botulinum toxin injection and/or deep-brain stimulation. Dysarthria often benefits from consultation with a speech therapist. Those with dysphagia often require measures to reduce oral secretions, use of thickened liquids and pureed foods to avoid aspiration, and eventually a gastrostomy to help maintain caloric intake. Hearing loss, intellectual disability, diabetes mellitus, and hypothyroidism are treated as per routine. Surveillance: Monitoring for endocrine abnormalities is recommended at the following ages: hypogonadism (12-14 years), diabetes mellitus (in the 20s or later), hypothyroidism (in the 20s or later). Neurologic manifestations should be monitored by a neurologist as well as experts in rehabilitative medicine, speech, and swallowing. Hearing should be monitored annually. Agents/circumstances to avoid: Persons with dystonia should avoid situations in which the risk of falling is increased. Evaluation of relatives at risk: Molecular genetic testing for the DCAF17 pathogenic variants identified in the proband is appropriate for evaluation of apparently asymptomatic older and younger sibs to identify, as early as possible, those who would benefit from early identification and treatment of potential complications.
GENETIC COUNSELING: WSS is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once the pathogenic DCAF17 variants have been identified in an affected family member, carrier testing for at-risk relatives, prenatal testing for a pregnancy at increased risk, and preimplantation genetic diagnosis are possible options.

PMID: 27489925

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Mortality in people with intellectual disabilities in England.

Mortality in people with intellectual disabilities in England.

J Intellect Disabil Res. 2016 Aug 2;

Authors: Glover G, Williams R, Heslop P, Oyinola J, Grey J

Abstract
BACKGROUND: People with intellectual disabilities (IDs) die at younger ages than the general population, but nationally representative and internationally comparable mortality data about people with ID, quantifying the extent and pattern of the excess, have not previously been reported for England.
METHOD: We used data from the Clinical Practice Research Datalink database for April 2010 to March 2014 (CPRD GOLD September 2015). This source covered several hundred participating general practices comprising roughly 5% of the population of England in the period studied. General practitioner (GP) records identified people diagnosed by their GP as having ID. Linked national death certification data allowed us to derive corresponding mortality data for people with and without ID, overall and by cause.
RESULTS: Mortality rates for people with ID were significantly higher than for those without. Their all-cause standardised mortality ratio was 3.18. Their life expectancy at birth was 19.7 years lower than for people without ID. Circulatory and respiratory diseases and neoplasms were the three most common causes of death for them. Cerebrovascular disease, thrombophlebitis and pulmonary embolism all had standardised mortality ratios greater than 3 in people with ID. This has not been described before. Other potentially avoidable causes included epilepsy (3.9% of deaths), aspiration pneumonitis (3.6%) and colorectal cancer (2.4%). Avoidable mortality analysis showed a higher proportion of deaths from causes classified as amenable to good medical care but a lower proportion from preventable causes compared with people without ID. International comparison to areas for which data have been published in sufficient detail for calculation of directly standardised rates suggest England may have higher death rates for people with ID than areas in Canada and Finland, and lower death rates than Ireland or the State of Massachusetts in the USA.
CONCLUSIONS: National data about mortality in people with ID provides a basis for public health interventions. Linked data using GP records to identify people with ID could provide comprehensive population-based monitoring in England, unbiased by the circumstances of illnesses or death; to date information governance constraints have prevented this. However, GPs in England currently identify only around 0.5% of the population as having ID, suggesting that individuals with mild, non-syndromic ID are largely missed. Notably common causes of death suggest control of cardiovascular risk factors, epilepsy and dysphagia, management of thrombotic risks and colorectal screening are important areas for health promotion initiatives.

PMID: 27489075 [PubMed - as supplied by publisher]

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Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review.

Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review.

Dysphagia. 2016 Aug 4;

Authors: Alali D, Ballard K, Bogaardt H

Abstract
Dysphagia or swallowing difficulties have been reported to be a concern in adults with multiple sclerosis (MS). This problem can result in several complications including aspiration pneumonia, reduced quality of life and an increase in mortality rate. No previous systematic reviews on treatment effects for dysphagia in MS have been published. The main objective of this study is to summarise and qualitatively analyse published studies on treatment effects for dysphagia in MS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied to conduct a systematic search of seven databases, using relevant key words, and subsequent analysis of the identified studies. The studies were required to meet all three inclusion criteria of including a statement on intention to treat, or measure the effects of treatment for dysphagia in adults with MS and data on treatment outcomes for at least one adult diagnosed with MS. Retained studies were evaluated by two independent reviewers using a critical appraisal tool. This study has not been registered. A total of 563 studies were identified from the database searches. After screening and assessment of full articles for eligibility, five studies were included in the review. Three examined electrical stimulation and two examined the use of botulinum toxin. One study testing electrical stimulation was a randomised controlled trial, two were well-designed case series and two were case series lacking experimental control. All studies reported some positive effects on dysphagia; however, treatments that involved the use of electrical stimulation showed larger effect sizes. There is a paucity of evidence to guide treatment of dysphagia in MS, with only electrical stimulation and botulinum toxin treatment represented in the literature search conducted here. While both treatments show initial promise for reducing the swallowing impairment, they require further research using well-controlled experimental designs to determine their clinical applicability and long-term treatment effects for dysphagia across different types and severity of MS.

PMID: 27488370 [PubMed - as supplied by publisher]

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Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study.

Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study.

Food Nutr Res. 2016;60:30456

Authors: Hede GW, Faxén-Irving G, Olin AÖ, Ebbeskog B, Crisby M

Abstract
BACKGROUND: Oropharyngeal dysphagia is one of the major complications of stroke and a risk factor for malnutrition and prolonged in-hospital stay.
OBJECTIVE: The overall aim was to describe to what extent nutritional assessments (i.e. BMI kg/m(2), eating problem, and weight loss) were performed and documented in the records of older stroke patients treated with enteral nutrition by percutaneous endoscopic gastrostomy (PEG). A secondary aim was to identify documented post-procedural complications after PEG insertion during hospital stay.
DESIGN: The study is retrospective. Data were collected from records of 161 stroke patients ≥65 years, who received PEG, admitted to three stroke units during a 4-year period.
RESULTS: Mean age of the patients was 82.2 (±7) years, and 86% of the patients were ≥75 years old. On admission, body weight was documented in 50% of the patients and at discharge in 38% of the patients. BMI data were not documented at all at discharge in one of the units. Almost 80% of the patients fulfilled the European Network criteria for multimorbidity. Morbidity and multimorbidity correlated to the length of stay (p<0.0005). Complications were reported in 111 (69%) of the patient records. In 53 patients (33%) more than one complication was reported. A total of 116 pressure ulcers were reported and 30 patients had more than one pressure ulcer. The number of complications was related to weight loss (p=0.046) and BMI change (p=0.018).
CONCLUSIONS: Essential information of the patient's nutritional status was poorly recorded which could affect the patient's nutritional treatment during the hospital stay. This study indicates that implementation of guidelines in patients with stroke is needed. The high number of pressure ulcers was an unexpected finding.

PMID: 27487849 [PubMed]

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FOREIGN BODY IN THE NASOPHARYNX; MASQUERADING AS PHARYNGOTONSILLITIS.

FOREIGN BODY IN THE NASOPHARYNX; MASQUERADING AS PHARYNGOTONSILLITIS.

Niger J Med. 2015 Oct-Dec;24(4):380-3

Authors: Enyuma CO, Offiong M, Adekanye A, Akpan U, Ezeanyagu N, Uffiah O

Abstract
Foreign body (FB) in the aerodigestive tracts has been commonly reported but findings of impacted foreign bodies in the nasopharynx following inhalation/ingestion are very rare. Most of the FB gets lodged as a result of forceful vomiting, coughing,and digital manoeuvres for removal of FB in the oropharynx. Several objects have been identified lodged in the nasopharynx. No age group is spared although most victims are children under 10 years of age. Foreign bodies in the nasopharynx can be uneventful or potentially dangerous depending on type, size and location as it may cause sudden airway obstruction, or local pressure necrosis of alimentary or respiratory tract or both. Presentation in children is usually with a history of swallowed FB which may not be witnessed in children, choking, cough, bluish discolouration, breathlessness, drooling of saliva, halitosis, rhinorrhoea, snoring, stridor, dysphagia, vomiting and dysphonia. A foreign body in the nasopharynx is a challenge to patient, parents, the physician and the ENT surgeon, as it may be miss-diagnosed, in the index case, as Pharyngotonsilitis. The index patient, a 14 month child,was presented with a two days history of fever, drooling of saliva, mouth breathing, and digital manipulation. Lateral imaging of the post nasal space following initial treatment with antibiotics, aided the diagnosis of a periwinkle shell in the nasopharyngx that was removed during a nasopharyngoscopy under general anaesthesia without complication and subsequently discharged home. This emphasizes a high index of suspicion for FB in the nasopharynx in children with history of missing foreign body, digital manipulation, drooling of saliva and mouth breathing. Lateral X-ray of the postnasal space, neck, chest and abdomen should be the minimum investigation required.

PMID: 27487618 [PubMed - in process]

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A jackhammer in the gullet: high amplitude oesophageal contractions as a cause of atypical chest pain.

Related Articles

A jackhammer in the gullet: high amplitude oesophageal contractions as a cause of atypical chest pain.

BMJ Case Rep. 2015;2015

Authors: Goel R, Anggiansah A, Wong T, Wilkinson M

Abstract
Chest pain is a common cause for referral to emergency departments. A proportion of these patients have non-cardiac chest pains with normal investigations. Such patients should be considered for oesophageal studies as these may reveal an underlying dysmotility disorder. We report the case of a 51-year-old man who presented with chest pain and underwent oesophageal studies. He was diagnosed with acid reflux and high amplitude oesophageal contractions, otherwise known as a jackhammer oesophagus. Treatment was successful with omeprazole and glyceryl trinitrate relieving his symptoms.

PMID: 26438674 [PubMed - indexed for MEDLINE]

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GeneReviews(®)

GeneReviews(®)

Book. 1993

Authors: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Fong CT, Mefford HC, Smith RJH, Stephens K

Abstract
CLINICAL CHARACTERISTICS: Virtually all individuals with Woodhouse-Sakati syndrome (WSS) have the endocrine findings of hypogonadism (evident at puberty) and progressive childhood-onset hair thinning that often progresses to alopecia totalis in adulthood. More than half of individuals have the neurologic findings of progressive extrapyramidal movements (dystonic spasms with dystonic posturing with dysarthria and dysphagia), moderate bilateral post-lingual sensorineural hearing loss, and mild intellectual disability. To date 32 families (including 23 with a molecularly confirmed diagnosis) with a total of 76 affected individuals have been reported.
DIAGNOSIS/TESTING: The diagnosis is established in a proband with suggestive clinical findings and by identification of biallelic pathogenic variants in DCAF17 (formerly known as C2orf37) on molecular genetic testing.
MANAGEMENT: Treatment of manifestations: Treatment is symptomatic and should be managed by a multidisciplinary team. Hypogonadism requires hormone replacement therapy to induce secondary sex characteristics and promote bone health at the usual age of puberty. Alopecia is treated symptomatically for cosmetic reasons only. Treatment for dystonia is routine; oral medications are tried first and followed in some instances by botulinum toxin injection and/or deep-brain stimulation. Dysarthria often benefits from consultation with a speech therapist. Those with dysphagia often require measures to reduce oral secretions, use of thickened liquids and pureed foods to avoid aspiration, and eventually a gastrostomy to help maintain caloric intake. Hearing loss, intellectual disability, diabetes mellitus, and hypothyroidism are treated as per routine. Surveillance: Monitoring for endocrine abnormalities is recommended at the following ages: hypogonadism (12-14 years), diabetes mellitus (in the 20s or later), hypothyroidism (in the 20s or later). Neurologic manifestations should be monitored by a neurologist as well as experts in rehabilitative medicine, speech, and swallowing. Hearing should be monitored annually. Agents/circumstances to avoid: Persons with dystonia should avoid situations in which the risk of falling is increased. Evaluation of relatives at risk: Molecular genetic testing for the DCAF17 pathogenic variants identified in the proband is appropriate for evaluation of apparently asymptomatic older and younger sibs to identify, as early as possible, those who would benefit from early identification and treatment of potential complications.
GENETIC COUNSELING: WSS is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once the pathogenic DCAF17 variants have been identified in an affected family member, carrier testing for at-risk relatives, prenatal testing for a pregnancy at increased risk, and preimplantation genetic diagnosis are possible options.

PMID: 27489925

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Endoscopy Dyspnea and Ulcerative Colitis.

Endoscopy Dyspnea and Ulcerative Colitis.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Papadopoulou D, Valsamidis K, Kamargiannis N

PMID: 27491054 [PubMed - as supplied by publisher]

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Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement.

Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Whittemore KR, Dornan BK, Dargie JM, Zhou G

Abstract
Importance: Obtaining hearing thresholds is an important step in the evaluation of a child with otitis media because decreased hearing in the presence of a chronic middle ear effusion factors into the decision to place tympanostomy tubes (TTs).
Objective: To provide evidence regarding appropriate use of perioperative hearing evaluations in conjunction with TTs.
Design, Setting, and Participants: Case series with medical record review of all patients aged 0 to 24 years who received TTs at a tertiary pediatric care facility from June 1, 2010, through June 1, 2011. Medical records were abstracted by 1 researcher for surgical, audiometric, tympanometric, clinical, and patient demographic data. The data analysis was performed between December 1, 2014, and June 1, 2015.
Main Outcomes and Measures: Audiometric data were examined to determine the number of patients with hearing loss preoperatively and postoperatively, with the intention to describe the population with no prior hypothesis regarding results.
Results: Of 2274 patients identified, 910 (40.0%) were female. Median (interquartile range) age at TT placement was 2.62 (1.48-4.94) years. A total of 1757 (77.3%) underwent audiometric evaluation preoperatively, 1742 (76.6%) postoperatively, and 1395 (61.3%) both preoperatively and postoperatively; 170 (7.5%) had no audiometric testing. Within 1 year after surgery, 271 (11.9%) of patients had evidence of nonfunctional tubes. Postoperatively, 19.9% (347 of the 1742 patients who received a postoperative evaluation) had hearing loss. In all, 89 (3.9%) patients had a permanent sensorineural hearing loss, and 15 (0.66%) had a persistent conductive hearing loss.
Conclusions and Relevance: A postoperative audiometric examination should be performed in children who have hearing loss when evaluated before TT placement to determine whether resolution of the hearing loss was obtained.

PMID: 27490425 [PubMed - as supplied by publisher]

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Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy.

Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Vasileiadis I, Karatzas T, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G

Abstract
Importance: Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection.
Objective: To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy.
Design, Setting, and Participants: This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece. Patients who had IONM during the procedure (n = 1481) were compared with patients who underwent surgery with nerve visualization alone (n = 1075). All patients underwent indirect laryngoscopy-fiberoptic nasopharyngoscopy both preoperatively and on day 2 after surgery to assess vocal cord motility.
Main Outcomes and Measures: Use of IONM and incidence of RLN injury.
Results: A total of 2556 patients (2028 women and 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) underwent total thyroidectomy. Univariate analysis showed that the use of IONM resulted in a significant reduction in RLN injury incidence (3.3% vs 0.7%) with a relative risk reduction of 2.6% (odds ratio [OR], 5.15; 95% CI, 3.12-8.49; number needed to treat, 19). Multivariate logistic regression showed that no use of IONM was an independent risk factor for RLN injury in patients who underwent total thyroidectomy (adjusted OR [AOR], 5.44; 95% CI, 3.26-9.09). Additional risk factors for RLN injury were operative time (AOR, 12.91; 95% CI, 6.66-25.06), maximum diameter greater than 45 mm of right thyroid lobe (AOR, 4.91; 95% CI, 3.12-8.56) and left thyroid lobe (AOR, 2.24; 95% CI, 1.39-4.32), extrathyroid extension (AOR, 3.26; 95% CI, 1.62-6.59), incidental parathyroidectomy (AOR, 3.30; 95% CI, 2.13-5.09), and tumor size larger than 10 mm (AOR, 3.24; 95% CI, 1.59-6.62).
Conclusions and Relevance: Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients.

PMID: 27490310 [PubMed - as supplied by publisher]

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Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Unsal O, Bozkurt G, Akpinar M, Akova P, Turk B, Coskun BU

Abstract
Importance: Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation.
Objectives: To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements.
Design, Setting, and Participants: This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images.
Main Outcomes and Measures: Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically.
Results: Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002).
Conclusions and Relevance: This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.

PMID: 27490193 [PubMed - as supplied by publisher]

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Destructive Otologic Foreign Body: Dangers of the Expanding Bead.

Destructive Otologic Foreign Body: Dangers of the Expanding Bead.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Sterling M, Mudd P

PMID: 27490040 [PubMed - as supplied by publisher]

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Eculizumab epitope on complement C5: Progress towards a better understanding of the mechanism of action

Publication date: September 2016
Source:Molecular Immunology, Volume 77
Author(s): Guillaume Brachet, Thomas Bourquard, Nathalie Gallay, Eric Reiter, Valérie Gouilleux-Gruart, Anne Poupon, Hervé Watier
Eculizumab is an anti-complement C5 monoclonal antibody which has greatly improved the prognosis and outcomes of nocturnal paroxysmal hemoglobinuria and atypical hemolytic and uremic syndromes. It is also known to be very species-specific for human C5, despite an important degree of conservation of the targeted macroglobulin domain, MG7, with that of other primates. However, the published eculizumab linear epitope does not explain this species specificity. Sequence analysis, in silico docking and reverse phase protein array were implemented to fully characterize the eculizumab epitope on human complement C5.Several residues potentially involved in the species specificity were identified outside the known epitope by sequence analysis. In silico docking confirmed the implication of a beta-hairpin located between residues 913 and 922, outside the known epitope, in the binding of eculizumab to C5. This beta-hairpin spreads from S913 to I922 and contains a tryptophan residue on position 917 which is unique to humans. The contribution of both this peptide and the already known one epitope, which spreads between residues C883 and S891, was validated by reverse phase protein assay, clearly demonstrating the discontinuous nature of the epitope. Two residues in particular, Arg885 and Trp917, were defined as major participants in the interaction of C5 and eculizumab. Their important role was confirmed by the recent publication of a crystal structure of eculizumab Fab bound to C5. The beta-hairpin not only explains the fine species specificity of eculizumab but is also an important site at the C5/C5 convertase interface, revealing how eculizumab acts as a competitor of C5 convertases.



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Endoscopy Dyspnea and Ulcerative Colitis.

Endoscopy Dyspnea and Ulcerative Colitis.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Papadopoulou D, Valsamidis K, Kamargiannis N

PMID: 27491054 [PubMed - as supplied by publisher]

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Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement.

Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Whittemore KR, Dornan BK, Dargie JM, Zhou G

Abstract
Importance: Obtaining hearing thresholds is an important step in the evaluation of a child with otitis media because decreased hearing in the presence of a chronic middle ear effusion factors into the decision to place tympanostomy tubes (TTs).
Objective: To provide evidence regarding appropriate use of perioperative hearing evaluations in conjunction with TTs.
Design, Setting, and Participants: Case series with medical record review of all patients aged 0 to 24 years who received TTs at a tertiary pediatric care facility from June 1, 2010, through June 1, 2011. Medical records were abstracted by 1 researcher for surgical, audiometric, tympanometric, clinical, and patient demographic data. The data analysis was performed between December 1, 2014, and June 1, 2015.
Main Outcomes and Measures: Audiometric data were examined to determine the number of patients with hearing loss preoperatively and postoperatively, with the intention to describe the population with no prior hypothesis regarding results.
Results: Of 2274 patients identified, 910 (40.0%) were female. Median (interquartile range) age at TT placement was 2.62 (1.48-4.94) years. A total of 1757 (77.3%) underwent audiometric evaluation preoperatively, 1742 (76.6%) postoperatively, and 1395 (61.3%) both preoperatively and postoperatively; 170 (7.5%) had no audiometric testing. Within 1 year after surgery, 271 (11.9%) of patients had evidence of nonfunctional tubes. Postoperatively, 19.9% (347 of the 1742 patients who received a postoperative evaluation) had hearing loss. In all, 89 (3.9%) patients had a permanent sensorineural hearing loss, and 15 (0.66%) had a persistent conductive hearing loss.
Conclusions and Relevance: A postoperative audiometric examination should be performed in children who have hearing loss when evaluated before TT placement to determine whether resolution of the hearing loss was obtained.

PMID: 27490425 [PubMed - as supplied by publisher]

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Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy.

Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Vasileiadis I, Karatzas T, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G

Abstract
Importance: Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection.
Objective: To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy.
Design, Setting, and Participants: This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece. Patients who had IONM during the procedure (n = 1481) were compared with patients who underwent surgery with nerve visualization alone (n = 1075). All patients underwent indirect laryngoscopy-fiberoptic nasopharyngoscopy both preoperatively and on day 2 after surgery to assess vocal cord motility.
Main Outcomes and Measures: Use of IONM and incidence of RLN injury.
Results: A total of 2556 patients (2028 women and 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) underwent total thyroidectomy. Univariate analysis showed that the use of IONM resulted in a significant reduction in RLN injury incidence (3.3% vs 0.7%) with a relative risk reduction of 2.6% (odds ratio [OR], 5.15; 95% CI, 3.12-8.49; number needed to treat, 19). Multivariate logistic regression showed that no use of IONM was an independent risk factor for RLN injury in patients who underwent total thyroidectomy (adjusted OR [AOR], 5.44; 95% CI, 3.26-9.09). Additional risk factors for RLN injury were operative time (AOR, 12.91; 95% CI, 6.66-25.06), maximum diameter greater than 45 mm of right thyroid lobe (AOR, 4.91; 95% CI, 3.12-8.56) and left thyroid lobe (AOR, 2.24; 95% CI, 1.39-4.32), extrathyroid extension (AOR, 3.26; 95% CI, 1.62-6.59), incidental parathyroidectomy (AOR, 3.30; 95% CI, 2.13-5.09), and tumor size larger than 10 mm (AOR, 3.24; 95% CI, 1.59-6.62).
Conclusions and Relevance: Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients.

PMID: 27490310 [PubMed - as supplied by publisher]

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Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Unsal O, Bozkurt G, Akpinar M, Akova P, Turk B, Coskun BU

Abstract
Importance: Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation.
Objectives: To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements.
Design, Setting, and Participants: This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images.
Main Outcomes and Measures: Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically.
Results: Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002).
Conclusions and Relevance: This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.

PMID: 27490193 [PubMed - as supplied by publisher]

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Destructive Otologic Foreign Body: Dangers of the Expanding Bead.

Destructive Otologic Foreign Body: Dangers of the Expanding Bead.

JAMA Otolaryngol Head Neck Surg. 2016 Aug 4;

Authors: Sterling M, Mudd P

PMID: 27490040 [PubMed - as supplied by publisher]

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Eculizumab epitope on complement C5: Progress towards a better understanding of the mechanism of action

Publication date: September 2016
Source:Molecular Immunology, Volume 77
Author(s): Guillaume Brachet, Thomas Bourquard, Nathalie Gallay, Eric Reiter, Valérie Gouilleux-Gruart, Anne Poupon, Hervé Watier
Eculizumab is an anti-complement C5 monoclonal antibody which has greatly improved the prognosis and outcomes of nocturnal paroxysmal hemoglobinuria and atypical hemolytic and uremic syndromes. It is also known to be very species-specific for human C5, despite an important degree of conservation of the targeted macroglobulin domain, MG7, with that of other primates. However, the published eculizumab linear epitope does not explain this species specificity. Sequence analysis, in silico docking and reverse phase protein array were implemented to fully characterize the eculizumab epitope on human complement C5.Several residues potentially involved in the species specificity were identified outside the known epitope by sequence analysis. In silico docking confirmed the implication of a beta-hairpin located between residues 913 and 922, outside the known epitope, in the binding of eculizumab to C5. This beta-hairpin spreads from S913 to I922 and contains a tryptophan residue on position 917 which is unique to humans. The contribution of both this peptide and the already known one epitope, which spreads between residues C883 and S891, was validated by reverse phase protein assay, clearly demonstrating the discontinuous nature of the epitope. Two residues in particular, Arg885 and Trp917, were defined as major participants in the interaction of C5 and eculizumab. Their important role was confirmed by the recent publication of a crystal structure of eculizumab Fab bound to C5. The beta-hairpin not only explains the fine species specificity of eculizumab but is also an important site at the C5/C5 convertase interface, revealing how eculizumab acts as a competitor of C5 convertases.



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Genetic determinants and post-orthodontic external apical root resorption in Czech children

Abstract

Objective

Genes, involved in the modulation of inflammatory response and bone remodeling, play a role in the development of post-orthodontic external apical root resorption (EARR). The aim of our study was to analyze possible associations between seven single nucleotide polymorphisms (SNPs) in interleukin-17A (IL-17), osteopontin (SPP1), purinoreceptor P2X7 (P2RX7) and tumor necrosis factor receptor superfamily member 11B (TNFRSF11B) genes and EARR in children after orthodontic treatment.

Subjects and Methods

This case-control study comprised 99 orthodontically treated patients (69 controls and 30 subjects with EARR). Genotype determinations of rs2275913, rs11730582, rs9138, rs208294, rs1718119, rs3102735 and rs2073618 were based on polymerase chain reaction using 5′nuclease TaqMan^® assays.

Results

While no significant differences were observed in allele or genotype frequencies of all seven studied SNPs, specific haplotype of P2RX7 (rs208294 and rs1718119) modified the risk of EARR development (P<0.05). In addition, the length of treatment with a fixed orthodontic appliance positively correlated with the presence of EARR (P<0.05).

Conclusions

Although the effect of individual SNPs studied on the EARR development was not confirmed in the Czech population, complex analysis suggested that variability in the P2RX7 gene and the length of orthodontic treatment may be important factors contributing to the etiopathogenesis of post-orthodontic EARR.

This article is protected by copyright. All rights reserved.

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Genetic determinants and post-orthodontic external apical root resorption in Czech children

Abstract

Objective

Genes, involved in the modulation of inflammatory response and bone remodeling, play a role in the development of post-orthodontic external apical root resorption (EARR). The aim of our study was to analyze possible associations between seven single nucleotide polymorphisms (SNPs) in interleukin-17A (IL-17), osteopontin (SPP1), purinoreceptor P2X7 (P2RX7) and tumor necrosis factor receptor superfamily member 11B (TNFRSF11B) genes and EARR in children after orthodontic treatment.

Subjects and Methods

This case-control study comprised 99 orthodontically treated patients (69 controls and 30 subjects with EARR). Genotype determinations of rs2275913, rs11730582, rs9138, rs208294, rs1718119, rs3102735 and rs2073618 were based on polymerase chain reaction using 5′nuclease TaqMan^® assays.

Results

While no significant differences were observed in allele or genotype frequencies of all seven studied SNPs, specific haplotype of P2RX7 (rs208294 and rs1718119) modified the risk of EARR development (P<0.05). In addition, the length of treatment with a fixed orthodontic appliance positively correlated with the presence of EARR (P<0.05).

Conclusions

Although the effect of individual SNPs studied on the EARR development was not confirmed in the Czech population, complex analysis suggested that variability in the P2RX7 gene and the length of orthodontic treatment may be important factors contributing to the etiopathogenesis of post-orthodontic EARR.

This article is protected by copyright. All rights reserved.

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Retrospective clinical study of ultrawide implants more than 6 mm in diameter

Abstract

Background

The prognosis of wide implants tends to be controversial. While wider implants were initially expected to result in a larger osseointegration area and have higher levels of primary stability, they were reported to have a relatively high rate of failure. The clinical outcome of ultrawide implants of more than 6 mm in diameter was evaluated through a retrospective study.

Methods

The investigation was conducted on patients who had received ultrawide implant (≥6 mm diameter) placements in Seoul National University Bundang Hospital from January 2008 to December 2013. Complications were investigated during the maintenance period, and marginal bone loss was measured using periapical radiography. Primary stability immediately after the implant placement and second stability after second surgery or during impression were measured using Osstell^® Mentor (Osstell, Sweden) as an implant stability quotient (ISQ).

Results

Fifty-eight implants were placed in 53 patients (30 male, 23 female), and they were observed for an average of 50.06 ± 23.49 months. The average ISQ value increased from 71.22 ± 10.26 to 77.48 ± 8.98 (P < 0.005). The primary and secondary stability shows significantly higher at the mandible than at the maxilla (P < 0.001). However, mean survival rate shows 98.28 %. Average marginal bone loss of 0.018 and 0.045 mm were measured at 12 and 24 months after the loading and 0.14 mm at final follow-up date (mean 46.25 months), respectively. Also in this study, the bone loss amount was noticeably small compared to regular implants reported in previous studies.

Conclusions

The excellent clinical outcome of ultrawide implants was confirmed. It was determined that an ultrawide implant can be used as an alternative when the bone quality in the posterior teeth is relatively low or when a previous implant has failed.

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The effect of 4-hexylresorcinol on xenograft degradation in a rat calvarial defect model

Abstract

Background

The objective of this study was to evaluate xenograft degradation velocity when treated with 4-hexylresorcinol (4HR).

Methods

The scapula of a cow was purchased from a local grocery, and discs (diameter 8 mm, thickness 1 mm) were prepared by trephine bur. Discs treated with 4HR were used as the experimental group. Untreated discs were used as the control. X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), antibacterial test, endotoxin test, and scanning electron microscopy (SEM) were performed on the discs. In vivo degradation was evaluated by the rat calvarial defect model.

Results

The XRD and FT-IR results demonstrated successful incorporation of 4HR into the bovine bone. The experimental disc showed antibacterial properties. The endotoxin test yielded results below the level of endotoxin contamination. In the SEM exam, the surface of the experimental group showed needle-shaped crystal and spreading of RAW264.7 cells. In the animal experiments, the amount of residual graft was significantly smaller in the experimental group compared to the control group (P = 0.003).

Conclusions

In this study, 4HR was successfully incorporated into bovine bone, and 4HR-incorporated bovine bone had antibacterial properties. In vivo experiments demonstrated that 4HR-incorporated bovine bone showed more rapid degradation than untreated bovine bone.

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Retrospective clinical study of ultrawide implants more than 6 mm in diameter

Abstract

Background

The prognosis of wide implants tends to be controversial. While wider implants were initially expected to result in a larger osseointegration area and have higher levels of primary stability, they were reported to have a relatively high rate of failure. The clinical outcome of ultrawide implants of more than 6 mm in diameter was evaluated through a retrospective study.

Methods

The investigation was conducted on patients who had received ultrawide implant (≥6 mm diameter) placements in Seoul National University Bundang Hospital from January 2008 to December 2013. Complications were investigated during the maintenance period, and marginal bone loss was measured using periapical radiography. Primary stability immediately after the implant placement and second stability after second surgery or during impression were measured using Osstell^® Mentor (Osstell, Sweden) as an implant stability quotient (ISQ).

Results

Fifty-eight implants were placed in 53 patients (30 male, 23 female), and they were observed for an average of 50.06 ± 23.49 months. The average ISQ value increased from 71.22 ± 10.26 to 77.48 ± 8.98 (P < 0.005). The primary and secondary stability shows significantly higher at the mandible than at the maxilla (P < 0.001). However, mean survival rate shows 98.28 %. Average marginal bone loss of 0.018 and 0.045 mm were measured at 12 and 24 months after the loading and 0.14 mm at final follow-up date (mean 46.25 months), respectively. Also in this study, the bone loss amount was noticeably small compared to regular implants reported in previous studies.

Conclusions

The excellent clinical outcome of ultrawide implants was confirmed. It was determined that an ultrawide implant can be used as an alternative when the bone quality in the posterior teeth is relatively low or when a previous implant has failed.

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The effect of 4-hexylresorcinol on xenograft degradation in a rat calvarial defect model

Abstract

Background

The objective of this study was to evaluate xenograft degradation velocity when treated with 4-hexylresorcinol (4HR).

Methods

The scapula of a cow was purchased from a local grocery, and discs (diameter 8 mm, thickness 1 mm) were prepared by trephine bur. Discs treated with 4HR were used as the experimental group. Untreated discs were used as the control. X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), antibacterial test, endotoxin test, and scanning electron microscopy (SEM) were performed on the discs. In vivo degradation was evaluated by the rat calvarial defect model.

Results

The XRD and FT-IR results demonstrated successful incorporation of 4HR into the bovine bone. The experimental disc showed antibacterial properties. The endotoxin test yielded results below the level of endotoxin contamination. In the SEM exam, the surface of the experimental group showed needle-shaped crystal and spreading of RAW264.7 cells. In the animal experiments, the amount of residual graft was significantly smaller in the experimental group compared to the control group (P = 0.003).

Conclusions

In this study, 4HR was successfully incorporated into bovine bone, and 4HR-incorporated bovine bone had antibacterial properties. In vivo experiments demonstrated that 4HR-incorporated bovine bone showed more rapid degradation than untreated bovine bone.

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Clinical relevance of the utilization of vital Lugol’s iodine staining in detection and diagnosis of oral cancer and dysplasia

Abstract

Objectives

The aim of this study is to assess the clinical relevance of the utilization of vital Lugol's iodine staining in detection of oral cancer and dysplastic lesions as well as demarcation of the extent of these lesions.

Materials and methods

A prospective, cross-sectional, hospital-based study was performed in Khartoum Teaching Dental Hospital, Sudan. Suspicious oral epithelial lesions indicating incisional biopsy were stained with 10 % Lugol's iodine solution and were clinically designated as "negative" for dysplasia or neoplasia when no unstained lesion (USL) area was observed, or as "positive" when a USL area is observed. Incisional biopsies involving both the unstained portion and the stained portion were obtained and histologically evaluated for definitive diagnosis.

Results

Forty-five biopsies were obtained from 28 patients. Histopathological examination of the specimens confirmed some degree of dysplasia or neoplasia in all clinically positive specimens with oral squamous cell carcinoma (OSCC) being the most common definitive diagnosis (17 patients, 60.7 %). Clinical relevance level of vital Lugol's iodine staining in detecting oral cancer and dysplasia was found to be 90.9 % (SE = 0.05, P = 0.05).

Conclusion

The findings of this study showed that Lugol's iodine is an easy, safe, and effective method of visualizing oral epithelial lesions and differentiating epithelial carcinoma and dysplasia from other benign mucosal lesions. Despite certain limitations, its use is of great value in detection and diagnosis of oral cancer and dysplasia.

Clinical relevance

Lugol's iodine staining can effectively be used in detection of the dysplastic and malignant superficial lesions of the oral epithelium.

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Clinical relevance of the utilization of vital Lugol’s iodine staining in detection and diagnosis of oral cancer and dysplasia

Abstract

Objectives

The aim of this study is to assess the clinical relevance of the utilization of vital Lugol's iodine staining in detection of oral cancer and dysplastic lesions as well as demarcation of the extent of these lesions.

Materials and methods

A prospective, cross-sectional, hospital-based study was performed in Khartoum Teaching Dental Hospital, Sudan. Suspicious oral epithelial lesions indicating incisional biopsy were stained with 10 % Lugol's iodine solution and were clinically designated as "negative" for dysplasia or neoplasia when no unstained lesion (USL) area was observed, or as "positive" when a USL area is observed. Incisional biopsies involving both the unstained portion and the stained portion were obtained and histologically evaluated for definitive diagnosis.

Results

Forty-five biopsies were obtained from 28 patients. Histopathological examination of the specimens confirmed some degree of dysplasia or neoplasia in all clinically positive specimens with oral squamous cell carcinoma (OSCC) being the most common definitive diagnosis (17 patients, 60.7 %). Clinical relevance level of vital Lugol's iodine staining in detecting oral cancer and dysplasia was found to be 90.9 % (SE = 0.05, P = 0.05).

Conclusion

The findings of this study showed that Lugol's iodine is an easy, safe, and effective method of visualizing oral epithelial lesions and differentiating epithelial carcinoma and dysplasia from other benign mucosal lesions. Despite certain limitations, its use is of great value in detection and diagnosis of oral cancer and dysplasia.

Clinical relevance

Lugol's iodine staining can effectively be used in detection of the dysplastic and malignant superficial lesions of the oral epithelium.

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Reflections on My Association with Henry G. Kunkel

Publication date: Available online 5 August 2016
Source:Clinical Immunology
Author(s): Shu Man Fu




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Prognosis of Good syndrome mortality and morbidity of thymoma associated immunodeficiency in perspective

Publication date: Available online 4 August 2016
Source:Clinical Immunology
Author(s): Anne Jansen, Marcel van Deuren, Joanne Miller, Jiri Litzman, Javier de Gracia, Matías Sáenz-Cuesta, Anna Szaflarska, Timi Martelius, Yuichi Takiguchi, Smita Patel, Siraj Misbah, Anna Simon
Good syndrome (GS) or thymoma-associated immunodeficiency, is a rare condition that has only been studied in retrospective case series. General consensus was that GS has a worse prognosis than other humoral immunodeficiencies. In this study, physicians of GS patients completed two questionnaires with a two year interval with data on 47 patients, 499 patient years in total. Results on epidemiology, disease characteristics, and outcome are presented. Mean age at diagnosis was 60years and median follow-up from onset of symptoms was 9years. There was a high frequency of respiratory tract infections due to encapsulated bacteria. Median survival was 14years. Survival was reduced compared to age-matched population controls (5-year survival: 82% versus 95%, p=0.008). In this cohort survival was not associated with gender (HR 0.9, 95% CI 0.3–3.0), autoimmune diseases (HR 2.9, 95% CI 0.8–10.1) or immunosuppressive use (HR 0.3, 95% CI: 0.1–1.2).



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The nucleoporin ALADIN regulates Aurora A localization to ensure robust mitotic spindle formation.

Related Articles

The nucleoporin ALADIN regulates Aurora A localization to ensure robust mitotic spindle formation.

Mol Biol Cell. 2015 Oct 1;26(19):3424-38

Authors: Carvalhal S, Ribeiro SA, Arocena M, Kasciukovic T, Temme A, Koehler K, Huebner A, Griffis ER

Abstract
The formation of the mitotic spindle is a complex process that requires massive cellular reorganization. Regulation by mitotic kinases controls this entire process. One of these mitotic controllers is Aurora A kinase, which is itself highly regulated. In this study, we show that the nuclear pore protein ALADIN is a novel spatial regulator of Aurora A. Without ALADIN, Aurora A spreads from centrosomes onto spindle microtubules, which affects the distribution of a subset of microtubule regulators and slows spindle assembly and chromosome alignment. ALADIN interacts with inactive Aurora A and is recruited to the spindle pole after Aurora A inhibition. Of interest, mutations in ALADIN cause triple A syndrome. We find that some of the mitotic phenotypes that we observe after ALADIN depletion also occur in cells from triple A syndrome patients, which raises the possibility that mitotic errors may underlie part of the etiology of this syndrome.

PMID: 26246606 [PubMed - indexed for MEDLINE]

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Different risk factor patterns for adult asthma, rhinitis and eczema: results from West Sweden Asthma Study

Atopic diseases including asthma, rhinitis and eczema have increased in the second half of the past century. This has been well studied among children and adolescents but with the exception of asthma to a muc...

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speech and language; +19 new citations

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

speech and language

These pubmed results were generated on 2016/08/04

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Preoperative Predictors in Chronic Suppurative Otitis Media for Ossicular Chain Discontinuity: A Cross-Sectional Study

Objective: Ossicular discontinuity may result from chronic suppurative otitis media and is usually detected intraoperatively. Our objective is to determine whether a preoperative audiogram can preoperatively predict the presence or absence of ossicular discontinuity. Methods: A cross-sectional study was prospectively run on our patients, aged 12-75 years, ultimately operated on for chronic suppurative otitis media. Preoperative audiograms were analyzed to measure frequency-specific air-bone gap (ABG) cutoff values. Intraoperatively, ossicular chain integrity was carefully checked. Logistic regression analysis was done to obtain a predictive model. Results: A total of 270 patients (306 ears) were included. Frequency-specific ABG cutoff values can predict ossicular discontinuity, namely: high ABGs at 1,000 Hz (>27.5 dB) and 2,000 Hz (>17.5 dB) are the most reliable variables associated with ossicular discontinuity. Conclusion: Preoperative audiograms can predict the presence of ossicular discontinuity in chronic suppurative otitis media. Large ABGs at both 1,000 and 2,000 Hz can predict ossicular discontinuity with a great degree of certainty.
Audiol Neurotol 2016;21:231-236

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Chronic Vomiting in Cats: Etiology and Diagnostic Testing.

Chronic Vomiting in Cats: Etiology and Diagnostic Testing.

J Am Anim Hosp Assoc. 2016 Aug 3;

Authors: Hauck SR, Gisselman K, Cordner A, Nicholson AG

Abstract
Chronic vomiting in cats is a common presenting problem seen in veterinary practice today. The initial step when presented with a vomiting patient is to differentiate between vomiting and regurgitation or dysphagia. There are numerous causes for chronic vomiting in cats, and therefore a detailed and comprehensive patient history and a systematic diagnostic approach are key steps in determining the cause for vomiting and the most appropriate treatment plan. Common causes for chronic vomiting in cats may include inflammatory bowel disease, food allergy, gastrointestinal motility disorders, neoplasia, and extra-gastrointestinal diseases, such as renal disease, hepatobiliary disease, and hyperthyroidism.

PMID: 27487349 [PubMed - as supplied by publisher]

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Spatiotemporal characteristics of the pharyngeal event-related potential in healthy subjects and older patients with oropharyngeal dysfunction.

Spatiotemporal characteristics of the pharyngeal event-related potential in healthy subjects and older patients with oropharyngeal dysfunction.

Neurogastroenterol Motil. 2016 Aug 2;

Authors: Rofes L, Ortega O, Vilardell N, Mundet L, Clavé P

Abstract
BACKGROUND: Oropharyngeal dysphagia (OD) is a highly prevalent symptom in older people. Appropriate oropharyngeal sensory feedback is essential for safe and efficient swallowing. However, pharyngeal sensitivity decreases with advancing age and could play a fundamental role in the physiopathology of swallowing dysfunction associated with aging. We aimed to characterize pharyngeal sensitivity and cortical response to a pharyngeal electrical stimulus in healthy volunteers (HV) and older patients with and without OD.
METHODS: Eight young HV, eight older HV without OD, and 14 older patients with OD were studied by electroencephalography through 32 scalp electrodes. Pharyngeal event-related potentials (ERP) were assessed following electrical stimulation of the pharynx. Sensory and tolerance thresholds to the electrical stimulus and latency, amplitude, and scalp current density of each ERP component were analyzed and compared. An ERP source localization study was also performed using the sLORETA software.
KEY RESULTS: Older participants (with and without OD) presented an increased sensory threshold to pharyngeal electrical stimulation (10.2 ± 1.7 mA and 11.5 ± 1.9 mA respectively), compared with young HV (6.0 ± 1.2 mA). The cortical activation of older HV in response to pharyngeal electrical stimulus was reduced compared with young HV (N2 amplitude: 0.22 ± 0.79 vs -3.10 ± 0.59, P<.05). Older patients with OD also presented disturbances to the pharyngo-cortical connection together with disrupted pattern of cortical activation.
CONCLUSIONS AND INFERENCES: Older people present a decline in pharyngeal sensory function, more severe in older patients with OD. This sensory impairment might be a critical pathophysiological element and a potential target for treatment of swallowing dysfunction in older patients.

PMID: 27485487 [PubMed - as supplied by publisher]

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Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy.

Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy.

Int J Radiat Oncol Biol Phys. 2016 Jun 15;

Authors: Goepfert RP, Lewin JS, Barrow MP, Gunn GB, Fuller CD, Beadle BM, Garden AS, Rosenthal DI, Kies MS, Papadimitrakopoulou V, Lai SY, Gross ND, Schwartz DL, Hutcheson KA

Abstract
PURPOSE: To characterize long-term MD Anderson Dysphagia Inventory (MDADI) results after primary intensity modulated radiation therapy (IMRT) for oropharyngeal carcinoma (OPC) among patients with "low-intermediate risk" OPC who would be eligible for current trials (eg, ECOG 3311, NRG HN002, CRUK PATHOS).
METHODS AND MATERIALS: A retrospective pooled analysis combined data from 3 single-institution clinical trials for advanced-stage head and neck carcinoma. Inclusion criteria were clinical stage III/IV OPC (T1-2/N1-2b, T3/N0-2b) treated with definitive split-field IMRT and prospectively collected MDADI at baseline and at least 1 posttreatment interval available in trial databases. Patients were sampled to represent likely human papillomavirus (HPV)-associated disease (HPV(+)/p16(+) or <10 pack-years if HPV/p16 unknown). The MDADI composite scores were collected at baseline and 6, 12, and 24 months after treatment. Pairwise tests were Bonferroni corrected for multiple comparisons.
RESULTS: Forty-six patients were included. All received bilateral neck irradiation with a median dose of 70 Gy and systemic therapy (57% concurrent, 43% induction only). Overall the mean baseline MDADI composite score was 90.1, dropping to 74.6 at 6 months (P<.0001) and rising to 78.5 (P<.0001) and 83.1 (P=.002) by 12 and 24 months relative to baseline, respectively, representing a clinically meaningful drop in MDADI scores at 6 months that partially recovers by 24 months (6 vs 24 months, P=.05). Poor MDADI scores (composite <60) were reported in 4%, 11%, 15%, and 9% of patients at baseline and 6, 12, and 24 months, respectively. Fifteen percent of patients had a persistently depressed composite score by at least 20 points at the 24-month interval.
CONCLUSION: "Low-intermediate risk" patients with OPC treated with laryngeal/esophageal inlet dose-optimized split-field IMRT are highly likely to report recovery of acceptable swallowing function in long-term follow-up. Only 15% report poor swallowing function and/or persistently depressed MDADI at 12 months or more after IMRT. These data serve as a benchmark future trial design and endpoint interpretation.

PMID: 27485284 [PubMed - as supplied by publisher]

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