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Publisher: Elsevier   (Total: 3163 journals)

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Showing 1 - 200 of 3163 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 88, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 394, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 244, 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: 10, 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: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
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: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
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: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3, SJR: 0.732, CiteScore: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, 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: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, 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: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, 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: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, 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: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, 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: 15, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, 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: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, 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: 8, 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: 8, 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: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
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: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (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: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 385, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 335, 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: 10, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 436, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, 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: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 43)
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: 203, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, 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: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 37, 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: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 15, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
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: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 174, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, 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)

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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
Published by Elsevier Homepage  [3163 journals]
  • Safety and efficacy of intratympanic ciprofloxacin otic suspension
           post-tubes in a real-world pediatric population
    • Authors: Joseph E. Dohar; Debra Don; Jeffrey Koempel; Chung H. Lu; Dean Hakanson; Kenny H. Chan
      Pages: 101 - 106
      Abstract: Publication date: March–April 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 2
      Author(s): Joseph E. Dohar, Debra Don, Jeffrey Koempel, Chung H. Lu, Dean Hakanson, Kenny H. Chan
      Purpose Otorrhea frequently follows tympanostomy tube (TT) placement. We evaluated otorrhea following single 6mg OTO-201 (OTIPRIO®, ciprofloxacin otic suspension 6%) intraoperative injection into each middle ear in a variety of effusion types and concurrent procedures in children undergoing TT placement. Secondary objective: Efficacy based on Medicaid status and safety. Basic procedures In this prospective, 8-week, multicenter, open-label study, 501 patients were enrolled: mean age 2.9years, male (56.9%), wet/wet ears (66.9%), wet/dry (16.8%), dry/dry (16.3%), and Medicaid-insured (32.9%). Main findings In per-protocol population (n=410), otorrhea rate through Day 15 were 8.8% (CI:5.7%–12.8%), 6.6% (CI:2.2%–14.7%), 3.3% (CI:0.4%–11.3%) in wet/wet, wet/dry, and dry/dry ears, respectively. For Medicaid patients through Day 15, Week 4 and Week 8, otorrhea rates were 8.1% (CI:4.1%–14.1%), 17.0% (CI:11.1%–24.5%), and 17.8% (CI:11.7%–25.3%) compared with those non-Medicaid insured: 7.3% (CI:4.5%–11.0%), 14.5% (CI:10.6%–19.3%), and 21.8% (CI:17.1%–27.2%), respectively. Safety was similar to previous Phase 3 trials. Principal conclusions OTO-201 demonstrated otorrhea rates consistent with Phase 3 trials in a broader, real-world, ENT practice-based pediatric population. Outcomes were similar in Medicaid- and non-Medicaid insured patients. OTO-201 was well-tolerated.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2017.12.016
       
  • Pediatric Cochlear implant soft failure
    • Authors: David Ulanovski; Joseph Attias; Meirav Sokolov; Tali Greenstein; Eyal Raveh
      Pages: 107 - 110
      Abstract: Publication date: March–April 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 2
      Author(s): David Ulanovski, Joseph Attias, Meirav Sokolov, Tali Greenstein, Eyal Raveh
      Purpose Hard cochlear implant failures are diagnosed by objective tests whereas soft failures are suspected on the basis of clinical signs and symptoms. This study reviews our experience with children in tertiary pediatric medical center who underwent revision cochlear implantation, with emphasis on soft failures. Materials and methods Children (age<18years) who underwent revision cochlear implantation from 2000 to 2012 were identified by database search. Pre- and post-explantation data were collected. Results Twenty-six revision surgeries were performed, accounting for 7.4% of all cochlear implant surgeries at our center during the study period. The pre-explantation diagnosis was hard failure in 7 cases (27%), soft failure in 12 (46%), and medical failure in 7 (27%). On post-explantation analysis, 7/12 devices from the soft-failure group with a normal integrity test had abnormal findings, yielding a 63% false-negative rate (12/19) for the integrity test. All children regained their initial performance. Compared to hard failures, soft failures were associated with a shorter median time from first implantation to symptom onset (8 vs 25months) but a significantly longer time from symptom onset to revision surgery (17.5 vs 3months; P =0.004). Conclusions Soft cochlear implant failure in young patients poses a diagnostic challenge. A high index of suspicion is important because a delayed diagnosis may have severe consequences for language development. A normal integrity test does not unequivocally exclude device failure and is unrelated to functional outcome after revision surgery. Better education of parents and rehabilitation teams is needed in addition to more accurate diagnostic tests.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2017.12.014
       
  • Inhalant allergen sensitization is an independent risk factor for the
           development of angioedema
    • Authors: Jacob E. Kuperstock; Nicholas Pritchard; Michal Horný; Christopher C. Xiao; Christopher D. Brook; Michael P. Platt
      Pages: 111 - 115
      Abstract: Publication date: March–April 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 2
      Author(s): Jacob E. Kuperstock, Nicholas Pritchard, Michal Horný, Christopher C. Xiao, Christopher D. Brook, Michael P. Platt
      Background/objective The etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema. Methods A retrospective review of patients who had in vitro inhalant allergy testing from 2006 to 2010 was performed. Patients with a diagnosis of angioedema who underwent inhalant allergy testing were identified. Analyses for co-morbidities, class of sensitization, seasonal timing of angioedema, and concurrent use of known hypertensive medications that can cause angioedema were performed. Results There were 1000 patients who underwent inhalant allergy testing and qualified for the study. 37/1000 had at least one episode of angioedema and of these patients, 34 had positive inhalant sensitization testing results. Multivariate regression models showed overall sensitization status, seasonal allergen and epidermal/mite sensitization as independent risk factors (p <0.001, p =0.005, p =0.025 respectively) when controlling for ACE inhibitor use and other covariates. Tree, and epidermal/mite sensitizations were independent risk factors for angioedema in mono-sensitized subject analysis (p =0.028, p =0.029, respectively). Conclusion Both seasonal and perennial allergen sensitizations are independent risk factors for the development of angioedema. In patients with angioedema and an unknown trigger, inhalant allergen sensitization should be considered as a potential contributing factor to the development of angioedema.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2017.12.013
       
  • Voice and swallowing outcomes following hypoglossal nerve stimulation for
           obstructive sleep apnea
    • Authors: Andrew J. Bowen; Amy S. Nowacki; Alan H. Kominsky; Douglas K. Trask; Michael S. Benninger; Paul C. Bryson
      Pages: 122 - 126
      Abstract: Publication date: March–April 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 2
      Author(s): Andrew J. Bowen, Amy S. Nowacki, Alan H. Kominsky, Douglas K. Trask, Michael S. Benninger, Paul C. Bryson
      Objective Hypoglossal nerve stimulation is an effective treatment for a subset of patients with Obstructive Sleep Apnea (OSA). Although multiple clinical trials demonstrate its efficacy, no previous literature explores the potential impact the stimulator has on swallowing and voice. Our primary objective is to evaluate patient reported post-operative changes in voice or swallowing following hypoglossal nerve stimulator placement. Study design Prospective cohort study. Setting Tertiary care hospital. Subject and methods Patients scheduled to receive a hypoglossal stimulator were enrolled. Participants completed baseline Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool-10 (EAT-10) questionnaires preoperatively and again at 1week, 3months, and 6months post-operatively following placement of a hypoglossal nerve stimulator. Results 9 males and 5 females completed the study. The mean pre-operative VHI-10 and EAT-10 score was 3 and 0.8 respectively. Using linear mixed models, a clinically and statistically significant increase in the mean EAT-10 score was observed post-operatively at 1week (p =0.007), which was not observed at the time points the stimulator was active. A clinically and statistically significant decrease in VHI-10 score was observed following 2months of active stimulator use (p =0.02), which was not observed at any other time point. Conclusion The implantation and use of the hypoglossal nerve stimulator over 5months did not demonstrate any sustained, patient reported changes in voice handicap and swallowing function. While larger studies are warranted, our findings can be used to provide further informed consent for hypoglossal nerve stimulator implantation.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2017.12.011
       
  • Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge
           about its management
    • Authors: Giuditta Mannelli; Roberto Santoro; Francesco Segala; Elisabetta Surrenti; Oreste Gallo
      Pages: 127 - 132
      Abstract: Publication date: March–April 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 2
      Author(s): Giuditta Mannelli, Roberto Santoro, Francesco Segala, Elisabetta Surrenti, Oreste Gallo
      Purpose Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients. Materials and methods Behavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES. Results 40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013). Conclusions Pre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2017.12.010
       
  • MRI screening of the internal auditory canal: Is gadolinium necessary to
           detect intralabyrinthine schwannomas'
    • Authors: Johnathan C. Valesano; Carrie M. Carr; Laurence J. Eckel; Matthew L. Carlson; John I. Lane
      Pages: 133 - 137
      Abstract: Publication date: March–April 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 2
      Author(s): Johnathan C. Valesano, Carrie M. Carr, Laurence J. Eckel, Matthew L. Carlson, John I. Lane
      Objective Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors. Methods 31 patients with ILSs and 36 patients without inner ear pathology that had dedicated MRI of the IAC performed with both non-contrast T2WI and post-contrast T1WI (T1 weighted image) were identified. Three board-certified neuroradiologists reviewed only the T2WI from these 67 cases. When an ILS was identified, its location and size were recorded. Sensitivity, specificity, and accuracy were calculated using the post-contrast T1WI as the “gold standard.” A consensus review of cases with discordant results was conducted. Results The sensitivity, specificity, and accuracy were 1.0, 1.0, and 1.0 for Observer 1; 0.84, 1.0, and 0.96 for Observer 2; 0.90, 1.0, and 0.98 for Observer 3. The 5 ILSs with discordant results were correctly identified upon consensus review. The median size of the ILSs was 4.4mm (±2.9mm) and most (18/31) were intracochlear in location. Conclusion Non-contrast high-resolution T2WI alone can detect ILSs with 84–100% sensitivity, suggesting that gadolinium may be unnecessary to exclude ILSs on screening MRI. These findings have implications for reducing cost, time, and adverse events associated with gadolinium administration in patients presenting with sudden or ASNHL. Level of evidence 4

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2017.12.009
       
  • Cochlear implants: Insertion assessment by computed tomography
    • Authors: Ana Luiza Mengatti Pavan; Allan Felipe Fattori Alves; Guilherme Giacomini; João Maurício Carrasco Altemani; Arthur Menino Castilho; Raquel Andrade Lauria; Vagner Antonio Rodrigues da Silva; Alexandre Caixeta Guimarães; Diana Rodrigues de Pina
      Abstract: Publication date: Available online 14 April 2018
      Source:American Journal of Otolaryngology
      Author(s): Ana Luiza Mengatti Pavan, Allan Felipe Fattori Alves, Guilherme Giacomini, João Maurício Carrasco Altemani, Arthur Menino Castilho, Raquel Andrade Lauria, Vagner Antonio Rodrigues da Silva, Alexandre Caixeta Guimarães, Diana Rodrigues de Pina
      Background and objectives Imaging exams play a key role in cochlear implants with regard to both planning implantation before surgery and quality control after surgery. The ability to visualize the three-dimensional location of implanted electrodes is useful in clinical routines for assessing patient outcome. The aim of this study was to evaluate linear and angular insertion depth measurements of cochlear implants based on conventional computed tomography. Methods Tools for linear and angular measurements of cochlear implants were used in computed tomography exams. The tools realized the insertion measurements in an image reconstruction of the CIs, based on image processing techniques. We comprehensively characterized two cochlear implant models while obviating possible changes that can be caused by different cochlea sizes by using the same human temporal bones to evaluate the implant models. Results The tools used herein were able to differentiate the insertion measurements between two cochlear implant models widely used in clinical practice. We observed significant differences between both insertion measurements because of their different design and construction characteristics (p = 0.004 and 0.003 for linear and angular measurements, respectively; t-test). The presented methodology showed to be a good tool to calculate insertion depth measurements, since it is easy to perform, produces high-resolution images, and is able to depict all the landmarks, thus enabling measurement of the angular and linear insertion depth of the most apical electrode contacts. Conclusion The present study demonstrates practical and useful tools for evaluating cochlear implant electrodes in clinical practice. Further studies should measure preoperative and postoperative benefits in terms of speech recognition and evaluate the preservation of residual hearing in the implanted ear. Such studies can also determine correlations between surgical factors, electrode positions, and performance. In addition to refined surgical techniques, the precise evaluation of cochlear length and correct choice of cochlear implant characteristics can play an important role in postoperative outcomes.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.04.009
       
  • The cartilaginous Eustachian tube: Reliable CT measurement and impact of
           the length
    • Authors: Benedicte Falkenberg-Jensen; Einar Hopp; Greg E. Jablonski; Are Hugo Pripp; Juha Tapio Silvola
      Abstract: Publication date: Available online 14 April 2018
      Source:American Journal of Otolaryngology
      Author(s): Benedicte Falkenberg-Jensen, Einar Hopp, Greg E. Jablonski, Are Hugo Pripp, Juha Tapio Silvola
      Purpose Balloon dilation of the Eustachian tube is a treatment option for obstructive Eustachian tube dysfunction. The desired balloon position is in the cartilaginous portion. However, the balloon catheter may slide into the bony portion without the surgeon's knowledge. Knowing the length of the cartilaginous portion may improve catheter positioning, but there is no published research on measuring this portion selectively or on whether the length has an impact on development of disease or treatment outcome. To evaluate whether a measurement obtained from CT images is valuable and accurate, to standardize the manner of which the length is measured, and to compare our radiologic measurements to procedural findings, we designed a combined study. Further, we tested the length's influence on development of disease and treatment outcome. Methods Anatomical end points of the cartilaginous part of the Eustachian tube were unambiguously defined. The length was retrospectively measured bilaterally in 29 CT examinations by two radiologists, and repeated by one after two weeks. New reformats and measurements were made after 18 months for 10 of the patients. Prospectively 10 patients were included in a study where the length measured on CT was compared to per-procedural measurements based on catheter insertion depth to isthmus. Various parameters including length and treatment outcome were measured in 69 patients and 34 controls. Results Correlation was adequate to excellent in all comparisons. The length of the cartilaginous Eustachian tube did not predict treatment outcome or disease development. The lengths were significantly shorter in females. Conclusion Measuring the cartilaginous portion of the Eustachian tube on CT images is precise and reproducible, and reflects the length measured intraoperatively. However, it does not seem have a prognostic value.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.04.010
       
  • An evidence based protocol for managing neonatal middle ear effusions in
           babies who fail newborn hearing screening
    • Authors: Brittany C. Weber; Scott M. Whitlock; Kaidi He; Blake S. Kimbrell; Craig S. Derkay
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Otolaryngology
      Author(s): Brittany C. Weber, Scott M. Whitlock, Kaidi He, Blake S. Kimbrell, Craig S. Derkay
      Objectives To evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS. Methods 85 infants with suspected middle ear pathology were retrospectively reviewed after referral for failed NBHS. All subjects underwent a diagnostic microscopic exam with myringotomy with or without placement of a ventilation tube in the presence of a middle ear effusion and had intra-operative auditory brainstem response (ABR) testing or testing at a later date. Results At the initial office visit, a normal middle ear space bilaterally was documented in 5 babies (6%), 29/85 (34%) had an equivocal exam while 51/85 (60%) had at least a unilateral OME. Myringotomy with or without tube placement due to presence of an effusion was performed on 65/85 (76%) neonates. Normal hearing was established in 17/85 (20%) after intervention, avoiding the need for any further audiologic workup. Bilateral or unilateral sensorineural hearing loss (SNHL) or mixed hearing loss was noted in 54/85 (64%) and these children were referred for amplification. Initially observation with follow up outpatient visits was initiated in 27/85 (32%) however, only 3/27 (11%) resolved with watchful waiting and 24/27 (89%) ultimately required at least unilateral tube placement due to OME and 14/24 (59%) were found to have at least a unilateral mixed or SNHL. Conclusions An effective initial management plan for children with suspected middle ear pathology and failed NBHS is diagnostic operative microscopy with placement of a ventilation tube in the presence of a MEE along with either intra-operative ABR or close follow-up ABR. This allows for the identification and treatment of babies with a conductive component due to OME, accurate diagnosing of an underlying SNHL component and for prompt aural rehabilitation.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.04.004
       
  • In whom does horizontal canal BPPV recur'
    • Authors: L. Pollak; R. Huna-Baron; Michael Osherov; Milo Roni
      Abstract: Publication date: Available online 5 April 2018
      Source:American Journal of Otolaryngology
      Author(s): L. Pollak, R. Huna-Baron, Michael Osherov, Milo Roni
      Purpose The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.04.003
       
  • A boy presenting with chronic ear drainage and associated middle ear mass
    • Authors: Kaelen Black; Jonathan Murnick; Brian K. Reilly
      Abstract: Publication date: Available online 4 April 2018
      Source:American Journal of Otolaryngology
      Author(s): Kaelen Black, Jonathan Murnick, Brian K. Reilly


      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.03.030
       
  • The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical
           trial
    • Authors: Chunli Liu; Han Lv; Tao Jiang; Jing Xie; Lu He; Guopeng Wang; Jiao Liu; Zhenchang Wang; Shusheng Gong
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Otolaryngology
      Author(s): Chunli Liu, Han Lv, Tao Jiang, Jing Xie, Lu He, Guopeng Wang, Jiao Liu, Zhenchang Wang, Shusheng Gong
      Purpose We intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI. Materials and methods In this study, we enrolled 11 older than 18 years old Chinese patients with normal hearing who had unilateral, chronic (longer than 6 months), sensorineural tinnitus, of frequencies between 125–8000 Hz, and an average loudness of 31 dB. The patients underwent the treatment with the CAABT method for 12 weeks and the outcomes were evaluated with tinnitus questionnaire scores, a set of psychoacoustic measures, and rs-fMRI testing before treatment and at 3 months. This was an earlier study of the controlled randomized clinical trial which was registered with ClinicalTrials.gov, number NCT02774122. Results Almost all the patients reported reduced tinnitus annoyance after the three-month treatment. The THI and VAS scores showed decreased tinnitus severity. The rs-fMRI results indicated that the right middle frontal gyrus and the right superior temporal gyrus displayed noticeable decreases of the ReHo values for the subjects between the before and after treatment, supporting the clinical evidence of significant tinnitus reduction. Conclusion The therapy seemed effective in patients of varying severities, and no side effects were observed in this trial. The CAABT can be an alternative for those who are suitable for sound therapy once a large scale of and better controlled clinical studies have validated the findings of this experiment.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.04.002
       
  • Financial outcomes of transoral robotic surgery: A narrative review
    • Authors: Sammy Othman; Brian J. McKinnon
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Otolaryngology
      Author(s): Sammy Othman, Brian J. McKinnon
      Objective To determine the current cost impact and financial outcomes of transoral robotic surgery in Otolaryngology. Data sources A narrative review of the literature with a defined search strategy using Pubmed, MEDLINE, CINAHL, and Web of Science. Review methods Using keywords ENT or otolaryngology, cost or economic, transoral robotic surgery or TORs, searches were performed in Pubmed, MEDLINE, CINAHL, and Web of Science and reviewed by the authors for inclusion and analysis. Results Six total papers were deemed appropriate for analysis. All addressed cost impact of transoral robotic surgery (TORs) as compared to open surgical methods in treating oropharyngeal cancer and/or the identification of the primary tumor within unknown primary squamous cell carcinoma. Results showed TORs to be cost-effective. Conclusion Transoral robotic surgery is currently largely cost effective for both treatment and diagnostic procedures. However, further studies are needed to qualify long-term data.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.04.001
       
  • Butterfly cartilage tympanoplasty outcomes: A single-institution
           experience and literature review
    • Authors: Mejd Jumaily; Joel Franco; James A. Gallogly; Joshua L. Hentzelman; Dary J. Costa; Alan P.K. Wild; Anthony A. Mikulec
      Abstract: Publication date: Available online 29 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Mejd Jumaily, Joel Franco, James A. Gallogly, Joshua L. Hentzelman, Dary J. Costa, Alan P.K. Wild, Anthony A. Mikulec
      Purpose In 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort. Materials and methods Butterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap. Results The reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%–100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB. Conclusions The butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.03.029
       
  • Tube patency: Is there a difference following otic drop
           administration'
    • Authors: Joseph E. Dohar; Chung H. Lu
      Abstract: Publication date: Available online 29 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Joseph E. Dohar, Chung H. Lu
      Purpose Many surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol. Materials and methods Post-hoc, retrospective analysis from three prospective, randomized, double-blind trials, (Phase 1b study [n = 83] and two Phase 3 studies [n = 532]) which enrolled children with confirmed middle ear effusion on the day of tympanostomy tube surgery and then randomized to placebo/sham (tubes alone) or OTO-201 and studied over a 28-day observation period. Patients with observed otorrhea post-tube were provided otic drops in the studies. An analysis was performed on the combined studies to evaluate tube patency, determined by pneumatic otoscopy and tympanometry, at four defined study visits over 28 days after the initial tube placement. Results The analysis included 591 total patients with similar baseline demographics across groups. Tube patency ranged from 87 to 95% for patients who received otic drops, and from 96 to 99% for patients who did not receive otic drops. Conclusion Based on a retrospective post-hoc analysis from three randomized controlled trials in nearly 600 patients, tympanostomy tube occlusion rates was not increased in patients who did not receive otic drops. From this analysis, occlusion is likely caused primarily by peri-operative otorrhea since patency rates approached 99% in the absence of this complication.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.03.027
       
  • Correlation between body mass index and obstructive sleep apnea severity
           indexes — A retrospective study
    • Authors: Domenico Ciavarella; Michele Tepedino; Claudio Chimenti; Giuseppe Troiano; Manuela Mazzotta; Maria Pia Foschino Barbaro; Lorenzo Lo Muzio; Michele Cassano
      Abstract: Publication date: Available online 27 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Domenico Ciavarella, Michele Tepedino, Claudio Chimenti, Giuseppe Troiano, Manuela Mazzotta, Maria Pia Foschino Barbaro, Lorenzo Lo Muzio, Michele Cassano
      Purpose To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA). Materials and methods Seventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p < 0.025. Results No correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r 2 = 0.424; p < 0.001) was found between the BMI index and the Nadir SaO2. Conclusions Higher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.03.026
       
  • Optical imaging with a high-resolution microendoscope to identify
           sinonasal pathology
    • Authors: Sarah M. Kidwai; Arjun K. Parasher; Victor J. Schorn; Elizabeth G. Demicco; Rebecca Richards-Kortum; Alfred Marc Iloreta; Satish Govindaraj; Brett A. Miles
      Abstract: Publication date: Available online 20 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Sarah M. Kidwai, Arjun K. Parasher, Victor J. Schorn, Elizabeth G. Demicco, Rebecca Richards-Kortum, Alfred Marc Iloreta, Satish Govindaraj, Brett A. Miles
      Objectives High-resolution microendoscopy (HRME) is an optical imaging modality that allows real time imaging of epithelial tissue and structural changes within. We hypothesize that HRME, using proflavine, a contrast agent that preferentially stains cell nuclei and allows detection of cellular morphologic changes, can distinguish sinonasal pathology from uninvolved mucosa, potentially enabling real-time surgical margin differentiation. Study design Ex vivo imaging of histopathologically confirmed samples of sinonasal pathology and uninvolved, normal sinus epithelium. Setting Single tertiary-level institution. Subjects and methods Five inverted papillomas, one oncocytic papilloma, two uninvolved sinus epithelia specimens, and three inflammatory polyps were imaged ex vivo with HRME after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation. Results Results show that sinonasal pathology and normal sinus epithelia have distinct HRME imaging characteristics. Schneiderian papilloma specimens show increased nuclear-to-cytoplasmic ratio, nuclear crowding, and small internuclear separation, whereas normal sinus epithelia specimens show small, bright nuclei with dark cytoplasm and relatively large internuclear separation. Inflammatory polyps, however, have varying imaging characteristics, that resemble both Schneiderian papilloma and normal sinus epithelia. Conclusions This study demonstrates the feasibility of HRME imaging to discriminate sinonasal pathology from normal sinus epithelia. While the system performed well in the absence of inflammation, discrimination of inflamed tissue was inconsistent, creating a significant limitation for this application. Novel imaging systems such as HRME with alternative contrast agents may assist with real-time surgical margin differentiation, enabling complete surgical resection of inverted papilloma and reducing recurrence rates.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.03.025
       
  • YouTube as a source of information for obstructive sleep apnea
    • Authors: Sameer K. Singh; Stanley Liu; Robson Capasso; Robert C. Kern; Christopher J. Gouveia
      Abstract: Publication date: Available online 19 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Sameer K. Singh, Stanley Liu, Robson Capasso, Robert C. Kern, Christopher J. Gouveia
      Purpose Assess the quality of information on obstructive sleep apnea (OSA) presented on YouTube for patients. Materials and methods “Obstructive sleep apnea” was entered into the YouTube search. Two independent reviewers categorized and analyzed videos utilizing a customized scoring-system along with search position, likes, and views. Results Forty-eight videos were analyzed. Most were educational (52.1%). Educational and news videos had significantly higher scores, but had no significant differences in search position, likes/day, or views/day. Most videos mentioned positive airway pressure (65%), and nearly half (44%) mentioned mandibular devices in the management of OSA. Few videos discussed surgery (13%) or otolaryngology (15%). Conclusion YouTube is a promising source of information for OSA patients. Educational and news videos are of highest quality. General quality measures like search position, views, and likes are not correlated with formally scored value. Sleep surgery and otolaryngologists are minimally mentioned, representing an opportunity for improvement.

      PubDate: 2018-04-15T20:06:34Z
      DOI: 10.1016/j.amjoto.2018.03.024
       
  • Infrahyoid involvement may be a high-risk factor in the management of
           non-odontogenic deep neck infection: Retrospective study
    • Authors: Hui Yuan; Rong Gao
      Abstract: Publication date: Available online 16 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Hui Yuan, Rong Gao
      Objectives This study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI. Method Eighty-one patients treated for non-odontogenic DNI over 5 years were retrospectively recruited into this study. Demographics, etiology, radiology results, treatments, duration/cost of hospital stay, and complications were recorded. Differences between DNIs with and without infrahyoid involvement, as defined based on an anatomical chart, were analyzed. Results Sixty-two male and 19 female patients with a median age of 46.22 years were included. Fifteen patients had cellulitis, and 66 patients had abscesses. Streptococcus was the most commonly observed bacterium. Compared with DNIs only in suprahyoid spaces (n = 60, 74.07%), DNIs with infrahyoid space involvement (n = 21, 25.93%) were associated with higher incidences of the involvement of ≥3 spaces (85.71%, P = 0.000), mediastinitis (38.10%, P = 0.000), tracheostomy (28.57%, P = 0.008), surgery using a transcervical approach (66.67%, P = 0.000), and intensive care unit therapy (19.05%, P = 0.004), as well as longer hospital stays (16 days, P = 0.000) and higher costs ($2872, P = 0.000). Conclusion Infrahyoid involvement should be regarded as a high-risk factor in the management of deep neck infection (DNI). A relatively aggressive plan that includes transcervical surgery and tracheostomy should be considered at earlier stages for DNI with infrahyoid involvement.

      PubDate: 2018-03-18T18:03:28Z
      DOI: 10.1016/j.amjoto.2018.03.009
       
  • Are surgeons overdosing patients with lidocaine'
    • Authors: Laura Garcia-Rodriguez; Jeffrey Spiegel
      Abstract: Publication date: Available online 14 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Laura Garcia-Rodriguez, Jeffrey Spiegel


      PubDate: 2018-03-18T18:03:28Z
      DOI: 10.1016/j.amjoto.2018.03.023
       
  • Mucoepidermoid carcinoma of the parotid gland: A National Cancer Database
           study
    • Authors: Karthik Rajasekaran; Vanessa Stubbs; Jinbo Chen; Pratyusha Yalamanchi; Steven Cannady; Jason Brant; Jason Newman
      Abstract: Publication date: Available online 14 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Karthik Rajasekaran, Vanessa Stubbs, Jinbo Chen, Pratyusha Yalamanchi, Steven Cannady, Jason Brant, Jason Newman
      Objective To describe the demographics, tumor characteristics, and prognostic features of mucoepidermoid carcinoma of the parotid gland. Materials and methods A retrospective study of the National Cancer Database was reviewed for all mucoepidermoid carcinomas of the parotid gland between 2004 and 2012). Patient demographics and tumor characteristics were abstracted and analyzed. Univariate and multivariate Cox multivariate regression models were used to identify predictors of survival. Results A total of 4431 patients met inclusion criteria. Average age at diagnosis was 57 years (median 62, SD 19), with no overall sex preference (52% female), and majority white (78%). The 1-year overall survival was 92.9% (95% CI [92.1–93.6]) and 5-year overall survival was 75.2% (95% CI [73.8–76.7%]). Median overall survival was not reached at 5 years. Factors associated with decreased survival were increasing age, comorbidities, high tumor grade, advanced pathologic group stage, and positive surgical margins. Female sex was the only factor associated with improved survival. Controlling for either histopathologic grade or pathologic stage to determine how patient demographics and tumor characteristics affected overall survival yielded similar results. Of note, intermediate grade tumors, although not independently associated with worse survival, when seen in conjunction with tumors ≥T2 and/or ≥N2, a negative impact on overall survival was seen. Conclusion Although mucoepidermoid carcinoma of the parotid gland is the most common parotid gland malignancy, it is still a rare tumor with a lack of large population-based studies. Advanced stage and high-grade tumors are significant predictors of decreased survival. Females have improved survival compared to males.

      PubDate: 2018-03-18T18:03:28Z
      DOI: 10.1016/j.amjoto.2018.03.022
       
  • Analysis of non-posterior canal benign paroxysmal positional vertigo in
           patients treated using the particle repositioning chair: A large,
           single-institution series
    • Authors: Alexander L. Luryi; David Wright; Juliana Lawrence; Seilesh Babu; Michael LaRouere; Dennis I. Bojrab; Eric W. Sargent; John Zappia; Christopher A. Schutt
      Abstract: Publication date: Available online 7 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Alexander L. Luryi, David Wright, Juliana Lawrence, Seilesh Babu, Michael LaRouere, Dennis I. Bojrab, Eric W. Sargent, John Zappia, Christopher A. Schutt
      Purpose Benign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool. Methods Retrospective review of patients diagnosed with and treated for BPPV at a high volume otology institution using the particle repositioning chair. Results A total of 610 patients with BPPV were identified, 19.0% of whom had NP-BPPV. Patients with NP-BPPV were more likely to have bilateral BPPV (52.6% vs. 27.6%, p < 0.0005) and Meniere's disease (12.1% vs. 5.9%, p = 0.02) and were more likely to have caloric weakness (40.3% vs. 24.3%, p = 0.01). Patients with NP-BPPV required more treatments for BPPV (average 3.4 vs. 2.4, p = 0.01) but did not have a significantly different rate of resolution, rate of recurrence, or time to resolution or recurrence than patients with posterior canal BPPV. Conclusions Comparison of NP-BPPV and P-BPPV is presented with reliable diagnosis by the particle repositioning chair. NP-BPPV affects 19% of patients with BPPV, and these patients are more likely to have bilateral BPPV and to require more treatment visits but have similar outcomes to those with P-BPPV. NP-BPPV is common and should be part of the differential diagnosis for patients presenting with positional vertigo.

      PubDate: 2018-03-18T18:03:28Z
      DOI: 10.1016/j.amjoto.2018.03.019
       
  • Parotid adenoid cystic carcinoma: Retrospective single institute analysis
    • Authors: Mohamed Nazmy ElBeltagi
      Abstract: Publication date: Available online 7 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Mohamed Nazmy ElBeltagi


      PubDate: 2018-03-18T18:03:28Z
      DOI: 10.1016/j.amjoto.2018.03.018
       
  • Nasal polyposis pathophysiology: Endotype and phenotype open issues
    • Authors: Giuseppe Brescia; Claudia Zanotti; Daniela Parrino; Umberto Barion; Gino Marioni
      Abstract: Publication date: Available online 7 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Giuseppe Brescia, Claudia Zanotti, Daniela Parrino, Umberto Barion, Gino Marioni
      Purpose Endotyping chronic rhinosinusitis with nasal polyps (CRSwNP) poses a challenge for rhinologists nowadays. Phenotyping CRSwNP proved inappropriate as an approach to their classification because of their common clinical features. Endotyping, being based on the pathogenic mechanism, provides a precise picture more appropriate for use in clinical practice. Patients' treatment and follow-up can thus be tailored to cope with the degree of aggressiveness of a specific CRSwNP endotype. The aim of this study was to analyze the available information about the main currently accepted endotypes of CRSwNP; furthermore, we reported and commented evidence regarding some clinical conditions associated with nasal polyposis which could be related with new endotypes. Materials and methods Pubmed and Scopus electronic database were searched. The main available studies about CRSwNP endotyping published predominantly in the last 5 years were critically analyzed. Results The pathophysiological features of some asthma-related CRSwNP (allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease) are quite well understood, including them among known endotypes of CRSwNP. On the other hand, because of their known pathophysiological mechanisms, some well-known diseases associated with aggressive forms of CRSwNP, such as eosinophilic granulomatosis with polyangiitis, primary ciliary dyskinesia and cystic fibrosis, should be investigated as potentially related with CRSwNP endotypes. Conclusions CRSwNP comprises several inflammatory endotypes defined by different pathogenic mechanisms. These endotypes correlate with the disease's clinical manifestations and behavior. A thorough understanding of CRSwNP endotypes will enable targeted medical therapies and tailored follow-up protocols.

      PubDate: 2018-03-18T18:03:28Z
      DOI: 10.1016/j.amjoto.2018.03.020
       
  • Efficacy and safety of eberconazole 1% otic solution compared to
           clotrimazole 1% solution in patients with otomycosis
    • Authors: Blanca Regina de la Paz Cota; Pedro Pablo Cepero Vega; Juan José Matus Navarrete; Gerardo Efrain Aguado Mulgado; José Juan Narváez Huerta; Enrique Lamadrid Bautista; Epifanio Fiscal Chauteco
      Abstract: Publication date: Available online 6 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Blanca Regina de la Paz Cota, Pedro Pablo Cepero Vega, Juan José Matus Navarrete, Gerardo Efrain Aguado Mulgado, José Juan Narváez Huerta, Enrique Lamadrid Bautista, Epifanio Fiscal Chauteco
      Purpose To demonstrate non-inferiority of eberconazole 1% otic solution to clotrimazole 1% solution, and to compare their safety profile in the treatment of otomycosis. Materials and methods Multicenter, randomized, double-blind, active treatment-controlled phase 3 clinical trial. One hundred and ninety patients with diagnosis of otomycosis were randomly assigned to eberconazole 1% otic solution or clotrimazole 1% solution. Results Baseline characteristics were comparable between both groups for age, gender, ethnicity, and clinical variables. Both study groups had high complete response rates: 81.8% in the eberconazole group and 83.5% in the clotrimazole group. Although non-inferiority of eberconazole relative to clotrimazole could not be demonstrated, a post-hoc sensitivity analysis demonstrated that eberconazole 1% otic solution was not inferior to clotrimazole 1% solution for the primary efficacy endpoint. Secondary endpoints also demonstrated that eberconazole 1% and clotrimazole 1% solutions were therapeutically similar at the end of the study. The incidence of adverse events was similar in both groups, and none had related AEs and withdrawals due to an AE. Conclusions Eberconazole 1% otic solution is an efficacious and safe option to treat otomycosis-affected patients in the general practice.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.017
       
  • Bioglass reconstruction of posterior meatal wall after canal wall down
           mastoidectomy
    • Authors: Samir Sorour Sorour; Nasser Nagieb Mohamed; Magdy M. Abdel Fattah; Mohammad El-Sayed Abd Elbary; Mohammad Waheed El-Anwar
      Abstract: Publication date: Available online 6 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Samir Sorour Sorour, Nasser Nagieb Mohamed, Magdy M. Abdel Fattah, Mohammad El-Sayed Abd Elbary, Mohammad Waheed El-Anwar
      Background Canal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, granulations, dizziness on exposure to cold or hot water and tendency of debris accumulation in the mastoid cavity demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using bioactive glass (BAG) that is fabricated and built up intraoperatively. Patients and methods This study was applied on 20 patients had atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by BAG that was prepared and built up intraoperatively. All patients were exposed to full preoperative evaluation and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results During a follow up of 12 to 36 months, postoperative appearance of external auditory canal contour was found smooth without hidden pouches, irregularities nor stenosis in all cases. No registered granulation, foreign body reaction, nor extrusion and/or displacement of the BAG material. No reported facial palsy or recurrent cholesteatoma. Significant hearing improvement was statistically reported (p = 0.0006). Conclusion Surgical reconstruction of the PMW using BAG that operatively fashioned immediately after CWD mastoidectomy appears to be reliable without considerable complications giving smooth appearance of the PMW and improving the hearing.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.007
       
  • Audiological profiling in postmenopausal women with osteoporosis
    • Authors: K. Kshithi; S. Vijendra Shenoy; M. Panduranga Kamath; Suja Sreedharan; N. Manisha; Meera N. Khadilkar; Vikranth Kamboj; Jayashree S. Bhat
      Abstract: Publication date: Available online 6 March 2018
      Source:American Journal of Otolaryngology
      Author(s): K. Kshithi, S. Vijendra Shenoy, M. Panduranga Kamath, Suja Sreedharan, N. Manisha, Meera N. Khadilkar, Vikranth Kamboj, Jayashree S. Bhat
      Objectives To compare the audiological profiles in postmenopausal women with and without osteoporosis and to study the pattern of hearing loss in osteoporotic patients. Materials and methods 80 postmenopausal women were evaluated at a tertiary referral center and were divided into normal, osteopenic and osteoporotic based on BMD results. The hearing evaluation was done using PTA, Impedance audiometry and DPOAE and the results were compared between the groups and analyzed. Results Osteoporotic patients had higher incidence of sensorineural hearing loss than normal and osteopenic patients and the results were statistically significant (P ≤0.001) on PTA and DPOAE testing. The mean pure tone thresholds were significantly higher in osteoporotic patients in comparison with normal and osteopenic patients. The average hearing loss in osteoporotic patients with sensorineural loss was of mild degree. Conclusion The data reveal that osteoporosis is associated with sensorineural hearing loss in postmenopausal women. The underlying mechanism needs further research but cochlear dysfunction could be an important factor.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.004
       
  • Cortactin expression in nasal polyps of aspirin-exacerbated respiratory
           disease (aerd) patients
    • Authors: Giuseppe Brescia; Daniela Parrino; Lorenzo Nicolè; Claudia Zanotti; Cristiano Lanza; Umberto Barion; Filippo Marino; Gino Marioni
      Abstract: Publication date: Available online 5 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Giuseppe Brescia, Daniela Parrino, Lorenzo Nicolè, Claudia Zanotti, Cristiano Lanza, Umberto Barion, Filippo Marino, Gino Marioni
      Purpose The term aspirin-exacerbated respiratory disease (AERD) refers to a combination of asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and acute respiratory tract reactions to nonsteroidal anti-inflammatory drugs. AERD has now been included among the CRSwNP endotypes, and is considered one of the most aggressive in terms of disease recurrence. Cortactin is a multi-domain protein with a part in several cellular mechanisms involving actin assembly and cytoskeleton arrangement. Cortactin seems to have a role in inflammatory responses and to be implicated in human airway secretion and contraction mechanisms. The novel aim of the present study was to examine cortactin expression in nasal polyps of a consecutive cohort of AERD patients. Materials and methods Cortactin expression was assessed immunohistochemically in nasal polyps from 18 consecutive AERD patients who underwent endoscopic sinus surgery. Results Concomitant allergy was found in 11 AERD patients, most of them male (8 cases; p = 0.026018). Cortactin expression in nasal polyps was definitely high (+3) in 17 out of 18 cases, in both epithelial cells (cytoplasmic and membranous immunoreactivity) and activated fibroblasts. A higher cortactin expression was seen in female than in male AERD patients (p = 0.05). Conclusions Given this preliminary evidence of cortactin upregulation in the polyps of AERD patients, prospective studies could further investigate the role of cortactin in the biology of AERD, and the potential role of cortactin-targeted approaches in integrated AERD treatments.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.012
       
  • The clinical value of the RGB value of an image of the interarytenoid area
           for diagnosis of laryngopharyngeal reflux
    • Authors: Zhengcai Lou; Zihan Lou
      Abstract: Publication date: Available online 5 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Zhengcai Lou, Zihan Lou


      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.016
       
  • Corrigendum to “Retropharyngeal abscess as a result of hyaluronic acid
           injection pharyngoplasy: A first of its kind” [Am J Otolaryngol 38(6)
           (Nov–Dec 2017) 718–719]
    • Authors: Joseph Capo; Samuel Helman; Lianne de Serres; Sivakumar Chinnadurai
      Abstract: Publication date: Available online 5 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Joseph Capo, Samuel Helman, Lianne de Serres, Sivakumar Chinnadurai


      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.01.014
       
  • Neuromuscular function of the soft palate and uvula in snoring and
           obstructive sleep apnea: A systematic review
    • Authors: Jagatkumar A. Patel; Bryan J. Ray; Camilo Fernandez-Salvador; Christopher Gouveia; Soroush Zaghi; Macario Camacho
      Abstract: Publication date: Available online 5 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Jagatkumar A. Patel, Bryan J. Ray, Camilo Fernandez-Salvador, Christopher Gouveia, Soroush Zaghi, Macario Camacho
      Objective A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. Methods PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. Results 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. Conclusions Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.006
       
  • Commentary on letter to editor titled “The clinical value of the RGB
           value of an image of the interarytenoid area for diagnosis of
           laryngopharyngeal reflux”
    • Authors: Anindya Nayak
      Abstract: Publication date: Available online 4 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Anindya Nayak


      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.015
       
  • Transoral robotic excision of laryngeal papillomas with Flex® Robotic
           System — A novel surgical approach
    • Authors: Bernard Tan Wen Sheng; Patrick Wong; Constance Teo Ee Hoon
      Abstract: Publication date: Available online 3 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Bernard Tan Wen Sheng, Patrick Wong, Constance Teo Ee Hoon
      Introduction Recurrent respiratory papillomatosis results in hoarseness, stridor and airway obstruction. Management is surgical, with most surgeons using microdebrider or laser. Transoral robotic surgery (TORS) has been successfully utilised for the excision of oropharyngeal malignancies and paediatric airway surgery. This is the first case report of TORS being used for the excision of laryngeal papillomas. Case report A 36 year old Chinese female was diagnosed with juvenile onset recurrent respiratory papillomatosis. She had 4 previous laryngeal surgeries. She was pregnant in her 2nd trimester and experienced rapid progression of her disease, leading to impending airway compromise. At her latest surgery (2 years ago), poor laryngeal exposure was encountered during laryngoscopy which made the surgery technically challenging. Thus, a flexible robotic system (Flex® Robotic System, Medrobotics Corporation, Raynham, Massachusetts, USA) was utilised with the aim of providing better surgical exposure. During surgery, laryngeal intubation was not possible and her airway was secured with needle cricothyroidotomy followed by tracheotomy. Transoral robotic excision of laryngeal papillomas was performed successfully. Complete excision of obstructing papillomas was achieved with postoperative restoration of airway and voice. Discussion Utilisation of TORS improved visualisation, dexterity and access. Drawbacks include cost, set up time, requirement for special equipment and advanced training. TORS approach can be considered as an alternative to the usual laryngoscopic technique, especially in cases where difficult anatomy and poor laryngeal exposure is anticipated.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.011
       
  • Does blindness affect ocular vestibular evoked myogenic potentials'
    • Authors: Ali Bayram; Mehmet Kalkan; Nuri Ünsal; Ahmet Kale; Bekir Küçük; Cemil Mutlu
      Abstract: Publication date: Available online 3 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Ali Bayram, Mehmet Kalkan, Nuri Ünsal, Ahmet Kale, Bekir Küçük, Cemil Mutlu
      Objective The aim of the present study was to investigate the influence of blindness on ocular vestibular evoked myogenic potentials (oVEMP) responses. Methods Thirty-one subjects with unilateral blindness (UB group) and 25 age and sex-matched healthy subjects (control group) were recruited for the present study. The oVEMP responses including latency, amplitude and amplitude asymmetry ratio (AR) were measured and compared between the blind side, the contralateral eye of the UB group and the control subjects. Results Ocular VEMP recordings were obtained from 29 of 31 patients (93.5%) for the blind side of the UB group. There was no significant difference in terms of latency, amplitude and AR value between the blind side and the contralateral eye of the UB group and the control subjects. Conclusion Clear oVEMP recordings can be elicited as long as the eyeball and extraocular muscles are preserved in a blind eye.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.010
       
  • Dynamic imaging with sialography combined with sialendoscopy to manage a
           foreign body in Stensen's duct
    • Authors: C. Blake Sullivan; Henry Hoffman
      Abstract: Publication date: Available online 3 March 2018
      Source:American Journal of Otolaryngology
      Author(s): C. Blake Sullivan, Henry Hoffman
      Objective We describe sialography as a dynamic imaging modality useful in establishing the diagnosis and planning for treatment of a parotid gland ductal foreign body. Methods Chart and radiographic imaging review of a 75 year-old male who had obstructive sialadenitis symptoms two years after welding slag pierced the cheek skin and identified as a ‘piece of steel stuck in his cheek’. Results Sialography was used to demonstrate a foreign body adjacent to the parotid gland to indicate its presence as a mobile element within the ductal system associated with marked pre-obstructive duct dilation. Sialendoscopy was used to successfully remove the foreign body. Conclusions In selected cases, the management of obstructive sialadenitis can be improved with sialography in permitting dynamic imaging of salivary duct anatomy. Although ultrasound has evolved as a standard component of salivary gland assessment, sialography may complement imaging with ultrasound (or CT as in this case) to offer the highest acuity definition of the salivary ducts.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.001
       
  • Detection of GSK-3β activation index in pediatric chronic tonsillitis is
           an indicator for chronic recurrent inflammation
    • Authors: Gao Yunfei; Mi Jiaoping; Chen Fenghong; Liao Zhenpeng; Feng Xiaoshan; Lv Minghui; He Haixin; Cao Yujie; Yan Yan; Zhu Zhe; Fan Yunping; Hong Haiyu
      Abstract: Publication date: Available online 3 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Gao Yunfei, Mi Jiaoping, Chen Fenghong, Liao Zhenpeng, Feng Xiaoshan, Lv Minghui, He Haixin, Cao Yujie, Yan Yan, Zhu Zhe, Fan Yunping, Hong Haiyu
      Purpose Chronic tonsillitis (TC) is among the most common bacterial diseases in pediatric otolaryngology. We aimed to evaluate the expression of glycogen synthase kinase 3β (GSK-3β) in a cohort of children with chronic tonsillitis (TC), and the correlation between GSK-3β activity index and inflammatory profiles of TC. Materials and methods The expression of GSK-3β was comparably evaluated between children with TC (n = 26) and tonsillar hypertrophy (TH, n = 26). GSK-3β expression was detected by immunohistochemistry, RT-qPCR, and Western blot. The inflammatory profiles between the TC and TH groups were also evaluated. Results We found that while GSK-3β was highly expressed in both TC and TH groups, no significant difference were detected at mRNA and protein levels between groups. The protein level of p-GSK-3β was significantly lower in the TC group as compared to the TH group. Additionally, the inflammatory markers, including NF-κB, T-bet, and IFN-γ were higher in the TC group compared to TH group. The GSK-3β activation index was positively correlated with the levels of NF-κB, T-bet, and IFN-γ in the TC group. Conclusions Our findings suggested that GSK-3β activation index was demonstrated to be a clinically applicable indicator for chronic recurrent inflammation in pediatric TC.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.005
       
  • Uvulopalatopharyngoplasty vs CN XII stimulation for treatment of
           obstructive sleep apnea: A single institution experience
    • Authors: Janki Shah; Jonathon O. Russell; Tina Waters; Alan H. Kominsky; Douglas Trask
      Abstract: Publication date: Available online 2 March 2018
      Source:American Journal of Otolaryngology
      Author(s): Janki Shah, Jonathon O. Russell, Tina Waters, Alan H. Kominsky, Douglas Trask
      Objectives Hypoglossal nerve stimulation (HNS) therapy is an emerging surgical treatment for select patients with obstructive sleep apnea (OSA). This study aims to compare outcomes in patients with moderate to severe OSA who underwent HNS surgery (Inspire Medical Systems) and those who underwent traditional airway reconstructive surgery, specifically uvulopalatopharyngoplasty (UPPP). Methods Patients who underwent HNS implantation (n = 20), all with moderate to severe OSA, inability to adhere to positive pressure therapy, and compliant with previously published inclusion criteria, were compared to a historical cohort that were intolerant of CPAP with similar inclusion criteria who all underwent UPPP (n = 20) with some also undergoing additional procedures such as septoplasty/turbinate reduction. Data including body mass index (BMI), pre- and post-implant apnea-hypopnea index (AHI) were assessed. Results For patients who underwent HNS, mean preoperative BMI was 28.0. Mean AHI decreased significantly from 38.9 ± 12.5 to 4.5 ± 4.8. All patients achieved an AHI < 20 post implant with 65% (13/20) with an AHI ≤ 5. For patients who underwent traditional airway surgery, mean preoperative BMI was 27.5; mean AHI decreased from 40.3 ± 12.4 to 28.8 ± 25.4. Conclusion While both traditional surgery and HNS are effective treatments for patients with moderate to severe OSA with CPAP intolerance, our study demonstrates that HNS is “curative” in normalizing the AHI to <5 in the majority of patients. For select patients, HNS therapy provides excellent objective improvement in outcome measures.

      PubDate: 2018-03-06T16:46:28Z
      DOI: 10.1016/j.amjoto.2018.03.003
       
  • Simple laryngeal suspension procedure by suturing the digastric muscle to
           the periosteum of the mandible in neck dissection for tongue cancer
    • Authors: Akira Ohkoshi; Takenori Ogawa; Shun Sagai; Ayako Nakanome; Kenjiro Higashi; Ryo Ishii; Kengo Kato; Yukio Katori
      Abstract: Publication date: Available online 31 January 2018
      Source:American Journal of Otolaryngology
      Author(s): Akira Ohkoshi, Takenori Ogawa, Shun Sagai, Ayako Nakanome, Kenjiro Higashi, Ryo Ishii, Kengo Kato, Yukio Katori
      Purpose In this article, a simple, new laryngeal suspension procedure is described. The effect of hyoid bone suspension by suturing the digastric muscle to the periosteum of the mandible is analyzed. Materials and methods To elucidate the effect of hyoid bone suspension, CT scans of 26 patients who underwent ipsilateral neck dissection with primary resection of tongue cancer were retrospectively reviewed, and the distance between the hyoid bone and the mandible was measured on the operated and unoperated sides of the neck. A total of 14 patients who underwent suturing of the digastric muscle to the mandible (digastric muscle-sutured group) and the 12 patients who did not (control group) were compared. Results In the digastric muscle-sutured group, the average distance between the hyoid bone and the mandible was significantly smaller on the operated side (17.8 ± 0.57 mm) than on the unoperated side (19.8 ± 0.93 mm; p < 0.05). In the control group, there was no significant difference between the operated side (21.0 ± 1.42 mm) and the unoperated side (19.7 ± 1.39 mm). The difference in the distance between the operated and unoperated sides was significantly larger in the digastric muscle-sutured group (1.97 ± 0.79 mm) than in the control group (−1.32 ± 0.61; p < 0.05). Conclusions It was shown for the first time that suturing of the digastric muscle to the periosteum of the mandible in neck dissection with primary resection of tongue cancer resulted in hyoid bone suspension. This simple procedure can be useful for laryngeal suspension.

      PubDate: 2018-02-25T16:05:05Z
      DOI: 10.1016/j.amjoto.2018.01.008
       
 
 
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