Growth pattern of temporal bone pneumatization: a computed tomography study with consecutive age groups

Abstract

Purpose

To investigate the growth pattern of temporal bone pneumatization (TBP) in consecutive age groups from birth to 18 years old using 3D air-density reconstruction of high-resolution CT (HRCT).

Methods

A total of 570 patients under 18 years old who performed temporal bone HRCT and with no structural abnormalities on both sides were included. Nineteen groups were created to represent consecutive ages, with 15 males and 15 females in each group. Volume rendering of air density was performed using a segmentation threshold of − 200 HU to obtain TBP volume of each side. The differences in TBP between the sides, sexes, and ages were statistically analyzed.

Results

The mean volume of TBP was measured as 1.17 ± 0.44 ml in patients less than 1 year old and 6.81 ± 1.93 ml as adult size. High consistencies of TBP volume between different sides or sexes were found in most of age groups. Significant differences were shown between sides only in 9- and 11-year-old female groups (p₉ = 0.031, p₁₁ = 0.016) while between sexes only in 6- and 16-year-old groups (p₆ = 0.001, p₁₆ = 0.043), although the volume was larger in all the male groups older than 6 years. The curve drawn by the mean volume in consecutive age groups showed that TBP continued to grow linearly in both males and females until they reached 14 years old. The corresponding linear regression equations were as follows: y_m = 1.553 + 0.370x, (x ≤ 14 years, R² = 0.596); y_f = 1.561 + 0.304x, (x ≤ 14 years, R² = 0.565).

Conclusion

The TBP volume shows a linear growth pattern from birth until reaching adult size after 14 years old.

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Do preoperative corticosteroids benefit patients with chronic rhinosinusitis with nasal polyposis?

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Do preoperative corticosteroids benefit patients with chronic rhinosinusitis with nasal polyposis?

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Evaluation of a New Algorithm to Optimize Audibility in Cochlear Implant Recipients

Objectives: A positive relation between audibility and speech understanding has been established for cochlear implant (CI) recipients. Sound field thresholds of 20 dB HL across the frequency range provide CI users the opportunity to understand soft and very soft speech. However, programming the sound processor to attain good audibility can be time-consuming and difficult for some patients. To address these issues, Advanced Bionics (AB) developed the SoftVoice algorithm designed to remove system noise and thereby improve audibility of soft speech. The present study aimed to evaluate the efficacy of SoftVoice in optimizing AB CI recipients' soft-speech perception. Design: Two studies were conducted. Study 1 had two phases, 1A and 1B. Sixteen adult, AB CI recipients participated in Study 1A. Acute testing was performed in the unilateral CI condition using a Harmony processor programmed with participants' everyday-use program (Everyday) and that same program but with SoftVoice implemented. Speech recognition measures were administered at several presentation levels in quiet (35 to 60 dB SPL) and in noise (60 dB SPL). In Study 1B, 10 of the participants compared Everyday and SoftVoice at home to obtain feedback regarding the use of SoftVoice in various environments. During Study 2, soft-speech perception was acutely measured with Everyday and SoftVoice for 10 participants using the Naida CI Q70 processor. Results with the Harmony (Study 1A) and Naida processors were compared. Additionally, Study 2 evaluated programming options for setting electrode threshold levels (T-levels or Ts) to improve the usability of SoftVoice in daily life. Results: Study 1A showed significantly higher scores with SoftVoice than Everyday at soft presentation levels (35, 40, 45, and 50 dB SPL) and no significant differences between programs at a conversational level (60 dB SPL) in quiet or in noise. After take-home experience with SoftVoice and Everyday (Study 1B), 5 of 10 participants reported preferring SoftVoice over Everyday; however, 6 reported bothersome environmental sound when listening with SoftVoice at home. Results of Study 2 indicated similar soft-speech perception between Harmony and Naida processors. Additionally, implementing SoftVoice with Ts at the manufacturer's default setting of 10% of Ms reduced reports of bothersome environmental sound during take-home experience; however, soft-speech perception was best with SoftVoice when Ts were behaviorally set above 10% of Ms. Conclusions: Results indicate that SoftVoice may be a potential tool for optimizing AB users' audibility and, in turn, soft-speech perception. To achieve optimal performance at soft levels and comfortable use in daily environments, setting Ts must be considered with SoftVoice. Future research should examine program parameters that may benefit soft-speech perception when used in combination with SoftVoice (e.g., increased input dynamic range). ACKNOWLEDGMENTS: The authors express their appreciation to the participants who graciously gave their time and effort to participate in this study and to Chris Brenner who assisted with data entry and editing parts of the manuscript. This research was supported by funds from Advanced Bionics, LLC and from NIH/NIDCD R01DC009010. The authors L.K.H., J.B.F., R.M.R., A.L.S., and L.M.L. designed the study, analyzed and interpreted data, and contributed to the writing of the manuscript. L.K.H. and N.Y.D. collected the data. N.Y.D. also assisted with interpretation of the data and writing the manuscript. A.L.S. and L.M.L. are employed by Advanced Bionics, LLC. J.B.F. serves on the audiology advisory boards for Advanced Bionics, LLC and Cochlear Americas. Address for correspondence: Laura K. Holden, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8115, St. Louis, MO 63110. E-mail: laurakholden@wustl.edu Received March 23, 2018; accepted September 27, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Speech-in-Noise and Quality-of-Life Measures in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss

Objectives: (1) Measure sentence recognition in co-located and spatially separated target and masker configurations in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH). (2) Compare self-reported hearing-related quality-of-life (QoL) scores in school-aged children with UHL and NH. Design: Listeners were school-aged children (6 to 12 yrs) with permanent UHL (n = 41) or NH (n = 35) and adults with NH (n = 23). Sentence reception thresholds (SRTs) were measured using Hearing In Noise Test–Children sentences in quiet and in the presence of 2-talker child babble or a speech-shaped noise masker in target/masker spatial configurations: 0/0, 0/−60, 0/+60, or 0/±60 degrees azimuth. Maskers were presented at a fixed level of 55 dBA, while the level of the target sentences varied adaptively to estimate the SRT. Hearing-related QoL was measured using the Hearing Environments and Reflection on Quality of Life (HEAR-QL-26) questionnaire for child subjects. Results: As a group, subjects with unaided UHL had higher (poorer) SRTs than age-matched peers with NH in all listening conditions. Effects of age, masker type, and spatial configuration of target and masker signals were found. Spatial release from masking was significantly reduced in conditions where the masker was directed toward UHL subjects' normal-hearing ear. Hearing-related QoL scores were significantly poorer in subjects with UHL compared to those with NH. Degree of UHL, as measured by four-frequency pure-tone average, was significantly correlated with SRTs only in the two conditions where the masker was directed towards subjects' normal-hearing ear, although the unaided Speech Intelligibility Index at 65 dB SPL was significantly correlated with SRTs in four conditions, some of which directed the masker to the impaired ear or both ears. Neither pure-tone average nor unaided Speech Intelligibility Index was correlated with QoL scores. Conclusions: As a group, school-aged children with UHL showed substantial reductions in masked speech perception and hearing-related QoL, irrespective of sex, laterality of hearing loss, and degree of hearing loss. While some children demonstrated normal or near-normal performance in certain listening conditions, a disproportionate number of thresholds fell in the poorest decile of the NH data. These findings add to the growing literature challenging the past assumption that one ear is "good enough." ACKNOWLEDGMENTS: The authors are grateful to Kelsey Cappetta for her assistance with subject recruitment and data collection, Kevin Randall and Michael Rogers for their support with software development, Kosuke Kawai for his assistance with statistical support, Patrick Zurek for his helpful comments on an earlier version of this article, and most especially to all the children and families who graciously participated in this research project. The authors also acknowledge the generosity of the following funding sources, which contributed to the execution of the research project: National Institute on Deafness and Other Communication Disorders DC-01625, University of Massachusetts Amherst Graduate School, Boston Children's Hospital Otolaryngology Foundation. Portions of this research were completed at the University of Massachusetts Amherst in partial fulfillment of the first author's doctoral dissertation requirements. Preliminary results of this study were presented at the Annual Scientific and Technology Conference of the American Auditory Society, Scottsdale, AZ, March 2017. The authors declare no conflict of interest. Address for correspondence Amanda Griffin, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 9 Hope Avenue, Waltham, MA 02453, USA. E-mail: Amanda.Griffin@childrens.harvard.edu Received April 23, 2018; accepted August 20, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Evaluation of a New Algorithm to Optimize Audibility in Cochlear Implant Recipients

Objectives: A positive relation between audibility and speech understanding has been established for cochlear implant (CI) recipients. Sound field thresholds of 20 dB HL across the frequency range provide CI users the opportunity to understand soft and very soft speech. However, programming the sound processor to attain good audibility can be time-consuming and difficult for some patients. To address these issues, Advanced Bionics (AB) developed the SoftVoice algorithm designed to remove system noise and thereby improve audibility of soft speech. The present study aimed to evaluate the efficacy of SoftVoice in optimizing AB CI recipients' soft-speech perception. Design: Two studies were conducted. Study 1 had two phases, 1A and 1B. Sixteen adult, AB CI recipients participated in Study 1A. Acute testing was performed in the unilateral CI condition using a Harmony processor programmed with participants' everyday-use program (Everyday) and that same program but with SoftVoice implemented. Speech recognition measures were administered at several presentation levels in quiet (35 to 60 dB SPL) and in noise (60 dB SPL). In Study 1B, 10 of the participants compared Everyday and SoftVoice at home to obtain feedback regarding the use of SoftVoice in various environments. During Study 2, soft-speech perception was acutely measured with Everyday and SoftVoice for 10 participants using the Naida CI Q70 processor. Results with the Harmony (Study 1A) and Naida processors were compared. Additionally, Study 2 evaluated programming options for setting electrode threshold levels (T-levels or Ts) to improve the usability of SoftVoice in daily life. Results: Study 1A showed significantly higher scores with SoftVoice than Everyday at soft presentation levels (35, 40, 45, and 50 dB SPL) and no significant differences between programs at a conversational level (60 dB SPL) in quiet or in noise. After take-home experience with SoftVoice and Everyday (Study 1B), 5 of 10 participants reported preferring SoftVoice over Everyday; however, 6 reported bothersome environmental sound when listening with SoftVoice at home. Results of Study 2 indicated similar soft-speech perception between Harmony and Naida processors. Additionally, implementing SoftVoice with Ts at the manufacturer's default setting of 10% of Ms reduced reports of bothersome environmental sound during take-home experience; however, soft-speech perception was best with SoftVoice when Ts were behaviorally set above 10% of Ms. Conclusions: Results indicate that SoftVoice may be a potential tool for optimizing AB users' audibility and, in turn, soft-speech perception. To achieve optimal performance at soft levels and comfortable use in daily environments, setting Ts must be considered with SoftVoice. Future research should examine program parameters that may benefit soft-speech perception when used in combination with SoftVoice (e.g., increased input dynamic range). ACKNOWLEDGMENTS: The authors express their appreciation to the participants who graciously gave their time and effort to participate in this study and to Chris Brenner who assisted with data entry and editing parts of the manuscript. This research was supported by funds from Advanced Bionics, LLC and from NIH/NIDCD R01DC009010. The authors L.K.H., J.B.F., R.M.R., A.L.S., and L.M.L. designed the study, analyzed and interpreted data, and contributed to the writing of the manuscript. L.K.H. and N.Y.D. collected the data. N.Y.D. also assisted with interpretation of the data and writing the manuscript. A.L.S. and L.M.L. are employed by Advanced Bionics, LLC. J.B.F. serves on the audiology advisory boards for Advanced Bionics, LLC and Cochlear Americas. Address for correspondence: Laura K. Holden, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8115, St. Louis, MO 63110. E-mail: laurakholden@wustl.edu Received March 23, 2018; accepted September 27, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Speech-in-Noise and Quality-of-Life Measures in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss

Objectives: (1) Measure sentence recognition in co-located and spatially separated target and masker configurations in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH). (2) Compare self-reported hearing-related quality-of-life (QoL) scores in school-aged children with UHL and NH. Design: Listeners were school-aged children (6 to 12 yrs) with permanent UHL (n = 41) or NH (n = 35) and adults with NH (n = 23). Sentence reception thresholds (SRTs) were measured using Hearing In Noise Test–Children sentences in quiet and in the presence of 2-talker child babble or a speech-shaped noise masker in target/masker spatial configurations: 0/0, 0/−60, 0/+60, or 0/±60 degrees azimuth. Maskers were presented at a fixed level of 55 dBA, while the level of the target sentences varied adaptively to estimate the SRT. Hearing-related QoL was measured using the Hearing Environments and Reflection on Quality of Life (HEAR-QL-26) questionnaire for child subjects. Results: As a group, subjects with unaided UHL had higher (poorer) SRTs than age-matched peers with NH in all listening conditions. Effects of age, masker type, and spatial configuration of target and masker signals were found. Spatial release from masking was significantly reduced in conditions where the masker was directed toward UHL subjects' normal-hearing ear. Hearing-related QoL scores were significantly poorer in subjects with UHL compared to those with NH. Degree of UHL, as measured by four-frequency pure-tone average, was significantly correlated with SRTs only in the two conditions where the masker was directed towards subjects' normal-hearing ear, although the unaided Speech Intelligibility Index at 65 dB SPL was significantly correlated with SRTs in four conditions, some of which directed the masker to the impaired ear or both ears. Neither pure-tone average nor unaided Speech Intelligibility Index was correlated with QoL scores. Conclusions: As a group, school-aged children with UHL showed substantial reductions in masked speech perception and hearing-related QoL, irrespective of sex, laterality of hearing loss, and degree of hearing loss. While some children demonstrated normal or near-normal performance in certain listening conditions, a disproportionate number of thresholds fell in the poorest decile of the NH data. These findings add to the growing literature challenging the past assumption that one ear is "good enough." ACKNOWLEDGMENTS: The authors are grateful to Kelsey Cappetta for her assistance with subject recruitment and data collection, Kevin Randall and Michael Rogers for their support with software development, Kosuke Kawai for his assistance with statistical support, Patrick Zurek for his helpful comments on an earlier version of this article, and most especially to all the children and families who graciously participated in this research project. The authors also acknowledge the generosity of the following funding sources, which contributed to the execution of the research project: National Institute on Deafness and Other Communication Disorders DC-01625, University of Massachusetts Amherst Graduate School, Boston Children's Hospital Otolaryngology Foundation. Portions of this research were completed at the University of Massachusetts Amherst in partial fulfillment of the first author's doctoral dissertation requirements. Preliminary results of this study were presented at the Annual Scientific and Technology Conference of the American Auditory Society, Scottsdale, AZ, March 2017. The authors declare no conflict of interest. Address for correspondence Amanda Griffin, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 9 Hope Avenue, Waltham, MA 02453, USA. E-mail: Amanda.Griffin@childrens.harvard.edu Received April 23, 2018; accepted August 20, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Clinical and patient-reported outcomes after image-guided intra-articular therapeutic hip injections for osteoarthritis-related hip pain: a retrospective study

Abstract

Objective

To evaluate change in patient-reported outcomes following image-guided intra-articular therapeutic steroid hip injections for pain and assess correlations of outcomes with patient- and injection-specific factors.

Materials and methods

We retrospectively reviewed consecutive patients treated for hip pain who completed outcomes assessments from October 2011 to September 2017 at an outpatient orthopedic surgery clinic. Only patients with radiographic hip osteoarthritis (Tönnis grade ≥ 1) who underwent steroid hip injections were included. Outcomes assessments included EuroQol-5 domain (EQ5D), EQ5D-visual analog scale (VAS), and hip disability and osteoarthritis outcome score (HOOS), obtained before and within 1–6 months post-injection. Among 113 patients who completed surveys, the mean age was 59 years (±13.7 years), including 77 women (68%) and 36 men (32%). Time to repeat injection or arthroplasty was recorded. Exact Wilcoxon signed rank test assessed score differences and Spearman correlation, Kruskal–Wallis, and Mann–Whitney tests assessed correlations.

Results

Of 113 patients, 34 had outcomes measured at <8 weeks and 79 at ≥8 weeks. There was no significant change among any of the patients, short- or long-term follow-up subgroups in EQ5D (p = 0.450, 0.770, 0.493 respectively), EQ5D-VAS (p = 0.581, 0.915, 0.455), average-HOOS (p = 0.478, 0.696, 0.443) or total-HOOS (p = 0.380, 0.517, 0.423) scores. Forty-nine patients underwent hip arthroplasty within 1 year. Positive correlation was found between days from injection to surgery and change in EQ5D (r = 0.29, p = 0.025), average-HOOS (r = 0.33, p = 0.019), and total-HOOS (r = 0.37, p = 0.008).

Conclusion

We demonstrated no significant change in patient-reported outcomes measured at short- and long-term intervals up to 6 months after therapeutic steroid hip injections.

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Clinical and patient-reported outcomes after image-guided intra-articular therapeutic hip injections for osteoarthritis-related hip pain: a retrospective study

Abstract

Objective

To evaluate change in patient-reported outcomes following image-guided intra-articular therapeutic steroid hip injections for pain and assess correlations of outcomes with patient- and injection-specific factors.

Materials and methods

We retrospectively reviewed consecutive patients treated for hip pain who completed outcomes assessments from October 2011 to September 2017 at an outpatient orthopedic surgery clinic. Only patients with radiographic hip osteoarthritis (Tönnis grade ≥ 1) who underwent steroid hip injections were included. Outcomes assessments included EuroQol-5 domain (EQ5D), EQ5D-visual analog scale (VAS), and hip disability and osteoarthritis outcome score (HOOS), obtained before and within 1–6 months post-injection. Among 113 patients who completed surveys, the mean age was 59 years (±13.7 years), including 77 women (68%) and 36 men (32%). Time to repeat injection or arthroplasty was recorded. Exact Wilcoxon signed rank test assessed score differences and Spearman correlation, Kruskal–Wallis, and Mann–Whitney tests assessed correlations.

Results

Of 113 patients, 34 had outcomes measured at <8 weeks and 79 at ≥8 weeks. There was no significant change among any of the patients, short- or long-term follow-up subgroups in EQ5D (p = 0.450, 0.770, 0.493 respectively), EQ5D-VAS (p = 0.581, 0.915, 0.455), average-HOOS (p = 0.478, 0.696, 0.443) or total-HOOS (p = 0.380, 0.517, 0.423) scores. Forty-nine patients underwent hip arthroplasty within 1 year. Positive correlation was found between days from injection to surgery and change in EQ5D (r = 0.29, p = 0.025), average-HOOS (r = 0.33, p = 0.019), and total-HOOS (r = 0.37, p = 0.008).

Conclusion

We demonstrated no significant change in patient-reported outcomes measured at short- and long-term intervals up to 6 months after therapeutic steroid hip injections.

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Are predictors of reading impairment in isolated cleft similar to those in idiopathic dyslexia?

Authors: Conrad AL Abstract Children with isolated cleft of the lip and/or palate (iCL/P) are at increased risk for reading impairment. The purpose of this study was to evaluate the impact of early risk factors (hearing, speech, and early literacy) on reading performance compared to unaffected participants with average (uAR) and impaired (uIR) reading. Reading achievement and early literacy skills were evaluated across three groups (27 iCL/P, 32 uAR, and 33 uIR). All participants were males, ages 8-11 years old. Those with history of head trauma/injury or major medical/mental health conditions were excluded. Group differences in achievement and early literacy skills were evaluated with ANCOVAs. Participants with impaired reading achievement (at or below 25th Percentile) were ident...

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Are predictors of reading impairment in isolated cleft similar to those in idiopathic dyslexia?

Authors: Conrad AL Abstract Children with isolated cleft of the lip and/or palate (iCL/P) are at increased risk for reading impairment. The purpose of this study was to evaluate the impact of early risk factors (hearing, speech, and early literacy) on reading performance compared to unaffected participants with average (uAR) and impaired (uIR) reading. Reading achievement and early literacy skills were evaluated across three groups (27 iCL/P, 32 uAR, and 33 uIR). All participants were males, ages 8-11 years old. Those with history of head trauma/injury or major medical/mental health conditions were excluded. Group differences in achievement and early literacy skills were evaluated with ANCOVAs. Participants with impaired reading achievement (at or below 25th Percentile) were ident...

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High take-up rate on HPV vaccination amongst boys

High take-up rate on HPV vaccination amongst boys  The Copenhagen Post - Danish news in englishFull coverage

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Mast cells at the crossroads of microbiota and IBD

This article is protected by copyright. All rights reserved (Source: European Journal of Immunology)

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Skin ‐homing CD8+ T cells preferentially express GPI‐anchored peptidase inhibitor 16, an inhibitor of cathepsin K

This study demonstrates robust association of cell surface peptidase inhibitor 16 (PI16) with skin ‐homing CD8+ T  cells. Human PI16 inhibits cathepsin K, but does not bind to other inflammatory skin proteases. PI16 persists on skin‐resident CD8+ T cells, but their reactivation induces rapid elimination of PI16 from the cell surface . AbstractThis study sought to identify novel CD8+ T  cell homing markers by studying acute graft versus host disease (aGvHD), typically involving increased T cell homing to the skin and gut. FACS‐sorted skin‐homing (CD8β+/CLA+), gut ‐homing (CD8β+/integrin β7+), and reference (CD8 β+/CLA–/integrin β7–) T  cells were compared in patients affected by cutaneous and/or gastrointestinal aGVHD. Microarray analysis, qPCR, and flow cytometry ...

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Biological characteristics and immunological properties in Muscovy ducks of H5N6 virus-like particles composed of HA-TM/HA-TMH3 and M1.

In this study, we composed two H5N6 virus-like particles (VLPs) composed of matrix-1 (M1) and hemagglutinin of wild-type (HA-TM) or hemagglutinin with transmembrane domain replacement (HA-TMH3) (designated as H5N6 VLPs-TM and H5N6 VLPs-TMH3). Biological characteristics of the composed H5N6 VLPs were compared including localization, expression, contents of HA trimers, thermal stability, morphology and immunogenicity in Muscovy ducks. Our results indicate that the H5N6 VLPs-TMH3 contained more HA trimers and presented better thermal stability. Moreover, Muscovy ducks immunized with H5N6 VLPs-TMH3 produced higher titer of HI antibody and IFN-γ compared with those immunized with the same dose of H5N6 VLP-TM, thus providing a promising approach for the development of influenza viruses vaccines...

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Is tioconazole contact dermatitis still a concern? Bringing allergic contact dermatitis caused by topical tioconazole back into the spotlight

Contact Dermatitis, EarlyView. (Source: Contact Dermatitis)

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Addressing the conundrums of p ‐phenylenediamine hair dye allergy by applying Friedmann’s principles of contact sensitization

SummaryIn the first conundrum, permanent hair dyeing uses aromatic amines such asp‐phenylenediamine (PPD), whose oxidation is pivotal to the dyeing process, but also generates potent allergens. Despite prolonged industry effort searching for safer alternatives, hair dyeing is still reliant on this type of aromatic amine. In the second conundrum, patch testing with 1% PPD remain s the most useful screen for hair dye contact allergy. However, there is a very small but real risk of actively sensitising the patient. Lowering the PPD concentration below 1% significantly reduces test sensitivity and diagnostic utility. Here we argue that by applying Friedmann's principles of c ontact sensitisation each conundrum can be addressed from a new perspective. These principles indicate that where th...

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Erythema multiforme ‐like contact dermatitis caused by herbal medicine

In this report, we will illustrate two cases of erythema multiform‐like contact dermatitis induced by local contact with herbal medicine. (Source: Contact Dermatitis)

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4 KIDS COMPLETE ALLERGY DAYTIME (Sodium Chloride, Aconitum Napellus, Luffa Operculata Fruit, Euphrasia Stricta,Galphimia Glauca Flowering Top, Histamine Dihydrochloride,Onion,Anemone Pulsatilla And Schoennocaulon Officinale Seed) Liquid [Hyland'S Inc.]

Updated Date: Nov 6, 2018 EST (Source: DailyMed Drug Label Updates)

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Mast cells at the crossroads of microbiota and IBD

This article is protected by copyright. All rights reserved (Source: European Journal of Immunology)

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Skin ‐homing CD8+ T cells preferentially express GPI‐anchored peptidase inhibitor 16, an inhibitor of cathepsin K

This study demonstrates robust association of cell surface peptidase inhibitor 16 (PI16) with skin ‐homing CD8+ T  cells. Human PI16 inhibits cathepsin K, but does not bind to other inflammatory skin proteases. PI16 persists on skin‐resident CD8+ T cells, but their reactivation induces rapid elimination of PI16 from the cell surface . AbstractThis study sought to identify novel CD8+ T  cell homing markers by studying acute graft versus host disease (aGvHD), typically involving increased T cell homing to the skin and gut. FACS‐sorted skin‐homing (CD8β+/CLA+), gut ‐homing (CD8β+/integrin β7+), and reference (CD8 β+/CLA–/integrin β7–) T  cells were compared in patients affected by cutaneous and/or gastrointestinal aGVHD. Microarray analysis, qPCR, and flow cytometry ...

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Biological characteristics and immunological properties in Muscovy ducks of H5N6 virus-like particles composed of HA-TM/HA-TMH3 and M1.

In this study, we composed two H5N6 virus-like particles (VLPs) composed of matrix-1 (M1) and hemagglutinin of wild-type (HA-TM) or hemagglutinin with transmembrane domain replacement (HA-TMH3) (designated as H5N6 VLPs-TM and H5N6 VLPs-TMH3). Biological characteristics of the composed H5N6 VLPs were compared including localization, expression, contents of HA trimers, thermal stability, morphology and immunogenicity in Muscovy ducks. Our results indicate that the H5N6 VLPs-TMH3 contained more HA trimers and presented better thermal stability. Moreover, Muscovy ducks immunized with H5N6 VLPs-TMH3 produced higher titer of HI antibody and IFN-γ compared with those immunized with the same dose of H5N6 VLP-TM, thus providing a promising approach for the development of influenza viruses vaccines...

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Is tioconazole contact dermatitis still a concern? Bringing allergic contact dermatitis caused by topical tioconazole back into the spotlight

Contact Dermatitis, EarlyView. (Source: Contact Dermatitis)

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Addressing the conundrums of p ‐phenylenediamine hair dye allergy by applying Friedmann’s principles of contact sensitization

SummaryIn the first conundrum, permanent hair dyeing uses aromatic amines such asp‐phenylenediamine (PPD), whose oxidation is pivotal to the dyeing process, but also generates potent allergens. Despite prolonged industry effort searching for safer alternatives, hair dyeing is still reliant on this type of aromatic amine. In the second conundrum, patch testing with 1% PPD remain s the most useful screen for hair dye contact allergy. However, there is a very small but real risk of actively sensitising the patient. Lowering the PPD concentration below 1% significantly reduces test sensitivity and diagnostic utility. Here we argue that by applying Friedmann's principles of c ontact sensitisation each conundrum can be addressed from a new perspective. These principles indicate that where th...

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Erythema multiforme ‐like contact dermatitis caused by herbal medicine

In this report, we will illustrate two cases of erythema multiform‐like contact dermatitis induced by local contact with herbal medicine. (Source: Contact Dermatitis)

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4 KIDS COMPLETE ALLERGY DAYTIME (Sodium Chloride, Aconitum Napellus, Luffa Operculata Fruit, Euphrasia Stricta,Galphimia Glauca Flowering Top, Histamine Dihydrochloride,Onion,Anemone Pulsatilla And Schoennocaulon Officinale Seed) Liquid [Hyland'S Inc.]

Updated Date: Nov 6, 2018 EST (Source: DailyMed Drug Label Updates)

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Recall of Bittersweet & Feve Chocolate Bars Due to High Levels of Milk Allergens

Today, Recchiuti Confections (San Francisco, CA) discovered two batches of their Bittersweet Chocolate Bar and two batches of their Feve Chocolate Bar contain high levels of milk protein after FDA sampling. No illnesses have been reported to date. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume these products. The chocolate bars can be enjoyed if you do not have milk allergies or sensitivities. Recchiuti Confections is issuing an immediate recall for bars with the following lot codes and best buy dates: (Source: Food and Drug Administration)

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ESNR—the next 50 years

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Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

ConclusionThe findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.ResumoIntroduçãoO cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio.ObjetivoO presente estudo teve...

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Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

ConclusionPatients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.ResumoIntroduçãoLesões na cavidade oral, faringe e laringe, em virtude de intubação endotraqueal, podem causar redução da motricidade e da sensibilidade local e comprometer o processo da deglutição, determinando disfagia orofaríngea.ObjetivoVerificar os fatores preditivos do desenvolvimento de disfagia orofaríngea e risco de aspiração em pacientes...

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Recall of Bittersweet & Feve Chocolate Bars Due to High Levels of Milk Allergens

Today, Recchiuti Confections (San Francisco, CA) discovered two batches of their Bittersweet Chocolate Bar and two batches of their Feve Chocolate Bar contain high levels of milk protein after FDA sampling. No illnesses have been reported to date. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume these products. The chocolate bars can be enjoyed if you do not have milk allergies or sensitivities. Recchiuti Confections is issuing an immediate recall for bars with the following lot codes and best buy dates: (Source: Food and Drug Administration)

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ESNR—the next 50 years

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Effects of diabetes mellitus and systemic arterial hypertension on elderly patients’ hearing

ConclusionIt was observed that the systemic arterial hypertension group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing.ResumoIntroduçãoDoenças crônicas podem atuar como fator de aceleração na degeneração do sistema auditivo. Os estudos sobre a associação da presbiacusia com o diabetes mellitus e com a hipertensão arterial sistêmica mostraram conclusões controversas.ObjetivoComparar a audiometria inicial (A1) com uma audiometria sequencial (A2) feita com um intervalo de três a quatro anos em uma população de idosos portadores de diabetes mellitus e/ ou hipertensão arterial sistêmica, a fim de saber s...

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Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

ConclusionThe findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.ResumoIntroduçãoO cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio.ObjetivoO presente estudo teve...

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Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

ConclusionPatients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.ResumoIntroduçãoLesões na cavidade oral, faringe e laringe, em virtude de intubação endotraqueal, podem causar redução da motricidade e da sensibilidade local e comprometer o processo da deglutição, determinando disfagia orofaríngea.ObjetivoVerificar os fatores preditivos do desenvolvimento de disfagia orofaríngea e risco de aspiração em pacientes...

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Human Leukocyte Antigen Associations in Drug Hypersensitivity Reactions

Severe adverse drug reactions are a common cause of morbidity and mortality. Some of the most severe reactions are immunologically mediated and have been linked to specific HLA alleles. The mechanisms underlying HLA-associated drug hypersensitivity are complex and not fully understood. Recent findings have provided insight into recognition mechanisms underlying drug-induced immunopathogenesis and criteria for increasing positive prediction of hypersensitivity. Refining pharmocogenetic testing strategies to better identify at-risk individuals can improve hypersensitivity prevention and mechanism characterization. (Source: Clinics in Laboratory Medicine)

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Human Leukocyte Antigen Associations in Drug Hypersensitivity Reactions

Severe adverse drug reactions are a common cause of morbidity and mortality. Some of the most severe reactions are immunologically mediated and have been linked to specific HLA alleles. The mechanisms underlying HLA-associated drug hypersensitivity are complex and not fully understood. Recent findings have provided insight into recognition mechanisms underlying drug-induced immunopathogenesis and criteria for increasing positive prediction of hypersensitivity. Refining pharmocogenetic testing strategies to better identify at-risk individuals can improve hypersensitivity prevention and mechanism characterization. (Source: Clinics in Laboratory Medicine)

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'I wanted to curl up and die' - life living with head and neck cancer

'I wanted to curl up and die' - life living with head and neck cancer  Surrey LiveFull coverage

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'I wanted to curl up and die' - life living with head and neck cancer

'I wanted to curl up and die' - life living with head and neck cancer  Surrey LiveFull coverage

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Recall of Bittersweet & Feve Chocolate Bars Due to High Levels of Milk Allergens

Today, Recchiuti Confections (San Francisco, CA) discovered two batches of their Bittersweet Chocolate Bar and two batches of their Feve Chocolate Bar contain high levels of milk protein after FDA sampling. No illnesses have been reported to date. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume these products. The chocolate bars can be enjoyed if you do not have milk allergies or sensitivities. Recchiuti Confections is issuing an immediate recall for bars with the following lot codes and best buy dates: (Source: Food and Drug Administration)

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In Appreciation: Daniel R. Boone

Daniel R. Boone, 1976 ASHA president, died Oct. 27, 2018, at age 90, in Tucson, Arizona.  Boone joined the U.S. Army in 1945, and after several stateside assignments was deployed in 1946 to Korea. After his honorable discharge in 1947, he attended the University of Redlands, graduating with a bachelor's degree in speech-language pathology in June 1951. From 1951 to 1953, he worked as an SLP in the Long Beach VA Hospital with World War II and Korean War veterans who had aphasia. Boone received both a master's and PhD from Case Western Reserve University in Cleveland, where he was an assistant professor. He also held academic appointments at the University of Kansas Medical Center, University of Denver, and University of Arizona, from which he retired in 1988 as professor emeritus.  F...

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Reconstruction of the Ear

Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction.

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Contents

Jeffrey S. Moyer

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Reconstruction of Defects Involving the Lip and Chin

Successful perioral reconstruction is the result of consideration of both functional and esthetic goals. The lips are complex esthetic units with multiple tissue layers and distinct anatomic landmarks. Reconstruction can be difficult due to variables affecting the defect, such as size, depth, location, and involvement of adjacent subunits. There are many local flaps that can be used to match the complex tissue layers and anatomic landmarks. Use of the same reconstructive principles can be applied to secondary reconstruction to attain a successful outcome. This article focuses on local reconstructive options for defects of the lip and chin.

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Copyright

ELSEVIER

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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies

Sentinel lymph node biopsy uses the concept of selective lymphatic drainage and the lymphatic microvasculature to identify first-echelon nodes draining a given malignancy. Although initially considered difficult and unreliable in the head and neck, experience with the technique has improved and evolved significantly over the last 3 decades. It is now recognized to be accurate and reliable for regional nodal staging and detection of occult nodal metastasis in the head and neck. Although initially described for nodal staging of melanoma, the usefulness of sentinel lymph node biopsy continues to expand and is now extended to other cutaneous malignancies.

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Forthcoming Issues

Facial Gender Affirmation Surgery

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Reconstruction of the Forehead and Scalp

Tissue inelasticity and the hair-bearing nature of the scalp and forehead pose unique challenges during reconstruction. A thorough understanding of the surgical anatomy of the scalp and forehead is paramount for optimal reconstructive outcomes. Primary wound closure is usually preferred over secondary intention healing and skin grafting. Use of dermal alternatives and tissue expansion are adjunctive therapies to facilitate scalp wound closure. Local skin and soft tissue flaps are commonly used for most small to medium defects; however, microsurgical free tissue transfer can be considered for large full-thickness skin defects of the forehead and scalp.

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Adjuvant and Neoadjuvant Treatment of Skin Cancer

Skin cancer represents a broad classification of malignancies, which can be further refined by histology, including basal cell carcinoma, squamous cell carcinoma and melanoma. As these three cancers are distinct entities, we review each one separately, with a focus on their epidemiology, etiology including relevant genomic data, and the current evidence-based recommendations for adjuvant and neoadjuvant therapy. We also discuss future directions and opportunities for continued therapeutic advances.

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Reconstruction of the Cheek

The goal of cheek reconstruction is to restore an illusion of "normal." Attention must be directed toward the contralateral cheek skin color, texture, thickness, and contour, because this serves a template for reconstruction. The cheek is a peripheral facial subunit and largely frames the more central subunits (eyelids, nose, lips). As such, avoiding distortion or disfigurement of the central subunits is of paramount importance. The cheek possesses significant tissue laxity, elasticity, and mobility, thus allowing for the vast majority of cheek defects to be addressed with primary closure, local flaps, or locoregional flaps.

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Health Outcome Studies in Skin Cancer Surgery

As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.

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Radiotherapy for Skin Cancers of the Face, Head, and Neck

Radiotherapy plays a role in the definitive or adjuvant management of early and late stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy in skin cancers of the head and neck is reviewed including early and advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma. In particular, the indications, oncologic outcomes, and technical aspects of radiotherapy for these diseases are discussed.

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In Appreciation: Daniel R. Boone

Daniel R. Boone, 1976 ASHA president, died Oct. 27, 2018, at age 90, in Tucson, Arizona.  Boone joined the U.S. Army in 1945, and after several stateside assignments was deployed in 1946 to Korea. After his honorable discharge in 1947, he attended the University of Redlands, graduating with a bachelor's degree in speech-language pathology in June 1951. From 1951 to 1953, he worked as an SLP in the Long Beach VA Hospital with World War II and Korean War veterans who had aphasia. Boone received both a master's and PhD from Case Western Reserve University in Cleveland, where he was an assistant professor. He also held academic appointments at the University of Kansas Medical Center, University of Denver, and University of Arizona, from which he retired in 1988 as professor emeritus.  F...

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Reconstruction of the Nose

Nasal reconstructive techniques have advanced significantly over the past 50 years. Modern techniques in nasal reconstruction are based on the nasal aesthetic subunits. In order to achieve ideal outcomes, reconstructive surgeons must consider differences in tissue qualities across the nasal aesthetic subunits and formulate reconstructive plans based on these differences. Local flaps, skin grafts, and several types of interpolated flaps comprise the most commonly used techniques for nasal reconstruction. Defects that involve structural or internal lining defects require reconstruction of significantly higher complexity.

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Reconstruction of the Ear

Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction.

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Contents

Jeffrey S. Moyer

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Mohs Micrographic Surgery

Mohs micrographic surgery (MMS) is the gold standard for treating various cutaneous tumors. MMS has evolved into a single-day, outpatient procedure. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histologic evaluation. The process is repeated as necessary until the tumor is completely removed, with maximal conservation of normal tissue. Evaluation of 100% of the surgical margin allows for exceptional cure rates. The Mohs surgeon is trained in tumor excision, histopathology interpretation, and surgical reconstruction. The use of MMS is often part of a multidisciplinary approach to treating cutaneous tumors.

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Contributors

J. REGAN THOMAS, MD

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Reconstruction of Defects Involving the Lip and Chin

Successful perioral reconstruction is the result of consideration of both functional and esthetic goals. The lips are complex esthetic units with multiple tissue layers and distinct anatomic landmarks. Reconstruction can be difficult due to variables affecting the defect, such as size, depth, location, and involvement of adjacent subunits. There are many local flaps that can be used to match the complex tissue layers and anatomic landmarks. Use of the same reconstructive principles can be applied to secondary reconstruction to attain a successful outcome. This article focuses on local reconstructive options for defects of the lip and chin.

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Copyright

ELSEVIER

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2FbUd8g

The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies

Sentinel lymph node biopsy uses the concept of selective lymphatic drainage and the lymphatic microvasculature to identify first-echelon nodes draining a given malignancy. Although initially considered difficult and unreliable in the head and neck, experience with the technique has improved and evolved significantly over the last 3 decades. It is now recognized to be accurate and reliable for regional nodal staging and detection of occult nodal metastasis in the head and neck. Although initially described for nodal staging of melanoma, the usefulness of sentinel lymph node biopsy continues to expand and is now extended to other cutaneous malignancies.

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Skin Cancer Treatment

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

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Forthcoming Issues

Facial Gender Affirmation Surgery

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State-of-the-Art in Skin Cancer Surgery

Skin cancer remains the most common cancer in the United States, affecting approximately 20% of Americans during their lifetime. Despite major advances in care delivery, including targeted drug therapies and immunotherapy, the primary treatment for early nonmelanoma skin cancer (NMSC) and melanoma continues to be careful surgical extirpation with clear margins, along with meticulous reconstruction that optimally addresses functional and aesthetic deficits.

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Reconstruction of the Forehead and Scalp

Tissue inelasticity and the hair-bearing nature of the scalp and forehead pose unique challenges during reconstruction. A thorough understanding of the surgical anatomy of the scalp and forehead is paramount for optimal reconstructive outcomes. Primary wound closure is usually preferred over secondary intention healing and skin grafting. Use of dermal alternatives and tissue expansion are adjunctive therapies to facilitate scalp wound closure. Local skin and soft tissue flaps are commonly used for most small to medium defects; however, microsurgical free tissue transfer can be considered for large full-thickness skin defects of the forehead and scalp.

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Adjuvant and Neoadjuvant Treatment of Skin Cancer

Skin cancer represents a broad classification of malignancies, which can be further refined by histology, including basal cell carcinoma, squamous cell carcinoma and melanoma. As these three cancers are distinct entities, we review each one separately, with a focus on their epidemiology, etiology including relevant genomic data, and the current evidence-based recommendations for adjuvant and neoadjuvant therapy. We also discuss future directions and opportunities for continued therapeutic advances.

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Reconstruction of the Cheek

The goal of cheek reconstruction is to restore an illusion of "normal." Attention must be directed toward the contralateral cheek skin color, texture, thickness, and contour, because this serves a template for reconstruction. The cheek is a peripheral facial subunit and largely frames the more central subunits (eyelids, nose, lips). As such, avoiding distortion or disfigurement of the central subunits is of paramount importance. The cheek possesses significant tissue laxity, elasticity, and mobility, thus allowing for the vast majority of cheek defects to be addressed with primary closure, local flaps, or locoregional flaps.

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Health Outcome Studies in Skin Cancer Surgery

As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.

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Radiotherapy for Skin Cancers of the Face, Head, and Neck

Radiotherapy plays a role in the definitive or adjuvant management of early and late stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy in skin cancers of the head and neck is reviewed including early and advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma. In particular, the indications, oncologic outcomes, and technical aspects of radiotherapy for these diseases are discussed.

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Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction

Three-dimensional (3D) printing has transformed craniofacial reconstruction over the last 2 decades. For cutaneous oncologic surgeons, several 3D printed technologies are available to assist with craniofacial bony reconstruction and preliminary soft tissue reconstructive efforts. With improved accessibility and simplified design software, 3D printing has opened the door for new techniques in anaplastology. Tissue engineering has more recently emerged as a promising concept for complex auricular and nasal reconstruction. Combined with 3D printing, several groups have demonstrated promising preclinical results with cartilage growth. This article highlights the applications and current state of 3D printing and tissue engineering in craniofacial reconstruction.

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Management of Early-Stage Melanoma

Melanoma is a potentially aggressive skin cancer with a steadily rising incidence. Most melanomas are diagnosed at an early stage and associated with an excellent prognosis when treated appropriately. Primary treatment for melanoma is surgical. Wider surgical margins and a variety of techniques for comprehensive histologic margin assessment may be considered for lentigo maligna type melanoma on the head and neck, due to characteristic broad subclinical extension. For invasive melanoma, sentinel lymph node biopsy may be indicated for staging, and to guide further management and follow-up. Appropriate treatment guidelines for early-stage melanoma are reviewed and discussed.

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Identification of inflammatory response patterns in experimental gingivitis studies

We used novel analytical approaches to identify inflammatory response patterns to plaque accumulation in experimental gingivitis studies in humans. Data from two experimental gingivitis studies [Dataset I (n = 40) and Dataset II (n = 42)], which differed in design and recording methods, were used. Both studies comprised a three‐phase program as follows: pre‐induction period (oral hygiene as usual for Dataset I; professional tooth cleaning for Dataset II); induction period (plaque accumulation); and resolution period (oral hygiene as usual). Clinical recordings of plaque and gingival inflammation were made on days 0, 4, 9, and 14 for Dataset I and on days −14, 0, 7, 21, and 35 for Dataset II. Group‐based‐trajectory and growth curve modeling were used for data analysis. In Dataset I, gingival response to plaque accumulation was found to be lagged in time. Different group‐based response patterns for gingival inflammation were not identified. However, in Dataset II, 'fast' and 'slow' gingival inflammation responders were identified. 'Slow' responders had lagged inflammation responses, whereas 'fast' responders seemed to respond immediately to plaque. The findings show that analytical approaches which consider the data structure allow investigation of the dynamics of the relationship between plaque accumulation and gingival inflammation and facilitate the identification of differential patterns of gingival inflammation development.

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Effect of methacrylated chitosan incorporated in experimental composite and adhesive on mechanical properties and biofilm formation

The lifespan of a resin‐based restoration is limited, with the main reason for failure being secondary caries. Biofilm formation at the tooth–material interface is a necessary etiological agent for caries development. Dental materials with antimicrobial properties may reduce formation of biofilm and thus increase the longevity of restorations. This study aimed to investigate the effect of methacrylated chitosan (CH‐MA), incorporated into the polymeric network of an experimental dental composite and adhesive, on biofilm growth of Streptococcus mutans and to assess the mechanical properties of the modified materials. The methacrylation of low‐molecular‐weight chitosan was achieved and biofilm studies confirmed the antibacterial effect of the modified polymer in solution. Methacrylated chitosan was incorporated into an experimental composite and adhesive, and the modified materials reduced the formation of S. mutans biofilm. The incorporation of CH‐MA did not alter the bond strength of the adhesives. However, the amount of CH‐MA in composite that is required to elicit an antibacterial response challenges the mechanical properties of the material. The hardness and flexural strength of the composite decreased with increasing amounts of CH‐MA. However, flexural strength values still met the requirement in the ISO standard.

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Identification of inflammatory response patterns in experimental gingivitis studies

We used novel analytical approaches to identify inflammatory response patterns to plaque accumulation in experimental gingivitis studies in humans. Data from two experimental gingivitis studies [Dataset I (n = 40) and Dataset II (n = 42)], which differed in design and recording methods, were used. Both studies comprised a three‐phase program as follows: pre‐induction period (oral hygiene as usual for Dataset I; professional tooth cleaning for Dataset II); induction period (plaque accumulation); and resolution period (oral hygiene as usual). Clinical recordings of plaque and gingival inflammation were made on days 0, 4, 9, and 14 for Dataset I and on days −14, 0, 7, 21, and 35 for Dataset II. Group‐based‐trajectory and growth curve modeling were used for data analysis. In Dataset I, gingival response to plaque accumulation was found to be lagged in time. Different group‐based response patterns for gingival inflammation were not identified. However, in Dataset II, 'fast' and 'slow' gingival inflammation responders were identified. 'Slow' responders had lagged inflammation responses, whereas 'fast' responders seemed to respond immediately to plaque. The findings show that analytical approaches which consider the data structure allow investigation of the dynamics of the relationship between plaque accumulation and gingival inflammation and facilitate the identification of differential patterns of gingival inflammation development.

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Effect of methacrylated chitosan incorporated in experimental composite and adhesive on mechanical properties and biofilm formation

The lifespan of a resin‐based restoration is limited, with the main reason for failure being secondary caries. Biofilm formation at the tooth–material interface is a necessary etiological agent for caries development. Dental materials with antimicrobial properties may reduce formation of biofilm and thus increase the longevity of restorations. This study aimed to investigate the effect of methacrylated chitosan (CH‐MA), incorporated into the polymeric network of an experimental dental composite and adhesive, on biofilm growth of Streptococcus mutans and to assess the mechanical properties of the modified materials. The methacrylation of low‐molecular‐weight chitosan was achieved and biofilm studies confirmed the antibacterial effect of the modified polymer in solution. Methacrylated chitosan was incorporated into an experimental composite and adhesive, and the modified materials reduced the formation of S. mutans biofilm. The incorporation of CH‐MA did not alter the bond strength of the adhesives. However, the amount of CH‐MA in composite that is required to elicit an antibacterial response challenges the mechanical properties of the material. The hardness and flexural strength of the composite decreased with increasing amounts of CH‐MA. However, flexural strength values still met the requirement in the ISO standard.

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Project Peace fundraiser helps support neck, head cancer survivors

Project Peace fundraiser helps support neck, head cancer survivors  WKRC TV CincinnatiFull coverage

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Project Peace fundraiser helps support neck, head cancer survivors

Project Peace fundraiser helps support neck, head cancer survivors  WKRC TV CincinnatiFull coverage

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2yX1008

Why Use Literary Interventions for Diverse Populations

How we can better support our diverse caseloads? This means supporting the communication needs of students and clients of color, those exposed to two or more languages, and members of the LGBTQ+ communities. When supporting diverse populations, I find carrying out out the following two activities prior to speech-language treatment yields positive outcomes. Build rapport Building rapport and trust with the client/student yields greater outcomes for gains in speech, language and social-pragmatic skills. Jeffrey Duncan-Andrade, an associate professor at San Francisco State University, studies elements of effective teaching with an emphasis on social and cultural factors. Without a relationship between a child and his teacher, he says, learning will not take place. He poignantly says, "To g...

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Magnetic resonance imaging with cochlear implants and auditory brainstem implants: Are we truly practicing MRI safety?

Objective

Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients.

Methods

Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality.

Results

Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI‐related complications were equipped with a U.S. Food and Drug Administration‐approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED‐EL (Innsbruck, Austria). Synchrony model (MED‐EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self‐aligning magnet.

Conclusion

Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI‐related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI‐related complications, and advocate for continued industry technological innovation.

Level of Evidence

4 Laryngoscope, 2018

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Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PSy5nC

Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross‐sectional study

Objectives/Hypothesis

To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events.

Study Design

Retrospective database review.

Methods

Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ#lary27405-bib-0002 test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant.

Results

The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3‐1.6) and less common among white children (OR: 0.8, 95% CI: 0.8‐0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection.

Conclusions

Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.

Level of Evidence

NA Laryngoscope, 2018

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Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

Objectives/Hypothesis

To evaluate the potential of a minimally invasive transoral–transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs).

Study Design

Cadaver study.

Methods

Five cadaveric specimens were dissected raising an inverted U‐shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross‐court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared.

Results

Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm² vs. 312.76 mm², P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm³ vs. 138.91 mm³, P < .005). MITA also offered greater angles of approach for all targets.

Conclusions

This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA.

Level of Evidence

NA Laryngoscope, 2018

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Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Objectives

1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial.

Study Design

Multicenter randomized pilot trial.

Methods

Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA.

Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA.

Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA.

Level of Evidence

1B. Laryngoscope, 2018

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Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

Objectives/Hypothesis

To evaluate the demographics, etiology, intraoperative findings, and treatment outcomes of patients with subglottic stenosis (SGS), comparing those patients aged <65 years to an elderly population aged ≥65 years.

Study Design

Retrospective cohort study.

Methods

Nine‐year retrospective review of patients with SGS. Forty‐eight adults presented for evaluation and treatment of SGS between January 2008 and December 2016. At the time of presentation, 41 were aged <65 years and seven were aged ≥65 years.

Results

Comparing the aged <65 years group to the aged ≥65 years group, the etiology was idiopathic SGS in 50.0% versus 42.8%, intubation‐related SGS in 22.5% versus 28.6%, and granulomatosis with polyangiitis in 27.5% versus 28.6%, respectively. No statistically significant difference was noted in the two groups when comparing the demographics, etiology, treatment, intraoperative findings, or intertreatment interval (ITI).

Conclusions

We sought to analyze an older patient population with SGS and found no statistically significant differences compared to a younger population. ITI trended toward older patients requiring surgery more frequently but was not significant.

Level of Evidence

4 Laryngoscope, 2018

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Interesting case of late Gore‐Tex extrusion following medialization laryngoplasty

A 65‐year‐old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore‐Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore‐Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 2018

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The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

Objective

Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers.

Methods

Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two‐clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified.

Results

The mean age of the cohort was 83 ( ± 12) years. Fifty‐three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty‐seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty‐two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence.

Conclusion

The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia.

Level of Evidence

3b. Laryngoscope, 2018

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Is a schirmer's test necessary before blepharoplasty?

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Does anatomic subsite influence oral cavity cancer mortality? A SEER database analysis

Objective

To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites.

Methods

Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5‐year cause‐specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5‐year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05.

Results

20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM.

Conclusion

Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite‐specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite‐directed research as a means to improve outcomes.

Level of Evidence

NA. Laryngoscope, 2018

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Evaluation of early oral cavity cancer treatment quality at a single institution

Objective

To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital.

Methods

This retrospective study identified patients treated for early‐stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992–2007) or after (current treatment group, 2008–2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups.

Results

Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time.

Conclusion

Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early‐stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified.

Level of Evidence

2c. Laryngoscope, 2018

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Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Objectives/Hypothesis

The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum.

Study Design

Retrospective cohort study in a tertiary referral center.

Methods

Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro‐otoscopy and magnetic resonance imaging (MRI) with diffusion‐weighted imaging (DWI).

Results

Ninety‐nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow‐up was 39.6 (standard deviation [SD] = 16.3). Mean follow‐up until the last MRI‐DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed (P = .066).

Conclusions

Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates.

Level of Evidence

4 Laryngoscope, 2018

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Measurement reliability of phonation threshold pressure in pediatric subjects

Objectives/Hypothesis

Phonation threshold pressure (PTP), the minimum subglottal pressure (P_s) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment.

Study Design

Pilot study evaluating PTP and P_s measurement reliability in children using labial and mechanical interruption.

Methods

Twenty‐two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between P_s and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and P_s and intrasubject coefficients of variation were compared. Correlations with age were evaluated.

Results

Mean PTP (P < .001) and P_s (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and P_s (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical‐mask trials only (r = −0.628, P = .00175).

Conclusions

Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment.

Level of Evidence

3b Laryngoscope, 2018

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I dream of Gini: Quantifying inequality in otolaryngology residency interviews

Objectives

Otolaryngology applicants routinely decry conflicting interview dates because this limits the number of interviews that one can attend, despite being offered an interview. Conversely, applicants also perceive that a large number of interviews are offered to a minority of applicants. We sought to verify and quantify the inequality in distribution of interviews attended.

Study Design

Retrospective analysis of the National Resident Matching Program (NRMP) 2016 Charting Outcomes in the Match and Electronic Residency Application Service (ERAS) historic specialty data.

Methods

The Gini coefficient, a commonly used indicator of economic inequality, was calculated using data from the 2016 Charting Outcomes in the Match to estimate the distribution of interviews attended. This data was compared to nine other specialties, comprising a wide range of competitiveness and specialty size.

Results

26% (110 of 416) of otolaryngology applicants accounted for half (1,721 of 3,426) of all possible interview positions. The Gini coefficient ranged from 0.43 to 0.84 across 10 specialties, with a higher coefficient indicating higher inequality. The Gini coefficient among otolaryngology applicants was 0.43, indicating lower inequality than most other specialties. When including only applicants who interviewed, the Gini coefficient was 0.23.

Conclusion

There is an unequal distribution of interview invitations, which likely reflects the reality of asymmetry in applicant competitiveness. Otolaryngology demonstrates the greatest equality in distribution, which may stem from a greater burden of hoarding. The specialty's perceived competitiveness mitigates factors such as cost and time, essentially encouraging more people to take as many interviews as they can.

Level of Evidence

NA. Laryngoscope, 2018

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Suture‐ligature technique for the closure of tracheocutaneous fistula in adults

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Magnetic resonance imaging with cochlear implants and auditory brainstem implants: Are we truly practicing MRI safety?

Objective

Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients.

Methods

Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality.

Results

Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI‐related complications were equipped with a U.S. Food and Drug Administration‐approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED‐EL (Innsbruck, Austria). Synchrony model (MED‐EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self‐aligning magnet.

Conclusion

Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI‐related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI‐related complications, and advocate for continued industry technological innovation.

Level of Evidence

4 Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Db8n7a

Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PSy5nC

Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

Objectives/Hypothesis

To evaluate the potential of a minimally invasive transoral–transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs).

Study Design

Cadaver study.

Methods

Five cadaveric specimens were dissected raising an inverted U‐shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross‐court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared.

Results

Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm² vs. 312.76 mm², P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm³ vs. 138.91 mm³, P < .005). MITA also offered greater angles of approach for all targets.

Conclusions

This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA.

Level of Evidence

NA Laryngoscope, 2018

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Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Objectives

1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial.

Study Design

Multicenter randomized pilot trial.

Methods

Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA.

Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA.

Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA.

Level of Evidence

1B. Laryngoscope, 2018

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Do preoperative corticosteroids benefit patients with chronic rhinosinusitis with nasal polyposis?

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