A Hemorrhagic Clival Chordoma with a Long Progression-Free Survival.

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A Hemorrhagic Clival Chordoma with a Long Progression-Free Survival.

World Neurosurg. 2017 Sep;105:1042.e1-1042.e4

Authors: Vilela MD, Pedrosa HAS, Dias Filho MA

Abstract
BACKGROUND: Chordomas and ecchordosis physaliphora may on rare occasions present with intracranial hemorrhage. Their distinction usually relies on the results of the Ki-67 proliferative index, with a result lower than 1% favoring ecchordosis physaliphora. Intracranial hemorrhagic chordomas have been linked to unfavorable prognosis, due to acute neurologic deterioration and death, or progression after treatment. To the best of our knowledge, this is the first report of a patient with an intracranial hemorrhagic chordoma who had a long progression-free survival.
CASE DESCRIPTION: A 67-year-old woman presented with a large hemorrhagic clival tumor that was resected through an endonasal endoscopic approach. Physallipharous cells interspersed in a myxoid matrix, positivity for S-100, cytokeratin, and epithelial membrane antigen were found, along with an extremely low Ki-67 index. Imaging findings of bone erosion, a large size, and enhancement favored the diagnosis of chordoma. The patient received adjuvant stereotactic radiotherapy and has remained disease free after 4 years.
CONCLUSIONS: Although hemorrhagic intracranial chordomas have been linked to unfavorable outcomes, our case demonstrates that they may have a low proliferative index, and a long progression-free survival may be seen.

PMID: 28698083 [PubMed - indexed for MEDLINE]

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Delayed Retroclival and Cervical Spinal Subdural Hematoma Complicated by Preexisting Chiari Malformation in Adult Trauma Patient.

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Delayed Retroclival and Cervical Spinal Subdural Hematoma Complicated by Preexisting Chiari Malformation in Adult Trauma Patient.

World Neurosurg. 2017 Sep;105:1039.e1-1039.e5

Authors: Nguyen HS, Choi H, Kurpad S, Soliman H

Abstract
INTRODUCTION: Traumatic spinal subdural hematoma involving the retroclival region and upper cervical spine is a rare pathology. To our knowledge, there have only been 2 prior cases in an adult trauma patient. We describe a patient with preexisting Chiari 1 malformation, who recently sustained a unilateral type 1 occipital condyle fracture with associated disruption of the tectorial membrane and transverse ligament, which returned with a retroclival subdural hematoma extending down to C7, causing spinal cord compression and symptomatic obstructive hydrocephalus.
CASE PRESENTATION: A 30-year-old female sustained a motor vehicle collision. Computed tomography C spine revealed a type I occipital condyle fracture. Magnetic resonance imaging C spine demonstrated disruption of the tectorial membrane and avulsion of the transverse ligament at its attachment to the left C1 tubercle; moreover, there was a Chiari 1 malformation. The patient was neurologically intact. A halo was recommended, but the patient opted for an aspen collar with close management. She was discharged but returned 3 days later with apneic episodes, along with bradycardia and hypertension. She was promptly intubated. Computed tomography head showed interval ventricular enlargement. Magnetic resonance imaging C spine revealed a new ventral hematoma spanning the retroclival region to C7, most pronounced at C2-C3. On examination, she opened her eyes to pain, her pupils were equal and reactive, and she withdrew in all extremities. An external ventricular drain was emergently placed. She underwent a suboccipital craniectomy, C1-3 laminectomies, and occiput-C4 instrumented fusion. The dura was significantly tense, and no epidural hematoma was observed during lateral exploration. Postoperatively, she woke up well, exhibiting a nonfocal neurologic examination. A diagnostic angiogram was negative. She was extubated uneventfully, and the external ventricular drain was weaned off in 4 days.
CONCLUSION: Traumatic spinal subdural hematoma involving both the retroclival region and upper cervical spine can lead to bulbar signs and symptomatic obstructive hydrocephalus. There should be vigilance for this pathology in patients with high-energy craniocervical trauma. Disruption of the tectorial membrane and therapeutic anticoagulation may be risk factors. The clinical scenario can be complicated in the setting of a preexisting Chiari 1 malformation.

PMID: 28647656 [PubMed - indexed for MEDLINE]

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Chemo-selection with docetaxel, cisplatin and 5-fluorouracil (TPF) regimen followed by radiation therapy or surgery for pharyngeal and laryngeal carcinoma.

Chemo-selection with docetaxel, cisplatin and 5-fluorouracil (TPF) regimen followed by radiation therapy or surgery for pharyngeal and laryngeal carcinoma.

Jpn J Clin Oncol. 2017 Aug 18;:1-7

Authors: Matoba T, Ijichi K, Yanagi T, Kabaya K, Kawakita D, Beppu S, Torii J, Murakami S

Abstract
Background: Induction chemotherapy for patients with head and neck cancer is widely performed, and several advantages of induction chemotherapy have been reported. However, there is currently insufficient evidence to strongly recommend induction chemotherapy. In this study, we analyzed the outcomes for patients treated with induction chemotherapy and subsequent definitive treatments.
Methods: Operable patients with untreated oropharyngeal, hypopharyngeal and laryngeal squamous cell carcinoma treated with induction chemotherapy were included in this retrospective study. We conducted induction chemotherapy using docetaxel, cisplatin and 5-fluorouracil and performed subsequent surgical treatment or radiotherapy according to the response to induction chemotherapy.
Results: A total of 65 patients were included in this study, and 50 patients (76.9%) had Stage IV tumors. The response to induction chemotherapy was CR in two patients, PR in 55 patients, and SD in eight patients. The subsequent definitive treatment was radiotherapy in 60 patients, and surgery in five patients. The 3-year overall survival rates for patients who received radiotherapy and surgery were 88.4% and 75.0%, respectively (P = 0.30). The 3-year disease-free survival rates for patients who received radiotherapy and surgery were 68.0% and 0%, respectively (P = 0.01). The 3-year laryngeal dysfunction free survival rates for patients who received RT and surgery were 77.8% and 0%, respectively (P < 0.01).
Conclusions: We achieved favorable survival outcomes and high larynx preservation rates. Our results suggest that induction chemotherapy using TPF regimen is one of the optimal treatment strategies when treating head and neck cancers. Further prospective studies with a larger cohort are required to confirm our findings.

PMID: 28973501 [PubMed - as supplied by publisher]

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Minimal Important Difference in Voice Handicap Index-10.

Minimal Important Difference in Voice Handicap Index-10.

JAMA Otolaryngol Head Neck Surg. 2017 Sep 28;:

Authors: Misono S, Yueh B, Stockness AN, House ME, Marmor S

Abstract
Importance: The minimal important difference (MID) on patient-reported outcome measures can indicate how much of a change on that scale is meaningful.
Objective: To use an anchor-based approach to estimate MID in the Voice Handicap Index-10 (VHI-10) total score.
Design, Setting, and Participants: In this cohort study, a volunteer sample of adult patients visiting the voice clinic at the University of Minnesota from April 7, 2013, through July 3, 2016, completed the VHI-10 (range, 0-40, with higher scores indicating greater voice-related handicap) at baseline and 2 weeks later in conjunction with a global rating of change. An anchor-based approach was used to identify an MID. The association between the global change score and change in VHI-10 score was analyzed using Pearson rank correlation. A distribution-based method was used to corroborate the findings.
Main Outcome and Measures: Global rating of change on the VHI-10.
Results: Of the 273 participants, 183 (67.0%) were women and 90 (33.0%) were men (mean [SD] age, 54.3 [15.6] years); 259 (94.9%) were white. Participants had a variety of voice disorders, most commonly muscle tension dysphonia, irritable larynx, benign vocal fold lesions, and motion abnormalities. Among patients reporting no change on the global change score, the mean (SD) change in VHI-10 score was 1 (5). Among those reporting a small change, the mean (SD) change in VHI-10 was also 1 (5). Among those reporting a moderate change in voice symptoms, the mean (SD) change in VHI-10 score was 6 (8). Among those with a large change, the mean (SD) change in VHI-10 score was 9 (13). The correlation between the global change score and the change in VHI-10 score was 0.32 (95% CI, 0.12-0.49). Distribution-based analyses identified effect sizes comparable to those of the anchor-based categories.
Conclusions and Relevance: These findings suggest that a difference of 6 on the VHI-10 may represent an MID. This difference was associated with a moderate change on the global rating scale, and the small-change and no-change categories were indistinguishable. Given the lack of differentiation between small and no change and the modest correlation between the global change score and change in the VHI-10 score, additional studies are needed.

PMID: 28973078 [PubMed - as supplied by publisher]

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Hospital-Based Cancer Incidence in Nepal from 2010 to 2013.

Hospital-Based Cancer Incidence in Nepal from 2010 to 2013.

Nepal J Epidemiol. 2017 Mar;7(1):659-665

Authors: Poudel KK, Huang Z, Neupane PR, Steel R, Poudel JK

Abstract
BACKGROUND: Cancer is one of the leading causes of death throughout the world. Analyzing the incidence of cancer by site, sex and age is essential to detect the burden of cancer. Throughout the twelve hospital based cancer registries of Nepal, a total of 29,802 cancer cases with known age, were registered from January 1st 2010 to 2013 December 31st. The purpose of this retrospective study is to present the incidence of all cancer sites in both males and females for this period.
MATERIALS AND METHODS: This paper reviews data from all the hospital based cancer registries over a four-year period. This retrospective study has illustrated the number of cases, frequencies and crude incidence of all cancers by sex and site. For statistical analysis, SPSS (version 23.0) and Microsoft Excel 2010 were used.
RESULTS: Over the four-year period from January 1st 2010 to 2013 December 31st the major cancer in males was identified as follows: lung cancer (17.5%) followed by stomach cancer (7.6 %) and larynx cancer (5.4%). Among females, for the same four-year period, the three common cancers were identified as cervix (18.9 %) followed by breast (15.6 %) and lung (10.2%).
CONCLUSION: This retrospective study concluded that cancer is being increased by calendar years both in males and females however, the incidence of cancer is higher in females compared to males. .

PMID: 28970948 [PubMed]

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Modality-specific target definition for laryngeal and hypopharyngeal cancer on FDG-PET, CT and MRI.

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Modality-specific target definition for laryngeal and hypopharyngeal cancer on FDG-PET, CT and MRI.

Radiother Oncol. 2017 Apr;123(1):63-70

Authors: Ligtenberg H, Jager EA, Caldas-Magalhaes J, Schakel T, Pameijer FA, Kasperts N, Willems SM, Terhaard CH, Raaijmakers CP, Philippens ME

Abstract
BACKGROUND AND PURPOSE: The goal of this study was to improve target definition by deriving modality-specific margins for clinical target volumes (CTV) for laryngeal and hypopharyngeal cancer on CT, MRI and 18-FDG-PET.
MATERIAL AND METHODS: Twenty-five patients with T3/T4 laryngeal/hypopharyngeal cancer underwent CT, MRI and 18-FDG-PET scans before laryngectomy. HE-sections were obtained from the surgical specimen and tumor was delineated (tumorHE). The GTVs on CT and MRI were delineated in consensus. PET-based GTVs were automatically segmented. The three-dimensionally reconstructed specimen was registered to the various images. Modality-specific CTV margins were derived and added to the GTVs to achieve adequate tumor coverage. The resulting CTVs were compared with each other, to tumorHE, and to CTVCT10 constructed on CT with the clinical margin of 10mm.
RESULTS: CTV margins of 4.3mm (CT), 6.1mm (MRI) and 5.2mm (PET) were needed to achieve adequate tumor coverage. The median volumes of the resulting modality-specific CTVs were 44ml (CT), 48ml (MRI) and 39ml (PET), while the CTV10mm was 80ml.
CONCLUSION: For laryngohypopharyngeal tumors, 45-52% target volume reduction compared with CTV10mm is achievable when modality-specific CTV margins are used. PET-based CTVs were significantly smaller compared to CT- and MRI-based CTVs.

PMID: 28259450 [PubMed - indexed for MEDLINE]

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Consequences of maternal omega-3 polyunsaturated fatty acid supplementation on respiratory function in rat pups.

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Consequences of maternal omega-3 polyunsaturated fatty acid supplementation on respiratory function in rat pups.

J Physiol. 2017 Mar 01;595(5):1637-1655

Authors: Tenorio-Lopes L, Baldy C, Jochmans-Lemoine A, Mercier O, Pothier-Piccinin O, Seaborn T, Joseph V, Marc I, Kinkead R

Abstract
KEY POINTS: Incomplete development of the neural circuits that control breathing contributes to respiratory disorders in pre-term infants. Manifestations include respiratory instability, prolonged apnoeas and poor ventilatory responses to stimuli. Based on evidence suggesting that omega-3 polyunsaturated fatty acids (n-3 PUFA) improves brain development, we determined whether n-3 PUFA supplementation (via the maternal diet) improves respiratory function in 10-11-day-old rat pups. n-3 PUFA treatment prolonged apnoea duration but augmented the relative pulmonary surface area and the ventilatory response to hypoxia. During hypoxia, the drop in body temperature measured in treated pups was 1 °C less than in controls. n-3 PUFA treatment also reduced microglia cell density in the brainstem. Although heterogeneous, the results obtained in rat pups constitute a proof of concept that n-3 PUFA supplementation can have positive effects on neonatal respiration. This includes a more sustained hypoxic ventilatory response and a decreased respiratory inhibition during laryngeal chemoreflex.
ABSTRACT: Most pre-term infants present respiratory instabilities and apnoeas as a result of incomplete development of the neural circuits that control breathing. Because omega-3 polyunsaturated fatty acids (n-3 PUFA) benefit brain development, we hypothesized that n-3 PUFA supplementation (via the maternal diet) improves respiratory function in rat pups. Pups received n-3 PUFA supplementation from an enriched diet (13 g kg(-1) of n-3 PUFA) administered to the mother from birth until the experiments were performed (postnatal days 10-11). Controls received a standard diet (0.3 g kg(-1) of n-3 PUFA). Breathing was measured in intact pups at rest and during hypoxia (FiO2  = 0.12; 20 min) using whole body plethysmography. The duration of apnoeas induced by stimulating the laryngeal chemoreflex (LCR) was measured under anaesthesia. Lung morphology was compared between groups. Maternal n-3 PUFA supplementation effectively raised n-3 PUFA levels above control levels both in the blood and brainstem of pups. In intact, resting pups, n-3 PUFA increased the frequency and duration of apnoeas, especially in females. During hypoxia, n-3 PUFA supplemented pups hyperventilated 23% more than controls; their anapyrexic response was 1 °C less than controls. In anaesthetized pups, n-3 PUFA shortened the duration of LCR-induced apnoeas by 32%. The relative pulmonary surface area of n-3 PUFA supplemented pups was 12% higher than controls. Although n-3 PUFA supplementation augments apnoeas, there is no clear evidence of deleterious consequences on these pups. Based on the improved lung architecture and responses to respiratory challenges, this neonatal treatment appears to be beneficial to the offspring. However, further experiments are necessary to establish its overall safety.

PMID: 27861919 [PubMed - indexed for MEDLINE]

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Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients.

Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817735309

Authors: Goel AN, Badran KW, Braun APG, Garrett AM, Long JL

Abstract
Objective We sought to describe the patient, tumor, and survival characteristics of minor salivary gland carcinoma (MSGC) of the oropharynx using a large, population-based database. Study Design Cross-sectional analysis of the National Cancer Institute's SEER database (Surveillance, Epidemiology. and End Results). Subjects and Methods We reviewed the SEER database for all cases of MSGC of the oropharynx from 1988 to 2013. Relevant demographic, clinicopathologic, and survival variables were extracted and analyzed. Cox multivariate regression was performed to identify prognostic factors. Results We identified 1426 cases of MSGC of the oropharynx (mean age, 58 years; 51% female). The soft palate (39.2%) and base of tongue (38.6%) were the most commonly involved sites. The most common histologic subtypes were mucoepidermoid carcinoma (32.1%), adenocarcinoma (25.9%), and adenoid cystic carcinoma (23.3%). Five- and 10-year rates of disease-specific survival were 75.1% and 61.6%, respectively. Independent prognostic factors included tumor grade, T stage, N stage, and age >70 years. Conclusions This study represents the largest multivariate survival analysis of MSGC of the oropharynx to date. Independent prognosticators include tumor grade, T stage, N stage, and age.

PMID: 28971745 [PubMed - as supplied by publisher]

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Absence of Measles Virus Detection from Stapes of Patients with Otosclerosis.

Absence of Measles Virus Detection from Stapes of Patients with Otosclerosis.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817733674

Authors: Flores-García ML, Colín-Castro CA, Hernández-Palestina MS, Sánchez-Larios R, Franco-Cendejas R

Abstract
Objective To determine molecularly the presence of measles virus genetic material in the stapes of patients with otosclerosis. Study Design A cross-sectional study. Setting A tertiary referral hospital. Subjects and Methods Genetic material was extracted from the stapes of patients with otosclerosis (n = 93) during the period from March 2011 to April 2012. The presence of viral measles sequences was evaluated by the real-time reverse transcriptase polymerase chain reaction (RT-PCR). The expression of the CD46 gene was determined. Results Ninety-three patients were included in the study. No sample was positive for any of 3 measles virus genes (H, N, and F). Measles virus RNA was not detected in any sample by real-time RT-PCR. CD46 levels were positive in 3.3% (n = 3) and negative in 96.7% (n = 90). Conclusion This study does not support the theory of measles virus as the cause of otosclerosis. It is necessary to do more research about other causal theories to clarify its etiology and prevention.

PMID: 28971731 [PubMed - as supplied by publisher]

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Association between Sex, CD4 Cell Counts, Antiretroviral Medications, and Olfactory and Gustatory Functions of HIV-Infected Adults.

Association between Sex, CD4 Cell Counts, Antiretroviral Medications, and Olfactory and Gustatory Functions of HIV-Infected Adults.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817733664

Authors: Fasunla AJ, Nwankwo U, Adebayo AM, Nwaorgu OG

Abstract
Objective To investigate the olfactory and gustatory functions of human immunodeficiency virus (HIV)-infected adults in Ibadan, Nigeria. Study Design A cross-sectional study of olfactory and gustatory functions of HIV-infected adults between March 2015 and December 2015. Setting Tertiary health institution. Subjects and Methods A structured questionnaire was administered to participants to obtain relevant sociodemographic and clinical information. Participants' nadir and most recent CD4 cell count and viral loads were obtained from their medical records. Participants' body mass indices were determined, and each subjectively rated their olfactory and gustatory performances. Objective olfactory and gustatory functions were determined using validated "Sniffin' Sticks" and "Taste Strips" impregnated with 4 different concentrations of sucrose, quinine hydrochloride, sodium chloride, and citric acid. Results In total, 135 HIV-infected adults, comprising 41 (30.4%) men and 94 (69.6%) women, were evaluated. Their ages ranged from 20 to 70 years, mean 43.4 ± 10.4 years. Participants were on highly active antiretroviral therapy for a mean duration of 75.8 ± 36.9 months. The proportions of male participants in HIV stages 1, 2, and 3 were 18 (43.9%), 19 (46.3%), and 4 (9.8%), respectively, while female participants were 46 (48.9%), 41 (43.6%), and 7 (7.4%), respectively. Participants' mean olfactory threshold, discrimination, identification, and TDI scores were 8.0 ± 4.9, 9.9 ± 4.7, 8.8 ± 4.5, and 26.7 ± 11.1, respectively, while total taste score was 25.1 ± 5.7. Conclusion HIV-infected adults have tendency to develop hyposmia and hypogeusia. These are worse with advanced stage of HIV infection.

PMID: 28971730 [PubMed - as supplied by publisher]

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Training Otolaryngologists in Palliative Care Delivery: An Underutilized Opportunity.

Training Otolaryngologists in Palliative Care Delivery: An Underutilized Opportunity.

Otolaryngol Head Neck Surg. 2017 Sep 01;:194599817735314

Authors: Lu-Myers Y

Abstract
Palliative care is an underutilized and often misunderstood discipline in the treatment of patients with head and neck cancer. The key components of palliative care include symptoms management, psychosocial support, and enhanced communications. Abundant evidence has demonstrated the beneficial effect for the early incorporation of palliative care in the treatment paradigm for patients with chronic diseases and malignancies, with findings supporting its positive effect on patients' quality of life as well their survival. Particularly for otolaryngologists, the unique morbidities of head and neck cancer make our patients especially vulnerable and even more in need of the support and benefits that can come from palliative care. While increased consultation with palliative care providers for patients with head and neck cancer is a good first step, training otolaryngologists to develop their own "primary palliative care competencies" is key for improving our patients' outcomes.

PMID: 28971721 [PubMed - as supplied by publisher]

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Perceptual Implications of Level- and Frequency-Specific Deviations from Hearing Aid Prescription in Children.

Perceptual Implications of Level- and Frequency-Specific Deviations from Hearing Aid Prescription in Children.

J Am Acad Audiol. 2017 Oct;28(9):861-875

Authors: McCreery RW, Brennan M, Walker EA, Spratford M

Abstract
BACKGROUND: The purpose of providing amplification for children with hearing loss is to make speech audible across a range of frequencies and intensities. Children with hearing aids (HAs) that closely approximate prescriptive targets have better audibility than peers with HA output below prescriptive targets. Poor aided audibility puts children with hearing loss at risk for delays in communication, social, and academic development.
PURPOSE: The goals of this study were to determine how well HAs match prescriptive targets across ranges of frequency and intensity of speech and to determine how level- and frequency-dependent deviations from prescriptive target affect speech recognition in quiet and in background noise.
STUDY SAMPLE: One-hundred sixty-six children with permanent mild to severe hearing loss who were between 6 months and 8 years of age and who wore HAs participated in the study.
DATA COLLECTION AND ANALYSIS: Hearing aid verification and speech recognition data were collected as part of a longitudinal study of communication development in children with HAs. Hearing aid output at levels of soft and average speech and maximum power output were compared with each child's prescriptive targets. The deviations from prescriptive target were quantified based on the root-mean-square (RMS) error and absolute deviation from target for octave frequencies. Children were classified into groups based on the number of level-dependent deviations from prescriptive target. Frequency-specific deviations from prescriptive target and sensation levels (SLs) were used to estimate the proximity of fittings across the frequency range. Lexical Neighborhood Test (LNT) word recognition in quiet and Computer-Assisted Speech Perception Assessment (CASPA) phoneme recognition in noise were compared across level-dependent error groups and as a function of SL at 4 kHz.
RESULTS: Children who had deviations from prescriptive target at all three input levels had poorer LNT word recognition in quiet than children who had fittings that matched prescriptive target within 5 dB RMS at all three input levels. Children with lower 4 kHz SLs through their HAs had poorer LNT recognition in quiet and CASPA phoneme recognition in noise than children with higher aided SLs.
CONCLUSIONS: Children with HAs fitted to provide audibility for speech across a range of inputs and frequencies had better speech recognition outcomes than peers with HAs that were not optimally fitted to prescriptive targets.

PMID: 28972473 [PubMed - in process]

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Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions.

Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions.

J Am Acad Audiol. 2017 Oct;28(9):838-860

Authors: Keefe DH, Archer KL, Schmid KK, Fitzpatrick DF, Feeney MP, Hunter LL

Abstract
BACKGROUND: Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis.
PURPOSE: To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis.
RESEARCH DESIGN: A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group.
STUDY SAMPLE: The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female).
DATA COLLECTION AND ANALYSIS: Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears.
RESULTS: Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic.
CONCLUSIONS: Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.

PMID: 28972472 [PubMed - in process]

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Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss.

Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss.

J Am Acad Audiol. 2017 Oct;28(9):823-837

Authors: Brennan MA, Lewis D, McCreery R, Kopun J, Alexander JM

Abstract
BACKGROUND: Nonlinear frequency compression (NFC) can improve the audibility of high-frequency sounds by lowering them to a frequency where audibility is better; however, this lowering results in spectral distortion. Consequently, performance is a combination of the effects of increased access to high-frequency sounds and the detrimental effects of spectral distortion. Previous work has demonstrated positive benefits of NFC on speech recognition when NFC is set to improve audibility while minimizing distortion. However, the extent to which NFC impacts listening effort is not well understood, especially for children with sensorineural hearing loss (SNHL).
PURPOSE: To examine the impact of NFC on recognition and listening effort for speech in adults and children with SNHL.
RESEARCH DESIGN: Within-subject, quasi-experimental study. Participants listened to amplified nonsense words that were (1) frequency-lowered using NFC, (2) low-pass filtered at 5 kHz to simulate the restricted bandwidth (RBW) of conventional hearing aid processing, or (3) low-pass filtered at 10 kHz to simulate extended bandwidth (EBW) amplification.
STUDY SAMPLE: Fourteen children (8-16 yr) and 14 adults (19-65 yr) with mild-to-severe SNHL.
INTERVENTION: Participants listened to speech processed by a hearing aid simulator that amplified input signals to fit a prescriptive target fitting procedure.
DATA COLLECTION AND ANALYSIS: Participants were blinded to the type of processing. Participants' responses to each nonsense word were analyzed for accuracy and verbal-response time (VRT; listening effort). A multivariate analysis of variance and linear mixed model were used to determine the effect of hearing-aid signal processing on nonsense word recognition and VRT.
RESULTS: Both children and adults identified the nonsense words and initial consonants better with EBW and NFC than with RBW. The type of processing did not affect the identification of the vowels or final consonants. There was no effect of age on recognition of the nonsense words, initial consonants, medial vowels, or final consonants. VRT did not change significantly with the type of processing or age.
CONCLUSION: Both adults and children demonstrated improved speech recognition with access to the high-frequency sounds in speech. Listening effort as measured by VRT was not affected by access to high-frequency sounds.

PMID: 28972471 [PubMed - in process]

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Listener Performance with a Novel Hearing Aid Frequency Lowering Technique.

Listener Performance with a Novel Hearing Aid Frequency Lowering Technique.

J Am Acad Audiol. 2017 Oct;28(9):810-822

Authors: Kirby BJ, Kopun JG, Spratford M, Mollak CM, Brennan MA, McCreery RW

Abstract
BACKGROUND: Sloping hearing loss imposes limits on audibility for high-frequency sounds in many hearing aid users. Signal processing algorithms that shift high-frequency sounds to lower frequencies have been introduced in hearing aids to address this challenge by improving audibility of high-frequency sounds.
PURPOSE: This study examined speech perception performance, listening effort, and subjective sound quality ratings with conventional hearing aid processing and a new frequency-lowering signal processing strategy called frequency composition (FC) in adults and children.
RESEARCH DESIGN: Participants wore the study hearing aids in two signal processing conditions (conventional processing versus FC) at an initial laboratory visit and subsequently at home during two approximately six-week long trials, with the order of conditions counterbalanced across individuals in a double-blind paradigm.
STUDY SAMPLE: Children (N = 12, 7 females, mean age in years = 12.0, SD = 3.0) and adults (N = 12, 6 females, mean age in years = 56.2, SD = 17.6) with bilateral sensorineural hearing loss who were full-time hearing aid users.
DATA COLLECTION AND ANALYSES: Individual performance with each type of processing was assessed using speech perception tasks, a measure of listening effort, and subjective sound quality surveys at an initial visit. At the conclusion of each subsequent at-home trial, participants were retested in the laboratory. Linear mixed effects analyses were completed for each outcome measure with signal processing condition, age group, visit (prehome versus posthome trial), and measures of aided audibility as predictors.
RESULTS: Overall, there were few significant differences in speech perception, listening effort, or subjective sound quality between FC and conventional processing, effects of listener age, or longitudinal changes in performance. Listeners preferred FC to conventional processing on one of six subjective sound quality metrics. Better speech perception performance was consistently related to higher aided audibility.
CONCLUSIONS: These results indicate that when high-frequency speech sounds are made audible with conventional processing, speech recognition ability and listening effort are similar between conventional processing and FC. Despite the lack of benefit to speech perception, some listeners still preferred FC, suggesting that qualitative measures should be considered when evaluating candidacy for this signal processing strategy.

PMID: 28972470 [PubMed - in process]

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Relationship of Grammatical Context on Children's Recognition of s/z-Inflected Words.

Relationship of Grammatical Context on Children's Recognition of s/z-Inflected Words.

J Am Acad Audiol. 2017 Oct;28(9):799-809

Authors: Spratford M, McLean HH, McCreery R

Abstract
BACKGROUND: Access to aided high-frequency speech information is currently assessed behaviorally using recognition of plural monosyllabic words. Because of semantic and grammatical cues that support word+morpheme recognition in sentence materials, the contribution of high-frequency audibility to sentence recognition is less than that for isolated words. However, young children may not yet have the linguistic competence to take advantage of these cues. A low-predictability sentence recognition task that controls for language ability could be used to assess the impact of high-frequency audibility in a context that more closely represents how children learn language.
PURPOSE: To determine if differences exist in recognition of s/z-inflected monosyllabic words for children with normal hearing (CNH) and children who are hard of hearing (CHH) across stimuli context (presented in isolation versus embedded medially within a sentence that has low semantic and syntactic predictability) and varying levels of high-frequency audibility (4- and 8-kHz low-pass filtered for CNH and 8-kHz low-pass filtered for CHH).
RESEARCH DESIGN: A prospective, cross-sectional design was used to analyze word+morpheme recognition in noise for stimuli varying in grammatical context and high-frequency audibility. Low-predictability sentence stimuli were created so that the target word+morpheme could not be predicted by semantic or syntactic cues. Electroacoustic measures of aided access to high-frequency speech sounds were used to predict individual differences in recognition for CHH.
STUDY SAMPLE: Thirty-five children, aged 5-12 yrs, were recruited to participate in the study; 24 CNH and 11 CHH (bilateral mild to severe hearing loss) who wore hearing aids (HAs). All children were native speakers of English.
DATA COLLECTION AND ANALYSIS: Monosyllabic word+morpheme recognition was measured in isolated and sentence-embedded conditions at a +10 dB signal-to-noise ratio using steady state, speech-shaped noise. Real-ear probe microphone measures of HAs were obtained for CHH. To assess the effects of high-frequency audibility on word+morpheme recognition for CNH, a repeated-measures ANOVA was used with bandwidth (8 kHz, 4 kHz) and context (isolated, sentence embedded) as within-subjects factors. To compare recognition between CNH and CHH, a mixed-model ANOVA was completed with context (isolated, sentence-embedded) as a within-subjects factor and hearing status as a between-subjects factor. Bivariate correlations between word+morpheme recognition scores and electroacoustic measures of high-frequency audibility were used to assess which measures might be sensitive to differences in perception for CHH.
RESULTS: When high-frequency audibility was maximized, CNH and CHH had better word+morpheme recognition in the isolated condition compared with sentence-embedded. When high-frequency audibility was limited, CNH had better word+morpheme recognition in the sentence-embedded condition compared with the isolated condition. CHH whose HAs had greater high-frequency speech bandwidth, as measured by the maximum audible frequency, had better word+morpheme recognition in sentences.
CONCLUSIONS: High-frequency audibility supports word+morpheme recognition within low-predictability sentences for both CNH and CHH. Maximum audible frequency can be used to estimate word+morpheme recognition for CHH. Low-predictability sentences that do not contain semantic or grammatical context may be of clinical use in estimating children's use of high-frequency audibility in a manner that approximates how they learn language.

PMID: 28972469 [PubMed - in process]

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Effect of Stimulus Polarity on Physiological Spread of Excitation in Cochlear Implants.

Effect of Stimulus Polarity on Physiological Spread of Excitation in Cochlear Implants.

J Am Acad Audiol. 2017 Oct;28(9):786-798

Authors: Spitzer ER, Hughes ML

Abstract
BACKGROUND: Contemporary cochlear implants (CIs) use cathodic-leading, symmetrical, biphasic current pulses, despite a growing body of evidence that suggests anodic-leading pulses may be more effective at stimulating the auditory system. However, since much of this research on humans has used pseudomonophasic pulses or biphasic pulses with unusually long interphase gaps, the effects of stimulus polarity are unclear for clinically relevant (i.e., symmetric biphasic) stimuli.
PURPOSE: The purpose of this study was to examine the effects of stimulus polarity on basic characteristics of physiological spread-of-excitation (SOE) measures obtained with the electrically evoked compound action potential (ECAP) in CI recipients using clinically relevant stimuli.
RESEARCH DESIGN: Using a within-subjects (repeated measures) design, we examined the differences in mean amplitude, peak electrode location, area under the curve, and spatial separation between SOE curves obtained with anodic- and cathodic-leading symmetrical, biphasic pulses.
STUDY SAMPLE: Fifteen CI recipients (ages 13-77) participated in this study. All were users of Cochlear Ltd. devices.
DATA COLLECTION AND ANALYSIS: SOE functions were obtained using the standard forward-masking artifact reduction method. Probe electrodes were 5-18, and they were stimulated at an 8 (of 10) loudness rating ("loud"). Outcome measures (mean amplitude, peak electrode location, curve area, and spatial separation) for each polarity were compared within subjects.
RESULTS: Anodic-leading current pulses produced ECAPs with larger average amplitudes, greater curve area, and less spatial separation between SOE patterns compared with that for cathodic-leading pulses. There was no effect of polarity on peak electrode location.
CONCLUSIONS: These results indicate that for equal current levels, the anodic-leading polarity produces broader excitation patterns compared with cathodic-leading pulses, which reduces the spatial separation between functions. This result is likely due to preferential stimulation of the central axon. Further research is needed to determine whether SOE patterns obtained with anodic-leading pulses better predict pitch discrimination.

PMID: 28972468 [PubMed - in process]

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Effects of Device on Video Head Impulse Test (vHIT) Gain.

Effects of Device on Video Head Impulse Test (vHIT) Gain.

J Am Acad Audiol. 2017 Oct;28(9):778-785

Authors: Janky KL, Patterson JN, Shepard NT, Thomas MLA, Honaker JA

Abstract
BACKGROUND: Numerous video head impulse test (vHIT) devices are available commercially; however, gain is not calculated uniformly. An evaluation of these devices/algorithms in healthy controls and patients with vestibular loss is necessary for comparing and synthesizing work that utilizes different devices and gain calculations.
PURPOSE: Using three commercially available vHIT devices/algorithms, the purpose of the present study was to compare: (1) horizontal canal vHIT gain among devices/algorithms in normal control subjects; (2) the effects of age on vHIT gain for each device/algorithm in normal control subjects; and (3) the clinical performance of horizontal canal vHIT gain between devices/algorithms for differentiating normal versus abnormal vestibular function.
RESEARCH DESIGN: Prospective.
STUDY SAMPLE: Sixty-one normal control adult subjects (range 20-78) and eleven adults with unilateral or bilateral vestibular loss (range 32-79).
DATA COLLECTION AND ANALYSIS: vHIT was administered using three different devices/algorithms, randomized in order, for each subject on the same day: (1) Impulse (Otometrics, Schaumberg, IL; monocular eye recording, right eye only; using area under the curve gain), (2) EyeSeeCam (Interacoustics, Denmark; monocular eye recording, left eye only; using instantaneous gain), and (3) VisualEyes (MicroMedical, Chatham, IL, binocular eye recording; using position gain).
RESULTS: There was a significant mean difference in vHIT gain among devices/algorithms for both the normal control and vestibular loss groups. vHIT gain was significantly larger in the ipsilateral direction of the eye used to measure gain; however, in spite of the significant mean differences in vHIT gain among devices/algorithms and the significant directional bias, classification of "normal" versus "abnormal" gain is consistent across all compared devices/algorithms, with the exception of instantaneous gain at 40 msec. There was not an effect of age on vHIT gain up to 78 years regardless of the device/algorithm.
CONCLUSIONS: These findings support that vHIT gain is significantly different between devices/algorithms, suggesting that care should be taken when making direct comparisons of absolute gain values between devices/algorithms.

PMID: 28972467 [PubMed - in process]

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Boys Town National Research Hospital: Past, Present, and Future.

Boys Town National Research Hospital: Past, Present, and Future.

J Am Acad Audiol. 2017 Oct;28(9):776-777

Authors: Janky K, McCreery R, Jesteadt W

PMID: 28972466 [PubMed - in process]

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Dural Closure in Confined Spaces of the Skull Base with Nonpenetrating Titanium Clips.

Dural Closure in Confined Spaces of the Skull Base with Nonpenetrating Titanium Clips.

Oper Neurosurg (Hagerstown). 2017 Jul 25;:

Authors: Glenn CA, Baker CM, Burks JD, Conner AK, Smitherman AD, Sughrue ME

Abstract
BACKGROUND: Dural repair in areas with limited operative maneuverability has long been a challenge in skull base surgery. Without adequate dural closure, postoperative complications, including cerebrospinal fluid (CSF) leak and infection, can occur.
METHODS: We reviewed 53 consecutive surgical patients in whom a dural repair technique utilizing titanium microclips was performed from 2013 to 2016 at our institution. The repairs primarily involved difficult-to-reach dural defects in which primary suturing was difficult or impractical. A detailed surgical technique is described in 3 selected cases involving the anterior, middle, and posterior fossae, respectively. An additional 5 cases are provided in more limited detail to demonstrate clip artifact on postoperative imaging. Rates of postoperative CSF leak and other complications are reported.
RESULTS: The microclip technique was performed successfully in 53 patients. The most common pathology in this cohort was skull base meningioma (32/53). Additional surgical indications included traumatic dural lacerations (9/53), nonmeningioma tumors (8/53), and other pathologies (4/53). The clip artifact present on postoperative imaging was minor and did not interfere with imaging interpretation. CSF leak occurred postoperatively in 3 (6%) patients. No obvious complications attributable to microclip usage were encountered.
CONCLUSION: In our experience, intracranial dural closure with nonpenetrating, nonmagnetic titanium microclips is a feasible adjunct to traditional methods of dural repair.

PMID: 28973649 [PubMed - as supplied by publisher]

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A Simple Scoring System to Predict the Resectability of Skull Base Meningiomas via an Endoscopic Endonasal Approach.

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A Simple Scoring System to Predict the Resectability of Skull Base Meningiomas via an Endoscopic Endonasal Approach.

World Neurosurg. 2016 Jul;91:582-591.e1

Authors: Mascarella MA, Tewfik MA, Aldosari M, Sirhan D, Zeitouni A, Di Maio S

Abstract
OBJECTIVE: To identify clinico-radiologic factors associated with incomplete anterior cranial fossa (ACF) meningioma resection via an endoscopic endonasal approach.
METHOD: Patients undergoing endoscopic endonasal resection of an ACF meningioma were retrospectively accrued from two university-affiliated centers. Demographic profiles and radiologic findings, including tumor dimensions and morphology, anatomic location, and vascular involvement, were stratified according to the extent of resection.
RESULTS: Twenty-five patients were included in this study. Factors associated with incomplete surgical resection via an endonasal route were: presence of hyperostosis (P = 0.04), cavernous internal carotid artery involvement (P = 0.001), maximal dural tail length in the transverse plane (P = 0.006), and its ratio to the inter-fovea ethmoidalis distance (P = 0.01). Using a multiple regression analysis, only cavernous internal carotid artery involvement (P = 0.002) and a large dural tail length to inter-foveal distance ratio (P = 0.04) were significant predictors of incomplete resection (multiple correlation coefficient = 0.71). The combination of predictive factors to determine the likelihood of complete endoscopic resection produced a scoring system with a sensitivity and specificity of 85.7% (95% confidence interval [CI], 42.1-99.6] and 100% (95% CI, 81.5-100), respectively.
CONCLUSION: The use of a simple scoring system outlined in our study can facilitate proper patient selection for endoscopic endonasal resection of ACF meningiomas.

PMID: 27150643 [PubMed - indexed for MEDLINE]

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Polymorphous Low Grade Adenocarcinoma of the Parotid in a Teenager.

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Polymorphous Low Grade Adenocarcinoma of the Parotid in a Teenager.

Iran J Otorhinolaryngol. 2017 Sep;29(94):299-302

Authors: Khosla D, Verma S, Gupta N, Punia RS, Kaur G, Pandey AK, Dimri K

Abstract
INTRODUCTION: Polymorphous low grade adenocarcinoma (PLGA) is a rare salivary gland neoplasm with an indolent course. It occurs primarily in the minor salivary glands but can rarely occur in the major salivary glands. It usually occurs in the fifth to seventh decades of life with female preponderance.
CASE REPORT: A 16-year-old male presented with recurrent painless swelling in the right preauricular region and with a history of surgical intervention at the same site in the past. His histopathology report was suggestive of pleomorphic adenoma. The swelling recurred after one year of excision and a superficial parotidectomy was performed. The detailed histopathological examination was suggestive of Polymorphous low grade adenocarcinoma. In view of close margins, the patient was given adjuvant radiotherapy. Thirty-three months post-surgery, he is alive and disease-free. We describe a rare case of PLGA of the parotid gland in a teenager with its clinical characteristics, histopathological features, and treatment.
CONCLUSION: The occurrence of PLGA in the parotid gland is rare with only a few cases reported in literature. The diagnosis of PLGA is challenging due to morphological diversity.

PMID: 28955679 [PubMed]

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Axillary Lymph Node Metastasis in Medullary Thyroid Carcinoma: A Case Report.

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Axillary Lymph Node Metastasis in Medullary Thyroid Carcinoma: A Case Report.

Iran J Otorhinolaryngol. 2017 Sep;29(94):295-297

Authors: Rasihashemi SZ, Azhough R, Ramouz A

Abstract
INTRODUCTION: Medullary thyroid cancer (MTC) is an uncommon neoplasm originating from parafollicular C cells. Distant metastasis in MTC, such as axillary node involvement, is extremely rare.
CASE REPORT: The present study describes a known case of MTC with axillary lymph node metastasis in a 31-year-old woman. In 2010, she underwent total thyroidectomy and right-sided modified radical neck dissection. In May 2015, she was referred with a 3-month history of a mass in the left axilla. Fine needle aspiration cytology (FNAC) confirmed MTC in the axillary nodes. Left axillary lymph node dissection was performed and postoperative histopathology revealed metastatic medullary thyroid carcinoma in prepared specimens.
CONCLUSION: MTC with axillary lymph node metastasis is a rare condition which has been reported in previous studies to impair patient prognosis. However, in the current case, the patient had no other MTC-related complications subsequent to final lymphadenectomy.

PMID: 28955678 [PubMed]

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Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case.

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Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case.

Iran J Otorhinolaryngol. 2017 Sep;29(94):291-294

Authors: Farhangi H, Silanian Toosi M, Alamdaran SA, Bagheri S

Abstract
INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a rare malignancy in children. Nasal obstruction, otitis media with effusion, pain in the ear, hearing problems, and unusual neck mass are among the signs and symptoms of this malignancy.
CASE REPORT: We report the case of a 13-year-old girl with NPC who later developed acute lymphoblastic leukemia (ALL) through the course of her disease. To our knowledge, this is the first report of ALL following childhood nasopharyngeal carcinoma in the English-language literature.
CONCLUSION: Reports of secondary malignancies at the site of radiotherapy for NPC exist, but this is the first report of ALL following NPC.

PMID: 28955677 [PubMed]

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A Rare Cause of Intranasal Mass: Bilateral Ectopic Nasal Teeth.

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A Rare Cause of Intranasal Mass: Bilateral Ectopic Nasal Teeth.

Iran J Otorhinolaryngol. 2017 Sep;29(94):287-289

Authors: Koçak HE, Özdamar K, Bilgi B, Acıpayam H

Abstract
INTRODUCTION: Ectopic teeth occur in a wide variety of sites, including the maxillary sinus, mandibular condyle, coronoid process, orbital, and nasal cavities. Reported symptoms and signs associated with nasal teeth include facial pain, external nasal deformities, foul-smelling rhinorrhea, recurrent epistaxis, and oronasal fistula. Ectopic teeth occurring bilaterally in the nasal cavity is very very rare.
CASE REPORT: A bilateral intranasal ectopic teeth case, which is asymptomatic on the right side and symptomatic on the left side, is presented. The tooth on left side was extracted endoscopically. There were no complications.
CONCLUSION: Extraction of an intranasal tooth under endoscopic guidance is an adequate treatment. If the ectopic intranasal tooth is asymptomatic, clinicians should follow with clinical examination and radiological imaging.

PMID: 28955676 [PubMed]

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Pesticide Exposure and Head and Neck Cancers: A Case-Control Study in an Agricultural Region.

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Pesticide Exposure and Head and Neck Cancers: A Case-Control Study in an Agricultural Region.

Iran J Otorhinolaryngol. 2017 Sep;29(94):275-285

Authors: Amizadeh M, Safari-Kamalabadi M, Askari-Saryazdi G, Amizadeh M, Reihani-Kermani H

Abstract
INTRODUCTION: Causes of head and neck cancers (HNCs) are multifactorial, and few studies have investigated the association between chemical exposure and HNCs. The objective of this study was to investigate associations between HNCs, agricultural occupations, and pesticide exposure. The potential for the accumulation of pesticides in the adipose tissue of patients was also investigated.
MATERIALS AND METHODS: A structured questionnaire was used to collect information on demographics, occupation, and exposure to pesticides in a hospital-based case-control study. Pesticide residue in the adipose tissue of the neck in both cases and controls was also monitored via gas chromatography-mass spectroscopy.
RESULTS: Thirty-one HNC cases were included in this study as well as 32 gender-, age-, and smoking-matched controls. An agricultural occupation was associated with HNC (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.13-9.43) after controlling for age, sex, and smoking. Pesticide exposure was associated with total HNC cases (OR, 7.45; 95% CI, 1.78-3.07) and larynx cancer (OR, 9.33; 95% CI, 1.65-52.68). A dose-response pattern was observed for HNC cases (P=0.06) and larynx cancer (P=0.01). In tracing the pesticide residue, five chlorinated pesticides, namely dichlorodiphenyltrichloroethane (DDT), dichlorodipheny-ldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), dieldrin, and lindane, were identified in the adipose tissue. Chlorinated pesticide detection was significantly associated with HNC (OR, 3.91; 95% CI 0.9-0.16.9).
CONCLUSION: HNCs were found to be associated with pesticide exposure after controlling for confounders. A high education level was identified as a modifying factor decreasing the risk of HNCs. Further studies with larger number of subjects are recommended to assess these relationships in greater detail.

PMID: 28955675 [PubMed]

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Vestibulo-Ocular Reflex Abnormalities in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pilot Study.

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Vestibulo-Ocular Reflex Abnormalities in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pilot Study.

Iran J Otorhinolaryngol. 2017 Sep;29(94):269-274

Authors: Fallahnezhad T, Adel Ghahraman M, Farahani S, Hoseinabadi R, Jalaie S

Abstract
INTRODUCTION: Benign paroxysmal positional vertigo (BPPV), involving the semicircular canals, is one of the most common diseases of the inner ear. The video head impulse test (vHIT) is a new test that examines the function of the canals. This study aimed to investigate the vestibulo-ocular reflex (VOR) gain, gain asymmetry and saccades after stimulating all six canals in patients definitively diagnosed with posterior semicircular canal BPPV (PSC-BPPV).
MATERIALS AND METHODS: Twenty-nine unilateral PSC-BPPV patients with normal oculographic and caloric results were enrolled in this study. vHIT was performed on six canals, and VOR gain, gain asymmetry and saccades were measured.
RESULTS: Sixteen (55.17%) patients had abnormal posterior canal VOR gains in the ipsilesional ear. VOR gains in both horizontal canals were within normal limits. Superior canal VOR gains were mostly lower than normal and were not correlated to PSC abnormalities (P>0.05). No corrective saccades could be observed.
CONCLUSION: VOR gain in the direction of the posterior semicircular canal may be reduced in PSC-BPPV patients. Evaluation of PSC-VOR parameters could be beneficial, although superior canal measurements should be interpreted with caution.

PMID: 28955674 [PubMed]

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Therapeutic effect of Intra-Tympanic Dexamethasone-Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss.

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Therapeutic effect of Intra-Tympanic Dexamethasone-Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss.

Iran J Otorhinolaryngol. 2017 Sep;29(94):255-260

Authors: Rogha M, Kalkoo A

Abstract
INTRODUCTION: Hearing loss is fairly a common disorder which is usually treated with corticosteroids via systemic administration and/or intra-tympanic injection. This study aimed to compare the effectiveness of intra-tympanic injections of dexamethasone with its combination with hyaluronic acid in patients with sudden sensorineural hearing loss.
MATERIALS AND METHODS: In this clinical trial, 40 patients were randomly assigned to two groups; in the first group, 20 patients received 2.4 mg intra-tympanic dexamethasone, while in the second group patients received injections of 2.4 mg of dexamethasone plus 2 mg of hyaluronic acid in combination. Patients in both groups were injected every other day to a total of three injections. The hearing status of patients was evaluated by pure tone audiometry (bone conduction threshold) before and 2 weeks after the intervention.
RESULTS: Assessment of hearing threshold before and after treatment in the two groups showed a significant difference between hearing thresholds at frequencies of 4,000 to 8,000 Hz (P<0.001). The difference at other frequencies was not meaningful; however, in general, we found a better therapeutic effect in patients who received the combination of dexamethasone and hyaluronic acid.
CONCLUSION: A combination of dexamethasone and hyaluronic acid in patients with sudden sensorineural hearing loss may be more effective than dexamethasone alone. Because hyaluronic acid lacks certain side effects, and also makes it possible to reduce the steroid dose, we recommend the use of this combination in the treatment of patients with sudden sensorineural hearing loss.

PMID: 28955673 [PubMed]

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Treatment of Advanced Carcinoma of the Larynx and Hypopharynx with Laser Followed by External Radiotherapy.

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Treatment of Advanced Carcinoma of the Larynx and Hypopharynx with Laser Followed by External Radiotherapy.

Iran J Otorhinolaryngol. 2017 Sep;29(94):247-253

Authors: Varghese L, Mathew J, John S, Job A

Abstract
INTRODUCTION: Radical laryngeal surgeries for extensive laryngeal and hypopharyngeal tumors often require a permanent tracheostomy, which has an immense impact on the quality of life of patients. A minimally invasive technique such as transoral laser microresection (TLM) followed by radiotherapy can preserve the functions of the voice and swallowing. The aim of this study is to evaluate the role of laser debulking in the treatment of carcinoma of the larynx and hypopharynx, to evaluate the response of the tumor to subsequent radiotherapy, and also to assess the usefulness of laser in avoiding tracheostomy and functional preservation of the voice and swallowing.
MATERIALS AND METHODS: This prospective cohort study included patients with carcinoma of the larynx and hypopharynx unwilling to have definitive surgery and those medically unfit for radical surgery. The clinical profile of patients at presentation, tumor status following laser debulking, immediately after radiotherapy (RT), 6 weeks post RT, 3 months post RT, and at the end of study; short term complications associated with laser surgery; and usefulness of laser in avoiding tracheostomy and in functional preservation of the voice were evaluated.
RESULTS: There were 18 (90%) male patients and 2 (10%) female patients. Age ranged from 24 to 78 years with a mean age of 55. Hoarseness of voice was the most frequent presenting complaint (90%) followed by progressive dysphagia (45%), odynophagia (40%), otalgia (40%), and dyspnoea (25%). 11 (55%) patients had T3 tumors, while 6 (30%) were T2, and 3 (15%) were T4 lesions. 65% of patients were free of lymph node metastasis at presentation. 2 (10%) had N1 and 5 (25%) had N2 nodes. At presentation 10 (50%) patients had Stage III disease and 6 (30%) had stage IV disease. 13 patients (65%) had moderately differentiated squamous cell carcinoma. None of the risk factors and co-morbid illnesses showed any statistically significant difference among the tumor sites. Apart from the 2 (10%) patients who had residual disease, 2 (10%) patients developed a recurrent tumor in the course of their follow up. None had neck recurrence. Two patients underwent tracheostomy, before laser surgery, for compromised airway and both had recurrence of their tumor and continued to be on tracheostomy.
CONCLUSION: Laser debulking followed by radiotherapy is a viable alternative in the management of malignancies of the larynx and hypopharynx for those who refuse radical surgery and for those patients in whom radical open surgery is impractical due to physiological reasons such as advanced age and poor pulmonary reserve.

PMID: 28955672 [PubMed]

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Is Decline Rate of Intact Parathyroid Hormone Level a Reliable Criterion for Early Discharge of Patients after Total Thyroidectomy?

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Is Decline Rate of Intact Parathyroid Hormone Level a Reliable Criterion for Early Discharge of Patients after Total Thyroidectomy?

Iran J Otorhinolaryngol. 2017 Sep;29(94):239-246

Authors: Kolahdouzan M, Shahabi Shahmiri S, Hashemi SM, Keleidari B, Nazem M, Mohammadi Mofrad R

Abstract
INTRODUCTION: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. The current study aimed at evaluating the comparative predictive role of serum calcium and intact parathyroid hormone (iPTH) for post-thyroidectomy hypocalcemia.
MATERIALS AND METHODS: This prospective study was performed in 83 consecutive patients undergoing total thyroidectomy. Laboratory data such as serum calcium, vitamin D level, serum iPTH and serum phosphorus levels before surgery, postoperative calcium, and PTH levels measured after 1 and 6 hours and on the first postoperative day (1POD) were recorded.
RESULTS: Among the 83 patients, the mean (SD) age was 45.87 (12.57) years (range, 21-72 years); 70 (84.3%) patients were female. Final pathology was benign for 47 (56.6%) patients and malignant for 36 (43.4%) patients. In total, lymph node dissections were performed in 19 subjects (22.9%). On histological examination of the specimens, the parathyroid gland was found to have been removed inadvertently in 13 (15.7%) cases. In total, 35 (40.9%) patients developed hypocalcemia after thyroidectomy; receiver operating characteristic (ROC) analysis showed that a cut-off value of 15.39 pg/ml for iPTH, with a decline rate of 73% 1 hour after thyroidectomy is a significant predictor of hypocalcemia (area under the curve [AUC], 0.878; 95% confidence interval [CI], 0.79-0.96, P<0.0001) compared with calcium <8 mg/dl (2 mmol/L) with AUC=0.639; 95% CI, 0.51-0.76); P=0.067).
CONCLUSION: The current study showed that the decline rate in iPTH is a more reliable factor for hypocalcemia after total thyroidectomy than serum calcium. Patients with a decline rate <73% in iPTH could be discharged at 1POD without supplementation.

PMID: 28955671 [PubMed]

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Abnormal Cervical Vestibular-Evoked Myogenic Potentials Predict Evolution of Isolated Recurrent Vertigo into Meniere's Disease.

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Abnormal Cervical Vestibular-Evoked Myogenic Potentials Predict Evolution of Isolated Recurrent Vertigo into Meniere's Disease.

Front Neurol. 2017;8:463

Authors: Lee SU, Kim HJ, Choi JY, Koo JW, Kim JS

Abstract
INTRODUCTION: Vestibular-evoked myogenic potentials (VEMPs) can be abnormal in patients with idiopathic recurrent spontaneous vertigo. We aimed to determine whether abnormal cervical vestibular-evoked myogenic potentials (cVEMPs) can predict evolution of isolated recurrent vertigo into Meniere's disease (MD).
METHODS: We had followed up 146 patients with isolated recurrent vertigo and an evaluation of cVEMPs for 0-142 months [median = 6, interquartile range (IQR) = 0-29] at the Dizziness Clinic of Seoul National University Bundang Hospital from June 2003 to May 2014. We defined the variables associated with a progression into MD and calculated cumulative progression rates.
RESULTS: Among the 94 patients with recurrent vertigo and abnormal cVEMPs, 18 (18/94, 19%) showed an evolution into MD while only 2 of the 50 (4%) patients with normal cVEMPs evolved into MD during the follow-up (p = 0.01). The interval between onset of vertigo and development of cochlear symptoms ranged from 1 month to 13.6 years (median = 3 years, IQR = 0.5-4.5 years). Overall, pure tone audiometry (PTA) threshold at 0.25 kHz [hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 1.0-1.2] and abnormalities of cVEMPs (HR = 5.6, 95% CI = 1.3-25.5) were found to be significantly associated with a later conversion into MD. The cumulative progression rate was 12% (95% CI = 5-18) at 1 year, 18% (8-26) at 2 years, and 22% (11-32) at 3 years.
CONCLUSION: Abnormal cVEMPs may be an indicator for evolution of isolated recurrent vertigo into MD. Patients with isolated recurrent vertigo may be better managed conforming to MD when cVEMPs are abnormal.

PMID: 28928714 [PubMed]

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Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo.

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Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo.

Otol Neurotol. 2017 Mar;38(3):379-385

Authors: DʼSilva LJ, Staecker H, Lin J, Maddux C, Ferraro J, Dai H, Kluding PM

Abstract
OBJECTIVE: Vestibular dysfunction is a well-recognized complication of type 2 diabetes (DM) that may contribute to increased fall risk. The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with DM. The impact of DM on the otolith organs of the vestibular system in people with BPPV is unknown. The purpose of this study was to analyze otolith function using vestibular-evoked myogenic potential (VEMP) tests in people with DM and concurrent BPPV (BPPV + DM), and to examine the relationships between VEMP variables and diabetes-related variables.
STUDY DESIGN: Prospective, cross-sectional study.
SETTING: Tertiary academic medical center.
SUBJECTS AND METHODS: Participants 40 to 65 years were recruited in four groups: controls (n = 20), people with DM (n = 19), BPPV (n = 18), and BPPV + DM (n = 14). Saccule and utricle function were examined using cervical VEMP (cVEMP) and ocular VEMP (oVEMP), respectively. Diabetes-related variables such as HbA1c, duration of diabetes, and presence of sensory impairment due to diabetes were collected.
RESULTS: The frequency of abnormal cVEMP responses was higher in the DM (p = 0.005), BPPV (p = 0.003), and BPPV + DM (p <0.001) groups compared with controls. In the participants with diabetes, higher HbA1c levels were correlated with prolonged P1 (p = 0.03) and N1 latencies (p = 0.03). The frequency of abnormal oVEMP responses was not different between groups (p = 0.2).
CONCLUSION: Although BPPV and DM may independently affect utricle and saccule function, they do not seem to have a distinct cumulative effect.

PMID: 27930443 [PubMed - indexed for MEDLINE]

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Detection of Saccular Endolymphatic Hydrops in Ménière's Disease Using a Modified Glycerol cVEMP Test in Combination With the Tuning Property Test.

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Detection of Saccular Endolymphatic Hydrops in Ménière's Disease Using a Modified Glycerol cVEMP Test in Combination With the Tuning Property Test.

Otol Neurotol. 2016 Sep;37(8):1131-6

Authors: Murofushi T, Komiyama S, Suizu R

Abstract
OBJECTIVE: To determine the optimal method for detecting saccular endolymphatic hydrops (EH) in patients with Ménière's disease (MD) using a glycerol cervical vestibular evoked myogenic potential (cVEMP) test in combination with a tuning property test.
STUDY DESIGN: Prospective patients series.
SETTING: Tertiary referral center.
PATIENTS: Twenty-three subjects (age: 36-77 years) were enrolled in this study. Seventeen subjects were diagnosed with definite MD. Six subjects were diagnosed with possible MD.
INTERVENTION: Diagnostic.
MAIN OUTCOME MEASURE: The corrected amplitudes of p13-n23 (cVEMP) were measured before and after the administration of 10% glycerol (500 ml, 2 h, intravenously). A tuning property index and the p13-n23 amplitude improvement ratio were calculated.
RESULTS: The positivity rate (PR) during the tuning property test was 55% (definite MD-affected ears), 35% (definite MD-unaffected ears), and 25% (possible MD ears). The PR during the glycerol cVEMP amplitude test was 60, 8, and 0%, respectively. The use of modified criteria for the glycerol cVEMP test in combination with the tuning property test resulted in the PR increasing to 75, 57, and 25%, respectively. The pre-glycerol stage results obtained using the tuning property test almost (except in two ears) completely agreed with the glycerol cVEMP test results by the modified criteria.
CONCLUSION: The tuning property test is an easy and useful way of detecting saccular EH. However, the glycerol cVEMP test is required in patients that do not respond to either 500 or 1000 Hz short tone bursts (STB).

PMID: 27525625 [PubMed - indexed for MEDLINE]

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Secondary Endolymphatic Hydrops After Acoustic Trauma.

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Secondary Endolymphatic Hydrops After Acoustic Trauma.

Otol Neurotol. 2016 Jun;37(5):428-33

Authors: Chen YJ, Young YH

Abstract
OBJECTIVE: This study applied an inner ear test battery in patients with secondary hydrops after acoustic trauma to assess the inner ear deficits.
STUDY DESIGN: Retrospective study.
SETTING: University hospital.
METHODS: Twenty patients with secondary hydrops after acoustic trauma were assigned to Group A. The interval between noise exposure and the testing time varied from 1 month to 3 years (median 3 months). Another 20 patients without progressive hearing loss for at least 3 years after acoustic trauma were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and noise source. Before treatment, all patients received audiometry, and caloric, ocular vestibular-evoked myogenic potential (VEMP), and cervical VEMP (cVEMP) tests.
RESULTS: Percentages of abnormal mean hearing level (MHL), cVEMP test, oVEMP test, and caloric test were 75%, 75%, 61%, and 43% in Group A, and 35%, 57%, 61%, and 39% in Group B, respectively. Both groups exhibited a significantly declining sequence in inner ear function. Comparison of the abnormalities in the inner ear test battery between Groups A and B revealed a significant difference in percentages of abnormal MHL, but not in those of abnormal cVEMP, oVEMP, and caloric tests.
CONCLUSION: Secondary hydrops after acoustic trauma occurs mainly on the cochlear part, but less on the vestibular part probably because previous acoustic trauma, i.e., firearms have severely damaged the vestibular partition.

PMID: 27093028 [PubMed - indexed for MEDLINE]

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[Loudness optimized registration of compound action potential in cochlear implant recipients].

[Loudness optimized registration of compound action potential in cochlear implant recipients].

Laryngorhinootologie. 2017 Sep 22;:

Authors: Berger K, Hocke T, Hessel H

Abstract
Background Postoperative measurements of compound action potentials are not always possible due to the insufficient acceptance of the CI-recipients. This study investigated the impact of different parameters on the acceptance of the measurements. Methods Compound action potentials of 16 CI recipients were measured with different pulse-widths. Recipients performed a loudness rating at the potential thresholds with the different sequences. Results Compound action potentials obtained with higher pulse-widths were rated softer than those obtained with smaller pulse-widths. Conclusions Compound action potentials measured with higher pulse-widths generate a gap between loudest acceptable presentation level and potential threshold. This gap contributes to a higher acceptance of postoperative measurements.

PMID: 28938498 [PubMed - as supplied by publisher]

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[Hearing rehabilitation with cochlear implants and cognitive abilities].

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[Hearing rehabilitation with cochlear implants and cognitive abilities].

HNO. 2017 Sep 25;:

Authors: Knopke S, Olze H

Abstract
The relevance of assessing cognitive functioning is increasing against the background of the continuing demographic changes. Up to a few years ago the focus was on the effects of cochlear implantation in children born deaf in comparison to healthy individuals. Currently, the question arises whether hearing rehabilitation in the elderly, e.g. by postlingual cochlear implantation, has a protective effect on cognitive functioning and therefore on the risk of onset of dementia. This review describes the association of cognitive functioning with hearing disorders and cochlear implantation. Historical aspects of intelligence testing are illustrated. Knowledge on cognitive aspects in elderly persons with hearing disorders and cochlear implants is rare in the currently available literature. Initial findings indicate a positive correlation between hearing improvement and cognitive functioning. Further studies are urgently required in order to elucidate appropriate guidelines for the treatment of patients with cognitive deficits and hearing impairment.

PMID: 28948301 [PubMed - as supplied by publisher]

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[Preoperative determination of nerve of origin in patients with vestibular schwannoma. German version].

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[Preoperative determination of nerve of origin in patients with vestibular schwannoma. German version].

HNO. 2017 Sep 25;:

Authors: Rahne T, Plößl S, Plontke SK, Strauss C

Abstract
BACKGROUND: Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin.
METHODS: The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively.
RESULTS: The novel scoring system was applied to 5 consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery.
CONCLUSION: The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.

PMID: 28948300 [PubMed - as supplied by publisher]

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[Intraoperative parathyroid hormone measurement is the best predictor of postoperative symptomatic hypocalcemia].

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[Intraoperative parathyroid hormone measurement is the best predictor of postoperative symptomatic hypocalcemia].

HNO. 2017 Sep 25;:

Authors: Bähler S, Müller W, Linder T, Frotzler A, Fischli S, Aqtashi B, Elmas F, Nader A

Abstract
BACKGROUND: The goal of this study is to evaluate risk factors for transient postoperative hypocalcemia (HC) and to define cutoff values for perioperative parathyroid hormone (PTH) and calcium parameters (Ca) to reduce the morbidity of symptomatic HC.
MATERIALS AND METHODS: At our tertiary referral hospital (Luzerner Kantonsspital, Switzerland), a total of 353 patients underwent total thyroidectomy between 2006 and 2013 and were analyzed retrospectively in terms of HC risk. The serum values of calcium and PTH were measured at strictly defined time intervals, and patients' symptoms and the necessity of treatments were determined from patients' charts.
RESULTS: The prevalence of transient postoperative HC was 43%; however, only 10% of patients were symptomatic. Significant risk factors for serum and symptomatic HC were calcium values (pre-, intra-, 4 h and 1 d postoperative), PTH values (intraoperative, 4 h and 1 d postoperative), and PTH decline. Interestingly, preoperative PTH values, patient age, weight of the thyroid gland, diagnosis, and sex were not significant risk factors. In the ROC analysis ('receiver operating characteristics'), calcium measurement 4 h postoperatively showed the best predictive ability for detecting serum HC, whereas intraoperative PTH measurements were predictive for symptomatic HC.
CONCLUSION: Calcium and PTH values as well as PTH decline are significant risk factors for postoperative HC. Preoperatively, only calcium measurement is prognostically significant. Intraoperative PTH measurement is the most reasonable and sensitive factor for early recognition of temporary postoperative HC in the clinical setting.

PMID: 28948297 [PubMed - as supplied by publisher]

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The nasal cycle 122 years on - are we any wiser?

The nasal cycle 122 years on - are we any wiser?

J Laryngol Otol. 2017 Oct;131(10):845

Authors: Fishman J, Youngs R, Fisher E, Hussain M

PMID: 28967353 [PubMed - in process]

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Impact of pre-operative body mass index in head and neck cancer patients undergoing microvascular reconstruction.

Impact of pre-operative body mass index in head and neck cancer patients undergoing microvascular reconstruction.

J Laryngol Otol. 2017 Oct 02;:1-5

Authors: Hyun DJ, Joo YH, Kim MS

Abstract
OBJECTIVES: To analyse the relationship of pre-operative body mass index with surgical complications and oncological outcomes in patients undergoing microvascular reconstruction for head and neck squamous cell cancer.
METHOD: A retrospective review was conducted of 259 patients who underwent microvascular free flap reconstruction after head and neck ablative surgery.
RESULTS: Mean body mass index was 22.48 kg/m2. There were no correlations between body mass index and: flap failure (p = 0.739), flap ischaemia (p = 0.644), pharyngocutaneous fistula (p = 0.141) or wound infection (p = 0.224). The five-year disease-specific survival rate was 63 per cent. On univariate analysis, the five-year disease-specific survival rate was significantly correlated with pre-operative body mass index, based on Kaplan-Meier survival curves (p = 0.028). The five-year disease-specific survival rates in underweight, normal weight, overweight and obese groups were 47 per cent, 55 per cent, 65 per cent and 80 per cent, respectively.
CONCLUSION: Pre-operative body mass index was a useful predictor for recurrence and survival in patients who underwent microvascular reconstruction for head and neck squamous cell cancer.

PMID: 28967346 [PubMed - as supplied by publisher]

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Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

J Voice. 2017 Sep 26;:

Authors: Kaneko M, Hitomi T, Takekawa T, Tsuji T, Kishimoto Y, Hirano S

Abstract
OBJECTIVES: Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG).
METHODS: Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed.
RESULTS: After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases.
CONCLUSIONS: This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality.

PMID: 28967588 [PubMed - as supplied by publisher]

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Word-initial rhotics in Slovenian 4-year-olds with typical versus protracted phonological development.

Word-initial rhotics in Slovenian 4-year-olds with typical versus protracted phonological development.

Clin Linguist Phon. 2017 Oct 02;:1-21

Authors: Ozbič M, Kogovšek D, Stemberger JP, Bernhardt BM, Muznik M, Novšak Brce J

Abstract
This paper describes word-initial (WI) rhotic cluster development in Slovenian 4-year-olds. Data for /l/ and WI singleton /r/ serve as comparisons. Participants were 19 children with typical development (TD) and 13 with more protracted phonological development (PPD). A single-word list included 15 WI /r/-clusters, 9 /l/-clusters and 3 singleton /r/s and /l/s each. Results showed significantly higher match (accuracy) levels for rhotics in the TD group. Among rhotic clusters, TD children showed highest match levels for labial clusters, and the PPD group, for /dr/. Match levels did not differ significantly between singletons and clusters or targets in stressed versus unstressed syllables. Substitutions were more frequent than deletions, and children with PPD had more frequent and varied mismatch patterns; for the PPD group, [l] was the most frequent substitution for /r/ and for the TD group, other rhotics. The study provides additional criterion reference data on Slovenian phonological development.

PMID: 28968145 [PubMed - as supplied by publisher]

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Word-initial rhotic clusters in typically developing children: European Portuguese.

Word-initial rhotic clusters in typically developing children: European Portuguese.

Clin Linguist Phon. 2017 Oct 02;:1-22

Authors: Ramalho AM, Freitas MJ

Abstract
Rhotic clusters are complex structures segmentally and prosodically and are frequently one of the last structures acquired by Portuguese-speaking children. This paper describes cross-sectional data for word-initial (WI) rhotic tap clusters in typically developing 3-4- and 5-year-olds in Portugal. Additional information is provided on WI /l/ as a singleton and in clusters. A native speaker audio-recorded and transcribed single words in a story-telling task. Results for WI rhotic clusters show an age effect consistent with previous research on European Portuguese. Singleton /l/ was in advance of /l/-clusters as expected, but the tap clusters were in advance of the /l/-clusters, possibly reflecting the velarized characteristics of the lateral. The prosodic variables word stress and word length were relevant for the WI rhotic clusters: shorter words and stressed syllables showed higher accuracy. Finally, mismatches ('errors') mainly reflected negative structural constraints (deletion of C2 and epenthesis) rather than segmental constraints (substitutions).

PMID: 28968136 [PubMed - as supplied by publisher]

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Multiple primary squamous cell carcinomas of the lower lip and tongue arising in discoid lupus erythematosus: a case report.

Multiple primary squamous cell carcinomas of the lower lip and tongue arising in discoid lupus erythematosus: a case report.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 30;:

Authors: Arvanitidou IE, Nikitakis NG, Georgaki M, Papadogeorgakis N, Tzioufas A, Sklavounou A

Abstract
Squamous cell carcinoma (SCC) developing in lesions of discoid lupus erythematosus (DLE) is rare, most frequently arising on sun-exposed skin and very rarely affecting the lips. A review of the English language literature revealed only 21 published cases of labial SCC in patients with DLE. Here, an unusual case of a patient with DLE who developed 3 primary SCCs of the oral and perioral region is presented. A 40-year-old female with a 24-year history of DLE with peri- and intraoral involvement initially developed SCC of the vermillion border of the right lower lip; the lesion was surgically removed and did not recur within 6 months. In spite of strong recommendation for regular follow-up, the patient failed to keep her appointments but returned 7 years later. No signs of recurrence of the original lower lip cancer were noticed, but a new SCC of the left lateral border of the tongue with cervical lymph node metastasis was diagnosed; despite aggressive combined treatment, locoregional recurrence and distant metastatic disease developed within a few months; in addition, a new primary SCC of the vermillion border of the left lower lip developed. This rare case and a thorough review of the pertinent literature underscore the possibility of development of even multiple intraoral and perioral SCCs in the context of longstanding DLE, which necessitates close long term follow-up for early diagnosis and management.

PMID: 28967499 [PubMed - as supplied by publisher]

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Erratum to "Efficacy of intralesional betamethasone for erosive oral lichen planus and evaluation of recurrence: a randomized, controlled trial [Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:584-590].

Related Articles

Erratum to "Efficacy of intralesional betamethasone for erosive oral lichen planus and evaluation of recurrence: a randomized, controlled trial [Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:584-590].

Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 May;117(5):655

Authors: Liu C, Xie B, Yang Y, Lin D, Wang C, Lin M, Ge L, Zhou H

PMID: 28964380 [PubMed]

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Highlights from the Current Issue: October 2017.

Highlights from the Current Issue: October 2017.

Otolaryngol Head Neck Surg. 2017 Oct;157(4):541-542

Authors: Krouse JH

PMID: 28967341 [PubMed - in process]

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A 23-year-old female with a painless left mandibular swelling.

A 23-year-old female with a painless left mandibular swelling.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep 06;:

Authors: Khan A, Peters SM, Han C, Yoon AJ, Philipone EM

PMID: 28964765 [PubMed - as supplied by publisher]

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Plasticity of white matter connectivity in phonetics experts.

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Plasticity of white matter connectivity in phonetics experts.

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

Authors: Vandermosten M, Price CJ, Golestani N

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

PMID: 26386692 [PubMed - indexed for MEDLINE]

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

Related Articles

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

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

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

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

PMID: 28958899 [PubMed - as supplied by publisher]

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