American Journal of Otolaryngology - Head and Neck Medicine and Surgery - Articles in Press

Ototoxicity of Burow solution on the guinea pig cochlea - Corrected Proof

2012-05-07

Abstract: Purpose of the study: The aim of the present study was to evaluate the ototoxicity of Burow solution.Procedures: Compound action potentials (CAPs) of the eighth nerve were measured before and 30 minutes after the application of the Burow solution in the middle ear cavity.Results: Use of the original Burow solution (pH 3.5) for 30 minutes caused a significant reduction of click sounds. A 2-fold diluted Burow solution (pH 4.4) for 30 minutes caused no reduction in CAP threshold. Burow solution, pH adjusted to 4.5, caused no changes in CAP threshold at 30 minutes. At 24 hours, Burow solution (pH 3.5) caused complete abolition of CAP.Conclusions: Burow solution is ototoxic in the guinea pig when applied in the middle ear cavity for 30 minutes or longer. In the clinical settings, it is advisable to avoid allowing the solution to contact the round window for extended times.

Vocal characteristics in patients with thyroiditis - Corrected Proof

2012-05-07

Abstract: Objective: The aim of the present study was to describe the vocal characteristics of patients with thyroiditis in a clinical setting.Materials and methods: A total of 17 consecutive patients with the diagnosis of thyroiditis presenting to the endocrinology clinic were invited to participate in the study. A group of 29 healthy subjects were used as controls. They underwent acoustic analysis and a perceptual evaluation using the GRABS classification. The mean score of each parameter was computed, and the distribution of severity of each perceptual parameter were listed.Results: There was no significant difference in any of the acoustic parameters between the patients and the controls, and there was no significant difference in the mean score of all the perceptual parameters between the patients and the controls. Even when examining the distribution of the severity of evaluation, there was no significant difference between the patients and the controls, as well.Conclusion: Patients with thyroiditis do not have abnormal perceptual vocal evaluation or acoustic findings compared with controls.

Bilateral enlarged vestibular aqueduct with associated bilateral Mondini dysplasia - Corrected Proof

Somasundaram Subramaniam, Tiong-Yong Tan, Heng-Wai Yuen — 2012-04-26

Abstract: Enlarged Vestibular Aqueduct (EVA) and Mondini's dysplasia ( incomplete partitioning type II) are entitites that have been fairly well described in the literature as potential causes of hearing loss in the young. However, it is uncommon for this condition to be detected bilaterally, especially so for both conditions to coexist bilaterally in the same patient. This is a brief description of a patient with the above bilateral condition with attached high resolution CT scan images of the temporal bone to illustrate the case.

Pattern of expression of cyclooxygenase-2 in malignant transformation of sinonasal inverted papilloma - Corrected Proof

2012-04-26

Abstract: Objective: Cyclooxygenases (COXs) are enzymes that catalyze the conversion of arachidonic acid to prostaglandins. Many studies have suggested that COX-2, the inducible form of COX, is important in carcinogenesis. However, little is known about the pattern of expression of COX-2 in a multistep process of malignant transformation of sinonasal inverted papilloma (IP). In this study, we investigated COX-2 expression in IPs, IPs with dysplasia, IPs with squamous cell carcinoma (SCC), and primary SCCs of sinonasal tract.Study design: A retrospective study was conducted.Setting: The setting was a tertiary care referral center.Subjects and methods: The expression of COX-2 was evaluated by immunohistochemistry in 56, 7, 18, and 17 cases of IPs, IPs with dysplasia, IPs with SCC, and primary SCCs, respectively. Furthermore, we investigated the possible correlation between the expression of COX-2 and clinicopathologic variables in patients with IPs with SCC and primary SCC patients.Results: Positive immunoreactivity for COX-2 was observed in 3 (5.4%) of 56 IPs, 7 (38.9%) of 18 IPs with SCC, and 7 (41.2%) of 17 primary SCCs, whereas it was not observed in IPs with dysplasia. The percentage of tumors with COX-2–positive immunostaining was significantly higher in IPs with SCC and primary SCCs compared with benign IPs. There was no significant correlation between the expression of COX-2 and clinicopathologic variables, such as tumor stage, histologic differentiation, and the proportion of malignant areas in patients with IPs with SCC.Conclusion: Cyclooxygenase-2 may play an important role in the process of malignant transformation from IP to SCC.

Etiology of unilateral hearing loss in a national hereditary deafness repository - Corrected Proof

2012-04-26

Abstract: Purpose: The aim of this study was to characterize the genetic, audiologic, and epidemiologic characteristics of unilateral hearing loss (HL) in a national hereditary deafness repository.Materials and Methods: This is a prospective clinical study involving 34 subjects identified in a national hereditary deafness repository. Clinical data and family history of HL were obtained on enrollment. Candidate deafness genes were screened by single-stranded conformation polymorphism, and mutations were confirmed with sequencing.Results: Thirty-four subjects (19 males, 15 females) with unilateral HL were identified, ranging in age from 2 months to 36 years. The mean age at diagnosis was 7 years, and the left ear was affected in 62% of the cases. The racial distribution of our sample was 62% white, 23% African American, and 15% Hispanic. Imaging results were available in 47%, and most (69%) were considered normal. Nineteen percent had enlarged vestibular aqueducts, 2 had ipsilateral Mondini dysplasia, and 1 had a common cavity deformity. Twenty subjects (59%) had a family history of HL, with 26% specifically reporting familial unilateral HL. Mutational screening revealed sequence variants in the GJB2 (connexin 26), GJB3 (connexin 31), TECTA, and COCH genes. Two novel mutations were detected in COCH and TECTA.Conclusions: Sequence variants in known deafness genes were detected in more than one-third of our study population, suggesting that gene/gene or gene/environmental interactions may indeed play a role in the etiology of some cases of unilateral deafness. Further prospective studies including congenital cytomegalovirus screening at birth and molecular screening of deafness genes in children with congenital unilateral HL will be required to establish the etiology of unilateral deafness with certainty.

Analysis of surgical margins in cases of mandibular osteoradionecrosis that progress despite extensive mandible resection and free tissue transfer - Corrected Proof

Soroush Zaghi, Mia Miller, Keith Blackwell, Beth Palla, Chi Lai, Vishad Nabili — 2012-04-23

Abstract: Introduction: Approximately 1 of 4 patients with osteoradionecrosis (ORN) of the mandible develop ongoing disease despite extensive mandible resection to margins determined by the presence of bleeding bone at the time of surgery.Objective: To determine whether pathologic examination of bony margins in assessing for the presence of necrotic edges is correlated with ongoing ORN.Methods: Resected mandible specimens from 34 patients with severe mandibular ORN were examined histologically for the presence of necrotic margins and compared with clinical outcome of ORN persistence at follow-up.Results: Median follow-up was 17.4 months. Eight specimens had histologic evidence of necrotic, nonviable bone at the margins of resections; however, there was no progression of disease among patients in this group. Twenty-six specimens were clear of necrotic margins; however, 8 patients from this group developed persistent disease.Conclusions: Irradiated mandible is susceptible to ORN progression even if clinical and final histopathologic assessments confirm complete resection of necrotic bone margins. Progression of disease in ORN is not related to inadequate resection of necrotic bone.

Smoking and chronic rhinitis: effects of nasal irrigations with sulfurous-arsenical-ferruginous thermal water: A prospective, randomized, double-blind study - Corrected Proof

2012-04-23

Abstract: Purpose: Smoking is a self-destructive behavior that is known to induce remodeling of the lower airways, leading to squamous metaplasia, but little is known about its effects on the nose and paranasal sinuses. Nasal irrigations are often mentioned as measures for treating sinonasal inflammations. The purpose of our study was to compare the effects of nasal irrigations with sulfurous-arsenical-ferruginous thermal water or isotonic sodium chloride solution in smokers with nonallergic chronic rhinosinusitis, based on clinical and olfactory evidence.Materials and methods: The present study was a prospective, randomized, double-blind study performed in a tertiary academic referral center. Seventy smokers with nonallergic chronic rhinitis were enrolled. Nasal endoscopy, rhinomanometry, nasal cytology, and odor threshold measurements were performed in subjects randomized to daily nasal irrigations with either thermal water or isotonic sodium chloride solution for 1 month.Results: Immediately after the treatment, the thermal water irrigations revealed a positive pharmacologic action, judging from a tendency toward lower nasal resistances (P = .07) and larger numbers of ciliated cells in the patients treated (P = .003). Endoscopic findings in the thermal water group were still better than in the control group a further 2 months later (P = .03).Conclusions: Our results indicate that nasal irrigations with thermal water had a good effect on endoscopic objective signs, nasal resistances, and epithelial trophism.

Comparing capsule exposure using extracapsular dissection with partial superficial parotidectomy for pleomorphic adenoma - Corrected Proof

Robert L. Witt, Mary Iacocca — 2012-04-19

Abstract: The aim of this study was to compare capsule exposure using extracapsular dissection (ECD) with partial superficial parotidectomy (PSP) for pleomorphic adenoma.Purpose: Long-term favorable results for recurrence and facial nerve function have been reported for ECD and PSP for parotid pleomorphic adenoma. Extracapsular dissection is distinguished from PSP in that the facial nerve is dissected in PSP but not in ECD. This article attempts to answer the following hypothesis: the margin of normal parotid tissue surrounding a parotid pleomorphic adenoma is less for ECD compared with PSP.Material and Methods: This is a retrospective individual case-control study. Twelve consecutive parotidectomy procedures with a final pathology report of pleomorphic adenoma were retrospectively measured for margin (the percent of capsule exposure around the tumor). In 8 highly selected patients, ECD was performed. Four parotid surgical procedures not meeting strict criteria underwent PSP and served as controls.Results: The eight patients with ECD had a mean of 80% (71%–99%) of the capsule exposed. The 4 PSP procedures had 21% (4%-50%) of the capsule exposed (P < .05).Conclusions: Extracapsular dissection results in higher capsule exposure.

Laser-assisted nasal decolonization of Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus - Corrected Proof

Yosef P. Krespi, Victor Kizhner — 2012-04-16

Abstract: Objectives: Methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S aureus (MRSA) contribute to 25% of nosocomial infections, increasing complications, health care cost, and growing antibiotic resistance. Nasal decolonization (ND) can reduce the staphylococcal infection rate. A new method of laser therapy (LT) MRSA ND was tested.Study design: This is a prospective, nonrandomized study.Methods: Following institutional review board approvals, 25 patients colonized with MSSA/MRSA were allocated to 4 treatment arms; low-power, dual-wavelength 870-/930-nm laser alone (GR1); low-power, dual-wavelength laser followed by erythromycin (E-mycin) cream (GR2); low-power, dual-wavelength laser followed by peroxide irrigation (GR3); and high-power 940-nm laser alone (GR4). Quantitative cultures were obtained before and after in all arms. Laser therapy was performed via a laser fiber diffuser, delivering 200 to 600 J/cm² to each naris circumferentially. Patient's distribution was 3 in GR1, 14 in GR2, 4 in GR3, and 4 in GR4 (last 10 recruited to GR4).Results: Nasal decolonization for GR1, GR2, GR3, and GR4 was 1 of 3, 13 of 14, 2 of 4, and 4 of 4, respectively. Because LT + E-mycin cleared all first 3 patients of MRSA and MSSA, all remaining patients were treated with LT + Er with over 90% of patients clearing. No adverse events or discomfort were reported.Conclusions: First human study using LT and topical E-mycin in ND is presented. Laser therapy can eradicate MRSA and potentially resensitization of bacteria to the antimicrobial effect of erythromycin. Although decolonization was maintained at 4 weeks posttreatment, further studies can determine the LT long-term effect.

Late onset (22 years) of simultaneous tonsillar and cervical lymph node metastases from breast ductal carcinoma - Corrected Proof

2012-04-09

Abstract: Breast cancer is the leading cause of cancer-related mortality in women worldwide; the most common metastatic sites are lymph nodes, lung, liver, and brain. Tonsil metastases from breast cancer are extremely rare. Herein, we report a case of a 74-year-old woman with simultaneous occurrence of tonsillar and cervical lymph nodes metastases after a disease-free interval of 22 years.

Zoster sine herpete causing facial palsy - Corrected Proof

2012-03-23

Abstract: Objectives: The aims of this study were to verify the characteristics of zoster sine herpete (ZSH) causing facial palsy and the effects of different treatments and to confirm the difference from other etiologies.Methods: From March 2010 to March 2011, a prospective study was performed on patients with ZSH with facial palsy. Patients were divided into a steroid-treated group and a steroid-antiviral combination group, and then the effects according to regimen of treatment were prospectively analyzed. Last, the difference between the ZSH group and patients diagnosed with Bell palsy and Ramsay Hunt syndrome in the same study period was confirmed retrospectively.Results: Forty-five patients were diagnosed as having ZSH. Significant improvement was not observed in the ZSH group regardless of the treatment regimen during a 3-week period (P < .05). In patients with ZSH with accompanying typical pain, significant continuous improvement after 6 weeks was observed in patients with combination therapy (P < .05). Compared with patients with Bell palsy and Ramsay Hunt syndrome, there was a significant difference in recovery rate between patients with ZSH (accompanying pain) and those with Bell palsy (89.9%) (P < .05).Conclusion: The initiation of recovery in ZSH started later than that in other peripheral palsies, and slower recovery was shown in patients with ZSH with pain compared with those with Bell palsy. Steroid-antiviral combination therapy was a more effective regimen for treatment compared with steroid-only treatment. To improve the accuracy of ZSH diagnosis, confirming the presence of accompanying typical pain is necessary.

Commentary on “Management of unknown primary head and neck squamous cell carcinoma: response to the paper by Wallace et al” - Corrected Proof

William M. Mendenhall — 2012-03-19

I appreciate the insightful remarks by Dr Hsing et al. Unfortunately, I do not agree with them. First, the statement that radiotherapy (RT) alone or combined with neck dissection (ND) results in a high probability of cure is not meant to imply that all patients should be treated with RT alone. Patients with an incomplete response to RT have an improved neck control rate if an ND is performed; the likelihood of an incomplete response increases with N-stage . Patients who have a complete response after RT have a very low chance of an isolated recurrence in the neck, and the ND may be safely withheld regardless of the initial neck stage . The proposal that all patients should undergo an ND to “stage the neck” is interesting but would mean that many patients would undergo an unnecessary ND and most would receive RT and concomitant chemotherapy regardless of the pathologic findings. An initial ND is indicated only for the small subset of patients with N1 disease who might be suitable for an ND alone and close follow-up and for those in whom a diagnosis cannot be obtained after several fine needle aspirates of the neck node(s). Otherwise, evaluation for a planned ND should take place after RT because many patients will not need to undergo the procedure and those who do may require a more limited dissection .

On chronic rhinosinusitis and the prevalence of fungal sinus disease: problems of diagnostic accuracy and a proposed classification of chronic rhinosinusitis - Corrected Proof

Anil A. Gungor — 2012-03-05

Abstract: There is considerable controversy in the diagnosis and classification of the type of inflammation that is attributed to various forms of chronic rhinosinusitis (CRS). Specimens obtained during surgical treatment of CRS have been invaluable resources for identifying the underlying inflammatory process. The classification of sinus inflammation is based on histopathologic examination of these surgical specimens. Accurate identification of the pathology and standardized reporting are invaluable for postsurgical treatment options and our understanding of CRS. In a large multispecialty referral hospital where multiple surgeons and pathologists are involved in clinical practice, the lack of standardization in specimen collection, specimen processing, and reporting introduce several variables that make it extremely difficult for retrospective analysis. This report focuses on consecutive endoscopic sinus surgical procedures performed by 4 different sinus surgeons over a period of 4 years in a Central Texas multispecialty hospital. This is an analysis of the reality of clinical practice without intervention. At the core of this analysis are pathology reporting practices for fungal sinus disease and the undesirable variables introduced by nonstandardized reporting. A practical classification of CRS based on pathology is proposed.

Prognostic features, human papillomavirus status, and epidermal growth factor receptor expression in oral squamous cell carcinoma in young adults - Corrected Proof

2012-03-05

Abstract: Purpose: There is still debate in literature about the survival outcomes of patients who have cancer of the oral cavity when young. Hence the aims were (1) to estimate disease-free survival, overall survival, and cause-specific survival in patients who developed oral cavity squamous cell carcinoma between 18 and 40 years of age and (2) to assess the clinicopathologic factors including detection of human papillomavirus and epidermal growth factor receptor (EGFR) overexpression in primary lesions affecting recurrence.Methods: This is a retrospective case-note review and reevaluation of histopathologic slides of patients treated more than 25 years. Descriptive statistics, Cox proportional hazard models, and Kaplan-Meier survival curves were used for statistical analysis.Results: A total of 62 patients were treated, with mean follow-up of 11.4 years. Forty-five were oral tongue tumors and 43 had stage I or II disease. The 5-year disease-free survival was 73.5%. The 10-year overall survival and cause-specific survival rates were 81.8% and 83.4%, respectively. Smoking and alcohol intake were not seen as risk factors in this population. Multivariate modeling identified only nodal involvement as significantly associated with overall survival and only extracapsular spread as significantly associated with locoregional recurrence. At 5 years after treatment, the cause-specific survival was 100% for patients with low EGFR expression and 81.1% for patients with high EGFR expression (hazard ratio for high vs low, 3.1; 95% confidence interval, 0.4–406.9; P = .46). Human papillomavirus was not detected in all but 2 tumor specimens.Conclusions: Survival outcomes are quite good in young patients with oral cancer.

Transmastoid approach to temporal bone cerebrospinal fluid leaks - Corrected Proof

Sepehr Oliaei, Hossein Mahboubi, Hamid R. Djalilian — 2012-03-02

Abstract: Purpose: The aim of the study was to evaluate various presentations and treatment options for spontaneous cerebrospinal fluid (CSF) leakage originating in the temporal bone.Materials and Methods: Clinical data and imaging results for 18 ears (15 patients) presenting with spontaneous CSF leakage originating in the temporal bone were reviewed. Average follow-up period was 13.5 months. The main outcome measure was presence of persistent CSF leak postoperatively. A standard postauricular mastoidectomy was performed.Results: Fifteen patients diagnosed with spontaneous CSF leakage over an 8-year period including 3 treated for bilateral disease were included in the study. The age ranged between 33 and 83 years. Presenting symptoms included serous otitis media (44%), persistent otorrhea after tympanostomy tube placement (28%), and meningitis (28%). Preoperative diagnosis was made using imaging studies and was substantiated by observation of CSF leakage and dural herniation intraoperatively. Treatment was eustachian tube plugging (5%), mastoidectomy with fat obliteration (61%), middle fossa approach with extradural (17%), intradural repair (5%), or combined middle fossa and transmastoid (TM) approach (11%). Successful treatment was obtained in 17 of the 18 cases. The last 9 patients in the series underwent TM approach alone for repair with no treatment failures.Conclusions: Repair of defects in tegmen mastoideum and posterior fossa can be successfully achieved on an outpatient basis without regard to size and multitude of defects via TM approach. This approach obviates the need for a craniotomy or lumbar drain.

Necessity of routine ipsilateral hemithyroidectomy during laryngopharyngectomy for pyriform sinus cancer - Corrected Proof

Ozan B. Ozgursoy, John R. Jacobs — 2012-03-01

Abstract: Purpose: The aim of this study was to revisit the role of hemithyroidectomy in the treatment of pyriform sinus cancer by determining the incidence of thyroid gland invasion by the tumor.Materials and Methods: Medical records of 27 patients with pyriform sinus cancer who underwent laryngopharyngectomy with ipsilateral hemithyroidectomy from 1999 to 2010 at a National Cancer Institute–designated comprehensive cancer center were retrospectively reviewed. Computed tomographic scans of the neck, operative notes, and surgical specimens were examined to determine the presence of thyroid gland invasion by imaging, clinical appearance, and pathology.Results: There were 19 male and 8 female patients (age range, 44-79 years; mean, 59.9 years). Most of the cases (85%) had advanced-stage disease. Extralaryngeal spread of tumor with thyroid cartilage invasion was noted in the computed tomographic scans of 5 patients; however, there was no radiologic evidence of thyroid gland invasion in any patient. No gross thyroid gland invasion by the tumor was appreciated in any patient during surgery. No histologic evidence of tumoral invasion of the thyroid gland was found in any of 27 surgical specimens.Conclusions: Results of this study suggest that thyroid gland invasion by pyriform sinus cancer is not common. Therefore, a routine ipsilateral hemithyroidectomy may not be necessary in the treatment of every patient with pyriform sinus cancer, unless there is evidence of thyroid gland invasion.

Missing fish bone: case report and literature review - Corrected Proof

Sandeep Kumar Jha, S. Prasanna Kumar, L. Somu, Arunachalam Ravikumar — 2012-02-24

Fish bone in throat is a frequent problem encountered in the otorhinolaryngology practice. One of the common problems faced in such patients is that of missing fish bone. Here, we are presenting a case report where the bone was missed on the first instance, leading to the retropharyngeal and oropharyngeal cellulitis making the extraction further more difficult and dangerous. Literature review has been done for past 20 years on cases and studies relating to the problem.

Traumatic tympanic membrane perforations: a study of etiology and factors affecting outcome - Corrected Proof

Zheng-Cai Lou, Zi-han lou, Qing-Ping Zhang — 2012-02-24

Abstract: Objective: The purposes of this study were to determine the factors involved in the spontaneous healing and to profile the various etiologies of traumatic tympanic membrane (TM) perforation.Methods: A retrospective review was performed on 729 cases of traumatic TM perforation diagnosed in the emergency department and outpatient clinic from January 2007 to March 2011.Results: A total 641 patients with traumatic TM perforations were enrolled in the study. The group consisted of 320 male and 321 female patients with a mean age of 33.6 years (3–79 years). The types of trauma included compression injury (554 patients), blast injury (55 patients), and instrumental injury (32 patients). The causes of conflict by a slap or a fist were spouse or lover (52%), parents and sibling (3%), school teachers (4%), schoolmate (12%), state police and prisoner (7%), and blow against the ear during street fight (22%). Of the 641, 137 were lost during follow-up; of the remaining 504, perforations closed spontaneously in 451 (89%), within a mean of 27.4 days. Wet perforations with bloody or watery discharge significantly improved the healing rate (P < .01) and shortened the average perforation closure time (P < .01), as compared with dry perforations. Although the perforation that involved malleus or umbo damage did not significantly affect the healing rate (P > .05), a significantly prolonged closure time (41.6 vs 23.8 days) was observed as compared with no damage. However, the curled edges did not also affect the outcome of spontaneous healing; the healing rate was 91% and 88% (P > .05), and the average closure time was 28.1 and 26.7 days (P > .05), respectively, for with and without curler edges. By perforation size, the overall healing rate was 92% and 54% (P < .01), and the average closure time was 22.8 and 47.3 days (P < .01), respectively, for small and larger perforations. Moreover, 7 patients had neomembrane formation on follow-up, 2 developed cholesteatoma, 1 developed tympanosclerosis, and 1 developed facial paralysis.Conclusion: In our experience, domestic violence and street fight were the most common causes of the traumatic TM perforation. Traumatic TM perforations have excellent prognosis. However, preexisting tympanosclerosis and the perforation that involved malleus or umbo damage could lengthen the healing time of perforation, Wet perforations with bloody or watery discharge accelerate the healing, but the curled edges did not affect the outcome of spontaneous healing.

Congenital cholesteatoma: clinical features and growth patterns - Corrected Proof

Hyun Woo Lim, Tae Hyun Yoon, Woo Seok Kang — 2012-02-23

Abstract: Objective: The clinical features and patterns of growth, relative to age, were examined in patients with congenital cholesteatoma to investigate disease progression and site of origin.Patients and methods: We retrospectively reviewed 72 children younger than 15 years with intraoperatively confirmed congenital cholesteatoma diagnosed using the inclusion criteria of Levenson et al. Patient demographics, history, and otoscopic and operative findings were evaluated. Correlation between mass volumetric and operation age was analyzed in patients with closed-type masses. Parameters of disease extent of middle ear quadrant, ossicular erosion, attic involvement, invasion of the mastoid cavity, and type of mass were assessed relative to age at operation.Results: Mean patient age was 63.1 months (range, 20–179 months), with 51 patients (70.8%) being asymptomatic and diagnosed incidentally. Nineteen patients (26.4%) had closed-type cystic masses, and 53 (73.6%) had open-type lesions. The volume of closed-type masses was linearly correlated with age at operation. Logistic regression showed that increased age at operation was associated with a lower proportion of anterosuperior quadrant lesions, resulting in uncertainty about the site of origin. The possibility of open-type masses also increased according to age at operation.Conclusion: Congenital cholesteatoma shows growth and extension over time. Early detection and intervention are necessary to avoid advanced disease.

Management of unknown primary head and neck squamous cell carcinoma: response to the article by Mendenhall et al - Corrected Proof

Chih-Yu Hsing, Shi-An Liu, Chen-Chi Wang — 2012-02-23

As a faithful reader of the American Journal of Otolaryngology, we read with great interest the article titled “Head and neck squamous cell carcinoma from an unknown primary site” by Mendenhall et al . We would like to compliment the authors on their large-scale analysis of the management of unknown primary head and neck squamous cell carcinoma (HNSCC). However, we found that their conclusion was somewhat arbitrary and was not supported by their statistical results. We also would like to offer our opinions on this topic that remains a matter of controversy.

Use of intravenous immunoglobulin to treat chronic bilateral otomastoiditis in the setting of rituximab induced hypogammaglobulinemia - Corrected Proof

2012-02-23

Abstract: The temporal bone may be affected by a variety of systemic pathology because the disease nature, location, and extent determine the symptoms. Middle ear and mastoid infections may be the initial clinical manifestation of autoimmune and acquired immunodeficiency disorders. Rituximab, an anti-CD20 chimeric antibody, has become increasingly popular as a therapeutic agent for patients with a wide range of autoimmune disorders refractory to standard treatments. Normal levels of immunoglobulin levels are usually maintained during and after rituximab therapy, and clinical trials to date have shown no statistically significant increase of serious infections among patients with autoimmune diseases being treated with rituximab (Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC, et al, for the REFLEX Trial Group. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at 24 weeks. Arthritis Rheum. 2006;54:2793-2806. Edwards JC, Szczepanski L, Szechinski J, Filipowicz-Sosnowska A, Emery P, Close DR, et al. Efficacy of B-cell–targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med. 2004;350:2572-2581). However, there have been several reports of opportunistic infections associated with rituximab (Kelesidis T, Daikos G, et al. Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis 2011;15:e2-e16. Teichmann LL, Woenckhaus M, Vogel C, et al. Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis. Rheumatology 2008;47:1256-1257), as well as cases of it accelerating the presentation of hypogammaglobulinemia (Diwakar L, Gorrie S, et al. Does rituximab aggravate pre-existing hypogammaglobulinaemia? J Clin Pathol 2010;63:275-277). Humoral immune defects can cause persistent acute and serous otitis media, with the development of chronic suppurative otitis media refractory to medical and surgical therapy (Sasaki CT, Askenase P, Dwyer J, et al. Chronic ear infection in the immunodeficient patient. Arch Otolaryngol 1981;107:82). Here, we describe the first presentation, diagnostic workup, and treatment with intravenous immunoglobulin of chronic bilateral otomastoiditis in the setting of rituximab-induced hypogammaglobulinemia.

Endoscopic forehead lift in patients with male pattern baldness - Corrected Proof

Taha Z. Shipchandler, Babar Sultan, Patrick J. Byrne — 2012-02-10

Abstract: Purpose: The presence of male pattern baldness poses a significant challenge when attempting to optimize treatment of the upper third of the face. The purpose of this study is to demonstrate and discuss results of the endoscopic forehead lift in patients with male pattern baldness.Materials and methods: This was a retrospective case series done in an academic medical center. Eleven patients with male pattern baldness (Norwood class IV–VII) underwent endoscopic forehead lift for forehead creases and brow ptosis.Results: All patients achieved smoothing of the forehead and elevation of the brow with no scalp anesthesia at 1 month postoperatively. All patients were pleased with the healing of their incisions in midline, paramedian, and temporal regions. Alloplastic fixation devices used were visible postoperatively in 2 patients initially.Conclusions: The endoscopic forehead lift is a suitable approach for treating the upper third of the face in the presence of male pattern baldness. The use of alloplastic fixation devices may be used in this patient population, but other fixation methods should be considered.

Radix astragali injection enhances recovery from sudden deafness - Corrected Proof

Min Xiong, Qinglian He, Huangwen Lai, Weiyi Huang, Luxia Wang, Chuanhong Yang — 2012-02-10

Abstract: Objectives: An acute interruption of the blood supply to the inner ear is one of the most likely causative factors for sudden deafness (SD). Reactive oxygen species (ROS) have been suggested to be important mediators of the tissue injury during cochlear ischemia and reperfusion. Radix astragali (RA) is natural antioxidant. The aim of this study was to investigate the efficacy of RA in patients with SD.Patients and methods: We compared the hearing gains from hearing impairment in 46 ears treated with RA with 46 ears treated with non-RA. RA was given intravenously daily for 10 days. There were no significant differences in clinical or audiological data between RA and non-RA groups.Results: The hearing gain at 250, 500, 1000, 2000, and 4000 Hz in RA group was much higher than that of non-RA group correspondingly (P < .01). Also, the hearing gain at PTA (pure-tone average of 250, 500, 1000, 2000, and 4000 Hz) in RA group was significantly higher than that of non-RA group (P < .01).Conclusion: The recovery of hearing was significantly better after treatment of RA than non-treatment of RA. RA can be valuable concurrent therapy for patients with SD.

Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver - Corrected Proof

Francesco Dispenza, Gautham Kulamarva, Alessandro De Stefano — 2012-02-10

Abstract: Objective: The prevalence of benign paroxysmal positional vertigo (BPPV) is becoming more frequent in elderly population. The presence of comorbid factors has to be considered before assessment as well as before commencing any repositioning treatment. Our aims were evaluation of the maneuvers efficacy and evaluation of the applicability of hybrid maneuver (HM) in patients with physical limitation.Study design and setting: This is a randomized study in 2 tertiary referral centers.Intervention: This is a therapeutic intervention.Patients: All consecutive patients with diagnosis of BPPV of posterior canal matching the inclusion criteria were enrolled. Patients underwent treatment soon after the initial diagnosis in all cases with a repositioning maneuver. The maneuver was casually selected among Semont, Epley, and hybrid. Patients were divided into 3 groups according to the maneuver adopted.Results: Eighty-eight patients with posterior canal BPPV were enrolled for treatment. Fisher exact test showed that no statistical differences exist between HM and other maneuvers in terms of efficacy. Latency of repositioning nystagmus appeared longer in HM in comparison with other maneuvers (P < .05). Efficacy of maneuvers used for BPPV decreases in case of cupulolithiasis (P < .0001). We found no relationship between age, sex, and length of disturbance on response to maneuvers.Conclusions: All maneuvers evaluated demonstrated similar efficacy. The HM, as our data showed, allows us to obtain a good percentage of success similar to most maneuvers used. It is also more comfortable for the patients with hip or neck functional limitation allowing an effective treatment of the posterior canal BPPV.

Two late complications of craniofacial trauma: case report and review of the literature - Corrected Proof

Daniel E. Cannon, Timothy S. Wells, David M. Poetker — 2012-02-10

Abstract: Injuries after blunt and penetrating trauma to the face are a common occurrence and are managed by specialists from several disciplines. After short-term care and immediate recovery, long-term complications can develop including cosmetic deformity, unsightly scarring, problems with soft tissue healing, malunion or nonunion of bony segments, diplopia or other visual complaints, malocclusion, hardware failure, and mucocele formation. Here, we present a report of 2 late complications recognized and treated in a patient 40 years after an episode of craniofacial trauma: epistaxis with symptomatic nasal congestion from fixation wires and mucocele formation. Management of this patient accompanied by endoscopic photographs and computed tomographic images is presented, and discussion of these complications along with review of the literature is provided.

Short-term audiologic effect of intratympanic gadolinium contrast agent application in patients with Ménière disease - Corrected Proof

Julia Palo Rodrigues Louza, Wilhelm Flatz, Eike Krause, Robert Gürkov — 2012-02-10

Abstract: Objectives: The aim of this study was to assess whether gadolinium-based contrast agent influences short-term hearing function in patients with Ménière disease undergoing intratympanically enhanced inner-ear magnetic resonance imaging.Design: This is a prospective cohort study.Setting: This study was conducted a tertiary referral university hospital, ENT department.Participants: In this study, 21 adult patients with definite, unilateral Ménière disease were included. According to the criteria of the Committee on Hearing and Equilibrium, all patients were in stage 1 or 2 of the disease, with largely preserved hearing function.Outcomes: All patients underwent clinical and audiologic testing before and 24 hours after intratympanic application of gadolinium-based contrast agent. The effects of the contrast medium on the hearing function were assessed by analysis of frequency thresholds, pure-tone average from 500 Hz to 3 kHz, and speech audiometry.Results: Pure-tone average and single-frequency thresholds in audiometry showed no statistically significant difference after the application of intratympanic gadolinium-based contrast agent. Furthermore, speech audiometry scores remained stable after the application of the contrast agent.Conclusions: This study did not demonstrate clinically significant short-term effects of intratympanic application of gadolinium-based contrast agent on hearing function in patients with Ménière disease in initial stages.

Adenoid cystic carcinoma of the head and neck - Corrected Proof

2012-01-06

Abstract: Purpose: To report our experience using radiotherapy alone or combined with surgery to treat adenoid cystic carcinoma of the head and neck.Materials and methods: Radiotherapy alone or combined with surgery was used to treat 120 previously untreated patients with adenoid cystic carcinoma (ACC) of the head and neck from August 1966 to March 2008. Patients were treated with curative intent. American Joint Committee on Cancer stage distribution was,T0 (n = 1), T1 (n = 26), T2 (n = 25), T3 (n = 14), T4 (n = 54), N0 (n = 113), N1 (n = 2), N2a (n = 1), N2b (n = 2), and N2c (n = 2). Treatment included surgery with postoperative radiotherapy (n = 71), radiotherapy alone (n = 46), and preoperative radiotherapy and surgery (n = 3). Incidental and clinical perineural invasion was found in 41 (34%) and 35 (29%) patients, respectively. Median follow-up was 8.6 and 11.6 years overall and among living patients, respectively.Results: The10-year overall, cause-specific, and distant metastasis-free survival rates, respectively, were as follows: radiotherapy alone, 37%, 46%, and 76%; surgery and radiotherapy, 57%, 71%, and 62%; and overall, 50%. The10-year local control rates were as follows: radiotherapy alone, 36%; surgery and radiotherapy, 84%; and overall, 65%. The 10-year neck control rates were as follows: elective nodal irradiation (ENI), 98%; no ENI, 89%; and overall, 95%.Conclusions: Surgery and adjuvant radiotherapy offer the best chance for cure for patients with resectable adenoid cystic carcinomas of the head and neck. Some patients with advanced, incompletely resectable disease can be cured with radiotherapy alone. ENI should be considered for primary sites located in lymphatic-rich regions.

Delayed lymph node metastases after elective neck dissection in patients with oral and oropharyngeal cancer and pN0 neck - Corrected Proof

2012-01-04

Abstract: Purpose: Patients with surgically treated head and neck cancer and clinical N0 neck with high risk of occult lymph node metastasis undergo elective neck dissection (ND). Late lymph node metastasis may appear in those patients with pN0 neck. The aim of the present study was to analyze the incidence and clinical relevance of late lymph node metastasis in patients with head and neck cancer.Materials and Methods: The clinical data of 61 patients with head and neck cancer who had undergone elective ND with pN0 neck were retrospectively analyzed. Only patients without local failure, second primary, or radiochemotherapy were included in the study.Results: Late lymph node metastasis could be observed in 4 (6.5%) cases at the margin or outside the initially dissected lymph node levels. In those patients, the primary tumor was localized in the oral cavity (n = 3) or oropharynx (n = 1) and was classified in all cases as T1 or T2. Lymph node metastasis could be found in levels I (n = 2), II (n = 1), and IV (n = 1), respectively.Conclusion: Even in the case of pN0 neck after an elective ND, the appearance of late lymph node metastases must be expected. The low proportion of patients with late lymph node metastases after a selective ND in clinical and histologic N0 does not justify an extended form of neck surgery.

The intraparotid facial nerve schwannoma: a diagnostic and management conundrum - Corrected Proof

2011-12-21

Abstract: Objectives: The aims of the study were (1) to review the management strategy and clinical outcomes of all intraparotid facial nerve (FN) schwannomas (PFNSs) treated at a single tertiary academic center from 1975 to 2010 and (2) to summarize all previously reported cases of PFNS in the international literature.Study design: A retrospective cohort study and literature review.Methods: Fifteen patients were diagnosed and treated at the authors' institution from 1975 to 2010. In addition, 124 published cases were systematically reviewed.Results: The most common presentation of PFNS was a painless parotid mass with normal FN function. Eccentric, loosely attached intraparotid tumors underwent gross total resection with nerve preservation granting satisfactory postoperative FN function, whereas “inseparable” intraparotid tumors were observed in 8 cases with stable long-term size. Lesions that extended into the fallopian canal underwent complete resection with FN sacrifice and nerve grafting in 10 cases, whereas 1 patient received subtotal resection of the intraparotid portion with stereotactic radiotherapy targeting the intratemporal component.Conclusions: Intraparotid FN schwannomas present similar to other primary salivary gland neoplasms, making an early diagnosis challenging. Intraoperative recognition of gross tumor characteristics and early histologic diagnosis with strategic biopsy are critical. Information including tumor location and extent, preoperative FN function, and the gross relationship between the tumor and the FN may guide the surgeon toward an optimal treatment plan emphasizing long-term neurologic preservation.

Heterotopic salivary tissue - Corrected Proof

Daniel E. Cannon, Sara Szabo, Valerie A. Flanary — 2011-12-21

Abstract: Salivary tissue can be present in the head and neck outside the usual locations of the major and minor salivary glands. This can be in the form of accessory salivary glands, in association with branchial cleft anomalies, or, less commonly, as heterotopic salivary gland tissue (HSGT). Heterotopic salivary gland tissue is defined as salivary tissue outside of the expected locations of major, minor, and accessory salivary glands with absence of clinical or histologic features of branchial cleft anomalies. Here we present the case of a 13-year-old girl who presented with a draining sinus of the lower neck, which was excised and, on histologic analysis, was consistent with HSGT. We include photographs and histologic images. A review of the literature on heterotopic salivary tissue in the neck is then presented including discussion of the presentation, clinical features, important considerations, and recommendations for management.

Skin carcinoma of the head and neck with perineural invasion - Corrected Proof

2011-12-21

Abstract: Purpose: The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT).Materials and methods: From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy.Results: The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%. The 5-year local control, local-regional control, and freedom from distant metastases for incidental and clinical PNIs were 80% vs 54%, 70% vs 51%, and 90% vs 94%. On univariate and multivariate (P = .0038 and .0047) analyses, clinical PNI was a poor prognostic factor for local control. The rates of grade 3 or higher complication in the incidental and clinical PNI groups were 16% and 36%, respectively.Conclusions: Radiotherapy plays a critical role in the treatment of this disease. Clinical PNI should be adequately irradiated to include the involved nerves to the skull base.

Location of airway obstruction in term and preterm infants with laryngomalacia - Corrected Proof

Eelam Adil, Terrence Rager, Michele Carr — 2011-12-19

Abstract: Objective: The aim of this study was to describe and compare the airway findings in term and preterm infants with laryngomalacia.Methods: A retrospective review of 130 patients diagnosed as having laryngomalacia at a tertiary referral center between July 2004 and August 2009 was conducted. Medical records were reviewed for demographic data, supraglottic and glottic airway findings, concomitant airway lesions, and the need for intervention.Results: The mean gestational age and age at diagnosis was 36 and 15 weeks, respectively. Combined posterior and anterior supraglottic collapse was the most common finding (31%). Posterior collapse alone occurred in 25%, anterior collapse in 14%, and lateral collapse in 10%. Twelve percent of patients had all 3 sites of collapse. Forty-one percent of patients had a secondary airway lesion, with tracheomalacia being the most common. Preterm infants had significantly higher rates of reflux and more sites of collapse than did term infants (P < .0001). Eight patients required an intervention for their symptoms.Conclusions: Children with laryngomalacia tend to have more than 1 area of supraglottic collapse, and more than one third have a secondary lesion. All patients who required an intervention had more than 1 area of collapse, and 63% of these patients had a secondary airway lesion. Our high incidence of secondary lesions is similar to recent reports.

Subcutaneous emphysema after otologic surgery: a case report - Corrected Proof

Nipun Chhabra, Rod P. Rezaee, Harvey M. Tucker, Cliff A. Megerian — 2011-12-19

Abstract: Subcutaneous emphysema of the head and neck after otologic surgery is exceedingly rare. The mechanism relates to the intimate relationship of the temporomandibular joint to the external auditory canal. We present a rare case of subcutaneous emphysema after otologic surgery for ear disease. An astute clinical index of suspicion coupled with prompt treatment can help minimize morbidity and improve patient outcomes.

An objective comparison of leakage between commonly used earplugs - Corrected Proof

Jeremiah A. Alt, William O. Collins — 2011-12-12

Abstract: Objective: We sought to determine the efficacy of commonly used earplugs using an anatomically correct ear model.Methods: The total volume and rate of water that leaked past the earplug and subsequent defect in the tympanic membrane over separately measured 30, 60, 120, and 180-second intervals were recorded. Scenarios tested included a control with no earplug, custom molded earplug (Precision Laboratories, Orlando, FL), Mack's plug (Warren, MI), Doc's plug (Santa Cruz, CA), and cotton balls coated with petroleum jelly.Results: All plugs tested resulted in less leakage at all time points when compared with no plug (P < .05). At 30 seconds, the custom molded, Mack's and Doc's plugs all showed significantly less leakage when compared with the cotton ball coated with petroleum jelly (P < .05). At 60, 120, and 180 seconds, Mack's, Doc's, and the cotton plugs all showed significantly less leakage compared with the customized plug (P < .05). At 120 and 180 seconds, Mack's plugs had significant less leakage than the cotton plug (P < .05). Among the types of plugs, the molded variety (Mack's) showed the least volume and lowest leakage rate (f4,45 = 94 [P < .001]). In addition, Doc's and cotton balls coated with petroleum jelly were more effective than the customized earplugs.Conclusions: If the clinician feels that middle ear and external canal water exposure should be minimized, then use of earplugs, particularly the moldable variety, merits further consideration.

Imaging techniques in parathyroid surgery for primary hyperparathyroidism - Corrected Proof

Arash Mohebati, Ashok R. Shaha — 2011-12-09

Abstract: As more patients present with the incidental diagnosis of primary hyperparathyroidism due to biochemical screening, treatment guidelines have been developed for the treatment of hyperparathyroidism. Management of primary hyperparathyroidism has evolved in recent years, with considerable interest in minimally invasive approaches. Successful localization of the diseased gland(s) by nuclear imaging and anatomical studies, along with rapid intraoperative parathyroid hormone assay, has allowed for focused and minimally invasive surgical approaches. Patients in whom the localization studies have identified single-gland adenoma or unilateral disease are candidates for such focused approaches instead of the traditional approach of bilateral exploration. These imaging techniques have also been critical in the successful management of patients with persistent or recurrent disease.\

Superior laryngeal nerve syndrome and the evaluation of anterior neck pain - Corrected Proof

Reginald F. Baugh, Aaron Baugh, Frederick Bunge — 2011-12-09

A 62-year-old woman presented to the general surgery clinic for evaluation of an anterior neck mass. She complained of hoarseness and dysphagia to both solid and liquids. Significantly, at the time of initial evaluation, the patient was unable to tolerate flexible laryngoscopy. Thyroid examination found significant enlargement with extension below the sternal notch. On the basis of this clinical picture, total thyroidectomy was elected. Triple endoscopy was performed in the operating room demonstrating normal anatomy throughout. The operating surgeons made specific note of the identification and sparing of both the superior and recurrent laryngeal nerves on the right side but made no comment about the left superior laryngeal nerve. The procedure was otherwise unremarkable, and the parathyroids were reimplanted into the sternocleidomastoids bilaterally. The patient was discharged on postoperative day 2 without notable complications.

Multiple cranial nerve dysfunction caused by neurosarcoidosis - Corrected Proof

Rivkah G.J. Loor, Joost van Tongeren, Wynia Derks — 2011-12-09

Abstract: Neurosarcoidosis is a rare identity and occurs in only 5% to 15% of patients with sarcoidosis. It can manifest in many different ways, and therefore, diagnosis may be complicated. We report a case presented in a very unusual manner with involvement of 3 cranial nerves; anosmia (NI), facial palsy (NVII), and hearing loss (NVIII). When cranial nerve dysfunction occurs, it is very important to take neurosarcoidosis into consideration.

Work environment discomfort and injury: an ergonomic survey study of the American Society of Pediatric Otolaryngology members - Corrected Proof

Jonathan Cavanagh, Maria Brake, Donald Kearns, Paul Hong — 2011-12-09

Abstract: Background: Workplace-related musculoskeletal pain has been studied in various occupations, but it is rarely reported in the surgical literature.Objective: The aim of this study was to examine work-related discomfort and injury among pediatric otolaryngologists and to assess their knowledge of workplace ergonomic principles.Methods: We surveyed current North American members of the American Society of Pediatric Otolaryngology. Our main outcomes were whether the physician had ever experienced discomfort or physical symptoms that they attributed to their surgical practice.Results: Response rate of 43.7% was attained, and 62.0% of respondents reported experiencing pain or discomfort that they attributed to their surgical practice. Women were significantly more likely to report experiencing pain or discomfort that they associated with their surgical practice (P = .033). There were no significant differences found among length of time in practice, academic vs community setting, or number of surgeries completed by the surgeon. Some of the surgeons (31.0%) were aware of ergonomic principles, and of those who were aware, 83.9% had implemented ergonomic principles into their surgical practice.Conclusion: Almost two thirds of surgeons who responded to the survey reported experiencing pain or discomfort that they attributed to their surgical practice. Only a minority of respondents were aware of ergonomic principles. These findings may confirm that most physicians believe that their physical health is affected by their operative environment. Increased knowledge of surgical ergonomics may lead to strategies that improve workplace health and safety.

Quantitative diffusion-weighted magnetic resonance imaging as a powerful adjunct to fine needle aspiration cytology for assessment of thyroid nodules - Corrected Proof

2011-12-08

Abstract: Objectives: The purpose of this study was to assess the value of the apparent diffusion coefficient (ADC) in the differential diagnosis between benign and malignant thyroid nodules, particularly those found to have indeterminate cytology with fine needle aspiration (FNA).Methods: Thirty-eight patients with 42 thyroid nodules underwent neck magnetic resonance imaging consisting of T1-, T2-, and diffusion-weighted imaging. The final diagnosis of all nodules was confirmed by surgery, revealing 23 with benign and 19 with malignant lesions. Preoperative FNA cytology was performed in 38 of 42 nodules, including 15 of indeterminate cytology. The mean ADC values in benign and malignant groups were compared.Results: There was a significant difference between mean ADC values in benign and malignant nodules and between mean ADC in benign and malignant nodules of indeterminate cytology. A cutoff value for malignant nodules of 1.60 × 10−3 mm2/s yielded sensitivity, specificity, and accuracy of 94.73%, 82.60%, and 88.09%, respectively.Conclusion: The present study revealed that ADC measurements could potentially quantitatively differentiate between benign and malignant thyroid nodules, even those of indeterminate cytology. We propose that diffusion-weighted imaging evaluation should be used for the assessment of thyroid nodules in addition to FNA cytology.

Prophylactic valacyclovir in a patient with recurrent vestibular disturbances secondary to vestibular neuritis - Corrected Proof

Kyle T. Amber, Johnathan E. Castaño, Simon I. Angeli — 2011-12-08

Abstract: A 57-year-old woman with herpes labialis and previously diagnosed with vestibular neuritis experienced recurrences of vertigo and disequilibrium. Initially preceded by oral herpes outbreaks or upper respiratory infections, these recurrences became spontaneous and more frequent. Vestibular function demonstrated a 25% decrease in energy function in the right and the patient had left beating nystagmus on positional maneuver. Her reoccurrences of vestibular disturbances were followed up. Concurrently, she was prescribed daily valacyclovir (500 mg, 1 per day) given for the prevention of herpes labialis outbreaks by her primary care physician. Recurrences of disequilibrium stopped completely as well as oral herpes outbreaks.

The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer - Corrected Proof

2011-12-02

Abstract: Purpose: The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients.Materials and methods: This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire–Turkish version and UW-QOL–Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires.Results: The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed.Conclusions: The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.

Transoral robotic surgery for supraglottic squamous cell carcinoma - Corrected Proof

2011-12-01

Abstract: Purpose: We present our experience with the use of transoral robotic surgery (TORS) for treatment of supraglottic squamous cell carcinoma.Materials and Methods: We studied all patients who underwent TORS for supraglottic squamous cell carcinoma, with or without adjuvant therapy, from March 2007 through June 2009, who had a minimum of 2 years of follow-up. Primary functional outcomes included dysphonia, tracheostomy dependence, and gastrostomy tube dependence. Disease control and survival were estimated with the Kaplan-Meier method.Results: Of 9 patients in the study group, 7 (78%) had advanced-stage disease. All 9 patients had negative margins after TORS, with no perioperative complications. Regional recurrence and local recurrence developed in 1 patient each. One patient died of disease. At last follow-up, 7 patients (78%) were tracheostomy free, and 7 (78%) were gastrostomy tube free.Conclusions: Transoral robotic surgery is a promising modality for resection of supraglottic squamous cell carcinoma. Transoral robotic surgery achieved functional laryngeal preservation in most patients with no complications.

Assessment of cochlear and auditory pathways in patients with migraine - Corrected Proof

Sherifa Ahmad Hamed, Ahmed Hamdy Youssef, Amal Mohammad Elattar — 2011-12-01

Abstract: Purpose: In this study, we aimed to determine the function of the cochlea and peripheral and central auditory pathways with migraine.Materials and methods: Fifty-eight patients with migraine and 40 healthy subjects were assessed using routine diagnostic audiometry along with transient evoked otoacoustic emissions (TOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) at high and low repetition rate frequencies.Results: Nearly two thirds of patients with migraine had one or more abnormalities in electrophysiological testing. Compared with control subjects, patients reported significant lowering of TOAEs amplitude at frequencies of 1 kHz (right: P = .0003; left: P = .002), 3 kHz (right: P = .025), and 4 kHz (right: P = .019); prolonged wave III latency (right: P = .009); and I-V interpeak latency (IPL) (left: P = .024) at high repetition rate frequencies. Significant correlations were identified between age, duration of illness and frequency of migraine and TOAEs total response and at amplitude of 4 kHz, amplitudes of DPOAEs at 1, 1.5, 2, 3, and 5 kHz and I, III and wave latencies and I-V IPL of ABR at high rate frequencies.Conclusions: These data suggest that subclinical changes in cochlear function and auditory pathways are associated with chronic migraine. It is possible that migraine could be accompanied by compromise of blood supply of auditory system.

Clinical significance of micrometastases in lymph nodes from laryngeal squamous cell carcinoma - Corrected Proof

Yanan Xu, Mengjia Fei, Jiadong Wang, Luying Zheng, Yiming Chen, Qiang Liu — 2011-12-01

Abstract: Objective: To assess the role of lymph nodes micrometastases in laryngeal squamous cell carcinoma and correlate the results with survival.Methods: We performed immunohistochemical analyses of lymph nodes after the resection of 126 patients for detection of micrometastasis. The lymph nodes were examined with hematoxylin and eosin (HE)–stained and cytokeratin (CK) antibodies AE1/AE3 stained. Recurrences and metastases were recorded during follow-up. The Kaplan-Meier method was used for survival analysis.Results: In total, 126 patients underwent neck dissection. Forty-one patients were HE positive (group 1), while 85 were HE negative. Thirty-three of these HE negative patients were CK positive (group 2), while 52 were CK negative (group 3). Patients in groups 2 and 3 had a different outcome (P < .001). Survival was worse in patients in group 2 (10-year survival of 52.12% vs 81.16% in group 3, P < .01).Conclusion: Immunohistochemical analysis is an efficient way to detect micrometastasis in lymph nodes after the resection of conventionally node-negative patients. The detection of CK-positive cells is an independent prognostic factor, and more aggressive treatment should be indicated in these patients.

Preauricular sinus: advantage of the drainless minimal supra-auricular approach - Corrected Proof

2011-12-01

Abstract: Objectives: We performed this study to introduce our minimal supra-auricular approach for the surgical management of a preauricular sinus (PAS) and to evaluate the advantages of this drainless technique.Study design: This was a retrospective study.Setting: The study was done in a tertiary referral center.Methods: We enrolled 94 patients (101 ears) with a PAS who underwent surgical treatment via a minimal supra-auricular approach performed by one surgeon between April 1999 and May 2010. After removing the specimen, meticulous subcutaneous suturing and no drain were used in 83 patients (89 ears) and a postoperative drain was inserted in 11 patients (12 ears). Surgical outcomes of this technique were compared between the groups with and without postoperative drain insertion.Results: With a good surgical view and meticulous subcutaneous mattress sutures in our minimal supra-auricular approach for PAS excision, there was no postoperative recurrence or other serious complication. In the drain group, previous operation history was more frequent (P = .010), and the rate of preoperative infection was higher than in the drainless group (P = .018). Postoperatively, a compression dressing was required more frequently (P = .002) and for longer in the drain group (P = .001). The rate of immediate postoperative wound infection was higher in the drain group (P = .003).Conclusion: Our drainless minimal supra-auricular approach for the surgical removal of a PAS has advantage in terms of good surgical results of no recurrence and is more comfortable for patients because of the reduced need for a compression dressing. We suggest that this technique is effective and safe for PAS excision.

Sphenoid sinus barotrauma after scuba diving - Corrected Proof

Jin Hyeok Jeong, Kuk Kim, Seok Hyun Cho, Kyung Rae Kim — 2011-12-01

Abstract: We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.

Orthostatic hypotension and psychiatric comorbidities in patients with dizziness - Corrected Proof

2011-11-24

Abstract: Purpose: The present study was undertaken to investigate orthostatic hypotension and psychiatric comorbidity with anxiety and depression in dizzy patients.Materials and methods: Sixty-three patients with nonspecific dizziness and 27 volunteer subjects were evaluated with the head-up tilt test (HUTT) and the Standardized Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I.Results: Orthostatic hypotension was induced by HUTT in 44% of patients and in 15% of volunteers (P = .0082); we found that the incidence of anxiety and depression was significantly higher (P < .05) in patients with nonspecific dizziness than in controls. Orthostatic hypotension was related to age but not to antihypertensive therapy and sex. Dizziness during the HUTT was reported by 49% of patients and 33% of volunteers (P = .2469). Among patients, dizziness was found to be related to sex (female) and anxiety. A correlation between dizziness and anxiety was also present in volunteers. Head-up tilt test induced vasovagal reactions in 2 volunteers.Conclusions: Orthostatic hypotension is present in a high percentage of patients with orthostatic dizziness, and anxiety and depression are an important factor in the onset of dizziness. A high percentage of abnormal responses in volunteer subjects seems to indicate that the HUTT is not indicated for routine use.

Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial - Corrected Proof

Sarah Edelman, Alison E.J. Mahoney, Phillip D. Cremer — 2011-11-21

Abstract: Purpose: The aim of this study was to evaluate the effects of a brief cognitive behavior therapy (CBT) intervention on the physical symptoms, illness-related disability, and psychologic distress of patients with chronic subjective dizziness.Materials and methods: Forty-one patients with chronic subjective dizziness referred by a neurootologic clinic were randomly assigned to immediate treatment or a wait-list control. Three weekly treatment sessions based on the CBT model of panic disorder, adapted for patients with dizziness, were administered by a clinical psychologist. Treatment included psychoeducation, behavioral experiments, exposure to feared stimuli, and attentional refocusing. Outcomes were measured on the Dizziness Handicap Inventory and the Depression, Anxiety and Stress Scales. Two further measures developed for this study; the Dizziness Symptoms Inventory and the Safety Behaviours Inventory were used to measure physical symptoms and safety behaviors.Results: The intervention was associated with significant reductions in disability on the Dizziness Handicap Inventory, reduced dizziness and related physical symptoms on the Dizziness Symptoms Inventory, and reduced avoidance and safety behaviors as measured by the Safety Behaviours Inventory. Pre- to posteffect sizes ranged from 0.98 to 1.15. There was no change in psychologic outcomes measured on the Depression, Anxiety and Stress Scales.Conclusions: A 3-session psychologic intervention based on the CBT model can produce significant improvements in dizziness-related symptoms, disability, and functional impairment among patients with chronic subjective dizziness. This suggests that treatment of this condition may be reasonably simple and cost-effective for most of the patients.

Nasal septal angiofibroma, a subclass of extranasopharyngeal angiofibroma - Corrected Proof

2011-10-05

Abstract: Objective: Extranasopharyngeal angiofibromas (ENA) arising from the nasal septum or nasal septal angiofibromas are extremely rare; only 13 such cases have been reported in the international literature. Our objective is to describe the presentation, workup, and surgical management of these lesions.Study design: Case reports were done.Setting: The setting was a tertiary care referral center and the Veterans Affairs Medical Center.Patients, interventions, and results: We present 2 cases of extranasopharyngeal angiofibroma occurring on the nasal septum.Conclusions: In this report, we discuss the occurrence, the histopathologic findings, and the treatment of nasal septal angiofibroma.