https://www.sciencedirect.com/journal/american-journal-of-otolaryngology/articles-in-press
Efficacy of lianhuaqingwen granules in the management of chronic rhinosinusitis without nasal polyps
Lin Lin, Fei Dai, Guoqiang Ren, Jinjin Wei, ... Xinyue Tang
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Objectives
Chronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP.
Materials and methods
CRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups.
Results
One hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4+ and CD8+ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4+ and CD8+ T cell subpopulations and concentrations of inflammatory substances.
Conclusion
These findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.
select article The clinical significance of methylation of MAGE-A1 and-A3 promoters and expression of DNA methyltransferase in patients with laryngeal squamous cell carcinoma
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The clinical significance of methylation of MAGE-A1 and-A3 promoters and expression of DNA methyltransferase in patients with laryngeal squamous cell carcinoma
Shenghui Liu, Yan Zhao, Yuru Xu, Meixiang Sang, ... Baoen Shan
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Purpose
Abnormal DNA methylation plays an important role in clinical diagnosis and prognosis of various tumors. DNA methylation is catalyzed by DNA methyltransferase (DNMT). However, the methylation status of MAGE-A1 and MAGE-A3 promoter regions in LSCC is unclear. To investigate the methylation levels of MAGE-A1, -A3 in LSCC and corresponding normal tissues. The expression of DNMTs (DNMT1, DNMT3a and DNMT3b) in LSCC and the relationship between the methylation status of MAGE-A1, -A3 were analyzed.
Materials and methods
We examined methylation status of MAGE-A1, -A3 in LSCC by using MSP. Meanwhile, the expression level of DNMTs in LSCC was detected by immunohistochemistry. And further analysis the correlation between DNMTs expression level and methylation status of MAGE-A1 and MAGE-A3.
Results
The unmethylation rate of MAGE-A1, -A3 were 39.62% and 46.23%. The expression of DNMTs was 33.02% to 37.74%. The level of demethylation of MAGE-A1 and MAGE-A3 were negative related to DNMTs protein. MAGE-A1 and MAGE-A3 unmethylation status and DNMT3a expression were independent prognostic factors for LSCC.
Conclusions
The DNMTs may participate in the methylation process of MAGE-A1 and MAGE-A3, which may play an important role in the occurrence and development of LSCC.
select article Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database
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Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database
Vanessa C. Stubbs, Karthik Rajasekaran, Steven B. Cannady, Jason G. Newman, ... Jason A. Brant
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Background
Given the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates.
Methods
Our analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES.
Results
15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p < 0.0001). We found that Asian Americans compared to whites had better overall survival (HR 0.75; 95% CI [0.58–0.95]). Black patients had improved survival compared to whites on univariate (HR 0.71; 95% CI [0.64–0.79]); but not multivariate analysis. Hispanic ethnicity and higher education level were protective (HR 0.76 95% CI [0.63–0.91] and HR 0.84 95% CI [0.74–0.96], respectively). We found no significant survival association based on income level.
Conclusion
In this national sample of patients with parotid malignancy, a rare form of cancer, we found a significant correlation between important social determinants of health and overall survival rate. Females, Asian-Americans, Hispanics, and patients with higher education level have better overall survival.
select article Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance
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Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance
Hülya Eyigör, İlknur Haberal Can, Armağan İncesulu, Yeşim Şenol
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Objective
The aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers.
Study design and setting
A prospective survey study.
Subjects and methods
The study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses.
Results
Out of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ± 6.1 (29–75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57).
Conclusion
Healthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.
select article Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis
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Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis
Shin Kariya, Mitsuhiro Okano, Takaya Higaki, Seiichiro Makihara, ... Kazunori Nishizaki
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Purpose
Chronic cough is a common complaint. Because the pathophysiology of chronic cough is complicated, the management of chronic cough is challenging. To the best of our knowledge, no previous study has examined the effect of macrolide antibiotics in chronic cough patients with chronic rhinosinusitis. The purpose of this study is to determine the changes in lung function for chronic cough patients with chronic rhinosinusitis who are treated by clarithromycin and carbocisteine.
Materials and methods
Thirty-two chronic cough patients with chronic rhinosinusitis were recruited. Patients using inhaled corticosteroids and/or a bronchodilator, asthmatic patients, and patients with abnormal findings on auscultation and/or chest X-ray examination were excluded from this study. The patients received low-dose clarithromycin treatment for 3 months. Both before and after the treatment, a computed tomography (CT) scan of the paranasal sinuses, lung function test, peripheral blood test, and sino-nasal outcome test (SNOT-20) were applied.
Results
Both the lung function and Lund-MacKay CT scores were improved by the long-duration therapy with macrolide antibiotics. The change in obstructive pulmonary function and the improvement of the CT score in each subject were significantly correlated. SNOT scores also improved after the treatment.
Conclusions
The macrolide antibiotics treatment has beneficial effects on lung function in non-asthmatic chronic cough patients with normal chest X-ray findings. The improvement of chronic rhinosinusitis may have some role in the lung condition. Upper respiratory tract examination and treatment may be useful for the management of chronic cough.
select article Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function
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Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function
Eugene H. Wong, Carolyn A. Orgain, E. Ritter Sansoni, Raquel Alvarado, ... Richard J. Harvey
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Objective
The impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery.
Study design
Retrospective case series.
Setting
Tertiary Australian Hospitals.
Subjects and methods
A retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0–4) was determined by the number of inferior or middle turbinate subtotal resections.
Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.)
Results
294 patients (age 52.9 ± 17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93–3.38], OR = 0.60[0.33–1.12], B = 0.56[−1.58–2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04–4.13], P = 0.04, OR = 3.97[1.08–14.49], P = 0.04, respectively).
Conclusion
In patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.
select article Atypical Schwannoma: A 10-year experience
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Atypical Schwannoma: A 10-year experience
Armine H. Kocharyan, Selena Briggs, Maura K. Cosetti, Sabrina M. Heman-Ackah, ... J. Thomas Roland
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Objective
The goal of this study was to describe the clinical presentation associated with atypical schwannoma of the cerebellopontine angle, characterize the pathologic findings and describe the long-term outcome.
Materials and methods
The study design was retrospective case review of patients with the histopathologic diagnosis of atypical and benign schwannoma of the cerebellopontine angle diagnosed at the study institution over a 10-year period.
Setting
Tertiary referral center.
Main outcomes measure
Demographic data of the cohort were recorded. Findings on pathology were evaluated. Initial treatment and post-operative course was recorded. Main outcome measures were clinical presentation, including cranial nerve deficits at the time of presentation, complication and recurrence rates.
Results
At presentation, a somewhat accelerated course of cranial nerve deficit was noted among patients with atypical schwannoma as compared to benign schwannoma. In the immediate post-operative period, there were no differences noted in the complication rate. Atypical schwannomas appear to have higher recurrence rate compared to benign schwannomas.
Conclusions
Atypical schwannoma is an intermediate disease process with an accelerated clinical course and higher recurrence rate as compared to vestibular schwannoma. Traditional operative approaches may be employed without increased concern for post-operative complications. Thorough counseling and close follow-up should be offered to these patients given the higher recurrence rate. Larger studies are required to determine if these patients need more frequent MRIs for long-term surveillance.
select article Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo
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Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo
Kyujin Han, Yeo-Min Yun, Sung Gyu Moon, Chang-Hee Kim
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Although the etiology of benign paroxysmal positional vertigo (BPPV) is idiopathic in most cases, the association of osteoporosis or vitamin D deficiency with BPPV has attracted much interest recently. While it is generally accepted that osteoporosis or vitamin D deficiency is related to the occurrence and/or recurrence of BPPV, the difference in serum vitamin D level and bone mineral density (BMD) among different subtypes of BPPV has not been investigated. We aimed to compare T-score of BMD score and serum 25-hydroxyvitamin D level among idiopathic BPPV patients with a different subtype. This study included 117 consecutive patients with idiopathic BPPV (26 men and 91 women; mean age, 55 ± 11 years; age range, 25 to 78 years) who underwent blood sampling for serum 25-hydroxyvitamin D level measurement and bone mineral densitometry of the anterior-posterior lumbar spine and femur between April 2018 and February 2019. Among 117 patients, 49 were diagnosed with posterior semicircular canal (PSCC) BPPV, 24 were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, and 44 were diagnosed with LSCC cupulolithiasis. The mean T-score of BMD was −1.5 ± 0.9 in PSCC BPPV, −1.5 ± 1.3 in LSCC canalolithiasis, and −1.5 ± 1.1 in LSCC cupulolithiasis, which was not significantly different (p = 0.998, One-way ANOVA test). The mean level of 25-hydroxyvitamin D was 22.5 ± 10.6 ng/ml in PSCC BPPV, 26.8 ± 16.0 ng/ml in LSCC canalolithiasis, and 25.4 ± 9.6 ng/ml in LSCC cupulolithiasis, which was not significantly different (p = 0.262, One-way ANOVA test). The proportion of osteoporosis/osteopenia or vitamin D deficiency/insufficiency did not show significant difference among idiopathic BPPV patients with different subtypes, and findings of this study indicate that either serum level of vitamin D or T-score of BMD is not a distinguishable characteristic among different subtypes of BPPV.
select article Prognostic value of lymph node density for major salivary gland carcinoma without clinical lymph node metastasis
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Prognostic value of lymph node density for major salivary gland carcinoma without clinical lymph node metastasis
Hoshino Terada, Hidenori Suzuki, Nobuhiro Hanai, Daisuke Nishikawa, ... Yasuhisa Hasegawa
In Press, Journal Pre-proof, Available online 5 October 2019
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Abstract
Abstract
Background and objective
This study aimed to investigate whether lymph node density (LND) was correlated with overall survival (OS) in major salivary gland carcinoma without clinical lymph node metastasis.
Methods
Sixty patients who were diagnosed with major salivary gland carcinoma without clinical lymph node metastasis were enrolled. Of these, 50 patients underwent neck dissection. LND was defined as the ratio of the number of positive lymph nodes to the total number of resected lymph nodes.
Results
An LND of ≥0.1 was significantly associated with a short OS (p < 0.05). Multivariate analysis with adjustment for pathological N classification and positive surgical margin showed that an LND of ≥0.1 is a predictor of OS.
Conclusion
Results demonstrated that lymph node density functions as a predictor of outcomes for major salivary gland carcinoma without clinical lymph node metastasis.
select article Complications of Palatal Pillar Implants: An analysis of the MAUDE database and literature review
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Complications of Palatal Pillar Implants: An analysis of the MAUDE database and literature review
Roman Povolotskiy, Mickey E. Abraham, Adam B. Leverant, Amishav Bresler, Boris Paskhover
In Press, Journal Pre-proof, Available online 5 October 2019
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Abstract
Abstract
Purpose
The Pillar Palatal Implant System is a minimally invasive procedure for the treatment of obstructive sleep apnea and snoring. Prior studies have examined the effectiveness of this procedure, however no prior study has thoroughly evaluated its complications. We anticipate that this analysis will provide valuable insight into these procedures which can be used in patient education and post-operative follow-up.
Materials and methods
The Manufacturer and User Facility Device Experience (MAUDE) database was queried for cases reporting injury related to the pillar procedure. The case narratives were individually analyzed and categorized by type of complication. A comparison of extruding parts and select complications was also performed using chi-square analysis.
Results
Of the 261 cases reported, 73.6% reporting extruding parts, 47.5% described patient pain, and 38.7% included patients describing a foreign body sensation. Infection was reported in 7.7% of the cases with cellulitis and abscess formation specifically mentioned in one case. Cases describing pain and difficulty swallowing were significantly more likely to have reported extruding parts (p < 0.05).
Conclusions
This study describes various complications associated with this procedure. The description of these complications and accompanying literature review may provide healthcare professionals and patients with an understanding of the scope of adverse events related to this procedure.
select article Epigenetic silencing of microRNA-335 contributes to nasopharyngeal carcinoma metastasis
Research articleOpen access
Epigenetic silencing of microRNA-335 contributes to nasopharyngeal carcinoma metastasis
Ju-hong Yang, Lie-Kun Lin, Song Zhang
In Press, Journal Pre-proof, Available online 5 October 2019
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Abstract
Abstract
Background
MircoRNA-335 (miR-335), a member of mircoRNAs (miRNAs) family, has been found to be correlated with tumor invasion and metastasis. In this study, we aimed to detect the effect of miR-335 methylation on metastasis of nasopharyngeal carcinoma.
Methods
RT-PCR and methylation-specific PCR were applied to detect the expression levels of miR-335 and miR-335 methylation in nasopharyngeal carcinoma tissues.
Results
The levels of miR-335 expression were significantly lower in nasopharyngeal cancer tissues with promoter methylation, compared to those with promoter unmethylation. The levels of miR-335 gene promoter methylation were higher in 14 (46.7%) out of 30 nasopharyngeal cancer tissues. Furthermore, the patients with cervical lymph node metastasis had higher methylation rate in miR-335 promoter (66.7% versus 16.7%) than those without cervical lymph node metastasis.
Conclusion
Gene methylation contributes the expression of miR-335 in nasopharyngeal carcinoma. The expression of miR-335 methylation is correlated with the metastasis of nasopharyngeal carcinoma.
select article Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS)
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Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS)
Giuseppe Brescia, Leonardo Franz, Lara Alessandrini, Daniela Parrino, ... Gino Marioni
In Press, Journal Pre-proof, Available online 13 September 2019
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Abstract
Abstract
Purpose
Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography.
Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS.
Materials and methods
A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed.
Results
Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not.
Conclusions
Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.
select article Trends of temporal bone cancer: SEER database
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Trends of temporal bone cancer: SEER database
Pankti P. Acharya, Deeksha Sarma, Brian McKinnon
In Press, Journal Pre-proof, Available online 12 September 2019
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Abstract
Abstract
Objective
This retrospective review aims to analyze epidemiological trends related to temporal bone cancer, and primarily of the squamous cell subtype. Potential trends analyzed included age, gender, and geographical location.
Data sources
This retrospective review analyzed data found in the National Cancer Institute's SEER Database for cases of carcinomas of the middle ear. Cases were selected between 1975 and 2016 and using the primary site of Middle Ear (Site code C30.1), and then narrowed using additional variables, which included age, sex, and state-county. Languages covered included English.
Data extraction
The extracted data was entered into an Excel spreadsheet for further analysis in SPSS Version 25.
Data synthesis
An Analysis of Covariance (ANCOVA) and a Bonferroni correction were applied to the data for further analysis of significant trends. The data was then placed into tables outlining the distribution of cases among select patient characteristics of age and sex, and significant age group pairwise comparisons.
Conclusions
Age at diagnosis of temporal bone cancer is strongly associated with the prevalence of temporal bone cancer. We urge providers to consider subtypes of temporal bone cancer, including squamous cell carcinoma, when evaluating older adults with risk factors for temporal bone cancer and an abnormal physical exam.
select article Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation
Research articleAbstract only
Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation
J. Eric Lupo, Allison Biever, David C. Kelsall
In Press, Journal Pre-proof, Available online 11 September 2019
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Abstract
Abstract
Purpose
To comprehensively assess and describe functional auditory performance in a group of adults with bilateral, moderate sloping to profound sensorineural hearing loss who were dissatisfied users of well-fit bilateral hearing aids and presented for Cochlear implant evaluation. Preoperatively, participants were evaluated with bilateral hearing aids and post implantation, with a Cochlear implant and contralateral hearing aid.
Methods
Study participants were assessed using pure tone audiometry, aided speech understanding in quiet (CNC words) and in noise (AzBio sentences at +5 dB SNR) in the sound field with unilateral and bilateral hearing aids fit to target. Participants completed subjective scales of quality of life, (Health Utilities Index Mark 3), hearing disability, (Speech, Spatial and Qualities of Hearing Scale) and a device use satisfaction scale. Participants ≥55 years were administered the Montreal Cognitive Assessment screening tool. One-hundred enrolled individuals completed baseline evaluations.
Results
Aided bilateral mean speech understanding scores were 28% for CNC words and 31% for AzBio sentences. Mean scale ratings were 0.46 for overall quality of life and 3.19 for functional hearing ability. Ninety percent of participants reported dissatisfaction with overall hearing performance.
Conclusions
Evaluation results, including functional performance metrics quantifying the deleterious effects of hearing loss for overall wellbeing, underscore that bilateral hearing aids are not an effective treatment for individuals with bilateral, moderate sloping to profound sensorineural hearing loss. Individuals with this degree of hearing impairment, who demonstrate poor aided speech understanding and dissatisfaction with hearing abilities in everyday life, require timely referral to a Cochlear implant clinic for further evaluation.
select article Olfaction in juvenile nasopharyngeal angiofibroma: The first study
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Olfaction in juvenile nasopharyngeal angiofibroma: The first study
Anupam Mishra, Pankaj Pandey, Subhash Chandra Mishra
In Press, Journal Pre-proof, Available online 10 September 2019
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Abstract
Abstract
Background
To study the pattern of olfactory dysfunction/recovery in juvenile nasopharyngeal angiofibroma (JNA).
Methods
Olfactory assessment was undertaken in 30 patients (category1) both pre- & post-operatively and in another 18 (category 2) only postoperative. All patients underwent transpalatal excision and variables of interest included age, radiological stage/parameters & tumor size.
Results
Objective olfactory dysfunction was seen in 60% while involvement of olfactory strip was suggested in 50%. Despite some marginal trends only noted between size/age with change of olfaction, Pearson's correlation test did not reveal any significance amongst multiple variables. However a better recovery of olfaction following surgery was evident in Category-2 where Chi-Square test (p < 0.05) significantly revealed this to be a function of postoperative duration. This regenerative course in JNA suggests an optimum period of 4 years for full recovery after surgery.
Conclusion
In this first study of olfaction in JNA many new trends have been appreciated. In general, deteriorations of olfaction were seen due to ‘vascular-concussion’ effect in early postoperative phase where post-surgical clearance of airway showed minimal effect in terms of improvement. The hypervascularity of olfactory epithelium with possible hormonal effects may be responsible for the unique pattern of olfactory function and recovery in JNA.
select article A faster parathyroidectomy: Techniques to shorten non-surgical operating room time
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A faster parathyroidectomy: Techniques to shorten non-surgical operating room time
Ayaka J. Iwata, Anna S. Wertz, Spandana Alluri, Michael C. Singer
In Press, Corrected Proof, Available online 10 September 2019
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Abstract
Abstract
Objective
To assess the capacity of different techniques to reduce non-operative times during parathyroid surgery. The impact of monitored anesthesia care (MAC) instead of general anesthesia, and the pre-operative placement of a second peripheral intravenous catheter (PIV) were analyzed.
Methods
A retrospective case series at an academic medical center was performed to study patients undergoing parathyroidectomy by a single surgeon between November 2013 and October 2016. Three operating room (OR) time measurements were compared: pre-incision time, post-closure time, and total OR time.
Results
Surgeries performed under MAC (n = 21) had statistically shorter pre-incision (33.2 min vs. 39.7 min, p < .001), post-closure (10.1 min vs. 16.2 min, p = .002), and total operative times (113.0 min vs. 151.5 min, p < .001) compared to those in which general anesthesia (n = 169) was used. Of the 169 patients who underwent general anesthesia, 25 had a second PIV placed preoperatively and 144 had only a single PIV. All 3 time periods were statistically shorter in patients who had a second PIV versus those who had only a single PIV (pre-incision 32.2 min vs. 41.0 min, p < .001; post-closure 12.2 min vs. 16.9 min, p < .001; total 117.9 min vs. 157.4 min, p < .001).
Conclusions
In patients undergoing parathyroid surgery in which ioPTH levels will be used, the placement of a second PIV in the pre-operative holding area and performance of surgery under MAC can significantly shorten non-operative and total OR time.
select article National 30-day readmission and prolonged length of stay after vestibular schwannoma surgery: Analysis of the Nationwide Readmissions Database
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National 30-day readmission and prolonged length of stay after vestibular schwannoma surgery: Analysis of the Nationwide Readmissions Database
Zachary G. Schwam, Rocco Ferrandino, Vivian Z. Kaul, Maura K. Cosetti, George B. Wanna
In Press, Corrected Proof, Available online 10 September 2019
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Abstract
Abstract
Purpose
To determine the risk factors for unanticipated readmission, prolonged index admission, and discharge to a facility after vestibular schwannoma surgery.
Materials and methods
Retrospective cohort study of those undergoing surgery for vestibular schwannoma in the Nationwide Readmissions Database (2013–2014). Main outcome measures included readmission rate, length of stay, discharge destination.
Results
There were 4585 cases identified. The overall unanticipated readmission rate was 8.1%, and 9.1% had a prolonged length of stay (PLOS) of ≥7 days. Mean and median LOS were 4.63 and 4.00 days, respectively, and >90% of patients were discharged after 7 days. Disposition to a facility occurred in 6.7% of cases. Teaching hospitals were protective against unintended readmission (odds ratio [OR] 0.44, p < .001). Major functional loss was associated with PLOS (OR 12.55, p < .001). High volume centers were associated with decreased risk of PLOS (OR 0.46, p < .001) and facility discharge (OR 0.68, p < .001). The most common readmission diagnoses included “other nervous system complications” (n = 128), cerebrospinal fluid leak (n = 71), “other postoperative infection” (n = 61), and meningitis (n = 59).
Conclusions
Unanticipated readmission and prolonged LOS following vestibular schwannoma surgery are common, with varied sociodemographic, hospital, and patient factors independently associated with each. Further studies are needed to investigate targeted interventions aimed at minimizing readmission and prolonged LOS using the factors outlined above.
select article Variations in the management of acute Bell's palsy
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Variations in the management of acute Bell's palsy
David A. Kasle, Sina J. Torabi, Emily Savoca, Jacob I. Tower, Douglas Hildrew
In Press, Corrected Proof, Available online 10 September 2019
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Abstract
Abstract
Objective
To identify presiding practices among neurotologists (ORL) in the care of acute Bell's palsy, and to compare them to neurologists' treatment patterns.
Study design and methods
Cross-sectional survey study.
Subjects
Neurotologists and neurologists.
Results
Ninety-one responses to the survey were obtained. The majority of participants (87.9%) always prescribe steroids. ORL were more likely to prescribe higher doses (≥60 mg) than neurologists (89.7% vs. 58.0%) (p = 0.001). Anti-viral medication was initially prescribed by 46.2% of respondents (56.1% ORL vs. 38.0% neurologists; p = 0.085). An MRI was always ordered by 17 participants (18.7%), while an MRI was sometimes ordered by 45 participants (49.5%). ORL were not only more likely to always order an MRI (24.4% vs. 14.0%), but also more likely to never order an MRI (43.9% vs. 22.0%) (p = 0.009). Laboratory blood work was never ordered by 45.1% of respondents, with 70.7% of OTO and 24.0% of neurologists indicating that they would never order labs (p < 0.001).
Conclusions
ORL almost always prescribe steroids, prescribe antivirals around 50% of the time, and only sometimes obtain imaging for acute Bell's palsy. Compared to neurologists, ORL are more likely to order high dose steroids (≥60 mg), more commonly prescribe antivirals, and are less likely to order laboratory blood work. Regarding the treatment of acute Bell's palsy, there are discrepancies both within otolaryngology, and between otolaryngology and neurology, despite recently published guidelines from both specialties.
select article Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions
Research articleAbstract only
Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions
Orly Yariv, Aron Popovtzer, Oshri Wasserzug, Narin Carmel Neiderman, ... Moshe Yehuda
In Press, Journal Pre-proof, Available online 10 September 2019
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Abstract
Abstract
Purpose
To assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome.
Materials & methods
We retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed.
Results
Twenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA.
Conclusion
FNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.
select article Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results
Research articleAbstract only
Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results
Alfonso Scarpa, Massimo Ralli, Claudia Cassandro, Federico Maria Gioacchini, ... Ettore Cassandro
In Press, Corrected Proof, Available online 9 September 2019
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Abstract
Abstract
Purpose
There are many therapeutic options for Meniere's disease (MD); intratympanic (IT) gentamicin has been proposed for intractable cases although controversy about dosage and method exists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method in which administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections.
Materials and methods
Forty-eight patients with unilateral intractable MD were included in the study. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A–F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessment with pure tone audiometry, vestibular bed-side examination and video head impulse test was performed.
Results
Before treatment patients had an average of 4.4 vertigo attacks/month; after treatment the average number decreased to 0.52. The majority of patients (77%) reached Class A vertigo control with 5 or less gentamicin injections. VOR gain was unaffected in the healthy side and significantly reduced in the affected side. No hearing deterioration was found in all treated patients.
Efficacy of lianhuaqingwen granules in the management of chronic rhinosinusitis without nasal polyps
Lin Lin, Fei Dai, Guoqiang Ren, Jinjin Wei, ... Xinyue Tang
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Objectives
Chronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP.
Materials and methods
CRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups.
Results
One hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4+ and CD8+ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4+ and CD8+ T cell subpopulations and concentrations of inflammatory substances.
Conclusion
These findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.
select article The clinical significance of methylation of MAGE-A1 and-A3 promoters and expression of DNA methyltransferase in patients with laryngeal squamous cell carcinoma
Research articleAbstract only
The clinical significance of methylation of MAGE-A1 and-A3 promoters and expression of DNA methyltransferase in patients with laryngeal squamous cell carcinoma
Shenghui Liu, Yan Zhao, Yuru Xu, Meixiang Sang, ... Baoen Shan
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Purpose
Abnormal DNA methylation plays an important role in clinical diagnosis and prognosis of various tumors. DNA methylation is catalyzed by DNA methyltransferase (DNMT). However, the methylation status of MAGE-A1 and MAGE-A3 promoter regions in LSCC is unclear. To investigate the methylation levels of MAGE-A1, -A3 in LSCC and corresponding normal tissues. The expression of DNMTs (DNMT1, DNMT3a and DNMT3b) in LSCC and the relationship between the methylation status of MAGE-A1, -A3 were analyzed.
Materials and methods
We examined methylation status of MAGE-A1, -A3 in LSCC by using MSP. Meanwhile, the expression level of DNMTs in LSCC was detected by immunohistochemistry. And further analysis the correlation between DNMTs expression level and methylation status of MAGE-A1 and MAGE-A3.
Results
The unmethylation rate of MAGE-A1, -A3 were 39.62% and 46.23%. The expression of DNMTs was 33.02% to 37.74%. The level of demethylation of MAGE-A1 and MAGE-A3 were negative related to DNMTs protein. MAGE-A1 and MAGE-A3 unmethylation status and DNMT3a expression were independent prognostic factors for LSCC.
Conclusions
The DNMTs may participate in the methylation process of MAGE-A1 and MAGE-A3, which may play an important role in the occurrence and development of LSCC.
select article Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database
Research articleAbstract only
Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database
Vanessa C. Stubbs, Karthik Rajasekaran, Steven B. Cannady, Jason G. Newman, ... Jason A. Brant
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Background
Given the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates.
Methods
Our analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES.
Results
15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p < 0.0001). We found that Asian Americans compared to whites had better overall survival (HR 0.75; 95% CI [0.58–0.95]). Black patients had improved survival compared to whites on univariate (HR 0.71; 95% CI [0.64–0.79]); but not multivariate analysis. Hispanic ethnicity and higher education level were protective (HR 0.76 95% CI [0.63–0.91] and HR 0.84 95% CI [0.74–0.96], respectively). We found no significant survival association based on income level.
Conclusion
In this national sample of patients with parotid malignancy, a rare form of cancer, we found a significant correlation between important social determinants of health and overall survival rate. Females, Asian-Americans, Hispanics, and patients with higher education level have better overall survival.
select article Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance
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Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance
Hülya Eyigör, İlknur Haberal Can, Armağan İncesulu, Yeşim Şenol
In Press, Journal Pre-proof, Available online 18 October 2019
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Abstract
Abstract
Objective
The aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers.
Study design and setting
A prospective survey study.
Subjects and methods
The study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses.
Results
Out of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ± 6.1 (29–75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57).
Conclusion
Healthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.
select article Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis
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Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis
Shin Kariya, Mitsuhiro Okano, Takaya Higaki, Seiichiro Makihara, ... Kazunori Nishizaki
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Purpose
Chronic cough is a common complaint. Because the pathophysiology of chronic cough is complicated, the management of chronic cough is challenging. To the best of our knowledge, no previous study has examined the effect of macrolide antibiotics in chronic cough patients with chronic rhinosinusitis. The purpose of this study is to determine the changes in lung function for chronic cough patients with chronic rhinosinusitis who are treated by clarithromycin and carbocisteine.
Materials and methods
Thirty-two chronic cough patients with chronic rhinosinusitis were recruited. Patients using inhaled corticosteroids and/or a bronchodilator, asthmatic patients, and patients with abnormal findings on auscultation and/or chest X-ray examination were excluded from this study. The patients received low-dose clarithromycin treatment for 3 months. Both before and after the treatment, a computed tomography (CT) scan of the paranasal sinuses, lung function test, peripheral blood test, and sino-nasal outcome test (SNOT-20) were applied.
Results
Both the lung function and Lund-MacKay CT scores were improved by the long-duration therapy with macrolide antibiotics. The change in obstructive pulmonary function and the improvement of the CT score in each subject were significantly correlated. SNOT scores also improved after the treatment.
Conclusions
The macrolide antibiotics treatment has beneficial effects on lung function in non-asthmatic chronic cough patients with normal chest X-ray findings. The improvement of chronic rhinosinusitis may have some role in the lung condition. Upper respiratory tract examination and treatment may be useful for the management of chronic cough.
select article Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function
Research articleAbstract only
Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function
Eugene H. Wong, Carolyn A. Orgain, E. Ritter Sansoni, Raquel Alvarado, ... Richard J. Harvey
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Objective
The impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery.
Study design
Retrospective case series.
Setting
Tertiary Australian Hospitals.
Subjects and methods
A retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0–4) was determined by the number of inferior or middle turbinate subtotal resections.
Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.)
Results
294 patients (age 52.9 ± 17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93–3.38], OR = 0.60[0.33–1.12], B = 0.56[−1.58–2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04–4.13], P = 0.04, OR = 3.97[1.08–14.49], P = 0.04, respectively).
Conclusion
In patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.
select article Atypical Schwannoma: A 10-year experience
Research articleAbstract only
Atypical Schwannoma: A 10-year experience
Armine H. Kocharyan, Selena Briggs, Maura K. Cosetti, Sabrina M. Heman-Ackah, ... J. Thomas Roland
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Objective
The goal of this study was to describe the clinical presentation associated with atypical schwannoma of the cerebellopontine angle, characterize the pathologic findings and describe the long-term outcome.
Materials and methods
The study design was retrospective case review of patients with the histopathologic diagnosis of atypical and benign schwannoma of the cerebellopontine angle diagnosed at the study institution over a 10-year period.
Setting
Tertiary referral center.
Main outcomes measure
Demographic data of the cohort were recorded. Findings on pathology were evaluated. Initial treatment and post-operative course was recorded. Main outcome measures were clinical presentation, including cranial nerve deficits at the time of presentation, complication and recurrence rates.
Results
At presentation, a somewhat accelerated course of cranial nerve deficit was noted among patients with atypical schwannoma as compared to benign schwannoma. In the immediate post-operative period, there were no differences noted in the complication rate. Atypical schwannomas appear to have higher recurrence rate compared to benign schwannomas.
Conclusions
Atypical schwannoma is an intermediate disease process with an accelerated clinical course and higher recurrence rate as compared to vestibular schwannoma. Traditional operative approaches may be employed without increased concern for post-operative complications. Thorough counseling and close follow-up should be offered to these patients given the higher recurrence rate. Larger studies are required to determine if these patients need more frequent MRIs for long-term surveillance.
select article Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo
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Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo
Kyujin Han, Yeo-Min Yun, Sung Gyu Moon, Chang-Hee Kim
In Press, Journal Pre-proof, Available online 17 October 2019
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Abstract
Abstract
Although the etiology of benign paroxysmal positional vertigo (BPPV) is idiopathic in most cases, the association of osteoporosis or vitamin D deficiency with BPPV has attracted much interest recently. While it is generally accepted that osteoporosis or vitamin D deficiency is related to the occurrence and/or recurrence of BPPV, the difference in serum vitamin D level and bone mineral density (BMD) among different subtypes of BPPV has not been investigated. We aimed to compare T-score of BMD score and serum 25-hydroxyvitamin D level among idiopathic BPPV patients with a different subtype. This study included 117 consecutive patients with idiopathic BPPV (26 men and 91 women; mean age, 55 ± 11 years; age range, 25 to 78 years) who underwent blood sampling for serum 25-hydroxyvitamin D level measurement and bone mineral densitometry of the anterior-posterior lumbar spine and femur between April 2018 and February 2019. Among 117 patients, 49 were diagnosed with posterior semicircular canal (PSCC) BPPV, 24 were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, and 44 were diagnosed with LSCC cupulolithiasis. The mean T-score of BMD was −1.5 ± 0.9 in PSCC BPPV, −1.5 ± 1.3 in LSCC canalolithiasis, and −1.5 ± 1.1 in LSCC cupulolithiasis, which was not significantly different (p = 0.998, One-way ANOVA test). The mean level of 25-hydroxyvitamin D was 22.5 ± 10.6 ng/ml in PSCC BPPV, 26.8 ± 16.0 ng/ml in LSCC canalolithiasis, and 25.4 ± 9.6 ng/ml in LSCC cupulolithiasis, which was not significantly different (p = 0.262, One-way ANOVA test). The proportion of osteoporosis/osteopenia or vitamin D deficiency/insufficiency did not show significant difference among idiopathic BPPV patients with different subtypes, and findings of this study indicate that either serum level of vitamin D or T-score of BMD is not a distinguishable characteristic among different subtypes of BPPV.
select article Prognostic value of lymph node density for major salivary gland carcinoma without clinical lymph node metastasis
Research articleAbstract only
Prognostic value of lymph node density for major salivary gland carcinoma without clinical lymph node metastasis
Hoshino Terada, Hidenori Suzuki, Nobuhiro Hanai, Daisuke Nishikawa, ... Yasuhisa Hasegawa
In Press, Journal Pre-proof, Available online 5 October 2019
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Abstract
Abstract
Background and objective
This study aimed to investigate whether lymph node density (LND) was correlated with overall survival (OS) in major salivary gland carcinoma without clinical lymph node metastasis.
Methods
Sixty patients who were diagnosed with major salivary gland carcinoma without clinical lymph node metastasis were enrolled. Of these, 50 patients underwent neck dissection. LND was defined as the ratio of the number of positive lymph nodes to the total number of resected lymph nodes.
Results
An LND of ≥0.1 was significantly associated with a short OS (p < 0.05). Multivariate analysis with adjustment for pathological N classification and positive surgical margin showed that an LND of ≥0.1 is a predictor of OS.
Conclusion
Results demonstrated that lymph node density functions as a predictor of outcomes for major salivary gland carcinoma without clinical lymph node metastasis.
select article Complications of Palatal Pillar Implants: An analysis of the MAUDE database and literature review
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Complications of Palatal Pillar Implants: An analysis of the MAUDE database and literature review
Roman Povolotskiy, Mickey E. Abraham, Adam B. Leverant, Amishav Bresler, Boris Paskhover
In Press, Journal Pre-proof, Available online 5 October 2019
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Abstract
Abstract
Purpose
The Pillar Palatal Implant System is a minimally invasive procedure for the treatment of obstructive sleep apnea and snoring. Prior studies have examined the effectiveness of this procedure, however no prior study has thoroughly evaluated its complications. We anticipate that this analysis will provide valuable insight into these procedures which can be used in patient education and post-operative follow-up.
Materials and methods
The Manufacturer and User Facility Device Experience (MAUDE) database was queried for cases reporting injury related to the pillar procedure. The case narratives were individually analyzed and categorized by type of complication. A comparison of extruding parts and select complications was also performed using chi-square analysis.
Results
Of the 261 cases reported, 73.6% reporting extruding parts, 47.5% described patient pain, and 38.7% included patients describing a foreign body sensation. Infection was reported in 7.7% of the cases with cellulitis and abscess formation specifically mentioned in one case. Cases describing pain and difficulty swallowing were significantly more likely to have reported extruding parts (p < 0.05).
Conclusions
This study describes various complications associated with this procedure. The description of these complications and accompanying literature review may provide healthcare professionals and patients with an understanding of the scope of adverse events related to this procedure.
select article Epigenetic silencing of microRNA-335 contributes to nasopharyngeal carcinoma metastasis
Research articleOpen access
Epigenetic silencing of microRNA-335 contributes to nasopharyngeal carcinoma metastasis
Ju-hong Yang, Lie-Kun Lin, Song Zhang
In Press, Journal Pre-proof, Available online 5 October 2019
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Abstract
Abstract
Background
MircoRNA-335 (miR-335), a member of mircoRNAs (miRNAs) family, has been found to be correlated with tumor invasion and metastasis. In this study, we aimed to detect the effect of miR-335 methylation on metastasis of nasopharyngeal carcinoma.
Methods
RT-PCR and methylation-specific PCR were applied to detect the expression levels of miR-335 and miR-335 methylation in nasopharyngeal carcinoma tissues.
Results
The levels of miR-335 expression were significantly lower in nasopharyngeal cancer tissues with promoter methylation, compared to those with promoter unmethylation. The levels of miR-335 gene promoter methylation were higher in 14 (46.7%) out of 30 nasopharyngeal cancer tissues. Furthermore, the patients with cervical lymph node metastasis had higher methylation rate in miR-335 promoter (66.7% versus 16.7%) than those without cervical lymph node metastasis.
Conclusion
Gene methylation contributes the expression of miR-335 in nasopharyngeal carcinoma. The expression of miR-335 methylation is correlated with the metastasis of nasopharyngeal carcinoma.
select article Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS)
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Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS)
Giuseppe Brescia, Leonardo Franz, Lara Alessandrini, Daniela Parrino, ... Gino Marioni
In Press, Journal Pre-proof, Available online 13 September 2019
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Abstract
Abstract
Purpose
Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography.
Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS.
Materials and methods
A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed.
Results
Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not.
Conclusions
Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.
select article Trends of temporal bone cancer: SEER database
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Trends of temporal bone cancer: SEER database
Pankti P. Acharya, Deeksha Sarma, Brian McKinnon
In Press, Journal Pre-proof, Available online 12 September 2019
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Abstract
Abstract
Objective
This retrospective review aims to analyze epidemiological trends related to temporal bone cancer, and primarily of the squamous cell subtype. Potential trends analyzed included age, gender, and geographical location.
Data sources
This retrospective review analyzed data found in the National Cancer Institute's SEER Database for cases of carcinomas of the middle ear. Cases were selected between 1975 and 2016 and using the primary site of Middle Ear (Site code C30.1), and then narrowed using additional variables, which included age, sex, and state-county. Languages covered included English.
Data extraction
The extracted data was entered into an Excel spreadsheet for further analysis in SPSS Version 25.
Data synthesis
An Analysis of Covariance (ANCOVA) and a Bonferroni correction were applied to the data for further analysis of significant trends. The data was then placed into tables outlining the distribution of cases among select patient characteristics of age and sex, and significant age group pairwise comparisons.
Conclusions
Age at diagnosis of temporal bone cancer is strongly associated with the prevalence of temporal bone cancer. We urge providers to consider subtypes of temporal bone cancer, including squamous cell carcinoma, when evaluating older adults with risk factors for temporal bone cancer and an abnormal physical exam.
select article Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation
Research articleAbstract only
Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation
J. Eric Lupo, Allison Biever, David C. Kelsall
In Press, Journal Pre-proof, Available online 11 September 2019
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Abstract
Abstract
Purpose
To comprehensively assess and describe functional auditory performance in a group of adults with bilateral, moderate sloping to profound sensorineural hearing loss who were dissatisfied users of well-fit bilateral hearing aids and presented for Cochlear implant evaluation. Preoperatively, participants were evaluated with bilateral hearing aids and post implantation, with a Cochlear implant and contralateral hearing aid.
Methods
Study participants were assessed using pure tone audiometry, aided speech understanding in quiet (CNC words) and in noise (AzBio sentences at +5 dB SNR) in the sound field with unilateral and bilateral hearing aids fit to target. Participants completed subjective scales of quality of life, (Health Utilities Index Mark 3), hearing disability, (Speech, Spatial and Qualities of Hearing Scale) and a device use satisfaction scale. Participants ≥55 years were administered the Montreal Cognitive Assessment screening tool. One-hundred enrolled individuals completed baseline evaluations.
Results
Aided bilateral mean speech understanding scores were 28% for CNC words and 31% for AzBio sentences. Mean scale ratings were 0.46 for overall quality of life and 3.19 for functional hearing ability. Ninety percent of participants reported dissatisfaction with overall hearing performance.
Conclusions
Evaluation results, including functional performance metrics quantifying the deleterious effects of hearing loss for overall wellbeing, underscore that bilateral hearing aids are not an effective treatment for individuals with bilateral, moderate sloping to profound sensorineural hearing loss. Individuals with this degree of hearing impairment, who demonstrate poor aided speech understanding and dissatisfaction with hearing abilities in everyday life, require timely referral to a Cochlear implant clinic for further evaluation.
select article Olfaction in juvenile nasopharyngeal angiofibroma: The first study
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Olfaction in juvenile nasopharyngeal angiofibroma: The first study
Anupam Mishra, Pankaj Pandey, Subhash Chandra Mishra
In Press, Journal Pre-proof, Available online 10 September 2019
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Abstract
Abstract
Background
To study the pattern of olfactory dysfunction/recovery in juvenile nasopharyngeal angiofibroma (JNA).
Methods
Olfactory assessment was undertaken in 30 patients (category1) both pre- & post-operatively and in another 18 (category 2) only postoperative. All patients underwent transpalatal excision and variables of interest included age, radiological stage/parameters & tumor size.
Results
Objective olfactory dysfunction was seen in 60% while involvement of olfactory strip was suggested in 50%. Despite some marginal trends only noted between size/age with change of olfaction, Pearson's correlation test did not reveal any significance amongst multiple variables. However a better recovery of olfaction following surgery was evident in Category-2 where Chi-Square test (p < 0.05) significantly revealed this to be a function of postoperative duration. This regenerative course in JNA suggests an optimum period of 4 years for full recovery after surgery.
Conclusion
In this first study of olfaction in JNA many new trends have been appreciated. In general, deteriorations of olfaction were seen due to ‘vascular-concussion’ effect in early postoperative phase where post-surgical clearance of airway showed minimal effect in terms of improvement. The hypervascularity of olfactory epithelium with possible hormonal effects may be responsible for the unique pattern of olfactory function and recovery in JNA.
select article A faster parathyroidectomy: Techniques to shorten non-surgical operating room time
Research articleAbstract only
A faster parathyroidectomy: Techniques to shorten non-surgical operating room time
Ayaka J. Iwata, Anna S. Wertz, Spandana Alluri, Michael C. Singer
In Press, Corrected Proof, Available online 10 September 2019
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Abstract
Abstract
Objective
To assess the capacity of different techniques to reduce non-operative times during parathyroid surgery. The impact of monitored anesthesia care (MAC) instead of general anesthesia, and the pre-operative placement of a second peripheral intravenous catheter (PIV) were analyzed.
Methods
A retrospective case series at an academic medical center was performed to study patients undergoing parathyroidectomy by a single surgeon between November 2013 and October 2016. Three operating room (OR) time measurements were compared: pre-incision time, post-closure time, and total OR time.
Results
Surgeries performed under MAC (n = 21) had statistically shorter pre-incision (33.2 min vs. 39.7 min, p < .001), post-closure (10.1 min vs. 16.2 min, p = .002), and total operative times (113.0 min vs. 151.5 min, p < .001) compared to those in which general anesthesia (n = 169) was used. Of the 169 patients who underwent general anesthesia, 25 had a second PIV placed preoperatively and 144 had only a single PIV. All 3 time periods were statistically shorter in patients who had a second PIV versus those who had only a single PIV (pre-incision 32.2 min vs. 41.0 min, p < .001; post-closure 12.2 min vs. 16.9 min, p < .001; total 117.9 min vs. 157.4 min, p < .001).
Conclusions
In patients undergoing parathyroid surgery in which ioPTH levels will be used, the placement of a second PIV in the pre-operative holding area and performance of surgery under MAC can significantly shorten non-operative and total OR time.
select article National 30-day readmission and prolonged length of stay after vestibular schwannoma surgery: Analysis of the Nationwide Readmissions Database
Research articleAbstract only
National 30-day readmission and prolonged length of stay after vestibular schwannoma surgery: Analysis of the Nationwide Readmissions Database
Zachary G. Schwam, Rocco Ferrandino, Vivian Z. Kaul, Maura K. Cosetti, George B. Wanna
In Press, Corrected Proof, Available online 10 September 2019
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Abstract
Abstract
Purpose
To determine the risk factors for unanticipated readmission, prolonged index admission, and discharge to a facility after vestibular schwannoma surgery.
Materials and methods
Retrospective cohort study of those undergoing surgery for vestibular schwannoma in the Nationwide Readmissions Database (2013–2014). Main outcome measures included readmission rate, length of stay, discharge destination.
Results
There were 4585 cases identified. The overall unanticipated readmission rate was 8.1%, and 9.1% had a prolonged length of stay (PLOS) of ≥7 days. Mean and median LOS were 4.63 and 4.00 days, respectively, and >90% of patients were discharged after 7 days. Disposition to a facility occurred in 6.7% of cases. Teaching hospitals were protective against unintended readmission (odds ratio [OR] 0.44, p < .001). Major functional loss was associated with PLOS (OR 12.55, p < .001). High volume centers were associated with decreased risk of PLOS (OR 0.46, p < .001) and facility discharge (OR 0.68, p < .001). The most common readmission diagnoses included “other nervous system complications” (n = 128), cerebrospinal fluid leak (n = 71), “other postoperative infection” (n = 61), and meningitis (n = 59).
Conclusions
Unanticipated readmission and prolonged LOS following vestibular schwannoma surgery are common, with varied sociodemographic, hospital, and patient factors independently associated with each. Further studies are needed to investigate targeted interventions aimed at minimizing readmission and prolonged LOS using the factors outlined above.
select article Variations in the management of acute Bell's palsy
Research articleAbstract only
Variations in the management of acute Bell's palsy
David A. Kasle, Sina J. Torabi, Emily Savoca, Jacob I. Tower, Douglas Hildrew
In Press, Corrected Proof, Available online 10 September 2019
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Abstract
Abstract
Objective
To identify presiding practices among neurotologists (ORL) in the care of acute Bell's palsy, and to compare them to neurologists' treatment patterns.
Study design and methods
Cross-sectional survey study.
Subjects
Neurotologists and neurologists.
Results
Ninety-one responses to the survey were obtained. The majority of participants (87.9%) always prescribe steroids. ORL were more likely to prescribe higher doses (≥60 mg) than neurologists (89.7% vs. 58.0%) (p = 0.001). Anti-viral medication was initially prescribed by 46.2% of respondents (56.1% ORL vs. 38.0% neurologists; p = 0.085). An MRI was always ordered by 17 participants (18.7%), while an MRI was sometimes ordered by 45 participants (49.5%). ORL were not only more likely to always order an MRI (24.4% vs. 14.0%), but also more likely to never order an MRI (43.9% vs. 22.0%) (p = 0.009). Laboratory blood work was never ordered by 45.1% of respondents, with 70.7% of OTO and 24.0% of neurologists indicating that they would never order labs (p < 0.001).
Conclusions
ORL almost always prescribe steroids, prescribe antivirals around 50% of the time, and only sometimes obtain imaging for acute Bell's palsy. Compared to neurologists, ORL are more likely to order high dose steroids (≥60 mg), more commonly prescribe antivirals, and are less likely to order laboratory blood work. Regarding the treatment of acute Bell's palsy, there are discrepancies both within otolaryngology, and between otolaryngology and neurology, despite recently published guidelines from both specialties.
select article Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions
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Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions
Orly Yariv, Aron Popovtzer, Oshri Wasserzug, Narin Carmel Neiderman, ... Moshe Yehuda
In Press, Journal Pre-proof, Available online 10 September 2019
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Abstract
Abstract
Purpose
To assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome.
Materials & methods
We retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed.
Results
Twenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA.
Conclusion
FNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.
select article Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results
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Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results
Alfonso Scarpa, Massimo Ralli, Claudia Cassandro, Federico Maria Gioacchini, ... Ettore Cassandro
In Press, Corrected Proof, Available online 9 September 2019
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Abstract
Abstract
Purpose
There are many therapeutic options for Meniere's disease (MD); intratympanic (IT) gentamicin has been proposed for intractable cases although controversy about dosage and method exists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method in which administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections.
Materials and methods
Forty-eight patients with unilateral intractable MD were included in the study. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A–F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessment with pure tone audiometry, vestibular bed-side examination and video head impulse test was performed.
Results
Before treatment patients had an average of 4.4 vertigo attacks/month; after treatment the average number decreased to 0.52. The majority of patients (77%) reached Class A vertigo control with 5 or less gentamicin injections. VOR gain was unaffected in the healthy side and significantly reduced in the affected side. No hearing deterioration was found in all treated patients.
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