Publisher: Elsevier   (Total: 3148 journals)

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Showing 1 - 200 of 3147 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 448, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 12, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 326, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 190, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 1, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 13)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 68, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 11)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 431, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 396, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 490, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 55, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 267, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 30, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 216, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 238, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 8, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 3, SJR: 0.451, CiteScore: 1)

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Similar Journals
Journal Cover
American Journal of Otolaryngology
Journal Prestige (SJR): 0.59
Citation Impact (citeScore): 1
Number of Followers: 25  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0196-0709 - ISSN (Online) 1532-818X
Published by Elsevier Homepage  [3148 journals]
  • Percutaneous endoscopic gastrostomy through a cervical esophageal fistula.
           An alternative, much improved technique for patient safety
    • Abstract: Publication date: Available online 23 January 2020Source: American Journal of OtolaryngologyAuthor(s): George Stavrou, Vassilios Grosomanidis, Anastasia Sarafidou, Gavriil Tsiropoulos, Stefanos Triaridis, Katerina KotzampassiAbstractPurposePercutaneous endoscopic gastrostomy [PEG] by the pull-technique is easy and safe to perform through the oral cavity. However, the presence of a cervical esophageal fistula, either due to tumor invasion or simply inflammation and tissue necrosis after previous intervention or radiotherapy, in the anterior cervical region is of crucial importance when passing the endoscope and the PEG catheter from the mouth downwards.MethodsWe describe a modification of the standard peroral PEG, which is to insert the endoscope from the cervical esophageal opening instead of the oral cavity, and we support the use of this “stoma” as a way to protect it and avoid possible forceful dilatation/expansion when advancing the endoscope and the gastrostomy catheter through the mouth.ResultsThe performance of PEG through the cervical esophageal opening was applied in 8 cases of esophageal fistula of different primary etiology but where the oro-pharyngeal passage was easily accessible. The procedure was technically successful in all patients, and no bleeding or tearing of the friable esophageal wall was evident.ConclusionThe use of the esophageal fistula at the anterior cervical region as a route for PEG insertion is a safe and practical alternative, highly to be recommended.
       
  • Management of invasive intralabyrinthine cholesteatoma: Can one
           realistically preserve hearing when disease is medial to the otic
           capsule'
    • Abstract: Publication date: Available online 21 January 2020Source: American Journal of OtolaryngologyAuthor(s): Khalid Al Zaabi, Fatemeh Hassannia, Michael J. Bergin, John Alexander RutkaAbstractPurposeTo report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma.Material and methodsThe study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated.Results10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results.ConclusionWe were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.
       
  • In response to: Gelfoam, bactroban ointment and ofloxacin drops facilitate
           the eardrum healing
    • Abstract: Publication date: Available online 21 January 2020Source: American Journal of OtolaryngologyAuthor(s): Samantha Anne, Janki Shah, Blake Smith, Elizabeth O. Shay
       
  • Gelfoam, bactroban ointment and ofloxacin drops facilitate the eardrum
           healing
    • Abstract: Publication date: Available online 20 January 2020Source: American Journal of OtolaryngologyAuthor(s): Zhengcai Lou
       
  • Narrow band imaging might contribute to the diagnosis of laryngopharyngeal
           reflux
    • Abstract: Publication date: Available online 17 January 2020Source: American Journal of OtolaryngologyAuthor(s): Dipanpan Wu, Xinhua Cui, Ying Guo, Bo Geng, Fangfang Gao, Hui LiangAbstractPurposeLaryngopharyngeal reflux (LPR) accounts for 4–10% of outpatient visits. The standard domestic LPR diagnostic tools are the reflux finding score (RFS) and reflux symptom index (RSI). Narrow band imaging (NBI) can identify previously unknown characteristic microvessel features. Our aim was to explore the role of NBI in LPR diagnosis.Materials and methodsWe recruited 56 LPR outpatients and 41 symptom-negative controls. All individuals received RSI and RFS scores and underwent 24-hour multichannel intraluminal impedance-PH (MII-pH) monitoring and endoscopic NBI before and after treatment. The positivity rates in the study and control groups, before and after treatment, and using NBI and the conventional method were evaluated.ResultsFifty-one LPR and six control patients had sparse light brownish dots or tufted light brownish dots in the postcricoid region. The RSI and RFS positivity rates were 31.3% and 87.1%, respectively. NBI is as effective as the RFS (P 
       
  • Commentary to “Epidermal growth factor on the healing of human subacute
           tympanic membrane perforation”
    • Abstract: Publication date: Available online 10 January 2020Source: American Journal of OtolaryngologyAuthor(s): Zhengcai Lou
       
  • The effect of passive smoking on the etiology of serous otitis media in
           children
    • Abstract: Publication date: Available online 10 January 2020Source: American Journal of OtolaryngologyAuthor(s): Yosunkaya M. TarhunAbstractSerous otitis media (SOM) is a disease mostly seen in the pediatric age group and characterized by serous effusion in the middle ear. The disease which is mostly silent can cause permanent hearing loss if it is not diagnosed and treated early. Passive smoking is one of the environmental factors in the etiopathology of the disease and risk factors for SOM formation in children. In our study, smoking habits of family members of 75 children with SOM and 50 healthy controls were investigated. At the end of the study, the correlation between SOM and passive smoke exposed was statistically significant in children (p 
       
  • Epidermal growth factor on the healing of human subacute tympanic membrane
           perforation
    • Abstract: Publication date: Available online 10 January 2020Source: American Journal of OtolaryngologyAuthor(s): Chao-Ya Liu
       
  • Laser ablation of posterior nasal nerves for rhinitis
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of OtolaryngologyAuthor(s): Yosef P. Krespi, Karen A. Wilson, Victor KizhnerAbstractBackgroundPosterior nasal nerve (PNN) surgery, Radiofrequency (RF), and cryoablation have been described as alternative treatments for allergic and vasomotor rhinitis. We hypothesize that endoscopic (diode) laser ablation (ELA) is effective and less invasive than previously described methods.MethodsAn IRB approved prospective study was performed. Thirty-two patients with chronic rhinitis and nasal congestion resistant to medical management were recruited. Total Nasal Symptom Score (TNSS) measurements were used to assess symptom severity and treatment outcomes. ELA was performed bilaterally in the clinic with a 940 nm diode laser with CW 5 W output, under topical/local anesthesia in 21 patients, while the remaining 11 were treated under sedation in the operating room. The 400-micron uninitiated diode laser fiber tip with a malleable protective shaft was specially designed for PNN ablation. The fiber was pre-shaped according to the intranasal anatomy and endoscopically advanced toward the posterior middle meatus. Patients were followed up for the first 90 days after treatment.ResultsELA was successfully completed in 97% of patients. No crusting, epistaxis, or other complications were observed. One patient could not be treated in the office due to limited endoscopic access. TNSS was reduced significantly after30 and 90 days (mean ± SD: 6.0 ± 0.7 prior to ablation, 2.3 ± 0.4 at 90 days, p 
       
  • Bilateral same-day endoscopic tympanoplasty
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of OtolaryngologyAuthor(s): Engin Dursun, Emine Demir, Suat Terzi, Zerrin Özergin Coşkun, Metin Çeliker, Özlem Çelebi ErdivanlıAbstractPurposeAlthough bilateral same-day tympanoplasty is a faster and more comfortable procedure for patients, it is rarely performed due to its theoretical risks. The present study aims to evaluate the results of patients who underwent bilateral same-day endoscopic tympanoplasty.Materials and methodsIn this study, 26 patients and 52 ears were evaluated. Postoperative anatomic success rate, pre- and postoperative hearing test results, hearing gains and postoperative complications were recorded.ResultsPostoperative anatomic success rate was 92.3% (48/52). Audiological tests revealed the preoperative air-bone gap (ABG) as 19.1 ± 8.8 (7–35) dB and postoperative ABG as 9.8 ± 5.7 (5–25) dB. Postoperative ABG decreased significantly (p:
       
  • Which element plays important role for the effect of myringoplasty between
           platelet rich plasma, hyaluronic acid and fat graft'
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of OtolaryngologyAuthor(s): Yachao Liu
       
  • Evaluation of emergence agitation after general anaesthesia in rhinoplasty
           patients: Inhalation anaesthesia versus total intravenous anaesthesia
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of OtolaryngologyAuthor(s): Gamze Talih, Ahmet Yüksek, Ender ŞahinAbstractBackgroundEmergence agitation (EA) is a clinical condition that occurs early in recovery from general anaesthesia, and reduces patient comfort. The aim of this study was to compare the effects of low-flow sevoflurane anaesthesia and total intravenous anaesthesia (TIVA) on agitation in rhinoplasty patients, and to determine the frequency of EA in low flow sevoflurane anaesthesia after rhinoplasty.Material and methodsA total of 90 rhinoplasty patients, under general anaesthesia were included in this prospective randomised study. After induction of anaesthesia, propofol infusion was initiated in the TIVA group (n = 45), and sevoflurane was administered in the SEVO group with a fresh gas flow of 1 l/min and MAC (minimum alveolar concentration) 1–1.1 (n = 45). Early emergence times, Richmond agitation-sedation scale (RASS), Boezaart scale, Likert scale and incidences of nausea/vomiting were recorded at the end of surgery.ResultsEarly emergence time was significantly shorter in the TIVA group, than in the SEVO group (p 
       
  • Transoral robotic surgery: Differences between online information and
           academic literature
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of OtolaryngologyAuthor(s): Kunal Ramanand Shetty, Kevin Wong, Sean Hashemi, Anisha Shetty, Jessica R. LeviAbstractObjectivesEvaluate the authorship, content, quality, and readability of information on Transoral Robotic Surgery (TORS) available to patients online.MethodsThe technical search term “TORS Surgery” and layperson's term “robotic surgery of the mouth” were utilized to conduct a search of the top 50 websites on Google, Bing, and Yahoo. Websites were evaluated according to the HONcode evaluation of content and quality, and readability was assessed using the Flesch Reading Ease Formula, Flesch-Kincaid Grade Level Formula, SMOG readability formula, Coleman Liau Index formula, and Gunning Fog Index. Statistical analysis was conducted using the Fisher Freeman- Halton test to compare differences in authorship, quality, and content between the three search engines and the Fisher exact test was used to determine if there was a difference in these variables between the two search terms.ResultsOverall, websites were predominantly from academic institutions with 97% mentioning benefits of TORS with 24% mentioning risks. 45% of TORS websites had no description of the TORS procedure, while 62% allowed individuals to make appointments. There was a significant difference in authorship with the layperson's terms yielding more news sources, but there were no significant differences in quality and content of information elicited through the technical and layperson search terms. The mean readability scores were Flesch Kincaid Grade Level 13.81(±3.32), Gunning-Fog Index 16.51(±3.39), SMOG 12.53(±2.40), and Automated Readability Index 14.05 (±4.17).ConclusionsCurrent online information on TORS surgery may not provide balanced information for patients to make informed healthcare decisions. The current readability of online information regarding TORS far exceeds the average literacy level of average American adults.
       
  • Characteristics and considerations for children with ankyloglossia
           undergoing frenulectomy for dysphagia and aspiration
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of OtolaryngologyAuthor(s): Lauren S. Buck, Hudson Frey, Morgan Davis, Michael Robbins, Christopher Spankovich, Vamsi Narisetty, Jeffrey D. CarronAbstractObjectiveThe purpose of this study is to analyze the basic demographics of patients who underwent frenulectomy at our institution as well as additional considerations regarding age, location of procedure, and possible effects on aspiration.MethodsA retrospective chart review was performed based on CPT codes for frenulectomy and basic demographic data was collected. Other information such as presenting symptoms, type of ankyloglossia, location of the procedure, and modified barium swallow study (MBSS) information were also obtained.ResultsA total of 226 (66.4% male) patients underwent frenulectomy in the study time frame. Younger patients underwent frenulectomy for feeding symptoms (average age 6.5 months) and older children typically presented with speech related symptoms (average age 3.8 years). Of patients who had MBSS before and after the procedure, 5/11 (43%) had improvement of their aspiration after frenulectomy.ConclusionsSymptomatic ankyloglossia is more common in boys. Two age groups typically present for frenulectomy, infants for feeding difficulties and toddlers/preschoolers for speech related difficulties. Children with aspiration may benefit from frenulectomy, though aspiration is unlikely to resolve if other comorbidities are present. Proper evaluation and documentation of anatomy and functional tongue movement is important for future studies and decision-making regarding frenulectomy.
       
  • Identification of MMP1 and MMP2 by RNA-seq analysis in laryngeal squamous
           cell carcinoma
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of OtolaryngologyAuthor(s): Weijun Fang, Jun ShenAbstractBackgroundLaryngeal squamous cell carcinoma (LSCC) is the most common histologic subtype of laryngeal cancer characterized by a poor prognosis. Determining gene expression changes in LSCC should improve our understanding of putative risk factors and provide potential targets for therapy.ObjectivesTo assess differential gene expression between LSCC tissue and paired normal laryngeal tissue, and to provide gene targets for future studies of this type of laryngeal cancer.Materials and methodsThree paired-sample groups (tumor and normal tissue) from patients with laryngeal squamous cell carcinoma were analyzed by RNA sequencing (RNA-seq).ResultsThe six cDNA libraries generated raw reads ranging from 15,195,586 to 21,443,488 counts. Changes in gene expression levels were determined in 40,205 of these counts, with 18,466 deferentially expressed genes in all three groups. Compared to normal tissue, the expression levels of MMP1 and MMP2 increased significantly in tumor tissue of patients with laryngeal squamous cell carcinoma.ConclusionsWhole transcriptome sequencing revealed that MMP1 and MMP2 are highly expressed in LSCC. These genes may be useful both as biomarkers for LSCC diagnosis and as targets for therapy, as well as for increasing our understanding of LSCC tumorigenesis.
       
  • Differences in self-reported symptoms in patients with chronic odontogenic
           and non-odontogenic rhinosinusitis
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of OtolaryngologyAuthor(s): Ivan Oreški, Tomislav Gregurić, Petar Gulin, Natalija Prica Oreški, Davor Brajdić, Davor VagićAbstractPurposeTo evaluate the possible differences in self-reported symptoms between patients with chronic odontogenic rhinosinusitis (CORS) and patients with chronic non-odontogenic rhinosinusitis (CnORS).Materials and methodsThe study included 64 patients diagnosed with chronic rhinosinusitis according to EPOS guidelines. 32 patients had CORS, and the control group were 32 patients with CnORS. Patients were matched according to gender and age. All the patients underwent a CT scan evaluated by a radiologist, and were evaluated by an oral surgeon and otorhinolaryngologist before being assigned to one of the groups. The severity of the symptoms was assessed through questioners SNOT-22 (sino-nasal outcome test) and VAS (visual analogue scale) symptom score. Kolmogorov-Smirnov's, Fisher's and Mann-Whitney U test were used in the statistical analysis of the data.ResultsPeople with CORS show similar symptomatology on SNOT-22 score to patients with CnORS, with no significant statistical difference between any of the SNOT-22 symptoms. VAS symptom score showed that odontogenic group had a significantly higher score for fever (p = .004) and halitosis (p = .003).ConclusionHalitosis and fever might be the most important symptoms in differentiating between CORS and CnORS symptomatology. Better diagnostic tools, such as VAS symptom score might help medical professionals to be quicker at recognizing CORS specific symptomatology, and help them treat the disease as early and adequately as possible.
       
  • Efficacy of nasal septal splints for preventing complications after
           septoplasty: A meta-analysis
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of OtolaryngologyAuthor(s): Su Jin Kim, Dong Sik Chang, Myoung Su Choi, Ho Yun Lee, Jung-Soo PyoAbstractBackgroundThe efficacy of nasal septal splints, which are used as alternatives to nasal packs for preventing complications such as synechia and maintaining septal stability after septoplasty, remains controversial. The present meta-analysis assessed the efficacy and safety of nasal septal splints used after septoplasty.MethodsPubMed and Google Scholar databases were systematically searched until June 20, 2019. Randomized controlled trials or cohort or case–control studies comparing patients who received nasal septal splints with those who did not receive splints after septoplasty were included. Primary outcomes included postoperative pain, infection, bleeding, hematoma formation, synechia, and perforation. Random effects models were used to calculate risk differences and risk ratios with 95% confidence intervals (CIs).ResultsThirty-three eligible studies were included. The estimated rate of synechia was significantly lower in the splint group (0.037, 95% CI 0.024–0.056) than in the no splint group (0.087, 95% CI 0.055–0.135; P = 0.003), while visual analog scale scores for pain and the estimated rates of infection, bleeding, hematoma, and perforation were comparable between groups.ConclusionsThese findings suggest that the use of nasal septal splints as alternatives or in addition to nasal packing prevent synechia after septoplasty without increasing other complications, including pain, thus adding to evidence supporting the use of septal splints, particularly in cases where postoperative synechia is expected.
       
  • The effect of fibromyalgia treatment on tinnitus
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of OtolaryngologyAuthor(s): O. Caglar Cil, C. Zateri, O. Guclu, S. Oymak, E. TezcanAbstractObjectivesWe investigated the frequency of tinnitus in fibromyalgia patients and the effect of drugs used for routine fibromyalgia on tinnitus.MethodsWe included 101 diagnosed fibromyalgia patients. After detailed ear nose throat examination, audiometric tests and tinnitus handicap index (THI) were performed. After the tests, routine treatment for fibromyalgia was started by the physical therapy and rehabilitation department. Two months after the beginning of the treatment, THI were repeated again and the results were statistically evaluated.ResultsAll patients included in the study were women. 74.3% of the patients had tinnitus. Pregabalin and selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant-treated patients were evaluated; In both groups, there was a statistically significant difference between pre- and post-treatment tinnitus levels (p 
       
  • Predictive factors for prolonged operative time in head and neck patients
           undergoing free flap reconstruction
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of OtolaryngologyAuthor(s): Michael Lindeborg, Sidharth V. Puram, Rosh K.V. Sethi, Nicholas Abt, Kevin S. Emerick, Derrick Lin, Daniel G. DeschlerAbstractPurposeDefining the predictive factors associated with prolonged operative time may reduce post-operative complications, improve patient outcomes, and decrease cost of care. The aims of this study are to 1) analyze risk factors associated with prolonged operative time in head and neck free flap patients and 2) determine the impact of lengthier operative time on surgical outcomes.MethodsThis retrospective cohort study evaluated 282 head and neck free flap reconstruction patients between 2011 and 2013 at a tertiary care center. Perioperative factors investigated by multivariate analyses included gender, age, American Society of Anesthesiologists class, tumor subsite, stage, flap type, preoperative comorbidities, and perioperative hematocrit nadir. Association was explored between operative times and complications including flap take back, flap survival, transfusion requirement, flap site hematoma, and surgical site infection.ResultsMean operative time was 418.2 ± 88.4 (185–670) minutes. Multivariate analyses identified that ASA class III (beta coefficient + 24.5, p = .043), stage IV tumors (+34.8, p = .013), fibular free flaps (−44.8, p = .033 for RFFF vs. FFF and − 67.7, p = .023 for ALT vs FFF) and COPD (+36.0, p = .041) were associated with prolonged operative time. History of CAD (−43.5, p = .010) was associated with shorter operative time. There was no statistically significant association between longer operative time and adverse flap outcomes or complications.ConclusionAs expected, patients who were medically complex, had advanced cancer, or underwent complex flap reconstruction had longer operative times. Surgical planning should pay special attention to certain co-morbidities such as COPD, and explore innovative ways to minimize operative time. Future research is needed to evaluate how these factors can help guide planning algorithms for head and neck patients.
       
  • Quality improvement in tracheostomy care: A multidisciplinary approach to
           standardizing tracheostomy care to reduce complications
    • Abstract: Publication date: Available online 24 December 2019Source: American Journal of OtolaryngologyAuthor(s): Samuel J. Rubin, Stefanie S. Saunders, Jacob Kuperstock, Dominick Gadaleta, Peter A. Burke, Gregory Grillone, James M. Moses, Jaime P. Murphy, Gerardo Rodriguez, Andrew Salama, Michael P. PlattAbstractPurposeDevelop a model for quality improvement in tracheostomy care and decrease tracheostomy-related complications.MethodsThis study was a prospective quality improvement project at an academic tertiary care hospital. A multidisciplinary team was assembled to create institutional guidelines for clinical care during the pre-operative, intra-operative, and post-operative periods. Baseline data was compiled by retrospective chart review of 160 patients, and prospective tracking of select points over 8 months in 73 patients allowed for analysis of complications and clinical parameters.ResultsImplementation of a quality improvement team was successful in creating guidelines, setting baseline parameters, and tracking data with run charts. Comparison of pre- and post-guideline data showed a trend toward decreased rate of major complications from 4.38% to 2.74% (p = 0.096). Variables including time to tracheotomy for prolonged intubation, surgical technique, day of first tracheostomy tube change, and specialty performing surgery did not show increased risk of complications. There were increased tracheostomy-related complications in cold months (p = 0.04).ConclusionsAn interdisciplinary quality improvement team can improve tracheostomy care by identifying system factors, standardizing care among specialties, and providing continuous monitoring of select data points.
       
  • Network meta-analysis of surgical treatment for secondary
           hyperparathyroidism
    • Abstract: Publication date: Available online 21 December 2019Source: American Journal of OtolaryngologyAuthor(s): Jianzhong Hou, Haojie Shan, Yingchao Zhang, Xianzhao Deng, Bomin Guo, Jie Kang, Bo Wu, Youben FanAbstractBackgroundMain surgical treatments for secondary hyperparathyroidism (SHPT) include subtotal parathyroidectomy (sPTX), total parathyroidectomy with autotransplantation (tPTX+AT), and total parathyroidectomy (tPTX); however, determining the best treatment is debatable. We conducted a network meta-analysis (NMA) comparing three treatments in terms of postoperative hypocalcemia (or hypoparathyroidism), postoperative recurrence, and reoperation.MethodsWe searched PubMed, Medline, the Cochrane Library, and Embase for relevant research from inception to July 30, 2019. We performed our Bayesian NMA using R 3.51 software to assess odds ratios (OR) and 95% confidence intervals (CI). Network and forest plots displayed study outputs. Potential publication bias was assessed with funnel plots using software Stata/MP 13.0.ResultsTwenty-six articles comprising 5063 patients were included in our NMA, which showed that postoperative hypocalcemia (or hypoparathyroidism) occurred more frequently in tPTX than in sPTX (OR = 3.50, 95% CI 1.10–11.0) or tPTX+AT patients (OR = 1.80, 95% CI 0.66–5.20). Regarding postoperative hypocalcemia (or hypoparathyroidism), there was no significant difference between sPTX and tPTX+AT (OR = 0.53, 95% CI 0.24–1.10). As for recurrence rates, statistically significant differences were observed between sPTX and tPTX (OR = 25.0, 95% CI 5.1–260), tPTX+AT and tPTX (OR = 20.0, 95% CI 4.2–200), and sPTX and tPTX+AT (OR = 1.30, 95% CI 0.65–2.50). Regarding reoperation rates, sPTX experienced higher incidence compared with tPTX+AT (OR = 1.20, 95% CI 0.53–2.70) or tPTX patients (OR = 2.70, 95% CI 1.20–14.00).ConclusionsTPTX+AT is recommended as the most efficient and safe surgical SHPT treatment with minimal adverse effects. Large-scale randomized controlled trials are recommended to confirm the NMA results.
       
  • Comparison of sonotubometry, impedance, tubo-tympano-aerography, and
           tubomanometry to test eustachian tube function
    • Abstract: Publication date: Available online 21 December 2019Source: American Journal of OtolaryngologyAuthor(s): Kaian Ruan, Jingyu Li, Songhua Tan, Lei Liu, Anzhou TangAbstractPurposeThere is currently no gold standard for the diagnosis of eustachian tube (ET) dysfunction. To provide an objective basis for the clinical diagnosis of ET dysfunction, we explored the characteristics of sonotubometry, impedance, tubo-tympano-aerography (TTAG), and tubomanometry (TMM) in volunteers with healthy ETs.Materials and methodsSonotubometry, impedance, TTAG, and TMM tests were performed in 110 healthy ears of 55 volunteers, and the characteristics of each ET test were compared and discussed.ResultsThe ET opening rate was compared between sonotubometry with dry swallowing, impedance with the Valsalva maneuver, TTAG with the Valsalva maneuver, and TMM with a nasopharyngeal pressure of 50 mbar in 100 (90.9%), 102 (92.7%), 99 (90.0%), and 104 (94.5%) ears, respectively; there was no significant difference among the four methods (P = 0.575). In sonotubometry, both dry swallowing and the Valsalva maneuver were superior to wet swallowing in terms of detecting ET opening (P = 0.000). In TMM, both the opening rate and the external auditory canal pressure were positively correlated with the nasopharyngeal pressure. Specifically, the opening rate and external auditory canal pressure increased with an increase in the nasopharyngeal pressure (r = 0.271, P = 0.000; r = 0.315, P = 0.000, respectively).ConclusionsSonotubometry, impedance, TTAG, and TMM have their own advantages and disadvantages. In clinical practice, the appropriate ET function test should be chosen on the basis of the patient's specific condition.
       
  • The anatomical basis and rational for the transoral approach during the
           surgical excision of the sublingual salivary gland for the management of
           plunging ranula
    • Abstract: Publication date: Available online 20 December 2019Source: American Journal of OtolaryngologyAuthor(s): Kabunda Syebele, Thifhelimbilu I. MunzheleleAbstractPurposeThe aim of this study was to illustrate and confirm that the complete intraoral excision of the sublingual gland alone, is anatomically the most rational approach, for the management of plunging ranula.Material and methodsWe retrospectively reviewed clinical charts of diagnosed HIV-infected patients presenting with plunging ranula. The intraoral approach was used for the complete excision of the sublingual gland with evacuation of the pseudocystic content only. Neither extra oral approach, nor ranula dissection / drainage was performed. The surgical procedure was performed using local anesthesia.Pre- and postoperative MRI-scan investigations were recorded. Histological reports were documented to confirm the diagnosis of oral mucocele. Patients were clinically monitored.ResultsWe identified 90 adults presenting with oral mucocele, type ranula. Seventy (77%) of them were diagnosed with HIV infection. Plunging ranula was recorded in 35 (50%) patients from the latter group. The study enrolled 11 operated patients whose files contained useable data, including an acceptable follow-up period. The postoperative follow-up period ranged from three to 15 months. The clinical and postoperative MRI-scans of operated patients demonstrated satisfactory results. There were neither postoperative complications nor recurrence of ranula reported.ConclusionThe location of the sublingual gland in the floor of the mouth coupled with the physio-pathogenesis of the plunging ranula, makes the transoral complete excision of the offending gland, with the intraoral evacuation of the pseudocyst, anatomically the most rational approach for plunging ranula management. There is no need for cervical approach, ranula dissection and/or postoperative placement of drainage.
       
  • Pain management and prescribing practices in otolaryngology residency
           programs
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Jaclyn Klimczak, Arvind Badhey, Anni Wong, Patrick Colley, Marita TengAbstractPurposeTo understand the knowledge, competency and influencing factors regarding postoperative opioid prescribing practices among Otolaryngology Residents. To understand the educational background and resources regarding pain management and opioid prescribing among Otolaryngology Residency Programs.Materials and methodsAn anonymous electronic survey was distributed to Otolaryngology residents in the greater New York City area. Subjects reported their preferred pain management prescription for eight common otolaryngology surgeries. Questions addressed opioid and non-opioid prescribing influences, use/knowledge of pain management resources, and prior opioid prescribing education (OPE). An anonymous survey was distributed to US Otolaryngology Program Directors addressing resident prescribing influences and OPE in residency training programs.ResultsThirty-Five residents and fifteen PDs participated. Resident opioid prescribing was widely variable with averages ranging from 3.8 to 21.1 narcotic pills among eight standard otolaryngology surgeries. Attending/senior preference was believed to largely influence resident prescribing habits among residents (3.66, ±6.68), and PDs (4.73, ±0.46). Only 20% of programs had formal OPE in place, consistent with the 65.71% of residents who reported no prior OPE.Conclusions and relevanceA large inconsistency in Otolaryngology resident postoperative pain management exists, despite their responsibility to provide analgesic therapy. The lack of formal OPE programs in US Otolaryngology residency programs may lead to outside factors unrelated to surgery influencing these prescribing practices. This brings light to the need of Otolaryngology Resident OPE to assist in standardizing prescribing practices, provide meaningful patient education on opioid use and disposal and educate residents on the risk assessment tools offered to provide the most appropriate and safe analgesic therapy to patients.
       
  • Dissociation between objectively quantified snoring and sleep quality
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Kori E. Macarthur, T. Douglas Bradley, Clodagh M. Ryan, Hisham AlshaerAbstractBackgroundThe impact of simple snoring on sleep structure and sleepiness has not been well described. In several studies, self-reported snoring was associated with increased daytime sleepiness. However, most studies did not distinguish patients with simple snoring from those with coexisting obstructive sleep apnea (OSA) using objective measures. We therefore evaluated the relationship between objectively measured snoring and both sleep structure and daytime sleepiness in patients with no or mild OSA.MethodsSubjects referred for suspected sleep disorders underwent polysomnography (PSG) during which breath sounds were recorded by a microphone. Those with an apnea-hypopnea index (AHI)  0.13). There was no correlation between SI and any of these variables (p > 0.29). In contrast, the AHI was significantly related to frequency of arousals (r = 0.23, p = 0.048).ConclusionsThese findings suggest that simple snoring assessed objectively is not related to indices of sleep structure or subjective sleepiness.
       
  • Predictive markers of long-term recurrence in chronic rhinosinusitis with
           nasal polyps
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Rosati Davide, Rosato Chiara, Pagliuca Giulio, Cerbelli Bruna, Della Rocca Carlo, Di Cristofano Claudio, Martellucci Salvatore, Gallo AndreaAbstractBackgroundIn last years, many attempts were made to recognize chronic rhinosinusitis with nasal polyps (CRSwNP) phenotypes focusing on identifying relevant key pathogenic molecules. Polyps recurrence rate ranges from 4% to 60%, so it's clear that not all clinical and immunologic factors associated with recurrence are known.ObjectiveWe investigate the inflammatory profile in patients with long term recurrent and non-recurrent CRSwNPs and if a specific profile is associated with recurrence, comparing eosinophilic, neutrophilic and lymphocytic infiltration, as well as IL-5 and IL-8 expression to long term recurrence rate.MethodsThis prospective study included 44 adult patients with CRSwNP treated with endoscopic sinus surgery between 2008 and 2010. Long term follow-up data (8–10 years) indicated that among 44 patients, 18 (40.1%) experienced long term recurrence of nasal polyposis needing maximal medical treatment or revision surgery. We realized two groups: one with patients who didn't present long term recurrence (26 patients) and another with patients who presented long term recurrence (18 patients) and in both groups eosinophilic, neutrophilic and lymphocytic infiltration and IL-5 and IL-8 expression were measured.ResultsThe parameters that reached statistical significance (p 
       
  • Variations in the management of acute Bell's palsy
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): David A. Kasle, Sina J. Torabi, Emily Savoca, Jacob I. Tower, Douglas HildrewAbstractObjectiveTo identify presiding practices among neurotologists (ORL) in the care of acute Bell's palsy, and to compare them to neurologists' treatment patterns.Study design and methodsCross-sectional survey study.SubjectsNeurotologists and neurologists.ResultsNinety-one responses to the survey were obtained. The majority of participants (87.9%) always prescribe steroids. ORL were more likely to prescribe higher doses (≥60 mg) than neurologists (89.7% vs. 58.0%) (p = 0.001). Anti-viral medication was initially prescribed by 46.2% of respondents (56.1% ORL vs. 38.0% neurologists; p = 0.085). An MRI was always ordered by 17 participants (18.7%), while an MRI was sometimes ordered by 45 participants (49.5%). ORL were not only more likely to always order an MRI (24.4% vs. 14.0%), but also more likely to never order an MRI (43.9% vs. 22.0%) (p = 0.009). Laboratory blood work was never ordered by 45.1% of respondents, with 70.7% of OTO and 24.0% of neurologists indicating that they would never order labs (p 
       
  • Prognostic role of blood eosinophil and basophil levels in allergic fungal
           rhinosinusitis (AFRS)
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Giuseppe Brescia, Leonardo Franz, Lara Alessandrini, Daniela Parrino, Umberto Barion, Gino MarioniAbstractPurposeAllergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography.Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS.Materials and methodsA consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed.ResultsSinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not.ConclusionsConsidering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.
       
  • Epigenetic silencing of microRNA-335 contributes to nasopharyngeal
           carcinoma metastasis
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Ju-hong Yang, Lie-Kun Lin, Song ZhangAbstractBackgroundMircoRNA-335 (miR-335), a member of mircoRNAs (miRNAs) family, has been found to be correlated with tumor invasion and metastasis. In this study, we aimed to detect the effect of miR-335 methylation on metastasis of nasopharyngeal carcinoma.MethodsRT-PCR and methylation-specific PCR were applied to detect the expression levels of miR-335 and miR-335 methylation in nasopharyngeal carcinoma tissues.ResultsThe levels of miR-335 expression were significantly lower in nasopharyngeal cancer tissues with promoter methylation, compared to those with promoter unmethylation. The levels of miR-335 gene promoter methylation were higher in 14 (46.7%) out of 30 nasopharyngeal cancer tissues. Furthermore, the patients with cervical lymph node metastasis had higher methylation rate in miR-335 promoter (66.7% versus 16.7%) than those without cervical lymph node metastasis.ConclusionGene methylation contributes the expression of miR-335 in nasopharyngeal carcinoma. The expression of miR-335 methylation is correlated with the metastasis of nasopharyngeal carcinoma.
       
  • Complications of Palatal Pillar Implants: An analysis of the MAUDE
           database and literature review
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Roman Povolotskiy, Mickey E. Abraham, Adam B. Leverant, Amishav Bresler, Boris PaskhoverAbstractPurposeThe Pillar Palatal Implant System is a minimally invasive procedure for the treatment of obstructive sleep apnea and snoring. Prior studies have examined the effectiveness of this procedure, however no prior study has thoroughly evaluated its complications. We anticipate that this analysis will provide valuable insight into these procedures which can be used in patient education and post-operative follow-up.Materials and methodsThe Manufacturer and User Facility Device Experience (MAUDE) database was queried for cases reporting injury related to the pillar procedure. The case narratives were individually analyzed and categorized by type of complication. A comparison of extruding parts and select complications was also performed using chi-square analysis.ResultsOf the 261 cases reported, 73.6% reporting extruding parts, 47.5% described patient pain, and 38.7% included patients describing a foreign body sensation. Infection was reported in 7.7% of the cases with cellulitis and abscess formation specifically mentioned in one case. Cases describing pain and difficulty swallowing were significantly more likely to have reported extruding parts (p 
       
  • Prognostic value of lymph node density for major salivary gland carcinoma
           without clinical lymph node metastasis
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Hoshino Terada, Hidenori Suzuki, Nobuhiro Hanai, Daisuke Nishikawa, Yusuke Koide, Yasuhisa HasegawaAbstractBackground and objectiveThis study aimed to investigate whether lymph node density (LND) was correlated with overall survival (OS) in major salivary gland carcinoma without clinical lymph node metastasis.MethodsSixty patients who were diagnosed with major salivary gland carcinoma without clinical lymph node metastasis were enrolled. Of these, 50 patients underwent neck dissection. LND was defined as the ratio of the number of positive lymph nodes to the total number of resected lymph nodes.ResultsAn LND of ≥0.1 was significantly associated with a short OS (p 
       
  • Atypical Schwannoma: A 10-year experience
    • Abstract: Publication date: January–February 2020Source: American Journal of Otolaryngology, Volume 41, Issue 1Author(s): Armine H. Kocharyan, Selena Briggs, Maura K. Cosetti, Sabrina M. Heman-Ackah, John G. Golfinos, J. Thomas RolandAbstractObjectiveThe goal of this study was to describe the clinical presentation associated with atypical schwannoma of the cerebellopontine angle, characterize the pathologic findings and describe the long-term outcome.Materials and methodsThe study design was retrospective case review of patients with the histopathologic diagnosis of atypical and benign schwannoma of the cerebellopontine angle diagnosed at the study institution over a 10-year period.SettingTertiary referral center.Main outcomes measureDemographic data of the cohort were recorded. Findings on pathology were evaluated. Initial treatment and post-operative course was recorded. Main outcome measures were clinical presentation, including cranial nerve deficits at the time of presentation, complication and recurrence rates.ResultsAt presentation, a somewhat accelerated course of cranial nerve deficit was noted among patients with atypical schwannoma as compared to benign schwannoma. In the immediate post-operative period, there were no differences noted in the complication rate. Atypical schwannomas appear to have higher recurrence rate compared to benign schwannomas.ConclusionsAtypical schwannoma is an intermediate disease process with an accelerated clinical course and higher recurrence rate as compared to vestibular schwannoma. Traditional operative approaches may be employed without increased concern for post-operative complications. Thorough counseling and close follow-up should be offered to these patients given the higher recurrence rate. Larger studies are required to determine if these patients need more frequent MRIs for long-term surveillance.
       
  • An association between marijuana use and tinnitus
    • Abstract: Publication date: Available online 13 November 2019Source: American Journal of OtolaryngologyAuthor(s): Z. Jason Qian, Jennifer C. AlyonoAbstractObjectiveWhile some advocates have argued for marijuana as a treatment for tinnitus, the relationship between marijuana use and tinnitus is unknown. The objective of this study was to evaluate associations between marijuana use and the prevalence, severity, and rate of occurrence of tinnitus.Study designCross-sectional analysis of nationally representative data.SettingNational Health and Nutrition Examination Survey 2011–2012.Subjects and methodsStatistical analysis was performed on data collected from 2705 non-institutionalized adults aged 20–69 who underwent audiometric testing and were administered questionnaires about hearing, drug use, current health status, and medical history.ResultsThe use of marijuana at least once per month for the previous 12 months was significantly associated with experiencing tinnitus during that 12-month month (X2(1) = 19.41, p 
       
  • The role of molecular testing in the diagnosis of medullary thyroid
           cancer: A case report of oncocytic medullary thyroid carcinoma and review
           of the literature
    • Abstract: Publication date: Available online 11 November 2019Source: American Journal of OtolaryngologyAuthor(s): Sarah L. Spaulding, Rebecca Ho, Sedef Everest, Raymond L. ChaiAbstractBackgroundMedullary thyroid carcinoma (MTC) is a somewhat rare, particularly aggressive form of thyroid cancer. The authors present what we believe to be the first case of MTC diagnosed solely on the basis of molecular testing, as well as a review of the literature concerning this topic and oncocytic variants of MTC.Case descriptionA 30-year-old female patient with a 1.1 cm thyroid nodule underwent a fine-needle aspiration biopsy showing a Bethesda IV Hurthle cell neoplasm. Molecular testing of the specimen identified a RET M918 T mutation. The patient underwent a total thyroidectomy and bilateral central neck dissection. Initial pathologic analysis yielded a diagnosis of Hurthle cell adenoma. Based on the patient's known RET mutation, immunohistochemistry for calcitonin was performed and yielded a positive result. The final diagnosis was amended to an oncocytic variant of medullary thyroid carcinoma.DiscussionHad this patient undergone fine-needle aspiration (FNA) biopsy without molecular testing or serum calcitonin measurement, the patient's disease would have been diagnosed as a Hurthle cell adenoma. Despite the lack of characteristic features of malignancy and the rarity of oncocytic MTC, the diagnostic pitfall in this oncocytic lesion was avoided due to molecular testing at the time of FNA biopsy.ConclusionThis case draws attention to the unique clinical value of molecular testing in the diagnosis of MTC. The authors believe this case supports the consideration for molecular testing to prevent missed diagnoses in cases of rare benign-appearing disease.
       
  • National 30-day readmission and prolonged length of stay after vestibular
           schwannoma surgery: Analysis of the Nationwide Readmissions Database
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Zachary G. Schwam, Rocco Ferrandino, Vivian Z. Kaul, Maura K. Cosetti, George B. WannaAbstractPurposeTo determine the risk factors for unanticipated readmission, prolonged index admission, and discharge to a facility after vestibular schwannoma surgery.Materials and methodsRetrospective cohort study of those undergoing surgery for vestibular schwannoma in the Nationwide Readmissions Database (2013–2014). Main outcome measures included readmission rate, length of stay, discharge destination.ResultsThere were 4585 cases identified. The overall unanticipated readmission rate was 8.1%, and 9.1% had a prolonged length of stay (PLOS) of ≥7 days. Mean and median LOS were 4.63 and 4.00 days, respectively, and>90% of patients were discharged after 7 days. Disposition to a facility occurred in 6.7% of cases. Teaching hospitals were protective against unintended readmission (odds ratio [OR] 0.44, p 
       
  • The racial disparity of nasopharyngeal carcinoma based on the database
           analysis
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Lei Zhou, Na Shen, Guangyao Li, Jiaye Ding, Danzheng Liu, Xinsheng HuangAbstractObjectiveTo investigate whether the racial/ethnical disparity of nasopharyngeal carcinoma exists among the four major ethical groups in the United States named Asians, Caucasians, African Americans and Hispanics between the years of 1973 to 2013 using the Surveillance, Epidemiology, and End Result (SEER) database.MethodsThe National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2013 was utilized in this study to calculate survival trends for the four main ethical groups in the United States. The cases of nasopharyngeal carcinoma were extracted based on the SEER code cs0204schema. Death due to the diagnosed nasopharyngeal cancer was considered to be the event of interest, and death due to other causes was treated as the censoring events. Kaplan–Meier model was adopted to estimate survival outcomes; the Cox proportional hazards model was employed to do the hazard ratios (HR) estimation.ResultsA total of 8068 eligible patients of nasopharyngeal carcinoma were identified. The cohort was composed of 40.69% Caucasians, 11.34% African Americans, 40.16% Asians and 7.81% Hispanics. According to the multivariate Cox regression analysis, Asians had a better survival prognosis against Caucasians (HR: 0.74, 95% CI: 0.65–0.84, P 
       
  • Hematologic malignancies of the larynx: A single institution review
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Karuna Dewan, Ross Campbell, Edward J. DamroseAbstractBackgroundPrimary hematologic malignancies of the larynx are rare diagnoses, accounting for less than 1% of all laryngeal tumors. They most commonly present as submucosal masses of the supraglottis, with symptoms including hoarseness, dysphagia, dyspnea and rarely cervical lymphadenopathy.Purpose1.To present a case series of primary hematologic malignancies of the larynx in patients treated in a tertiary care laryngology practice.2.To review the literature on primary hematologic malignancy of the larynx.MethodsRetrospective case series of patients in a tertiary academic laryngeal practice with hematologic malignancy of the larynx presenting over a 10 year period; charts were reviewed for diagnosis, symptoms, treatment, and outcomes.Results12 patients were found to have primary presentation of a hematologic malignancy within the larynx between 2009 and 2019. A submucosal mass was the most common finding, and hoarseness was the most common symptom. Local control of disease was high. Airway obstruction was managed with tracheostomy. Several patients required tube feeding prior to disease control. Most patients underwent radiation therapy and chemotherapy, although surgery alone was effective in patients with isolated disease.ConclusionsHematologic malignancies of the larynx are rare but treatable. Biopsy is the mainstay of diagnosis, and imaging may be helpful to exclude diseases with a similar physical presentation (i.e., laryngocele). Prognosis depends on diagnosis but is generally favorable.
       
  • Clinical efficacy and safety of cervical intralymphatic immunotherapy for
           house dust mite allergic rhinitis: A pilot study
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Kai Wang, Rui Zheng, Youmou Chen, Qingqing Yu, Hanrong Zhong, Ping Xiao, Yuejian Wang, Jun TangAbstractBackgroundPrevious studies have demonstrated that intralymphatic immunotherapy (ILIT), a less time-consuming alternative to conventional subcutaneous immunotherapy (SCIT), is safe and effective. However, because of the private location of inguinal lymph nodes, inguinal ILIT is relatively inconvenient. We proposed a novel form of ILIT that involves 3 injections of allergen into cervical lymph nodes. The aim of this study is to determine the clinical efficacy and safety of cervical ILIT on house dust mite induced allergic rhinitis (AR) in adults.MethodsIn this study, we performed a prospective cohort study to determine the clinical efficacy and safety of cervical ILIT on house dust mite induced AR in adults, by comparing the symptom scores, quality-of-life scores (QOLS) and drug scores (use of rescue medication) before and after treatment. Meanwhile, side events were also recorded.ResultsCervical ILIT elicited no moderate-severe adverse events. Patients receiving cervical ILIT experienced a significant improvement in nasal symptoms, eye symptoms and quality of life, as compared to baseline (P all
       
  • Can the Jankovic-assessment be used as an alternative to
           electromyography' A cross-sectional study on facial dystonia patients
           treated with Botulinum toxin
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Arianna Di Stadio, Laura Dipietro, Valeria Gambacorta, Maria Cristina Cristi, Mario Faralli, Antonio della Volpe, Giampietro RicciAbstractPurposeThis study aims to quantitatively compare the Jankovic assessment (JA) with electromyography (EMG)-based measures for assessing changes in facial movements in patients with facial dystonia.Materials and methodsThirteen patients (five males and eight females) affected with different forms of facial dystonia (hemifacial spasm and synkinesis) participated in this study. All patients were treated with Botulinum Toxin (BTX) and evaluated with the JA scale and EMG-based measures, including motor unit potentials (MUP) latency and presence of polyphasic potentials before and after BTX injection. Correlation between the JA scores and the EMG-based measures was calculated. Statistical analysis was performed with the Pearson test.ResultsCorrelation between the JA scores and the EMG-based measures was found to be statistically significant, both before and after treatment with BTX.Conclusion and relevanceJA scores significantly correlated with more objective EMG-based measures, suggesting that the JA scale can be used to assess facial movement changes, for example elicited by a treatment such as BTX injection. Thus, in facial dystonia patients, the JA scale may be used for evaluating treatment outcomes as a valid and low-cost alternative to EMG.
       
  • Prevalence of humoral immunodeficiency in adult patients with recurrent
           tonsillitis
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Osama G. Abdel-Naby AwadAbstractPurposeRecurrent tonsillitis in adults has a significant impact on patients' daily life and healthcare costs. Humoral immunodeficiency increases the susceptibility to recurrent infections. The purpose of this study was to investigate the prevalence and contribution of humoral immunodeficiency in adult patients with recurrent tonsillitis.Material and methodsA prospective cross-sectional study conducted over 3 years duration with two groups of subjects. Group 1: included 50 normal adult subjects and group 2: included 50 adult patients with recurrent tonsillitis. Recruitment occurred in a tertiary care hospital in Egypt. Different immunoglobulins (Ig A, Ig M and Ig G isotypes) were quantitatively assessed and compared in 2 groups. Incidence of different infections was also compared in patients with humoral immunodeficiency versus patients with intact immunity.Results4 (8%) subjects in group 1 had selective humoral Immunodeficiency versus 13 (26%) patients in group 2. Patients with recurrent tonsillitis had significantly lower mean of most assessed immunoglobulins: IgA (P = 0.002), IgM (P = 0.003), IgG (P 
       
  • Novel treatment for mild and moderate velopharyngeal insufficiency using
           implantable AlloDerm for posterior pharyngeal wall augmentation and review
           of surgical repair techniques
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Kunal R. Shetty, Libby M. Ward, Jessica R. Levi, Gregory GrilloneAbstractPurposeMild and moderate velopharyngeal insufficiency is a relatively common structural defect of the velopharyngeal sphincter that occurs congenitally or secondarily to various medical conditions resulting in speech inadequacy. Currently, multiple surgical methods exist to treat mild and moderate velopharyngeal insufficiency; however, the revision rates are high and the outcomes are variable. This case series describes a novel technique using implantable AlloDerm to repair the posterior pharyngeal wall to treat mild and moderate velopharyngeal insufficiency.Materials and methodsThis paper presents four patients with mild or moderate velopharyngeal insufficiency who were treated with implantable AlloDerm in the posterior pharyngeal wall at a large, safety-net hospital in New England from 2000 to 2019. Additionally, a review of surgical repair techniques for velopharyngeal insufficiency was conducted with synthesis of a qualitative overview.ResultsThere were sufficient follow-up data in three of these patients. All three reported subjective improvements in symptoms after the procedure. One patient had implant extrusion one month following the procedure with subsequent removal.ConclusionUltimately, implantable AlloDerm for posterior pharyngeal wall augmentation is a useful, low risk method for treating mild to moderate velopharyngeal insufficiency.
       
  • Partial pharyngolaryngectomy with infrahyoid flap: Our experience
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Sophie Cortese, Enrico Muratori, Romina Mastronicola, Medarine Roch, Emilie Beulque, P. Rauch, Lucie Dekerle, Alberto Deganello, Gilles DolivetAbstractAimWe evaluated a cohort of advanced hypopharyngeal squamous cell carcinoma, treated with conservative surgery, reconstruction with infrahyoid flap and radio-chemotherapy.MethodsWe used partial pharyngo-laryngectomy and radio-chemotherapy to treat fifty-seven patients with stage III–IV hypopharyngeal SCC from November 1994 to December 2011. Clinical examination and speech therapy evaluation were used for estimation of laryngeal function.ResultsAll patients received a partial pharyngo-laryngectomy. All patients underwent neck dissection; 56 patients received bilateral neck dissection. Reconstruction was achieved by infra-hyoid flap. Five-year overall and disease-specific survival rates were 54.4% and 61.4%, respectively. Successful laryngeal function preservation with complete five-year remission was achieved in 44% of the patients.ConclusionSelected even if advanced carcinomas of the hypopharynx maybe treated with partial pharyngo-laryngectomy with reconstruction with pedicled flap. Both oncological and functional results showed a good outcome.
       
  • Cytomegalovirus-induced pathology in human temporal bones with congenital
           and acquired infection
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Vladimir Tsuprun, Nevra Keskin, Mark R. Schleiss, Pat Schachern, Sebahattin CureogluAbstractObjectivePublications on histopathology of human temporal bones with cytomegalovirus (CMV) infection are limited. We aim to determine histopathology of the inner ears and the middle ears in human temporal bones with congenital and acquired CMV infections.MethodsTemporal bones from 2 infants with congenital and 2 adults with acquired CMV infection were evaluated by light microscopy.ResultsTwo infants with congenital CMV infection showed striking pathological changes in the inner ear. There was a hypervascularization of the stria vascularis in the cochlea of the first infant, but no obvious loss of outer and inner hair cells was seen in the organ of Corti. However, cytomegalic cells and a loss of outer hair cells were found in the cochlea of the second infant. The vestibular organs of both infants showed cytomegalic cells, mostly located on dark cells. There was a loss of type I and type II hair cells in the macula of the saccule and utricle. Loss of hair cells and degeneration of nerve fibers was also seen in the semicircular canals. Both infants with congenital infection showed abundant inflammatory cells and fibrous structures in the middle ear cavity. No evidence of cytomegalic cells and hair cell loss was found in the cochlea or vestibular labyrinth in acquired CMV infection.ConclusionsIn two infants with congenital CMV infection, the cochlea, vestibule, and middle ear were highly affected. Temporal bones of adult donors with acquired viral infection showed histological findings similar to donors of the same age without ear disease.
       
  • Mandibular rescue: Application of the ALT fascia free flap to arrest
           osteoradionecrosis of the mandible
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Timothy Haffey, Ryan Winters, Rhorie Kerr, Michael FritzAbstractObjectivesTo evaluate the use of the anterolateral thigh fascia free flap for use in neovascularization of mandibular bone in moderate osteoradionecrosis (ORN). All patients had ORN secondary to prior radiation therapy that was not severe enough to warrant segmental resection and reconstruction.Study designCase series.SettingTertiary medical center.MethodsIRB approval was obtained, and a retrospective chart review performed of all mandibular rescue procedures performed from 2011 to 2014. Patients with a minimum of two years of follow-up were included in the study.ResultsAll surgeries were performed by the senior surgeon (MF). Eight patients underwent the mandibular rescue procedure with resolution of pain and return to oral feeding in all patients, and no evidence of ORN progression on follow-up imaging. A total of 9 ALT free flaps were performed (one patient had 2 surgeries). Gender was distributed evenly (4 female/4 male). The average age was 66 (58-78), average length of hospitalization was 2.8 days (1–7), and average follow-up was 46.5 months (25–63).ConclusionsThe mandibular rescue procedure is a novel technique using the ALT fascia lata free flap to provide coverage and nutrient blood flow to mandible devascularized secondary to radiation therapy. The flap provides the advantages of low morbidity, ease of harvest, two-team approach to ablation and reconstruction, and quick recovery resulting in ‘short-stay’ free flap surgery. Although conclusions must be tempered in this small case series, our early clinical experience shows the ALT fascia lata flap holds promise in halting the destructive progression of ORN that is not yet advanced enough to require a segmental resection and reconstruction.
       
  • Hypermethylation of DcR1, DcR2, DR4, DR5 gene promoters and clinical
           significance in tongue carcinoma
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Yong Zhou, ShuCan Zheng, QingHua Luo, XuYao Huang, Yong Zhou, ZhaoHui LiAbstractObjectiveTongue squamous cell carcinoma (TSCC) is one of the most common malignancies in the oral cavity, and its incidence and mortality have been constantly increasing these years. A large number of tumor suppressor genes are involved in the development of the TSCC and it has been reported that the aberrant hypermethylation of tumor suppressor genes may play a key role in the process of the TSCC. In this study, we sought to analyze the association of methylation of DcR1, DcR2, DR4 and DR5 gene promoters and clinical significance in the TSCC to evaluate association between methylation of DcR1, DcR2, DR4 and DR5 gene and Clinical Significance in tongue squamous cell carcinoma.MethodsMethylation-specific PCR(MSP) was used to analyze the methylation of the promoters of TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) receptors in 45 TSCC cases. Real-Time PCR was used to detect the expression of the DcR1, DcR2, DR4 and DR5 gene.ResultsAll the four genes (DcR1, DcR2, DR4 and DR5) showed different methylation of promoters in TSCC, while methylation of these promoters in paired adjacent normal tissues were almost undetectable. Patients with high methylation index were diagnosed at younger age when compared with the ones with low methylation index. DcR1 and DR4 hypermethylation was correlated significantly with patients' TNM stage.ConclusionsMethylation of DcR1, DcR2,DR4 and DR5 promoters are found in TSCC and may associate with its occurrence and development. Taking the reversibility of methylation into account,methylation is a potential targeted therapy of TSCC.
       
  • Anesthesia and ventilation options for flex robotic assisted
           laryngopharyngeal surgery
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Yosef Krespi, Victor Kizhner, Robert Koorn, Anthony GiordanoAbstractBackgroundTransoral treatment of benign and malignant lesions of laryngopharynx has limitations in exposure and access, partially due to the endotracheal tube (ETT). With a proper airway control to tailor ventilation and maximize exposure, transoral Flex robotic surgery (FLEX), using its 3D camera and instruments, can expand its ability. Choosing the right ETT, including a novel concept of using jet ventilation (JV) in FLEX, and placement technique can allow augmentation of the advantages that robotic surgery offers.MethodsChart review of FLEX assisted procedures was performed. Attention was given to demographics, all events of airway manipulation and ventilation type, procedures performed and outcomes including adverse effects.ResultsFifty-two patients underwent eighty procedures. The airway was manipulated sixty-four times to include 8 JV. All possible FLEX instruments including CO2 laser were used. Three novel possible indications for trans-oral robotic surgery including the feasibility of JV in FLEX procedures were shown.ConclusionsLesions of the tongue base, hypopharynx, larynx and trachea have the possibility to be managed with adequate exposure with minimal obstruction from ETT. Robotic HD camera permits both the surgeon and anesthesiologist to observe surgery and safely monitor the airway. An algorithm was developed for selecting ideal ventilation method for different procedures. The FLEX and the utilization of JV allows flexibility of two instruments without obstruction.
       
  • Comparison of adverse events between cluster and conventional
           immunotherapy for allergic rhinitis patients with or without asthma: A
           systematic review and meta-analysis
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Zihan Jiang, Hao Xiao, Hongting Zhang, Shixi Liu, Juan MengAbstractBackgroundCluster schedule of allergen-specific immunotherapy (AIT) is a cost-effective choice for allergic rhinitis (AR) patients, but its safety has been questioned due to the greater dosages required at each treatment compared with conventional immunotherapy. It remains a question that whether cluster schedule leads to a higher risk of side effects.ObjectiveThis study was designed to update the evidence and investigate whether cluster schedule leads to a higher risk of local adverse reactions (LARs) and systemic adverse reactions (SARs) than cluster schedule does.MethodsWe searched the Cochrane Central Register of Controlled Trials, EMBASE and Medline thoroughly and included studies comparing cluster and conventional schedules. A meta-analysis of 5 outcomes related to adverse events was performed after bias and heterogeneity assessments. And as a result of language limitations, we considered only articles in Chinese and English.Results5 observational studies and 6 interventional studies were included in the meta-analysis. There were no differences between cluster and conventional schedules when analyzing SARs by the number of patients, delayed SARs, grade 2 SARs and LARs. Analyses of SARs by injection, grade 1 SARs and LARs by injection in observational studies showed that cluster schedule had a lower risk of adverse events than did conventional schedule.ConclusionOur data suggest that cluster schedule is as safe as or even safer than conventional schedule for AR patients with or without asthma (AS).
       
  • The rhinogenic headache resulting from the contact point between inferior
           turbinate and septal spur
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Zhengcai Lou
       
  • A systematic review of the nasal septal turbinate: An overlooked surgical
           target
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): William J. Moss, Farhoud Faraji, Aria Jafari, Adam S. DeCondeAbstractObjectiveThe nasal septal turbinate (NST) is a conspicuous structure located in the anterior nasal cavity that impacts the internal nasal valve. Its structure and function is often thought to be poorly characterized, and it is rarely addressed surgically. The authors perform a systematic review in an attempt to synthesize what has been learned of this structure and to evaluate its potential as a treatment target.MethodsA query of the Medline, Embase, Web of Science and Cochrane databases was undertaken in search of studies evaluating the NST. This qualitative systematic review was performed in accordance with PRISMA guidelines. Study quality and risk of bias were assessed with established criteria.ResultsOf the initial 1069 hits from the four databases, 16 articles were ultimately included in the review, which varied in quality and risk of bias. The included articles consisted predominantly of radiographic and histopathologic studies. Four studies evaluated NST treatment outcomes. The NST represents a fusiform-shaped region of erectile tissue, similar in structure and function to that of the inferior turbinates. Preliminary treatment outcomes suggest the NST represents an important surgical target in nasal airway surgery.ConclusionWhen evaluating nasal obstruction patients, surgeons should assess the NST and consider addressing it surgically.
       
  • Nasal bone fractures and the use of radiographic imaging: An
           otolaryngologist perspective
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Edward Westfall, Benton Nelson, Dominic Vernon, Mohamad Z. Saltagi, Avinash V. Mantravadi, Cecelia Schmalbach, Jonathan Y. Ting, Taha Z. ShipchandlerAbstractObjectiveTo determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures.Study designAn 8-question survey on isolated nasal bone fractures was designed.SettingSurveys were sent to all otolaryngology residency program directors for distribution among residents and faculty. Additional surveys were distributed to private practice otolaryngology groups.Results140 physicians responded to the survey. 57% of the respondents were practicing otolaryngologists (75% with 10+ years of experience), while 43% of respondents were residents-in-training. 56% of respondents treated 1–5 nasal bone fractures per month. 80% of all respondents reported imaging being performed prior to consultation. If imaging was obtained before consultation, plain films and computed tomography (CT) maxillofacial/sinus scans were the most frequent modalities. 33% of residents and 70% of practicing otolaryngologists report imaging as ‘rarely’ or ‘never’ helpful in guiding management. 42% of residents and 20% of practicing otolaryngologists report asking for imaging when it wasn't already obtained. Decreased use of radiography was associated with greater years in practice and higher frequency of fractures treated.Conclusions and relevanceOtolaryngologists seldom request imaging to evaluate and treat isolated nasal bone fractures. When ordered, imaging is utilized more often among residents-in-training and non-otolaryngology consulting physicians. This study highlights an opportunity to educate primary care and emergency room providers as well as otolaryngology residents on the value of comprehensive physical exam over radiographic imaging in the work-up of isolated nasal fractures. In addition, widespread adoption of a “no x-ray policy” in this setting may result in better resource utilization.
       
  • Does intravenous acetaminophen reduce perioperative opioid use in
           pediatric tonsillectomy'
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Allison G. Chisholm, Madhankumar Sathyamoorthy, Samantha R. Seals, Jeffrey D. CarronAbstractObjectivePostoperative pain control is of significant interest in pediatric otolaryngology given the safety concerns with opioid use. We sought to determine if addition of intraoperative intravenous acetaminophen decreases perioperative morphine use in pediatric tonsillectomy.MethodsThis study is a retrospective cohort study performed at a tertiary care academic children's hospital. 166 pediatric patients (aged 1–16 years) who underwent tonsillectomy with or without adenoidectomy were for review. Seventy-four patients received intraoperative intravenous acetaminophen (intervention cohort), while ninety-two patients served as our control and did not receive any intraoperative intravenous acetaminophen. Perioperative (intraoperative and postoperative) morphine use was our primary outcome measure. Rate of adverse events in the post anesthesia care unit and time for discharge readiness were secondary outcome measures. Wilcoxon two-sample t-test approximation and Fisher's exact test were used for data analyses.ResultsPatients in the intravenous acetaminophen cohort received less morphine (mg/kg) intraoperatively (0.058 versus 0.070, p = 0.089) and in the post anesthesia care unit (0.034 versus 0.051, p = 0.034) than the control cohort. The median time to discharge readiness for the intravenous acetaminophen and control groups was 108.5 versus 105 min (p = 0.018). There was no adverse respiratory event (oxygen desaturation
       
  • Commentary on bacterial cellulose graft versus fat graft in closure of
           tympanic membrane perforation
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s): Zhengcai Lou
       
  • Publisher's Note
    • Abstract: Publication date: November–December 2019Source: American Journal of Otolaryngology, Volume 40, Issue 6Author(s):
       
  • Risk factors for post-tonsillectomy hemorrhage in adult population: Does
           smoking history have an impact'
    • Abstract: Publication date: Available online 6 November 2019Source: American Journal of OtolaryngologyAuthor(s): Nurullah Seyhun, Senem Kurt Dizdar, Alican Çoktur, Merve Ekici Bektaş, Onuralp Albuz, Zeynep Nur Erol, Suat Turgut
       
  • Endoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy
           and reproducible technique sparing the middle turbinate
    • Abstract: Publication date: Available online 1 November 2019Source: American Journal of OtolaryngologyAuthor(s): Christopher J. Ito, Nelson May, Stilianos KountakisAbstractObjectiveThe purpose of this study was to evaluate the outcomes of patients with cribriform cerebrospinal fluid leaks undergoing endoscopic repair with an easy and reproducible middle turbinate-sparing technique.Material and methodsDate was obtained by retrospective chart review and includes a description of the technique with technical pearls and contraindications to the approach.ResultsWe report 17 patients who underwent repair of cribriform cerebrospinal fluid leaks with a middle turbinate-sparing technique with 100% success rate at a mean follow up of 38 months. One patient complained of hyposmia. There were no other complications.ConclusionsThe endoscopic middle turbinate-sparing approach to repair cribriform cerebrospinal fluid leaks using a free mucosal graft is easy, effective, and reproducible.
       
  • Orbital complication of acute ethmoiditis: A Tunisian paediatric cross
           sectional study
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of OtolaryngologyAuthor(s): Asma Ben Mabrouk, Selmen Wannes, Mehdi Hasnaoui, Amina Werdani, Nouha Ben Hamida, Saida Jerbi, Nabil Driss, Bahri MahjoubAbstractObjectiveThe anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis.Design and methodsThis cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5).ResultsIn total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment.ConclusionOrbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention.
       
  • Alternative techniques in cochlear implant surgery: Subtotal petrosectomy
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of OtolaryngologyAuthor(s): Santiago Hernández, Juan C. Ospina, Elisa Gutiérrez-Gómez, María Teresa Rodríguez-Ruiz, Juan G. TrujilloAbstractObjectivesTo report and analyze three cases of subtotal petrosectomy (SP) in cochlear implant surgery at our institution, and establish the indications, surgical technique and complications encountered.Materials and methodA retrospective descriptive study is proposed, analyzing a series of three clinical cases of subtotal petrosectomy as surgical technique for cochlear implant surgery at San Ignacio University Hospital (Bogotá, Colombia) from year 2004 to 2019.ResultsA total of three cases of subtotal petrosectomy as surgical technique in cochlear implant candidates were analyzed. The indications were the presence of a wide mastoid cavity after canal wall down mastoidectomy, extrusion of the electrode into the external auditory canal with a wide mastoid cavity and erosion of the posterior wall of the ear canal, and the presence of cholesteatoma in a cophotic ear with previous surgery.The ear canal was defunctionalized in all three cases; in two of them with obliteration of the Eustachian tube and in none of the cases the mastoid was obliterated. There was a single complication associated with the procedure corresponding to a small retention cholesteatoma in the skin of the obliterated duct sac, that didn't required surgical intervention.ConclusionSubtotal petrosectomy is a surgical alternative for cochlear implant surgery in patients with chronic ear pathology, wide cavities or cochlear implant extrusion, not associated to significant complications.
       
  • Submental flap practice patterns and perceived outcomes: A survey of 212
           AHNS surgeons
    • Abstract: Publication date: Available online 30 October 2019Source: American Journal of OtolaryngologyAuthor(s): Liyang Tang, Andrew T. Day, Rebecca Lee, Eli Gordin, Kevin Emerick, Urjeet A. Patel, Daniel G. Deschler, Jeremy D. RichmonAbstractObjectivesTo describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications.MethodsThe design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications.ResultsAmong 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced “very few” complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p 30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course.ConclusionsPractice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported “very few” complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.
       
  • Clinical significance of head shake movement in three planes in
           individuals with dizziness
    • Abstract: Publication date: Available online 30 October 2019Source: American Journal of OtolaryngologyAuthor(s): Büşra Altın, Songül AksoyAbstractPurposeThis study aims to evaluate the efficacy of head shake movement on three head movement planes (yaw, pitch and, roll) in patients with dizziness despite normal vestibular test results.Materials and methodsTwenty individuals aged between 20 and 51 years with complaints of dizziness were included in the study, and their results were compared with the results from twenty age- and gender-matched controls. Participants were assessed using the Sensory Organization Test, Head Shake-Sensory Organization Test which is based on the modification of the Sensory Organization Test on the yaw, pitch, and roll planes, videonystagmography, caloric test, and Dizziness Handicap Inventory.ResultsSignificant differences were found in the yaw (p = 0.007), pitch (p 
       
  • Therapeutic effects of metformin for noise induced hearing loss
    • Abstract: Publication date: Available online 30 October 2019Source: American Journal of OtolaryngologyAuthor(s): Özge Gedik, Remzi Doğan, Mehmet Ali Babademez, Ersin Karataş, Mehmet Şerif Aydın, Abdurrahim Koçyiğit, Mukaddes Eşrefoğlu, Orhan ÖzturanAbstractObjectiveThis study aimed to investigate the healing effect of metformin on noise induced hearing loss (NIHL) by measuring audiological, biochemical and histological parameters.Materials and methods32 rats were divided into four groups (Group 1: Noise, Group 2: Noise + Metformin, Grup 3: Metformin, Grup 4: Control). Broadband noise was applied to Group 1 and Group 2 after basal measurements. Measuring audiological (distortion product otoacoustic emission (DPOAE) and Auditory Brainstem Response (ABR)), biochemical (total antioxidant status (TAS), total oxidant status (TOS), oxidative status index (OSI), DNA damage, IL-1 beta, IL-6, TNF alfa, HSF-1 and COX-2) and histological parameters.ResultsGroup 2 had significant decreases in ABR thresholds on day 7 and day 14 compared to day 1. DPOAE values of Group 2 on the 7th and 14th days were significantly higher than the post-noise levels. DNA damage, TOS and OSI values of Group 1 were significantly higher than the other groups. The Cox-2 value of Group 1 was higher than all other groups. The HSF-1 value of Group 2 was significantly higher than that of Group 1. In terms of IL-1 Beta, IL-6 and TNF-alpha values, there was no significant difference between groups 2, 3 and 4 and these values were significantly lower than group 1. In histopathological results of our study, no significant difference was found between the groups being exposed to noise and the control group.ConclusionThis study showed that early period of Metformin treatment has therapeutic effect on NIHL.
       
  • The effect of transcutaneous electrical nerve stimulation (TENS) on
           chronic subjective tinnitus
    • Abstract: Publication date: Available online 29 October 2019Source: American Journal of OtolaryngologyAuthor(s): Belgin Tutar, Sevgi Atar, Güler Berkiten, Onur Üstün, Tolgar Lütfi Kumral, Yavuz UyarAbstractObjectivesChronic Subjective Tinnitus is a very highly prevalent disorder worldwide. There is no definitive treatment. The aim of this study is to investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) applied to the auricula for treating tinnitus using the Depression Anxiety Stress Scales (DASS) and Tinnitus Handicap Inventory (THI).MethodsThe 60 patients were randomly divided into 3 groups of 20 patients. The first group (A) had one ear stimulated with TENS, and the second group (B) had both ears stimulated. Group C (placebo group) received no electrical or sound stimulation. All group patients received total of 10 sessions with a maximum of 4 days between the sessions.ResultsThe THI and DASS scores decreased significantly after the treatment (p 
       
  • An update on autoimmune inner ear disease: A systematic review of
           pharmacotherapy
    • Abstract: Publication date: Available online 28 October 2019Source: American Journal of OtolaryngologyAuthor(s): David Strum, Sunny Kim, Timothy Shim, Ashkan Monfared
       
  • Zenker's diverticulotomy with bipolar tissue sealer: Retrospective review
           of safety and short-term outcomes
    • Abstract: Publication date: Available online 25 October 2019Source: American Journal of OtolaryngologyAuthor(s): K.K. Bommakanti, W.J. Moss, R.A. Weisman, P.A. WeissbrodAbstractObjectivesThe objective of this study is to analyze and report the institution's experience using the Enseal bipolar tissue sealing device to perform endoscopic Zenker's diverticulotomy. Safety and early functional outcomes are presented as primary endpoints of the study.Materials & methodsThis is a retrospective study of consecutive patients with Zenker's diverticulum (ZD) treated via a transoral approach using a rigid endoscope and a bipolar tissue sealer between 2011 and 2019. Demographic data, ZD size, complications and preoperative versus postoperative symptoms were assessed. The Eating Assessment Tool-10 (EAT-10) questionnaire was used to evaluate functional outcomes, and statistical comparisons were made using the student's t-test.ResultsNineteen ZD patients were identified who underwent rigid endoscopic diverticulotomy using a bipolar tissue sealer. The mean age was 71 years and 74% were male. The mean diverticulum size was 3.1 cm. There were no intraoperative or postoperative complications identified. Average pre-operative EAT-10 score was 21 and post-operative EAT-10 score was 12 at one to two weeks after surgery (p = .05).ConclusionsEvidence from this preliminary study of endoscopic Zenker's diverticulotomy using the Enseal device indicates that it is both safe and effective. Several features of the device, including its narrow profile, articulation and rotation capability, rapid repeatable activation, and low risk of collateral thermal injury, make it an appealing option for endoscopic Zenker's diverticulotomy.
       
  • Comparison of arytenoid vertical height discrepancy in normal versus
           patients with vocal cord palsy
    • Abstract: Publication date: Available online 24 October 2019Source: American Journal of OtolaryngologyAuthor(s): Eugene H. Wong, Murray Smith, Richard Tjahjono, Danielle B. Stone, Niranjan Sritharan, Carsten E. Palme, Mark C. Smith, Faruque RiffatAbstractObjectiveCadaveric experiments and more recently clinical data have demonstrated that patients with vertical height discrepancy between their arytenoids experience poorer voice outcomes in patients with unilateral vocal cord palsy (UVP) after medialisation laryngoplasty. However, the presence or severity of height discrepancy in normal patients without UVP has not yet been clearly defined.Study designCase-control study.SettingTertiary Australian hospitals.Subjects and methodsA retrospective review was performed on patients who underwent high computed tomography imaging of the neck. Scans were assessed for discrepancy in arytenoid vertical height discrepancy and compared to a cohort with known UVP.Results44 normal patients (50% female, mean age 57.6 ± 14.8 years) were compared to 23 patients with UVP (43.4% female, mean age 52.3 ± 14.9 years.) Normal patients were found to have a smaller height discrepancy compared to UVP patients (student's t-test,2.00 mm ± 0.00 vs 2.39 mm ± 0.72, p 
       
  • Expression of maspin tumor suppressor and mTOR in laryngeal carcinoma
    • Abstract: Publication date: Available online 23 October 2019Source: American Journal of OtolaryngologyAuthor(s): Gino Marioni, Giancarlo Ottaviano, Andrea Lovato, Leonardo Franz, Luigia Bandolin, Giacomo Contro, Luciano Giacomelli, Lara Alessandrini, Roberto Stramare, Cosimo de Filippis, Stella BlandamuraAbstractPurposeThe main aim of this study was to conduct a preliminary investigation into the possible relationship between mTOR and the nuclear tumor suppressor maspin in laryngeal carcinoma (LSCC).Materials and methodsmTOR expression and maspin pattern were ascertained, also with the aid of image analysis in 79 consecutive LSCCs.ResultsConsidering the whole series, univariate statistical analysis identified significant differences in the distributions by lymph node status (N0 vs N+) between two subgroups of patients with and without loco-regional carcinoma recurrences (p = 0.017). The log-rank test also showed a shorter disease-free survival (DFS) in pN+ patients (p = 0.0008). mTOR expression was significantly higher in patients whose disease recurred (p = 0.009). The DFS rate was also significantly shorter in cases of LSCC with an mTOR expression ≥11.55% (p = 0.049). Multivariate analysis showed that N status (p = 0.002) and mTOR expression (p = 0.037) retained their prognostic significance in relation to cancer recurrence.In a subgroup of LSCCs with a non-nuclear maspin pattern, mTOR expression was significantly higher in patients whose disease recurred. Multivariate analysis disclosed that N stage (p = 0.012) retained its independent prognostic significance for disease recurrence in this setting. mTOR expression showed a trend towards independent significance in terms of carcinoma recurrence (p = 0.083).ConclusionsmTOR inhibitors seem promising for use in cancer therapies. Further investigations are needed on the prospects of incorporating modern mTOR inhibitors in multimodality or multitarget strategies against advanced LSCCs, also considering the role and expression of tumor suppressor genes.
       
  • Efficacy of lianhuaqingwen granules in the management of chronic
           rhinosinusitis without nasal polyps
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of OtolaryngologyAuthor(s): Lin Lin, Fei Dai, Guoqiang Ren, Jinjin Wei, Zheng Chen, Xinyue TangAbstractObjectivesChronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP.Materials and methodsCRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups.ResultsOne hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4+ and CD8+ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4+ and CD8+ T cell subpopulations and concentrations of inflammatory substances.ConclusionThese findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.
       
  • Social determinants of health and survivorship in parotid cancer: An
           analysis of the National Cancer Database
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of OtolaryngologyAuthor(s): Vanessa C. Stubbs, Karthik Rajasekaran, Steven B. Cannady, Jason G. Newman, Said A. Ibrahim, Jason A. BrantAbstractBackgroundGiven the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates.MethodsOur analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES.Results15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p 
       
  • Women in otolaryngology in Turkey: Insight of gender equality, career
           development and work-life balance
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of OtolaryngologyAuthor(s): Hülya Eyigör, İlknur Haberal Can, Armağan İncesulu, Yeşim ŞenolAbstractObjectiveThe aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers.Study design and settingA prospective survey study.Subjects and methodsThe study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses.ResultsOut of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ± 6.1 (29–75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57).ConclusionHealthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.
       
  • The clinical significance of methylation of MAGE-A1 and-A3 promoters and
           expression of DNA methyltransferase in patients with laryngeal squamous
           cell carcinoma
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of OtolaryngologyAuthor(s): Shenghui Liu, Yan Zhao, Yuru Xu, Meixiang Sang, Ruili Zhao, Lina Gu, Baoen ShanAbstractPurposeAbnormal DNA methylation plays an important role in clinical diagnosis and prognosis of various tumors. DNA methylation is catalyzed by DNA methyltransferase (DNMT). However, the methylation status of MAGE-A1 and MAGE-A3 promoter regions in LSCC is unclear. To investigate the methylation levels of MAGE-A1, -A3 in LSCC and corresponding normal tissues. The expression of DNMTs (DNMT1, DNMT3a and DNMT3b) in LSCC and the relationship between the methylation status of MAGE-A1, -A3 were analyzed.Materials and methodsWe examined methylation status of MAGE-A1, -A3 in LSCC by using MSP. Meanwhile, the expression level of DNMTs in LSCC was detected by immunohistochemistry. And further analysis the correlation between DNMTs expression level and methylation status of MAGE-A1 and MAGE-A3.ResultsThe unmethylation rate of MAGE-A1, -A3 were 39.62% and 46.23%. The expression of DNMTs was 33.02% to 37.74%. The level of demethylation of MAGE-A1 and MAGE-A3 were negative related to DNMTs protein. MAGE-A1 and MAGE-A3 unmethylation status and DNMT3a expression were independent prognostic factors for LSCC.ConclusionsThe DNMTs may participate in the methylation process of MAGE-A1 and MAGE-A3, which may play an important role in the occurrence and development of LSCC.
       
  • Long-term treatment with clarithromycin and carbocisteine improves lung
           function in chronic cough patients with chronic rhinosinusitis
    • Abstract: Publication date: Available online 17 October 2019Source: American Journal of OtolaryngologyAuthor(s): Shin Kariya, Mitsuhiro Okano, Takaya Higaki, Seiichiro Makihara, Tomoyasu Tachibana, Kazunori NishizakiAbstractPurposeChronic cough is a common complaint. Because the pathophysiology of chronic cough is complicated, the management of chronic cough is challenging. To the best of our knowledge, no previous study has examined the effect of macrolide antibiotics in chronic cough patients with chronic rhinosinusitis. The purpose of this study is to determine the changes in lung function for chronic cough patients with chronic rhinosinusitis who are treated by clarithromycin and carbocisteine.Materials and methodsThirty-two chronic cough patients with chronic rhinosinusitis were recruited. Patients using inhaled corticosteroids and/or a bronchodilator, asthmatic patients, and patients with abnormal findings on auscultation and/or chest X-ray examination were excluded from this study. The patients received low-dose clarithromycin treatment for 3 months. Both before and after the treatment, a computed tomography (CT) scan of the paranasal sinuses, lung function test, peripheral blood test, and sino-nasal outcome test (SNOT-20) were applied.ResultsBoth the lung function and Lund-MacKay CT scores were improved by the long-duration therapy with macrolide antibiotics. The change in obstructive pulmonary function and the improvement of the CT score in each subject were significantly correlated. SNOT scores also improved after the treatment.ConclusionsThe macrolide antibiotics treatment has beneficial effects on lung function in non-asthmatic chronic cough patients with normal chest X-ray findings. The improvement of chronic rhinosinusitis may have some role in the lung condition. Upper respiratory tract examination and treatment may be useful for the management of chronic cough.
       
  • Turbinate loss from non-inflammatory sinonasal surgery does not correlate
           with poor sinonasal function
    • Abstract: Publication date: Available online 17 October 2019Source: American Journal of OtolaryngologyAuthor(s): Eugene H. Wong, Carolyn A. Orgain, E. Ritter Sansoni, Raquel Alvarado, Jessica Grayson, Larry Kalish, Raymond Sacks, Richard J. HarveyAbstractObjectiveThe impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery.Study designRetrospective case series.SettingTertiary Australian Hospitals.Subjects and methodsA retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0–4) was determined by the number of inferior or middle turbinate subtotal resections.Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.)Results294 patients (age 52.9 ± 17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93–3.38], OR = 0.60[0.33–1.12], B = 0.56[−1.58–2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04–4.13], P = 0.04, OR = 3.97[1.08–14.49], P = 0.04, respectively).ConclusionIn patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.
       
 
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